(Illustration by Raffi Marhaba, The Dream Creative)
In vibrant and thriving communities, people have the power and resources to realize their vision of health and well-being. Residents, regardless of zip code or how much money they have, can breathe clean air, eat healthy and culturally appropriate food, and have a safe, affordable place to call home.
However, in far too many places in the United States, that’s not the case. Decades of discriminatory housing, transportation, and land-use policy combined with economic disinvestment have resulted in communities that are residentially segregated by income, race, ethnicity, language, and immigration status. There are inequities in housing quality, stability, and access; and imbalances of power that favor markets, developers, and landlords.
The importance of housing as a social determinant of health has been well-documented by researchers and philanthropies alike. The research finds that housing affects health through three pathways: housing stability, housing affordability, and access to a health-promoting neighborhood. Housing instability—whether through homelessness or frequent evictions and moves—creates chronic, toxic stress and exposes people to traumatic and unhealthy situations. When housing is unaffordable, it leaves little money left over to buy healthy foods and critical medicines. The home you can afford also determines the neighborhood you can live in—a neighborhood with access to public transportation that can connect you with jobs and opportunities, grocery stores with nutritious foods, and safe spaces to exercise or one filled with pollutants, high-traffic roads, and crime, all of which have an impact on health. And when it comes to housing, just having a roof over your head is not enough. Whether it is developing asthma from mold caused by leaky ceilings, dealing with diseases caused by rodent infestations, or suffering from deadly waves of extreme heat when air conditioning units don’t work and don’t get fixed, poor housing conditions directly harm people’s health.
Safe, stable, and affordable housing in many ways is like preventive care, reducing the risk and likelihood of both displacement and poor health. When communities are uprooted and displaced, connections between neighbors, families, and other sources of community support are severed. Separating people from who and what they need causes trauma not just individually, but at the community level, which has negative consequences for people’s health.
At The Kresge Foundation, we wanted to learn more about how the work at the intersection of housing, health equity, and community power is being done and how we can incorporate this new understanding of these connected approaches into our grantmaking strategies. In 2018, we developed the Advancing Health Equity Through Housing (HEH) funding opportunity and supported 31 organizations working at the intersection of housing and health equity in cities across the United States. Many are grassroots organizations working on the ground with community residents, like Miami Workers Center, Latino Health Access, and New Kensington Community Development Corporation. Others, such as Stewards of Affordable Housing for the Future, are intermediary organizations working to create tables and partnerships with other institutions and remove barriers. Some are doing both.
Kresge embraced the HEH grants as an opportunity to learn in concert with grantees. We understood that there were grantees at the local level who were already using housing as a vehicle for equity and community power. What was unknown was how to describe the intersectional nature of the work. Our solution was to create multiple entry points where organizations could apply for planning grants to think through their strategy or implementation grants if their work addressing health equity, community power, and housing was already in place. The non-prescriptive nature allowed grantees to respond at different phases of their ongoing work and with different anchors for that work. This resulted in a diverse pool of grantees—from grassroots leaders working on power-building issues to intermediaries working on policy issues—all of whom shared a strong belief in the importance of using community-driven approaches and ways of operationalizing the intersection of housing and health equity with a bent towards community power.
In this article, we share insights from grantees on how they work at the intersection of housing, health equity, and community power and recommendations for how funders can support organizations in engaging their communities and creating opportunities for collective learning.
Flexible, Collaborative Learning
Together with our evaluation partners at Success Measures at NeighborWorks America and Verge Impact Partners, we embarked on a journey in 2019 to learn about the strategies and approaches grantees were already using in their communities to advance health equity through housing. The evaluation was designed to be developmental (supporting real-time learning to inform ongoing work) and equitable (centering undervalued and historically marginalized voices and holding advancing equity as a core purpose for conducting the evaluation itself). Both the foundation and grantees participated in developing learning questions, sensemaking, and application of learning to practice.
During the evaluation, the COVID-19 pandemic emerged alongside the resurgence of national protests and demonstrations demanding an end to excessive force by law enforcement against people of color, particularly Black and Indigenous people. This moment presented unprecedented challenges for people’s housing and health, and also elevated the connections between housing, health, and community in a real and tangible way. In response, we shifted grantee requirements, which allowed them to adapt their work to meet community needs, as well as glean insights about how organizations were serving their community in innovative ways and thinking about housing policy differently.
Learning About Community Power
While approaches to building power varied across grantee organizations, all grantees agreed that building power, which they loosely defined as an ability to cause something “to be or happen” with and for community residents, is central to using housing to advance health equity. In other words, residents’ ability to cause things “to be” in their communities is essential for addressing and remedying systemic housing injustices and improving health.
One grantee explained, “Power exists now with people who make development decisions about neighborhoods or who reinforce enforcement laws that favor landlords. These are the folks that are in power now to determine what the health conditions will be for the Black and Brown people in our community. We want to shift that so that the people most impacted are the ones who have that power to decide what the future of their community will be.”
We learned that among grantees, housing practices that advance health equity and build community power draw on a few common principles and foundational practices.
Recognizing residents as experts and engaging them in decision-making. For example, to help address the housing shortage, Hawaiian Community Assets has partnered with other local nonprofits and community members to create the Affordable Hawaii for All (AHA) Fellows, a program designed to deepen leadership within the Native Hawaiian and Pacific Islander communities and foster community-driven change in the local housing market. The fellows, some of whom do not have homes, are committed to creating a model for affordable communities built by and for the people who will live there. AHA works with community members to build connection and capacity first, and then to engage with the broader housing assembly and policy makers. This shift in power creates housing and community-building efforts like the Pu‘uhonua O Wai‘anae village or “Aloha Lives Here,” a village of approximately 250 unhoused people living on 20 acres of land on the leeward side of the island of Oʻahu, that serves as a refuge for healing from financial disaster, trauma, abuse, addiction, and injury.
Building collective community power by building up individual power. In communities where rents and displacement are rising, residents understood the neighborhood would improve but not for people like them. For Hope Community Inc. in Minneapolis, owning the land is paramount for building power to change things. Its train-the-trainer model supports lower-income renters to become owners of small multi-family dwellings. Given the long-term (two years or more) nature of preparing for homeownership, relationships that Hope is building with residents and the relationships residents are building with one another are at the center of the effort. Residents connect with others who are passionate about their communities, come together as a cohort for training led by other residents, and build collective leadership skills to talk and advocate for themselves. Quality housing directly impacts residents’ overall health and well-being, as well as the feeling of belonging and security in their community.
Fueling narrative change with community power. As part of its long-term strategy to advance health equity through community-driven housing solutions, Miami Workers Center in Florida is building community land trusts to create affordable housing in the Liberty City neighborhood. But that isn’t the end goal. Miami Workers Center is also organizing and using direct action and strategic communication to bring more light and attention to what it actually takes for communities to give people the dignified housing they deserve. Ultimately, it aims to shift the narrative toward understanding that housing is a human right.
The Importance of Relational Infrastructure
Many on-the-ground HEH grantees cited creating a relational infrastructure as key to exploring new and equitable ways to operationalize both health and racial equity and directly related to the ways they approach housing and health overall. Infrastructure that centers relationship building often means working at a speed and trajectory that are comfortable for the community or, in the case of intermediaries, the pace of larger institutional partners, and may feel slower than a traditional project timeline. Grantees shared that centering relationships provides a path for organizations to be open to transformative processes that are rooted in community voice and community intention. These relationships lay the groundwork to establish trust and enable deeper partnership between organizations and community residents, and between organizations and nontraditional institutional partners, providing the foundation for transformational change.
For example, Comunidades Latinas Unidas en Servicio (CLUES) used a cohort model to help low-income renters better understand how they could contribute to systems-level change. Twenty-nine residents, representing a spectrum of lived experience, participated in thinking through and designing systems solutions. CLUES began the work by building relationships and trust, listening to the stories residents shared and lifting up shared themes that emerged to facilitate personal connections among the group. Although the formal engagement of the cohort has ended, this group of residents has continued to network and problem-solve housing issues in their community. CLUES’ role in the work was to listen to residents’ ideas, share information in useful ways related to those ideas, and build confidence and capacity for residents in the cohort to speak to a wide variety of audiences ranging from other community members to government officials and to advocate for changes in housing policy and practice.
One staff member shared in the evaluation, “We want them [residents] to feel confident. Now, having completed the process, they say, ‘When you told us in the beginning that we were going to speak to legislators, I thought you were crazy! But now I do see myself as a leader. I can do this!’ That’s the goal! To ignite that confidence in people to feel their own power to make change.”
How Philanthropy Can Do Better
Change comes from communities. But it’s hard to create that change unless communities have the chance to come together. Through our evaluation process with grantees, we were reminded that relationship building and deep community engagement take time and expertise to ensure that change benefits residents. And they take money.
Community-led work is dynamic, so it’s important to be flexible with funding and open to shifting priorities, partners, and processes for carrying out the work as learning occurs for grantees. For example, funders can provide flexible operational support that helps organizations engage with their communities. Support that allows them to fairly compensate residents—the parents and guardians, students, business owners, and others who are busy managing their day-to-day lives—for the expertise they bring to the table to drive change.
Funders can also lean into the principles of trust-based philanthropy, including flexible reporting and proposal requirements. Grantees stressed to us how difficult it is to produce numerous grant reports for funders, and they would much rather spend the limited time and bandwidth they have on their work. In addition, finding ways to connect and directly sharing with grantees that the foundation trusts how they are carrying out the work matters.
Within the foundation, having infrastructure and pathways to process, make sense of, and embed learning from evaluation has been crucial. As with most systems change work, outcomes take time. Understand that interim measures, such as building relationships and trust, can take years instead of months.
It’s also important to be sensitive to the fact that the fields of community development and health are still recovering from the pandemic and need to focus on healing themselves and their communities.
Creating a Learning Community
Our evaluative experience highlighted the importance of philanthropy not only funding the work in ways that are accessible and holistic, but also creating opportunities for learning, engagement, and connection among grantees. We recognized the need for continuous learning around the interconnectedness of this work, which led to the creation of a new learning community with all HEH grantees that will take place over the course of the next 18 months. Together, they can move the field forward, deepen their own practices and strategies through peer learning and reflection, and surface and distill best practices.
As one of the founding members of the funder collaborative Funders for Housing and Opportunity (FHO), we value having a space where we can not only share what we learn from our work but learn from other members of the collaborative who care just as deeply about housing and health equity. Our FHO peers and grant-funded partners played an important role in informing some of our early thinking that led to the Advancing Health Equity through Housing initiative. We can achieve more collectively than as individual organizations. Together, we can bring our knowledge to policy makers and align investments to help make change so communities thrive.
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Read more stories by Stacey Barbas, Kate McLaughlin, Jessica Mulcahy & Vedette R. Gavin.