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National Health Center Week 2020 — Public Health in Housing Day

National Health Center Week 2020 — Public Health in Housing Day

By:
Bob Burns, Director
Saqi Maleque Cho, Director of Research, Policy, and Health Promotion
National Center for Health in Public Housing

 

The theme for this year’s National Health Center Week is, “Community Health Centers: Lighting the Way for Healthier Communities for Today and in the Future.” I cannot think of a more timely and appropriate way to describe the efforts our Health Centers have made this year. The COVID-19 pandemic has proven to be challenging for the entire health system. But Health Centers have demonstrated their flexibility, resilience, and an outstanding commitment to their communities during this strenuous time in our history.

It is important to acknowledge, however, that while this is all fresh on our minds, it is not new. Since 1990, Public Housing Primary Care Health Centers have been working hard to deliver high quality, culturally competent, comprehensive primary care, as well as supportive services such as health education, translation, and transportation to the Nation’s most vulnerable individuals and families. Funded by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), the PHPC Health Center Program has supplied much-needed health services to public housing communities.  In 2018, Health Centers provided care to nearly 4.5 million individuals living in or near public housing developments and more than 800,000 of these patients were served at PHPC Health Centers.

While the landscape has changed since the PHPC Health Center program started, the current pandemic has shown that the issues and challenges that public housing residents face in accessing health care remains. According to the U.S. Department of Housing and Urban Development (HUD),  more than 93% of public housing residents live at or below the federal poverty level and 17% are uninsured.

In 2020, there were roughly 1.7 million residents of public housing. Approximately 93% were living below poverty, 33% were headed by a single female, 37% of the households had children, and 38% had a member that was disabled. (Source: HUD)

A federal cross-agency collaboration between HUD and the Centers for Disease Control and Prevention (CDC) revealed that individuals with housing assistance are more likely to have chronic health conditions and are higher utilizers of health care than the rest of the U.S. population. They are more likely to be obese, have diabetes, respiratory illnesses, be smokers, have a disability, or mental health challenges. In some instances, the prevalence of disease in public housing residents is double or triple that of the general population. What is more concerning is that public housing residents are also more likely to have poorer health outcomes compared to other low-income renters. Further demonstrating the role that the social determinants of health (SDOH), i.e. the social, economic, and environmental factors, such as income and safe and healthy environments, play in shaping the health of a community.

Prevalence of Select Health Conditions for Individuals Receiving Housing Assistance

HUD-Assisted Low-income renters All Adults
Fair/Poor Health​ 35.8%​ 24%​ 13.8%​
Overweight/ Obese​ 71%​ 60%​ 64%​
Disability​ 61%​ 42.8%​ 35.4%​
Diabetes​ 17.6%​ 8.8%​ 9.5%​
COPD​ 13.6%​ 8.4%​ 6.3%​
Asthma​ 16.3%​ 13.5%​ 8.7%​
Serious Psychological Distress 11.6% 8.7% 3.7%
Distress with Mental Hardship 39.3% 35.4% 21.4%
Source: U.S. Department of Housing and Urban Development, Office of Policy Development and Research. A Health Picture of HUD-Assisted Adults, 2006-2012.

COVID-19 has also highlighted the extent of health inequities, structural racism, and other obstacles that public housing residents face, particularly those from racial and ethnic minority groups. An analysis of HRSA data revealed that at the end of May, close to 80% of COVID-19 positive cases at PHPC Health Centers were minorities.

For more COVID-19 related resources, please go to nchph.org.

PHPCs have been working tirelessly to address those underlying issues and improve access to healthcare and the health outcomes of public housing residents.

  • Health Centers like La Maestra in San Diego, CA found themselves providing food pantry items to members of the community, in addition to tackling health care delivery under the duress of limited personal protective equipment (PPE).
  • Zufall Health Center in Dover, NJ, created an informative video on proper mental self-care practices in the era of COVID-19. The magnitude of the COVID-19 pandemic can take a significant toll on the mental health of healthcare workers. This video features Zufall Health Staff members demonstrating their ability to keep a positive state of mind during the pandemic. For more information, click here.
  • Esperanza Health Centers, in Chicago, IL was one of three dozen Health Centers to sign off on a letter announcing that they would collaborate on addressing inequities in health coverage.

Take a look at the public housing resources located nchph.org for data, best practices, and recommendations on how to improve access to care, health equity, and health outcomes for this important population.

What’s Next?

Health Centers can continue to “Light the Way for Healthier Communities” by preparing for the key issues that will face public housing residents in the future.

  1. Affordable housing– While lack of affordable housing is not a new issue, it continues to be a major challenge facing low-income populations. Traditional public housing continues to have a significant footprint; however, its numbers are declining. The real growth in affordable housing has been in mixed-income, integrated units located throughout the community that are subsidized by HUD through voucher programs.

In many ways, that transition from project-based housing to subsidized, mixed-income units provides access to opportunities not otherwise available to residents of public housing. However, it poses a challenge to Health Centers as they deploy screening tools to identify social determinants of health (SDOH) needs and then make referrals to local community resources. To adapt to the trend of decentralization in housing property locations and management, Health Centers must work closely with public housing authorities, schools, and other community organizations to provide holistic services that address the many SDOH needs residents face. NCHPH will be hosting a series of learning collaboratives on partnership building and screening tools for SDOH affecting public housing residents.

  1. Building and Maintaining Partnerships- A key component to improving the health and well-being of public housing residents is through engaging in cross-sector collaborations. HUD established the EnVision Center Demonstration Program in 2017 to help support the integrated delivery of health, self-sufficiency, and economic services to public housing residents. Currently there are 42 sites with plans to expand the demonstration to 100 sites around the country by October 2020. EnVision Centers are designed to address SDOH, and there is a central focus to improve health and wellness specifically at Health Centers. Therefore, the initiative offers an opportunity for collaboration. NCHPH staff has been involved in kickoff events and ongoing implementation efforts and has a variety of resources on how to engage EnVision Center partners to improve health of public housing residents.
  2. COVID-19– Health Equity and Immunizations- The COVID-19 outbreak has demonstrated the severe impact of infectious disease across all aspects of life and has highlighted the structural racism and health inequities faced by racial and ethnic minorities. Public housing residents are at high risk for infection because they live in densely populated areas; are disproportionately racial and ethnic minorities, elderly, and or disabled; more likely to suffer from chronic disease; and if employed, are often essential workers. For a COVID-19 vaccine to be fully effective, immunization rates at PHPCs must be increased. That will require clear targeted health communication campaigns, collaborations between PHPC Health Centers, public housing agencies, and federal and local agencies.

 

  1. Telehealth– Until COVID-19, telehealth had long been viewed as a resource with unlimited potential but limited utilization and acceptance. Today, only 4 months since the COVID-19 stay at home orders began, it is widely thought that Telehealth will only grow in use as a mainstay in the healthcare toolbox. In 2018, roughly 50% of Health Centers were offering Telehealth services, today over 95% do.  Its application makes the need for addressing the digital divide crucial. Patients who lack access to technology equipment or internet, or need the skills sufficient to operate the technology will be at a severe disadvantage, including public housing residents. Health Centers will need to strategize on the programs and collaborations to improve access to telehealth services.

There is a long way to go to improve health access to public housing residents, but PHPC Health Centers and other safety net providers are leading the effort to provide high-quality health care for those living in public housing developments.


Visit the National Center for Health in Public Housing website for further information or connect with the organization on social media:

Facebook: www.facebook.com/NCHPH.org

Twitter: @NCHPHorg