What Can Population Health Learn About Financing from Affordable Housing and Community Development?
To help communities thrive, the United States currently invests in affordable housing and community development through centralized financing structures, implemented at the state and local levels. By any measure, it has been a tremendous success.
For example, Housing Choice Voucher Program vouchers (formerly known as Section 8) have supported 5.3 million people with safe and secure housing between 1974-2014. The Community Development Block Grant, first passed in 1974, has brought forth $144 billion in community development investments. And, as of 2013, an estimated 13.3 million people have resided in homes financed by Low-Income Housing Tax Credits.
At ReThink Health, we have learned that the multi-sector partnerships addressing population health in their communities have been mostly financed through grants. And this made us curious: if affordable housing and community development were financed only through grants, where would our communities be today? We also wonder, how did these structures come to be? And, how might communities approach sustainable financing for population health in much the same way?
We prepared a couple of case studies investigating the development of central financing structures for these two sectors, and found that the stories provide a lot of food for thought. Here are three standout observations.
Observation 1: Stakeholders stayed the course across generations.
The affordable housing and community development movements unfolded over 100+ years. As time progressed, stakeholders’ perseverance (people, organizations, public entities, and more) was essential to further advance the foundational work completed by early stakeholders. Without such determination, commitment to sustainable financing structures could have waned after early successes.
For example, the signing of the Housing Act of 1937, as part of the New Deal, was just one step on the journey toward the affordable housing financing policies we have today. The Section 8 amendment, which increased access to–and availability of–affordable housing, was passed more than 35 years after the first federal affordable housing bill was put into place. Despite ever changing political and social agendas, stakeholders stayed the course to improve and advocate for changes that built upon the impact of the original bill.
Observation 2: Stakeholders were willing to work collectively.
In the affordable housing and community development movements, there wasn’t just one lone voice pushing these movements forward–success came when multiple stakeholders found common ground and worked together. Undoubtedly self-interest was part of their motivation for getting behind these movements, but even so, individuals, organizations, public policy makers, and corporations saw value in advocating for these policies together.
Results of stakeholders’ collective work include amendments to the Community Reinvestment Act (CRA), made in the 1990s. The CRA was passed in 1977 to regulate banks in demonstrating their ability to serve the needs of the community for credit and debit services. The CRA was enacted due to concerns that the banking industry was reinforcing poverty by using locally deposited funds for out-of-state projects, thereby limiting the amount of community reinvestment in low-income communities.
Just over a decade later, a federal probe into the lending institutions and banks in Atlanta found racial disparities in mortgage lending, leading to a national conversation about the importance of banks practicing fair lending and being rated on performance as a means to community growth. Stakeholders in the community development movement, both new and veteran, leveraged the national spotlight on Atlanta to push for an overhaul of the CRA to hold banks more accountable for supporting — by investing in — the communities they served. Not only were stakeholders successful in maintaining their collective advocacy and pressure, but they were able to move the community development agenda forward.
Observation 3: Stakeholders made choices to balance federal-level structures with state- and local-level implementation.
State and local stakeholders in the affordable housing and community development movements knew that local financing wouldn’t be enough to achieve their agendas, and that federal financing structures would be needed. But they worried that federal financing would come with too many strings attached; strings that wouldn’t necessarily work well in every community. So most adopted a shared, broader federal agenda that balanced the need for federal structures with the need to maintain local control over implementation.
One such example is the creation of the Community Development Block Grant Program (CDBG), an annual federal appropriation that provides unrestricted community development funds to state, city, and county governments. Advocates pushed for this federal funding structure to boost investment in communities experiencing population growth and increasing energy costs. They also pressed for state-and local-governments to deploy those investments in community development projects that would best contribute to the community’s strength.
If we want sustainable financing for population health, what can we learn from these observations? Where are we strong? And what do we need to improve? When it comes to financing, is there a “we” at all, such that 100 years from today, people could look back and point to how stakeholders got behind an agenda for financing population health that impacted millions of lives?
Penny for your thoughts…
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