Reconnecting Health and Housing: Philanthropy's New Opportunity

The connection between health and housing was widely understood by nineteenth century social reformers and philanthropists and was the dominant framework for low-income housing until the early twentieth century. The Affordable Care Act has not only set in motion reform in the nation’s health care system, but also opens up new opportunities for re-connecting the housing and health sectors. While housing affordability will remain the central challenge for lowand middle-income people, the strong evidence of how housing quality and affordability impacts health calls for a new framework that envisions housing as a platform for improving quality of life. This platform can be conceived as a multi-layered: as service delivery portal, as target for prevention, and as anchor for healthy neighborhoods. These layers are associated with different at-risk populations and different strategies for financing and policy action. Philanthropy can play a key role in re-connecting the sectors through its capacity to build the evidence base, change the discourse about housing, foster policy change, and promote innovation. Florence Nightingale’s observation about the connection between health and housing would have found a receptive audience among her contemporaries. It reflected what had become a broadly shared view on both sides of the Atlantic towards the burgeoning tenements and slums of a rapidly urbanizing England and America. In America, waves of immigration increased the urban population from 300,000 in 1800 to 54 million by 1920. The immigrant poor were housed in dark, crowded, unventilated, and unsanitary slums, which became hotbeds for major outbreaks of diseases such as cholera, typhus, small pox, and yellow fever. Middle class social reformers, including physicians, joined with philanthropists to mount a social movement to address the problem. Reformers led the fight to improve sanitation, ventilation, and other housing related conditions—efforts which led to the creation of the modern public health system. Philanthropists were instrumental in the creation of model tenements and ‘‘social housing.’’ Both wealthy individuals and early industrialists helped build such housing for the growing factory working class, becoming a precursor for the public housing of the twentieth century. Reform efforts did not stop at housing amelioration, but also extended to direct charitable work and public Mr. Fukuzawa is the managing director of the Kresge Foundation’s Health program in Troy, Michigan. Mr. Karnas is a senior fellow at the Kresge Foundation in Troy, Michigan. Howard Frumkin, Lawrence Frank, Richard Jackson, Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities (Island Press, 2004), 52–53; Lawrence Frank, Peter Engelke, Thomas Schmid, Health and Community Design: The Impact of the Built Environment on Physical Activity (Island Press, 2003), 12–13. Russ Lopez, ‘‘Public Health, the APHA, and Urban Renewal,’’ American Journal of Public Health 99 (Sept. 2009), 1603. Peter Dreier, ‘‘Philanthropy and the Housing Crisis: The Dilemmas of Private Charity and Public Policy,’’ Housing Policy Debate 8:1 (1997), 235–293, DOI: 10.1080/10511482.1997, 9521253, 239–240. ENVIRONMENTAL JUSTICE Volume 8, Number 3, 2015 a Mary Ann Liebert, Inc. DOI: 10.1089/env.2015.0006