Developing Communities With Health in Mind

The Health Impact Project spends a great deal of time talking about the social determinants of health and about health equity, but what do these terms really mean? Simply put, a person’s health is affected by a complex array of social and environmental factors, which research shows are best addressed in a comprehensive and coordinated way. A Texas-based nonprofit, Foundation Communities—which supplies affordable homes and support services to low-income families, women and children who were formerly homeless, veterans, and individuals with disabilities—is providing access to jobs, education, physical activity, medical care, and healthier food to address clients’ health and ability to succeed. Foundation Communities has helped to transform neighborhoods into flourishing places that have enabled thousands of low-income families and individuals to improve their lives.  

I recently traveled to Austin with my colleagues from the NeighborWorks Achieving Excellence program. Julian Huerta, deputy executive director of Foundation Communities, led us through three of the affordable housing developments his organization owns and manages in the Texas capital. The complexes we visited were Capital Studios, M Station, and the Sierra Vista Apartments. What made these places so remarkable was Foundation Communities’ holistic approach, which expanded beyond shelter to include child care, preschool, after-school programs, financial services, physical activity and nutrition classes, and access to integrated primary and mental health care services, including substance abuse counseling.  Research confirms that low-income and minority individuals experience higher rates of chronic diseases. Foundation Communities helps to meet that need with on-site services that address barriers to care, such as a lack of transportation and child care.  For example, one resident overcame more than 20 years of substance abuse, finding treatment and support at the Spring Terrace community. Another client had repeated kidney failures and other complications that put him in a nursing home at age 40. Now, as a Skyline Terrace resident, he receives in-home medical care and meets regularly with an onsite social worker. Offering services has become increasingly common in affordable housing, yet the variety of services provided by Foundation Communities, and its thoughtful targeting of services to meet residents’ needs, stands out.

Additionally, each development’s design and location included health considerations. For example, M Station is one of the first affordable housing developments to meet the U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) standards. The architects designed the apartments with an eye toward sustainability and health—for example, by upgrading the ventilation systems to provide apartments with fresh air and reduced humidity and by installing wood laminate flooring instead of carpet to help reduce asthma triggers.  The developments’ locations provide easy access to public transportation so that residents don’t need cars.

Foundation Communities is helping to address health inequities by tackling the avoidable factors that negatively influence the health of particular groups. For example, educational achievement is strongly linked to health, beginning in early childhood. More than 700 children and teens have access to year-round after-school and summer learning programs, while adult education opportunities empower parents to improve their language and literacy skills, which can be transformative for families. 

The efforts by Julian and his colleagues are working; the families and individuals living in these communities are thriving. Literacy rates are increasing, and kids’ grades are improving, with more than 700 students attaining an average GPA of 3.58 last year. Thanks to a grant from the Substance Abuse and Mental Health Services Administration, formerly homeless individuals with mental health issues that may have affected their ability to keep jobs and homes were able to receive at least weekly access to behavioral health support, which resulted in 91 percent of them maintaining housing after being discharged from the program. Moreover, 77 percent of those who were seeking to recover from addiction maintained a level of sobriety, either reducing their dependence on substances or stopping use all together. Mobile health clinics are providing immunizations and exams, family planning and nutrition counseling, and monthly specialty care referrals to help connect residents to affordable care services.

However, it’s not just community developers and nonprofit organizations that are realizing the connection between housing and health in Austin. For example, the insurer United Healthcare is seizing the opportunity to proactively address wellness outside of a traditional medical setting to keep members healthier. It invested $11.7 million in Capital Studios as part of more than $150 million that the company has provided to finance affordable housing communities throughout the United States. According to the company’s president, Donald Langer: “Expanding access to affordable housing is important in breaking the cycle of homelessness and poverty and helping people live healthier lives.”  

I was impressed by what I saw in Austin and hope to find ways to replicate those successes with our partners across the country. To do so, we need to bring housing and health professionals together. Housing professionals can help health care systems to identify people in need of insurance and health care services. Conversely, health care systems and public health professionals can help to bring much-needed resources to affordable housing, as evidenced by United Healthcare’s investment in Austin and elsewhere. Foundation Communities is showing that it can be done.