Despite the well-documented connections between housing and health, practitioners in each sector often work in silos and miss opportunities to collaborate on local efforts that can advance health, housing and equity goals in localities. The Housing Solutions Lab recently held a virtual event to explore how housing and health stakeholders can build stronger partnerships and increase collaboration on local planning processes. Hosted in partnership with the National Fair Housing Alliance, the event focused on the Community Health Needs Assessments and Fair Housing Assessments as opportunities for local cross-sector collaboration. 

Moderated by James Hardy of the Robert Wood Johnson Foundation, the session included a presentation from Joseph Schilling of the Urban Institute and a panel discussion with Debby Goldberg at the National Fair Housing Alliance; Angela Mingo of Nationwide Children’s Hospital; and Sandra Serna from the Office of Health Equity and the Virginia Department of Health. 

Panelists emphasized the importance of bridging the two sectors in order to foster healthier, more equitable communities and encouraged local governments to support cross-sector collaboration through improved data sharing, alignment of planning processes, and reciprocal representation at relevant decision-making tables. 

Background

Enacted through the Affordable Care Act in 2010, nonprofit hospitals are required to conduct a Community Health Needs Assessment (CHNA) every three years to identify community health needs and guide community benefit expenditures. Among the requirements, the process requires collection and review of local data, community engagement, and the development of a plan to address identified needs. Local governments often participate through representation from the public health department. The CHNA process aims to help nonprofit hospitals move beyond simply providing “charity care” to addressing social, economic and environmental factors that influence health outcomes, such as housing. 

In 2015, the US Department of Housing and Urban Development (HUD) adopted a new rule requiring recipients of federal housing funds to develop an Assessment of Fair Housing (AFH) every five years. The rule directed localities to document housing inequities, identify goals to reduce them and develop strategies in response. Similar to the CHNA process, Assessments of Fair Housing involve the review of data, identification of priorities, and engagement of community. While the 2015 rule was rolled back under the Trump Administration in 2020 and additional changes are expected under the current administration, many localities have completed assessments affirming their commitment to identifying and addressing fair housing concerns. In 2021, the Biden Administration restored aspects of the 2015 rule and HUD provides data to support planning processes, but localities are not currently required to complete assessments.

These two local planning processes share similar features,  setting forth systematic strategies to help localities identify, analyze, and take steps towards addressing the needs of underserved residents in a community. While focused on different outcomes, the CHNA and AFH both provide an opportunity for local leaders to review key data and engage community residents in a process that can help localities identify, prioritize, and monitor issues that shape health, well-being and opportunity. 

Taking action

The following lists identify simple steps that local housing and health stakeholders can take to begin engaging with community health and fair housing processes to advance collaboration and promote healthier and more equitable communities.

Housing stakeholders:

1. Identify the nonprofit hospital in your community and review their most recent Community Health Needs Assessment. The IRS requires that hospitals make this report available online. Review the report to learn more about the needs that have been identified in your community and issues relevant to housing, community and economic development. 
2. Reach out to your local hospital and offer to be a resource on housing issues. CHNAs typically include a responsible hospital staff contact in the community benefits or government affairs department. Local housing organizations and agencies can reach out to hospital staff to offer support for the CHNA process, such as quantitative or qualitative data on housing issues. The hospital may also provide formal opportunities to participate in public meetings or provide written feedback on the report. 
3. Become familiar with additional health organizations and agencies that serve the community. Nonprofit hospitals are only one player in the local healthcare and public health ecosystem. Housing stakeholders can also become more informed about issues at the intersection of health and housing by contacting entities such as the city or county health department and state Medicaid agency. These entities may value connecting with housing stakeholders who work on a variety of housing issues, particularly homelessness,  housing discrimination, and housing and neighborhood hazards.

Health stakeholders:

1. Learn about the fair housing planning processes in your community. Given the strong links between residential segregation and health, health stakeholders should become familiar with local fair housing planning efforts. Contact the city housing or planning department to find out how your locality identifying and assesses fair housing issues. 
2. Look for opportunities to contribute health data and/or expertise that detail local place-based health disparities. Local health agencies and institutions are well-positioned to highlight the ways that segregation can limit equal access to healthy environments and neighborhoods of opportunity. Offer to provide relevant health data and information to local officials, advocacy groups and planning organizations who are engaged in fair housing planning efforts.
3. Support efforts to reinstate and enhance the federal AFH requirement. The 2015 rule provided a strong framework and requirement for localities to conduct systematic fair housing planning. Health stakeholders should connect with housing advocacy groups to stay informed on federal developments and for opportunities to provide input to HUD about the value of a robust fair housing planning process.

Additional resources

Examples of community health needs assessments and assessments of fair housing

• Nationwide Children’s Hospital Community Health Needs Assessment (Central Ohio)
• Assessment of Fair Housing (Philadelphia, PA)

Tools to support health and housing partnerships

• Build Healthy Places Network provides a Jargon Buster to promote shared language among health, housing and community development stakeholders. 
• ChangeLab Solutions provides a Health and Housing Starter Kit to help local housing and health institutions take the first steps towards partnership.