“The greatest compliment that was ever paid to me was when one asked me what I thought, and attended to my answer.”  — Henry David Thoreau

National research and practice increasingly demonstrate the critical connection between stable housing and improved health. However, housing and health care too often operate as distinct fields, rarely recognizing their intertwined relationship. Mercy Housing and the Colorado Coalition for the Medically Underserved (CCMU) are partnering to bring together stakeholders across both sectors to explore housing as a platform for addressing health needs and prioritizing ways the two fields can work together to improve health outcomes.

The collaboration between CCMU and Mercy Housing began innocuously enough. One day a Mercy Housing resident named Lawrence was standing outside of Mercy Housing’s Aromor Apartments building in Denver, enjoying the weather, and he struck up a conversation with a passerby. The passerby was Marc Reece of the Colorado Association of Health Plans, who was on his way to the State Capitol to discuss health care policy in Colorado. Lawrence was intrigued and asked if Marc might return later and help the residents of the Aromor better understand the health care changes that lay ahead.  Marc agreed, and invited Gretchen Hammer of CCMU to come along and help facilitate a health care conversation with the Aromor residents.

When the residents of the Aromor came to learn more about health care policy from Marc and Gretchen, they packed the house.  The questions they asked and the experiences they shared proved this was a truly savvy group, and one that had witnessed first-hand the shortcomings of the health care system.  Following the conversation, staff from both Mercy Housing and CCMU recognized they needed to continue to work together – not only to uplift the voices of the medically underserved like those in Mercy Housing properties – but to influence the housing and health care sectors to recognize how powerful collaboration could be in improving the lives of vulnerable families.

Thanks to a Convening for Colorado grant from The Colorado Trust, what started as a conversation at one Mercy Housing property spread across the city, as Mercy Housing and CCMU ventured out on a listening tour (which was truly all about listening) to hear from residents from many different walks of life about their own health care experiences.

Whether speaking with the formerly homeless, with low-income families, or with the elderly, we found some surprises.  Here are just a few:

• Adults have a much more difficult time seeking care for themselves than for their children. Though the health system serves children well, adults consistently slip through the cracks, even when they do have public health insurance. Adults often go without care because the waiting times for clinic appointments can be up to six months. If they are desperate enough, they head to the emergency department for care, which is not their preference but sometimes is the only way to be seen. Staying home sick without a doctor’s note often puts employment at risk and can impact housing in the longer-term.
• Cost remains a significant barrier to good health. For people living in poverty, even finding the funds to ride the bus to the doctor’s office can be a challenge. Affording co-pays for visits or medications is even more challenging.  As one resident noted, “Alcohol is the one medication I can afford.”
• Living in poverty is itself a health issue.  The daily stressors of trying to find the resources to survive, navigate complex bureaucracies and juggle many different competing demands leave people feeling emotionally frail.
• Taking responsibility for their own health is important, but there are barriers to eating well and exercise.  Many find that transportation to grocery stores is a challenge, and often affording healthy produce is difficult, particularly by the end of the month when public benefits are dwindling.  For those who live alone, cooking for one using fresh ingredients is not always cost effective.

Residents also had a number of suggestions for improving their health.  These included:

1. Use housing as a platform to deliver health services, by considering affordable housing sites as places to help with enrolling in benefits, providing on-site care, and promoting prevention activities.
2. Improve access to health care for adults, including dental, vision and behavioral health care because they are particularly difficult to access and the needs are great.
3. Increase access to healthy foods, exercise and education, through community gardens, cooking classes, exercise opportunities and other ways that help low-income people reach out and engage with the broader community.
4. Commit to compassion and decency by improving customer service in health care and the way that people are treated, so that they don’t feel looked down upon but receive common courtesy.

This is just a snapshot of what we heard during the listening tour.  We encourage you to read the full Health in Residence report to learn more about the health experiences and ideas that were shared.

Looking Forward to the Future

In March 2013, CCMU and Mercy Housing convened nearly 30 key experts from the housing and health care fields to learn from the listening tour and to consider areas for future collaboration. Two areas in particular seemed to resonate most with those in attendance: housing as a way to improve access to health; and housing as a platform for promoting active, healthy living. CCMU and Mercy are now continuing these local conversations and will be bringing in national experts in May to talk about other models that have successfully used housing as a platform to achieve these goals, helping to inspire Colorado about what might be possible.