Where you live matters to your health. According to the Build Healthy Places Network, a US organisation working at the intersection of community development and health, your postcode often has a bigger impact on your health than your genetic code. In New Orleans, this is plain to see. Neighbourhoods within a few miles of one another have a life expectancy difference of 25 years.

The reason for this striking disparity is poverty. New Orleans is an extreme example of something found nation-wide with data showing that the richest Americans live 10 - 15 years longer than the poorest. As the Network’s most recent report spells out, “as income and wealth increase or decrease, so does health.”

Living in a deprived neighbourhood exposes you to multiple health risks but access to “quality, affordable housing is a key intervention because in many ways it serves as a foundation for good health and prosperity,” explains Professor Douglas Jutte, executive director of the Build Healthy Places (BHP) Network. “We believe that by joining forces, health and community development will be more successful in achieving their shared goals of prosperity and good health.”

there can be little joined-up thinking across housing, community development and public health organisations who often work in silos

According to the Robert Wood Johnson Foundation (RWJF), a philanthropic organisation which has supported the BHP Network since its inception in 2014, 38.1 million US households are spending more than 30% of their income on housing, with 50% of those spending more than half.

This has a knock-on effect to health, as RWJF president, Rich Besser, explained in their 2019 annual message. “I’ve seen bright children and caring families living in communities that are under-served and under-resourced,” he said. “Kids struggling with asthma because of mould in their homes. And families who can’t move because those are the only places they can afford - and they’re still spending half their income on rent.”

Dr Lisa Richardson, chief impact officer at the Institute of Women and Ethnic Studies, who researches healthy neighbourhoods, agrees that the quality and location of a person’s housing “plays a significant role” in their health and life expectancy. “Housing policies have been used to concentrate some people into neighbourhoods with more access to the social and economic resources that promote health, longevity and wellbeing and concentrate others into communities without access to the same resources,” she says.

Silos

But while affordable housing is clearly a public health issue, there can be little joined-up thinking across housing, community development and public health organisations who often work in silos.

The barriers to working across sectors often comes down to competing priorities among collaborating parties, explains Richardson. “It can be a challenge to get leaders in health, housing, business, and government to settle on a shared definition of what the ‘problem’ is that they are trying to solve,” she says. “Every sector has its own frameworks, its best practices and definitions for successful outcomes.”

This is something the BHP Network is working hard to combat. “Each sector has its own jargon, priorities, timelines, resources and styles of communication,” says Jutte.

The network points to examples of hospitals, health departments, and community organisations that are working together to improve economic opportunities and access to affordable housing in low-income neighbourhoods

The network aims to encourage more cross-sector working by connecting leaders, curating examples of what works and developing tools to encourage a silo-busting approach. “A lot of what we do is help break down these barriers in awareness and communication and encourage cross-sector work by raising up success stories — showing it can be done — and highlighting the value of partnerships for all of the participating organisations,” says Jutte.

“Once they see that they can do their work more successfully with partners than without then we've achieved our goal.”

Getting it right

This joined-up way of working is beginning to emerge in places. The Network points to examples like the Alliance for Health Equity in Illinois where the Public Health Institute, hospitals, health departments, and community organisations are working together to improve economic opportunities and access to affordable housing in low-income neighbourhoods. But while such examples point to “bright spots,” their latest report says “this work is still not widely practised.”

Another success story, which could be said to be the embodiment of effective cross-sector working, is the Conway Centre, an affordable housing project in a run-down neighbourhood in Washington D.C.

The $90 million centre which takes up an entire city block is a community development investment which aims to address multiple social determinants of health simultaneously. Completed last year, it sits directly opposite a metro station, providing 202 affordable homes, employment training and health care for the wider community, all under one (green, living) roof.

Demonstrating impact

At the end of last year the Network commissioned research looking into how to demonstrate the financial benefits of the Conway Centre. The resulting return of investment (ROI) calculator was able to demonstrate vast health returns. When the researchers ran The Conway Centre’s numbers through the calculator, even by conservative estimates, they found health returns of almost 300% for a range of organisations “including hospital systems, bank lenders and other investors, transportation agencies, residents, and society at large.”

Jutte says the intent of the calculator “was to review existing public health and medical literature for evidence of the positive impacts of community investment but then, importantly, to take the next step and try to assign dollar value to those positive impacts.

“Too often those of us in public health don't take that last step and instead rely on our potential partners in business or housing or other private sectors to just figure out the value of better health on their own,” he says.

The benefits for low-income families and previously homeless individuals who now call The Conway Centre home are clear to see. But as well as proving hugely beneficial to residents and users, the calculator shows the huge economic returns to a range of participating organisations. The hope is that developing tools like this, which clearly demonstrate the positive impact of joined-up working between sectors, will “drive continued investments in low-income communities to improve health and well-being.” — Natalie Leal

(Picture credit: Unsplash)