Healthy Neighborhood Investments, a Build Healthy Places Network initiative funded by Blue Shield of California Foundation, promotes community development and healthcare partnerships as the go-to sustainable model in California for addressing the social determinants of health (SDOH) in low income communities and communities of color.
More than $1 trillion is spent on medical care each year in the U.S. treating preventable health conditions caused by poverty. The Build Healthy Places Network (The Network) and the Foundation are working to shift the paradigm from treatment to prevention by fostering healthcare and community development partnerships. Both the community development* and health sectors have worked for decades to address the root causes of poverty and poor health, sometimes serving the same places and people, and yet the two sectors rarely work together. The Network connects these sectors to mobilize and leverage investments in communities to advance equity, health, and well-being.
From October 2018 until March 2020, we worked in the City of San Bernardino with Nonprofit Finance Fund and National CORE; in the Coachella Valley with Local Initiatives Support Corporation, Coachella Valley Housing Coalition, and the Center to Advance Community Health and Equity; in Santa Rosa with Enterprise Community Partners; and in Stockton with Low Income Investment Fund.
Healthy Neighborhood Investments is helping us better understand barriers to collaboration, tailor our technical assistance based on what we learn, and work to embed capacity within local organizations to address those barriers.
What we’ve learned so far:
The role of policy
- In recent years, federal and state governments have adopted policies and regulations that can serve as a platform for community development and healthcare collaboration but have rarely been used to create cross-sector projects to impact health and wellbeing. This includes California SB 1152 that elevates homelessness as a healthcare issue. Local hospitals are struggling to comply with SB 1152, but growing demand and limited capacity across stakeholders present immense challenges for providers.
- Opportunity Zone designations also can be a connecting point for CDFIs and healthcare partners. In our Healthy Neighborhood Investments communities, hospitals and healthcare systems are typically one of the largest employers, and we are finding that they have assets that go far beyond their clinical offerings, such as deep community relationships and existing community health outreach programs. They also serve as a clearinghouse for investors and investments, since many of the hospitals are running successful businesses in distressed census tracts.
- The field-informed Principles for Building Healthy and Prosperous Communities can help guide cross-sector work and provide an actionable framework across communities to achieve an equitable future where fair opportunity is an outcome for all.
- Developing sustainable, long-term relationships between community development and healthcare takes time and is complicated. Often, investment partnerships require hospitals to bring together different parts of their own organizations that haven’t worked together before (treasury, community benefit, etc). This creates a heightened level of coordination, time and complexity.
- Healthcare partners are interested in collaborating with community development to develop respite care facilities for persons experiencing homelessness who are too ill to recover from a physical illness or injury on the streets but are not ill enough to be in a hospital. The respite model allows hospitals and health plans to partner with community development partners who can transition these patients to a more permanent housing solution.
- Finding common language that we can use to communicate between sectors has been a challenge. In San Bernardino, for example, we’re starting with translating language across sectors. For those working in health care, “transitional housing” means housing once someone leaves a hospital; for those working at a CDFI “transitional housing” is a defined part of the HUD Continuum of Care program to address homelessness.
- The starting place for partnership looks different in each place. There’s no blueprint. The Network and our partners are challenged to find common ground that allow partnerships to flourish. For example, in Coachella, there is opposition by government and residents to build more affordable housing and transitional housing for the homeless. Here, the hospitals – for which addressing homelessness is a priority in their CHNAs – can help influence elected officials and planning commissions and shape public opinion to understand the benefit of affordable housing and how it combats homelessness.
By joining forces the community development and health sectors can achieve an unprecedented scale of prevention and advance good health, well-being, and opportunity for all.
* Community Development Finance Institutions (CDFIs) and Community Development Corporations (CDCs) are critical partners for successful investment collaboration. CDFIs coordinate financing and innovate financial tools in order to meet needs in low income communities such as, financing affordable housing, Federally Qualified Health Centers, and other community infrastructure; CDCs turn the financing into bricks and mortar. Yet, despite growing interest in cross-sector collaboration, key players still lack capacity, cross-sector understanding, and resources for effective partnership. Healthcare generally does not recognize CD organizations as partners, thereby missing opportunities to include community development in their community health improvement plans or to leverage their investments with other sources of capital. CDFIs and CDCs increasingly see how their work impacts health, but they do not have effective strategies for approaching healthcare, using healthcare language, or making the case for partnership.