Affordable Healthy Housing

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SAHF Collaborative Strives for Health Equity 

“Housing is a key driver of all the social determinants of positive outcomes, and safe, healthy housing is foundational.” That is the essential message expressed by Rebecca Schaaf, senior vice president for energy at SAHF—Stewards of Affordable Housing for the Future—the Washington, DC-based nonprofit collaborative of 13 multistate affordable housing providers whose collective stated mission is to “Advance the creation and preservation of healthy, sustainable affordable rental homes that foster equity, opportunity and wellness for people of limited economic resources.”

“We call ourselves a collaborative because we embrace topical issues together and find there is more success working together than working alone,” Schaaf continues. “We are providing affordable housing as a way of addressing health.” The organization was founded in 2003. The energy efficiency work began five years later in 2008, and a healthy building materials unit was launched about two years ago.

Health Equity
The phrase SAHF used to describe its main goal is “health equity,” and that can be interpreted in both senses of the word: the fairness of giving everyone an equal opportunity at health resources, and the personal benefits each individual builds up as a result of access to, and following healthy lifestyle and practices. The premise under which the members operate is the growing body of literature indicating that traditional medical care has a limited impact on overall health outcomes, particularly for the population segment represented by affordable housing residents. The social determinants Schaaf alludes to—the conditions in which people are born, grow, live, are educated, work and age—have a greater impact on health status. Serving the most vulnerable populations, including low-income children, families and seniors, SAHF and its members work to leverage the impact of service-enhanced affordable housing to directly improve the health outcomes for residents.

SAHF purposes its goal through five main focus areas: mental and behavioral health; toxic stress and trauma-informed strategies; food security; aging-in-place; and healthy building materials.

Achieving that goal is pursued through three ever-evolving strategies: Health Sector Partnerships; Data-Driven Solutions; and Thought Leadership.

“We really rely on a lot of partners,” Schaaf says. “For example, the Healthy Building Network [a national organization dedicated to healthy building practices and headquartered in Washington, DC] has an initiative on affordable housing backed up by a team of chemists. It’s all directed to the question of what is our residents’ daily experience of living in our [members’] properties and how do we hold ourselves accountable to that?”

However, she notes, “All of the resources and tools we develop for our members, we make available to others. Resident outcomes work is where we’ve really distilled a set of metrics that we continually monitor and evaluated over time [See Sidebar]. All of the things that go into [the research] we’re always exploring for scale and actual best practices.”

Dual-Purpose Strategies
The three main strategies SAHF employs each have a dual purpose. They are aimed not only at improving the health and wellbeing of affordable housing residents, but also increasing efficiencies in cost and delivery of services, Schaaf says. “In my own concentration, energy, the energy efficiency sector understands that we’re not just doing this to lower our utility bills. We tie energy efficiency directly to the health sector. Bringing these two groups together can be a challenge, even on the vocabulary side, since each industry speaks a different language. But we’d like to see more integration of energy and health, and a partnership between energy efficiency resources and housing providers to promote cross-sectoral teamwork. And I think people have been very receptive.”

These creative Health Sector Partnerships include healthcare payers, hospitals and health systems. SAHF searches for synergies to implement initiatives and collaborations to improve health outcomes for residents and reduce healthcare costs.

As to Data-Driven Solutions, through its Outcomes Initiative, SAHF members collect data on a variety of social determinants of health metrics. These include healthcare access, insurance status, social cohesion, food safety and education. This data allows members to understand and calibrate the impact of services provided to residents, as well as creating a conduit for partnership building when approaching other sectors through common or standardized metrics of the impact.

Thought leadership is established through the same type of cooperative effort. SAHF’s 13 members essentially provide 13 individual laboratories to test best practices and determine what works and what does not. Lifting up and sharing lessons learned “on the ground” and with other industry partners offers an enhanced opportunity to contribute to the great field of knowledge on the importance of housing investments that improve outcomes and create greater health equity.

The Built Environment
An important concentration in health and housing is the built environment itself, and through their analysis, the SAHF members have zeroed in on the factors that have the greatest impact. These include active design considerations, such as sustainability and energy efficiency and, as Schaaf puts it, “a conservation overlap with building quality that promotes health; no smoking; promises safety and security; water quality; dust and pest control; moisture control; thermal health; air quality; proper ventilation, lighting and views; noise; water quality; and avoidance of toxic materials and chemicals that can cause asthma, cancer, reproductive and endocrine disorders, among others problems.

“In the last couple of years, Fannie Mae has been incentivizing healthy housing,” Schaaf points out. She expects the trend to continue. And legislation regulating some or all of these sometimes “invisible” hazards is currently being considered in 29 states. And in terms of transparency, SAHF’s Health Product Declaration (HPD) provides a standardized method of reporting the material contents of building products and the health effects associated with these materials. The website dubs it “an ingredient list for the built environment.”

And finally, those living in SAHF communities have their own roles to play. “We’re always trying to do a better job of engaging residents in our efficiency and health efforts,” Schaaf states. “It gives them a sense of control of their own lives, and that is empowering.”

SAHF Members
The 13 SAHF members own and operate more than 140,000 affordable residences across the nation: BRIDGE Housing; CommonBond Communities; Community Housing Partners; The Evangelical Lutheran Good Samaritan Society; Homes for America; Mercy Housing; National Church Residences; National Housing Trust/Enterprise; The NHP Foundation; Preservation of Affordable Housing; Retirement Housing Foundation; The Community Builders; and Volunteers of America.