How to Stock the Pharmacy with Housing

Guest Post by Megan Sandel, MD MPH and Andrew Hyatt

Sometimes as a doctor who cares about housing, I feel lonely. As physicians, we are trained to diagnose and treat the sources of disease, not just the symptoms. When I see a kid struggling to breath, I often think the asthma attack is the symptom, and the underlying disease is their moldy home. While medications can be useful, what is truly needed is a stable decent affordable home. Unfortunately, though I may want to write a prescription for a healthy home, too often the hospital I work at does not stock that in their pharmacy.

Thankfully for our patients, there are growing signs that this is changing. Policy makers are beginning to realize that safe affordable housing is essential for good health, and doctors and hospitals are taking notice. Many people don’t realize that over 70% of privately-held hospitals are non-profit. In order to keep their non-profit status, hospitals have long had to give back to their communities through “community benefit” programs. Traditionally hospitals have not used this opportunity to invest in their communities, and directed less than 5% of their total community benefit spending towards community health improvement.

This could start to change as the Affordable Care Act (ACA) begins to take effect. The ACA stipulates that hospitals undertake Community Health Needs Assessments every three years, focusing on unmet health needs. The new rules emphasize “the need to prevent illness, to ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health in the community.”

Even more encouragingly, the IRS has included housing quality improvements and housing for vulnerable populations as activities that may count towards hospitals’ community engagement activities to meet their community benefit obligations. In April of 2015, The American Hospital Association and the Catholic Hospital Association wrote the IRS urging them to explicitly allow hospitals to improve housing quality and make grants to subsidize healthy housing as a part of their community benefit activity.

What this means is that while physicians and housing advocates have often felt alone in trying to address the problem of affordable housing, the tide is shifting.  Because of new federal IRS requirements and hospital advocacy, now is the time for creative partnerships between the health and housing communities. We suggest three concrete steps to advance these collaborations:

1. Do your homework.

• Research local county health statistics.
• Look up community health needs assessments (CHNA), which should be publically available on hospital websites.
• Look up the hospital's form 990, which often include implementation plans.

2. See who you can reach out to.

• Look up the community benefit or population health offices at local hospitals.
• Investigate to see if there is any overlap between your board, contacts of your board members, and governing boards of the hospital.

3. Engage with health care organizations.

• Invite a health care practitioner or administrator to sit on your board.
• Consider submitting a joint application for a health improvement grant such as the RWJF Culture of Health prize.

Together, the housing and health communities can work towards a world where the pharmacy is not barren, but is stocked with safe, decent, and affordable homes to improve the health of communities.