The voices of Urban Institute's researchers and staff
January 26, 2017

Carson’s health background could be good for housing

January 26, 2017

“I think the research is clear or getting clearer: stable, safe housing is critical for better health outcomes for all Americans.”

On Tuesday night, the Senate Committee on Banking, Housing, and Urban Affairs unanimously voted to approve Ben Carson’s nomination to become secretary of the US Department of Housing and Urban Development. Though observers have raised questions about whether Carson, a retired neurosurgeon, can lead an agency with which he has little experience, his medical background could be an asset.

As his response to Sen. Sherrod Brown, quoted above, demonstrates, Carson is aware of the effects of safe, affordable housing on health and well-being. As Carson crafts his strategic goals for the agency, he should look to emerging cross-sector collaborations across the country that are bringing the public, private, and nonprofit sectors together to improve health outcomes through housing.

Housing, along with education, nutrition, employment, and social supports, is a key driver of health outcomes, or a social determinant of health. Studies have documented the relative importance of these factors: 60 to 80 percent of a person’s health outcomes are influenced by social determinants. Health care leaders have developed a newfound appreciation for the levers that federal housing policy offers for the health of individuals and families.

In a series of case studies on health-led interventions to address housing challenges, we are learning about ways hospitals, health care systems, and insurers are partnering with local or state governments and other community partners to increase access to safe and affordable housing to improve health. Some hospitals and health care organizations have invested in Low-Income Housing Tax Credit rental housing developments serving low-income households to address the immediate shortage of adequate, affordable housing in their communities. Others have provided resources for rehabilitation and affordable homeownership opportunities around their campuses. Most recently, a group of health care providers pooled resources to invest in developing permanent supportive housing for their city’s homeless population.

Other collaborations have taken advantage of the requirement that nonprofit hospitals provide community benefits to retain their tax-exempt status. This requirement was historically met by providing charity care to uninsured patients, but greater access to insurance under the Affordable Care Act and new requirements for hospitals to conduct periodic community health needs assessments have opened up additional avenues for investment.

Meanwhile, cities are thinking about community-based solutions, including those that involve partnerships between public housing authorities and local public health departments:

These and other innovations represent creative partnerships between the public, private, and nonprofit sectors and rely on a meaningful government role in crafting solutions. But challenges remain. In our research, several people noted that they could better assist people with complex health care needs if greater housing resources were available. Moreover, innovative projects often rely on matching public and proprietary data—not always easily attainable—to target those with the most critical needs. Recent congressional proposals to eliminate federal funding for these types of data will undermine the innovations Carson wants to champion.

As he steps into his new role, Carson should remember the promise of cross-sector initiatives to improve health and well-being and look to the critical work already happening in communities across the country. Carson’s health care background may be his window into the need for forward-thinking housing policy that will “improve communities and better lives.”

Ben Carson testifies on Capitol Hill in Washington, Thursday, Jan. 12, 2017, at his confirmation hearing before the Senate Banking, Housing, and Urban Affairs Committee. Photo by Zach Gibson/AP.

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