Nancy Andrews on Healthy Communities: Critical Discussion on Community Development and Health
Safe, vibrant neighborhoods are vital to health. The community development industry—a network of nonprofit service providers, real estate developers, financial institutions, foundations and government—brings together public and private funds and directs them into investments that transform impoverished neighborhoods into better-functioning communities.
Last week, Nancy O. Andrews, President and CEO of the Low Income Investment Fund, recently moderated a panel on “Healthy Communities” at the National Interagency Community Reinvestment Conference, a premier biannual conference for community development professionals. Andrews previously moderated several sessions on the intersection of community development and health at a series of “Healthy Communities” conferences co-sponsored by the Federal Reserve Bank of San Francisco, The Pew Charitable Trusts and the Robert Wood Johnson Foundation. [Watch an archived video of the “Capital Systems Change” session at the Healthy Communities Conference in November 2011 here.]
NewPublicHealth: What is the connection between community development and human development, particularly when it comes to health? Or, how does investment in a community actually improve the health of the people living there?
Nancy Andrews: Human development, community development and health are inseparable. There is a growing body of knowledge that makes it clear that the communities we live in can help us or hurt us in every conceivable way. The effects of living in poverty can be life-long and can affect one’s ability to be physically, mentally and emotionally healthy. Just in the last six months there have been new data from a 10-year study by the Department of Housing and Urban Development that demonstrates that living in quality housing in a good community reduces obesity and diabetes by as much as 20 percent – that’s an impact a great as a medical intervention! We also know medical interventions can solve only about 10 percent of our health issues. Much, much more of a person’s health outcomes are a result of our environment, our upbringing and our habits. It is almost impossible to overstate how important the environment is on our ability to lead healthy, quality lives.
NPH: You recently led the "Healthy Communities" panel at the National Interagency Community Reinvestment Conference. What did this session cover?
Nancy Andrews: The most important goal of the session was to illuminate the answers to the question you just asked—how important our community, our social networks and our economic stability are to our overall health and wellbeing. We looked at the health and community development sectors—how we link those sectors, how we create better collaboration between them—so we can have better outcomes for low- and moderate-income people. We also talked about investments that allow us to capture savings by creating healthy people in healthier communities. One of the big questions we all have to address is: if we think this is a good thing, just how good is it? Is it good enough that it pays for itself? Is it good enough that we should be investing the future resources of our country in this? Is there a way we can we materially bend the health care cost curve, recognizing that that is an increasing share of the taxpayer’s expenses every year?
NPH: When did the light bulb go off for you that the community development sector should consider the health impact of its work?
Nancy Andrews: For me, it all came together when I read a paper that described the physical changes that occur in the brains of young children when they live in persistent and concentrated poverty. That environment has a physical impact that is very hard to change over a child’s life. It changes their ability to reason to analyze, to learn for a long, long time. That to me was huge. If you damage those abilities, you’ve taken away much of that person’s chances to create a better life for themselves. If we’re working only on programs that deal with employment skills or trying to help people graduate from high school or get into college but we’ve left out the early developmental process for children, we’ve allowed poverty to so corrosively impact them that we’re always playing a back-filling game and never getting ahead of the problem.
We’ve been working in the area of the built environment for the last 30 years. We have had successes and important accomplishments all along the way. But at the same time, there’s been an intuitive understanding that we can’t think of ourselves as people who only build housing or as educators or as people that care for young children. We can’t think of ourselves only as health practitioners. We really have an obligation to put those pieces together in a way that considers whole communities, whole people and whole families, and takes life outcomes into account.
NPH: What is the role of community developers in bridging the work of different sectors towards a common goal? What is that common goal?
Nancy Andrews: I think community development is uniquely positioned to move the idea of healthy people and places forward. We are one of the very few social sectors that live at the intersection of people and place. We work from within low income communities to improve them, but our true objective is to change lives and improve life outcomes. Our work gives us the chance to play the quarterback role, that is, to bring relevant sectors and stakeholders together. Ultimately, that allows us to braid together different programs in a holistic view that touches on the many different things people need to lift themselves out of poverty—all the way from housing to early learning to schools to nutrition to access to jobs. All of those are areas community developers invest in and are things we can bring together to improve the lives and life outcomes of low-income people.
NPH: What changes would you like to see in how the community development sector works with the health sector? How is the LIIF leading that work?
Nancy Andrews: The community development sector has strong boots on the ground and strong experience working well in communities to change outcomes. The health sector has a whole different expertise than we do, but also understands how valuable community is. The health sector is very good at thinking about outcomes and developing data to track those outcomes. There’s a natural marriage of strengths that would produce something much greater than working separately.
We understand now much more than ever how important all of the social determinants, all these aspects of community and life, are in determining health outcomes. We know we have a role to play in getting there. The partnership between the health and community development sectors is a very natural one.
NPH: What are some highlights of the programs is the LIIF pioneering to improve the health of communities?
Nancy Andrews: LIIF is looking at innovative work in transit-oriented development and healthy food financing. We’re also working on a national initiative to pilot ways of scaled financing for health clinics. We’re developing a number of channels for getting at this idea of investing in whole communities and whole life cycles as a core part of our work. We feel we’re advancing the healthy people agenda for the families we serve.
NPH: The LIIF just reached its “1 Billion for 1 Million” goal, which was to provide $1 billion in financing to help improve the lives of one million low-income people by 2014. Do you have a sense of how the $1 billion investment has influenced health?
Nancy Andrews: The “1 Billion for 1 Million” goal was set even before we understood the health value of our investment work. While we’ve never tried to measure our work in terms of specific health outcomes, we know we have generated over $20 billion in savings and benefits for families and society through our investments. By creating stable, affordable housing for tens of thousands of families, we help those families save resources and direct a greater share of their budget to their wellbeing. We know one of the very first things that happens when a family gets affordable housing is that spending on food almost doubles. It’s a very direct relationship between housing and nutrition. We know that the second biggest thing they spend additional money on is health insurance and health care. We know that we’ve helped more than 100,000 kids in the State of California gain access to affordable, quality child care services. That kind of early nurturing is crucial to their future life chances. On top of that, LIIF has financed almost $300 million of high-quality schools in low-income communities that are adding to the skills of young people and improving their prospects to graduate from high school, go to college and get better-paying jobs. Those things are all building blocks that help people have much healthier lives and much better futures.
>>Bonus Reading: Nancy Andrews penned a series of articles that called on the community development sector invest more in people-based solutions to poverty, like education, child care and health. Read the most recent article, co-authored by Nancy and David Erickson, here and an earlier piece here.