As the body of research on housing as a social determinant of health grows, healthcare and housing leaders in the U.S. are increasingly looking for ways to work together to improve lives. We see over and over that housing is an essential foundation for individual and community health. Cross-sector collaborations between health systems and affordable housing and community developers hold great potential to yield healthier communities at lower costs than when the two fields operate in silos.
More than 20 million renter households in the U.S. spend more than 30% of their total income on housing, which is the threshold experts say begins to put pressure on household budgets. Renters' concerns about being able to afford their housing often leads to sacrificing medical care to pay their rent.
In our recent survey with Wakefield Research, more than half of renters reported delaying medical care because they couldn't afford it, and 100% of medical professionals said they have some patients worried about being able to afford housing. Many also reported that financial concerns were causing them enough stress that they were losing sleep.
The struggle millions of renters face to afford a healthy home is compounded by a lack of access to healthcare. Only half of renters reported that they are satisfied with their access to care. This exacerbates their difficult position of having to choose between their housing and their health.
As anchor institutions and major employers, health systems are uniquely positioned to identify and invest in solutions that ensure people live in housing they can afford that also improve their health. Just this week, 14 of the country's largest hospital systems pledged to invest more than $700 million toward community-based initiatives aimed at addressing the economic and environmental drivers behind a widening disparity in health outcomes. Those efforts will target housing instability, among other issues.
Enterprise Community Partners is working to infuse health into affordable housing and community development, with the Health Begins with Home initiative deploying $250 million over five years to spur collaboration across sectors and elevate homes as a platform for health.
There are already instructive models for how health and housing players can forge powerful partnerships. For example, Enterprise has launched a Housing for Health Fund with Kaiser Permanente in California. Potentially totaling $85 million, this equity fund will serve more than a dozen Bay Area counties–among the most expensive areas in the country–with half of the capital designated to promote health and preserve affordable homes in the city of Oakland. On the other side of the country, Boston Medical Center recently committed a $6.5 million investment in a multitiered housing strategy designed to improve population and community health.
A separate $100 million loan fund that includes a $50 million loan from Kaiser Permanente to Enterprise expects to create and preserve 3,250 affordable homes in Kaiser Permanente's service areas nationwide. Developers that qualify for the loans will target reductions in chronic diseases, such as diabetes and asthma, as well as solutions to issues like mental health, social cohesion and economic security.
In Baltimore, Bon Secours Mercy Health takes a holistic approach to community health that offers another model for collaboration. The health system operates a wide variety of programs to support resident health and community well-being, including job training, early childhood development, financial education, fresh produce grown on its ½-acre urban farm and—through a partnership with Enterprise–more than 800 affordable homes, a majority of which are for seniors and people with disabilities.
All these examples hint at the vast potential of the healthcare sector to help tackle the affordable housing challenge and get ahead of its unhealthy consequences. Millions of Americans struggle each day to find an affordable home and affordable healthcare. Armed with a deepening understanding that housing challenges are health challenges, health systems should put their power and resources towards cross-sector partnerships that advance the health of their communities where it begins—at home.