Health and Housing: Where Should the Money Come From?

When we published our focus issue on health and housing and neighborhoods, one of the themes that came up in a few different ways was that properly funding stable, permanent housing and healthy neighborhoods could drastically save us money that is currently being spend on medical care, both emergency and chronic. This, many of us thought, meant that perhaps some of the vast amount of resources being spent on health could be better and more efficiently used if it were devoted to housing.

The savings—not to mention, of course the better outcomes in terms of both health and housing!—are pretty clear cut, at least when it comes to some basic provisions like a Housing First approach to homelessness or supportive housing.

I, and others in our pages, have lamented that it is hard to make that funding leap, though, because the budget lines are separate and the health savings are longer-term than the upfront costs of providing housing and our budget cycles and pots are too divorced from each other to allow the big picture win-win to get political momentum. Speculation about the possibilities for the Affordable Care Act to increase partnerships in that direction are also ramping up.

So imagine my surprise when at a workshop at the National Low-Income Housing Coalition's recent conference panelists questioned whether that was even a good goal.

In response to a suggestion about it from the audience Ann O'Hara of the Technical Assistance Collaborative and Andrew Sperling of the National Alliance on Mental Illness responded that they were uncomfortable with the idea of turning to funds marked for health to fund housing for a couple reasons:

First, people with disabilities, for example, should still get their housing needs met by housing funds. To suggest otherwise is to stigmatize them, make them patients first, and relieve those responsible for providing housing from the responsibility of figuring out how to do it appropriately for everyone.

Second, that housing funding, especially rental assistance, needs to be a long term commitment. One of the main things that we need more of in housing in order to improve health is stability. So turning to a funding source for whom housing might be the flavor-of-the-day way to experiment with collaborations is an unhelpful precedent.

Ted Houghton of the Supportive Housing Network of New York told me later he shared these concerns. 

They definitely have some ring to them, though I'll say that while the need is so high and the resources so constrained, I wonder if there isn't some way to do it without running into those problems. Gap funding for development, for example, rather than ongoing operating subsidy or rental assistance? What do you think? 

Miriam Axel-Lute is CEO/editor-in-chief of Shelterforce. She lives in Albany, New York, and is a proud small-city aficionado.


  1. I am both an affordable housing professional and licensed NJ Pest Control Applicator. I became one to have the license necessary to treat our own non-profit affordable housing rental properties and transitional housing for the homeless. Over the years I have become increasingly aware of and concerned about the relationship of health and housing. One the poor end of the socio-economic scale, lower income families usually live in the lowest quality housing that is filled with asbestos, lead-based paint, mold, vermin and roaches. There is a critical link between pests dropping feces and rotting carcases and asthma. On the high end of the income scale, kids and adults now drive 99% of the places they go to visit, shop or recreate. We have destroyed the once normal walkable communities where healthy people exercised as a routine part of their daily activities. Video games, television, computers and other sedentary activities have replaced active recreation to the detriment of children and adults. All of this links directly to housing. We need new models and alternatives that can nurture us back to health.

  2. Whlie I greatly appreciate the concerns, I think we really need to separate out the issue of funding from the use of the funds. Advocates are right to want to avoid medicalizing housing models as the solution for affordable housing. However, to decribe money as “Health funds” or “housing funds” is a trap for us as advocates. The evidence that our work can produce improvements in health and sometimes cost savings is incredibly important. For years, we have been rining the same bell— “Housing is a right” or “Fully fund Trust Fund X” without much of a change in either funding levels or getting much closer to providing housing opportunities for all of those that need them. With the link to health outcomes, we can make the case that paying for services, capital, and rental subsidies is an intelligent and cost-effective solutoin. I hope that our emphasis as advocates focuses on the nature of the services or housing and not on the funding source.

  3. I am surprised by the dismissal around the intersection of health and housing especially on leveraging health funds to stabilize housing. I recently heard Nancy Bernstine from the National AIDS Housing Coalition speak about the Evidence-based advocacy for HIV/AIDS housing and there is no doubt that housing saves lives. Her powerpoint from the AIDS Housing conference in Providence was powerful- housing is trreatment. So before talking about the “flavor of the day” in connecting health funding to housing let’s review the evidence with those on the ground.


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