A Homeownership Program that Takes Health into Account

A 10-city initiative to boost homeownership also aims to align required fair housing and health needs assessments. Can it be done?

Keys, both vintage and modern, are suspended from thin wire to give a floating-in-air effect.
Photo by Flickr user KE Dickinson, CC B-ND 2.0

Where you live matters, for both economic prospects and health. A recently released study of 10 U.S. cities confirms the gap between majority-white areas and neighborhoods of color is still increasing in key health and financial amenities.

The study, by Zillow, was commissioned by the National Fair Housing Alliance (NFHA) for the 50th anniversary of the Fair Housing Act in 2018, and updated this year to cover all 10 cities in NFHA’s Keys Unlock Dreams Initiative, a three-year project that aims to sharply boost homeownership among people of color.

While the primary goal is removing barriers to homebuying, one of the unusual things about the initiative is its attempt to break new ground in connecting fair housing assessments and health assessments in the target metropolitan areas—Atlanta, Baltimore, Columbus, Detroit, Houston, Memphis, New Orleans, Oakland, Philadelphia, and Washington, D.C.

“The Zillow report really brought home how communities of color lag in access to health amenities, so we’ll be looking at the disparities and looking at how the health and housing ecosystems can better collaborate,” says Laurie Benner, associate vice president of programs at NFHA and program manager for Keys Unlock Dreams.

In addition, the COVID-19 pandemic’s racially disparate toll has dramatically highlighted the health and housing connection, showing the life-and-death importance of housing stability when a shelter-in-place advisory comes—especially for people of color, who already endure lower access to health care, higher rates of underlying conditions like heart disease and diabetes, and are more likely to hold essential jobs and live in multigenerational households.

For each target metro area, the Keys Unlock Dreams team plans to examine two types of documents. The first type is the local Analysis of Impediments (AI) to Fair Housing Choice or Assessment of Fair Housing reports compiled by HUD grant recipients such as states, local governments, and public housing agencies as part of their obligations under the Fair Housing Act. The second type the team will examine is the community health needs assessments (CHNAs) that nonprofit hospitals must produce every three years under the Affordable Care Act.

Fair housing assessments and CHNAs are similar in that both incorporate community input and both can vary widely in scope and engagement. In some cases, Benner notes, the two documents do relate to each other. “For example, in Baltimore, the fair housing impediments document has a whole section related to health, looking at environmental factors, lead, asthma, violent crime—and includes a survey of resident perspectives of healthy neighborhood indications,” she says. “But others are completely silent on these matters.”

After looking at the documents, the plan is to convene health and fair housing stakeholders in each city to discuss how assessments could be more aligned in the future and how to improve collaboration between health institutions and the entities creating fair housing assessments.

“Each side of that table needs the other to make plans. It can’t be done in silos,” says Benner.

As for a timetable, the intent is to conduct these document examinations and convenings in each city as the three-year homeownership initiative moves along—ideally early enough so the outcomes could inform the panel discussions at the big consumer- and industry-facing homeownership events planned for each city. That plan may lag a little behind schedule this year, as the pandemic has forced Keys Unlock Dreams events for the first three cities (Columbus, Detroit, and Memphis) into the last two months of 2021 instead of being spread throughout the year—and with the Delta strain still threatening, there’s the distraction of having to be at the ready to alter plans or shift in-person events to virtual.

The long-term vision, Benner says, is “These two ecosystems will collaborate better, they’ll develop plans and programs that contemplate the other. And the end game to that enhanced collaboration is with the health outcomes of residents. In a given city, the pressing problems might be childhood asthma or diabetes or lead-based paint, but improvement will be seen.”

Local Partnerships

A crucial piece of the initiative is forming partnerships with local organizations in the 10 target cities that can help not only to gather industry representatives and panel speakers for the big events, but to introduce NFHA to other local partners such as hospitals in neighborhoods facing health and housing disparities.

In Columbus, the primary homeownership partner for Keys Unlock Dreams is Nationwide insurance. The firm helped connect NFHA to Nationwide Children’s Hospital to kickstart discussions about bringing some of their health assessment stakeholders together with local fair housing assessment folks. Lu Yarbrough III, Nationwide’s vice president for enterprise diverse and cause marketing, says his firm has supported Nationwide Children’s Hospital on past housing and employment initiatives in an underserved Columbus neighborhood. A similar initiative is underway in another city neighborhood that includes adding a hospital outpost there, bringing improved health care access and job opportunities.

High Ambitions, Careful Approach

Without doubt, the silo-tackling mission of syncing up fair housing and health assessments is ambitious. It can be a lengthy and complex process just to get hospitals to coordinate with one another, much less bring two entirely different sectors together. One complication to navigate in this case, Benner notes, is that while CHNAs are attached to particular health institutions like Nationwide Children’s Hospital, fair housing documents may be regional and involve more diverse entities like housing departments, health departments, disabilities organizations, and school systems. Benner imagines each convening could include dozens of stakeholders.

Moreover, the document examination is likely to be labor-intensive and the process potentially sensitive, as the Keys Unlock Dreams team may be seen as critics of existing and perhaps entrenched assessment processes. A facilitator not aligned with any of the entities locally will be key, and Benner has an RFP out to locate someone to help analyze the documents and facilitate the local convenings.

“We are a national organization, and I expect some resentment or hesitancy in working with us. We have to be really delicate and diplomatic and friendly when we go to them and say ‘Hey, we looked at your document and we noticed X, Y, and Z,’ so it’s not seen as a criticism,” Benner says. “And with the CHNAs, not only are we an outsider, but our work is in housing. We have to be very careful to just be a facilitator, to try to bring these groups together.”

She adds, “I’m optimistic, maybe naively, that the pandemic has brutally highlighted the health and housing connection enough to make people eager to engage.”

And if the effort is successful, it could serve as a new model of aligning housing and health efforts. “The concept of cooperation is not new,” Benner says, “but I’ve not seen a big homeownership program take health into account in its approach. I think that’s new.”

Sandra Larson is Shelterforce's health fellow.

1 COMMENT

  1. Can we stop equating multi generational household with undesirable living conditions? Most cultures do not live alone. This is us perpetuating a white, American stereotype. If you are worried about crowding, say crowding as defined by a certain number of people per square footage.

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