Built Environment CohortCall #3

Monday, September 19, 2016

ATTENDEES*Albuquerque (Leigh Caswell, Michelle Melendez, Tatiyana Rodríguez)*Baltimore - Grace, Roscoe Johnson *Cleveland – Mandy Metcalf *Chicago - Rod Chicago Department of Health*Des Moines – Claire Richmond

*Springfield – Sarah PageKelsey - Academy HealthJanna – PLKenisha – PLCourtney – TA Coordinator

BUILD HEALTHY PLACES NETWORK

Colby Dailey , Managing Director, Build Healthy Places Network (BHPN)

About the Build Healthy Places Network:

Based in San Francisco, BHPN launched in 2014 with funding from RWJF. BHPN connects leaders across sectors, and builds the knowledge base for collaboration by providing resources and examples of what works.

Community Development and Public Health sectors have been working in same places with the same people, but often not together.

Community Development Sector - $2 billion sector is the action arm for addressing social determinants of health and promoting health equity. It has Community Development Corporations (CDCs) and Community Development Finance Institutions (CDFI’s).

Examples of Community Development investments - health clinics, grocery stores, affordable housing, community centers.

Joining forces program with Kresge Foundation to connect BUILD grantees through the CDC sector.

Joining Forces Planning Grant - BHPN recognized an opportunity to specifically link those working on the built environment with the CDC sector in an intentional way. They hosted a breakfast with the Opportunity Finance Network Annual Meeting in Detroit.

Connected CDFI's and 4 Build grantees identified by Kresge: Cleveland, Springfield, Albuquerque, and Harris County. Small Planning grant opportunity for those who attended, work with CDFI to develop a financing plan. Springfield, Albuquerque, and Harris County were awarded Planning Grants.

Opportunity to really tap into new market tax credit dollars, new market funding streams, and packets that investors would need about investing on projects BUILD are working on.

Sustainable/Non-traditional Funding Sources for Housing Repair Healthy Homes program – program by the U.S. Department of Housing and Urban Development

(HUD) that provides grants to local governments and other organizations to assess housing-related hazards such as asthma and lead poisoning. This not just limited to public housing. Check with your city and county governments to see if there are any local agencies that allocate these funds.

o Example: Alameda County allocates these funds through their Community Development Agency. In other cities, it might be a city government or even non-profit program.

Community Development Corporations (CDCs) and housing developers often specialize in home renovation like the Bedford Stuyvesant Restoration Corporation in NY.

o If you are interested in learning more about what is in your city, check out the National Alliance of Community Economic Development Associations or NeighborWorks to get a better sense of the community development players in your area relevant to your project.

o Local Initiatives Support Corporation (LISC) – CDFI working to integrate financing with local CDC’s and local orgs doing this work. They would be good to connect to.

o BPHN Partner finder - find a list of LISCs and other partners. o Capital Impact Partners - national CDFI that dedicates a specific part of its mission to

assisting in financing housing for seniors. o Enterprise Community Partners - national CDFI's just started a health and housing effort

- they have offices around the country. o Opportunity Finance Network will have a list of all CDFI's registered with OFN. o The CDFI's aren't doing it directly, but they are finding ways to partner more and moreo Community Land Trusts - way for families to own homes - there’s a reserve component

that all home owners pay into (similar to an HOA) for owners to pay for enhancements on their property with a specific code of the land trust. Many of those also address health. That provides a reserve mechanism for homeowners.

Health Impact Assessments - The BHPN has a blog post on how Health Impact Assessments (HIAs) guided the renovation of manufactured housing in Curry County, OR. It mentions a public-private partnership that was created to fund home repairs.

o Qualified Allocation Plan - housing authorities use these to allocate tax credits to developers around the state.

o In GA, health impact assessments have been used as a way to drive policy so that qualified allocation plans from developers.

o Healthy Neighborhoods Equity Fund - In Massachusetts, a HIA actually informed metrics that an Equity fund used for investing in low income communities. Metrics are derived directly from HIA. Excellent policy lever. To the extent that BUILD can influence policy in that direction, that's a bigger macro.

In affordable homeownership programs – those run by cities or Community Land Trusts – frequently homeowners are required to contribute to a reserve in order to address repairs including health hazards. Look to the Community Land Trust Network for more information.

Bonds on the ballet or city initiatives for retrofitting - multifamily and not necessarily affordable housing - allows for mitigation for different health hazards, e.g. energy efficiency and pest control. The city is often the initiator - that can be a voteable bond on a ballet.

Utility companies often offer incentives for energy efficiency programs that can address health multiple ways, e.g. installing energy efficient air conditioning, insulation. Sometimes utility companies will provide grants, or compensation.

o Cleveland was able to partner with a utility company - to work on a weatherization program. Interested in opportunities to partner with cities’ moderate income energy savers program.

Utilizing Community Health Needs Assessments (CHNA’s) - every 3 years non-profit hospitals are required to go through a CHNA process that requires broad stakeholder input. Organizations should try to be a part of that process, if not already, to encourage a focus on prevention and community needs. (Click here for a guide to understanding CHNAs).

o Example: Trinity Health - Transforming Community’s Initiative - $80 mil investment through CDFI's and their hospitals in addressing SDH in their communities. $40 through CDFIs and $40 through tracking obesity and smoking. View slides from PPB National Meeting presentation by Bechara Choucair, MD, Senior Vice President, Safety Net Transformation and Community Benefit, Trinity Health.

o Children's hospitals are coming around to this idea (especially in Ohio). They just convened an Ohio based meeting talking about the role that hospitals play as an anchor institution.

Example: A children's hospital in Philadelphia partners with a city to develop a health, literacy and recreation hub – Read More.

o Example: In Samford CT, the housing authority partnered with the local hospital to work on housing contiguous to the hospital. Read More.

o How do you steer CHNA to focus on housing and not chronic diseases? Finding entry points into CHNA process is the best way to get started. More and more, hospitals and health departments are aligning their CHNA processes. That has been a good entry place for expanding focus on chronic disease. Example: in Ohio, a hospital asked their local CDFI to be part of the process, conversation was focused on affordable housing and access to healthy foods.

How are BUILD Sites thinking about funding these programs?

Cleveland had a healthy homes program that combined it with the city of Cleveland weatherization program. Targeted asthma cases with patients being admitted on a regular basis. Those are not available every year, so not a source they can really rely on for sustainability. Trying to find other sources - Care Source (local healthcare insurer) to fund asthma interventions with local hospital - show Care Source that it's worth investing in. In Springfield, MA, Partners for Healthier Community applied for regular healthy homes funding, and didn't get it last year, but now the city got funding through disaster resilience after they were hit by a tornado and qualified and competed well in that competition. Asthma coalition, as part of partners for healthier community, has funding through that. Also putting together a pay for success program (like the one being done in Baltimore) whole financing package that is funded by investors and repaid by hospital

and insurance if they're able to prove that the asthma triggers were addressed and healthcare costs went down after they did remediation. Pay for success model has a lot of potential, but not many people around the country have gotten them off the ground.

Baltimore’s falls reduction initiative is engaging neighborhood data with green and healthy home initiatives. Go into home and look for health related home repairs specifically related to aging populations. These orgs have money from HUD, but their goal with the Baltimore Health Department, is to push those resources towards individuals with highest risk for falls. They are getting less and less funding for these repair programs. Des Moines is attempting to minimize asthma triggers in homes using referrals from hospitals. Looking at ways to sustain the program. Currently use Polk County Housing Trust Fund dollars. Came to the board to present healthy homes when they won the BUILD grant. Goal is to preserve affordable housing that residents are currently in. The Board has been supportive and they will continue to sustain it. They are looking for funding to maintain other aspects of programs. Talking with MCOs and state Medicaid office.

Conclusion and next steps Folks are encouraged to share successes and opportunities with BHPN so they can learn

about these kinds of partnerships and lift up examples of what works. Build Healthy Places Network will be hosting a #NetworkCommons on October 5 at 10 a.m.

PT featuring the BUILD Grantees who have used their Joining Forces Planning Grants (via Kresge) to partner directly with Community Development Financial Institutions (CDFIs). Springfield, Harris County, and Albuquerque are participating. Register here.