Public Health and Housing Partnerships: Lessons from New York and Rhode Island

August 25, 2022 | Janet Oputa

The COVID-19 pandemic has elevated and kept public health top of mind world-wide. One issue highlighted by the pandemic that has been keenly felt in New York State and Rhode Island is housing policy. From January-July 2022, ASTHO, with CDC support, hosted a technical assistance program with the New York State Department of Health (NYSDOH) and the Rhode Island Department of Health (RIDOH) to develop and expand cross-sector collaborations with housing.

As they embarked on their housing projects, both states:

• Conducted an environmental scan of existing grant, staff and programmatic work related to health and housing.
• Identified an external subject matter expert and organizational partner to support development and building of state health agency housing expertise.
• Established a regular meeting cadence between key public health (e.g., long-term care, behavioral health, environmental health, maternal and child health, health equity, infectious disease) and housing leaders.
• Established common goals related to health and housing.

Defining a State Health Agency’s Role in Housing

NYSDOH views itself as a convener who manages relationships between state housing partners and local health department (LHD) leaders to improve local engagement and education in state housing and health priorities.

In February 2022, New York Governor Kathy Hochul announced a Master Plan on Aging that offers funding for cross-sector collaboration and statewide initiatives to improve healthy living conditions for older adults. The plan catalyzed NYSDOH and New York Academy of Medicine’s Housing, Health, and Longevity Learning Collaborative, which launched in April 2022. The Collaborative provides monthly trainings and resources to LHDs to better incorporate healthy aging principles into housing regulations and policies.

NYSDOH governs the work of LHDs and uses their Collaborative to connect state housing partners with LHDs (as identified through a LHD needs assessment survey). This survey assessed for local housing and health priorities and current engagement between LHDs and housing. Other New York state partners (e.g., Home and Community Renewal, and Planning Development and Community Infrastructure) provide LHDs with resources on housing affordability, availability, and transportation initiatives related to housing. This created an environment for resource sharing, education, and collaboration among public health and housing.

RIDOH views itself as a hub that provides assets (e.g., funding, professional development, and data) in exchange for housing resources. RIDOH has an active partnership with Rhode Island Foundation as part of their health equity zone initiative, which uses an equity-centered and community-led approach to address social determinants of health. RIDOH leverages community partners (e.g., homeless congregate shelters, lead taskforce partners, harm reduction leaders) to support housing projects across the state that address housing affordability, availability, and safety.

Rhode Island also developed an internal housing and health workgroup that pulls from experts within a variety of public health programs to strategize and share information on housing. Programs leverage funding streams from across the agency (e.g., maternal and child health, health equity, asthma and lead hazard mitigation, community health workers, behavioral health) to support the housing workgroup activities. External housing partners, such as the Rhode Island Housing Alliance, also participate in monthly workgroup calls to share knowledge on housing concepts, track housing policies, and develop joint public health and housing services that address housing insecurity in the state.

Data Sharing

NYSDOH and RIDOH use public health and housing data to identify housing issues (e.g., housing stock, affordability, quality), track impact of housing policy on community health, and develop data driven legislative communication strategies.

• NYSDOH: Through this ASTHO/CDC project and in partnership with New York Academy of Medicine, New York developed a housing and health data dashboard to publish housing indicator data broadly and track the impact of housing policy changes on community health.
• RIDOH: Through an existing partnership with a nonprofit academic organization, HousingWorks RI actively develops a housing factbook on healthy housing (e.g., housing stock, affordability, quality) and environmental health impacts.

Challenges

NYSDOH and RIDOH are still learning how to identify funding that can improve agency infrastructure and secure resources that are solely dedicated to cross-collaboration and social determinants of health projects. Both agencies described funding as one of the biggest challenges to advancing housing. To address this issue, RIDOH drew funding or staff support from public health program teams that contribute to housing projects, such as the housing workgroup and housing factbook.

Additionally, both agencies indicated that a challenge to advancing housing is internal public health infrastructure, limited staff time, and housing policy expertise.

• The New York Academy of Medicine’s knowledge of aging populations and community relationships is a cornerstone of the success of the New York Housing, Health and Longevity Learning Collaborative.
• Rhode Island credits HousingWorks RI for facilitating state health agency relationships with community-based housing partners. This partnership supports state health agency led resource dissemination, health related subject matter expertise support, and public health trainings for housing entities across the state.

Role of ASTHO and Federal Partners

ASTHO/CDC can support state health agencies with sustaining housing partnerships by:

• Sharing tactical examples (e.g., survey instruments, policy assessments) of assessing for housing stock, safety, and affordability challenges in older adult populations.
• Offering support with evidence-based research and data collection on housing and health, and training staff to identify proper housing and health indicator data that can be useful for policy planning, development, and implementation.
• Sharing examples of successful housing and health policy interventions/state funded programs driven by multisector collaboration.
• Promoting private, public, and federal funding opportunities that facilitate cross-sector collaboration and support housing and health projects led by public health.
• Offering capacity building opportunities that help public health staff address social determinants of health in socio-political environments.

The lessons garnered from NYSDOH and RIDOH share best practices on public health’s role in housing and describe the differences and similarities in state approaches to initiating and sustaining relationships. To properly advance housing, public health needs support from state, federal, and community partners to reduce siloes and foster connections with social determinants of health partners, implement evidence-based practices and interventions, and navigate socio-political environments. Funding will also be critical for securing public health resources and to sustain this work going forward.