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Bill & Melinda Gates Foundation

Housing is Healthcare

June 02, 2015

Twenty-five years ago, in the earlier years of the AIDS epidemic, health care and housing providers figured out that without housing, the health of people living with AIDS deteriorated far more rapidly than for those who had stable homes.  AIDS Housing of Washington, now Building Changes, helped coin a critically important phrase that became a game changer in the fight against AIDS:  “Housing is healthcare.”

A quarter century later the phrase still rings true, and has expanded meaning in the challenging work of ending homelessness for all people, including families, single adults, youth, and veterans.

The Bill & Melinda Gates Foundation recently hosted more than 100 state and local leaders in ending family homelessness together with health care leaders responsible for implementing the Affordable Care Act (ACA) and Medicaid expansion here in Washington State.  As the health care system changes, the opportunities to integrate and improve the delivery of both housing and health services to families recovering from homelessness have the potential to be transformational.

What might this look like in practice?  We can now envision and realize the possibilities, thanks to a 5-year, $65 million competitive federal grant for State Innovations in Medicaid secured by the Washington State Health Care Authority.  In part, this grant offers the opportunity to think in new and innovative ways about “social determinants of health,” the broad set of conditions in which we live and work, at home and with our families, including the air we breathe and the water we drink, that play a more important role in promoting long-term health than medical interventions.

 Health starts where we live, learn, work and play.

As the Corporation for Supportive Housing has demonstrated, there is significant evidence to support the proposition that “housing is the best medicine." The challenge is to create partnerships between the housing and health care systems that prevent and reduce homelessness while simultaneously ensuring that families can access a range of care and supportive services that promote both health and safety, as well as pathways to stability and economic security.

Bringing the homelessness and health care systems into alignment won’t be an easy task.  The health care system is large, complex and faces priorities and challenges that dwarf the issue of homelessness in comparison.  But that doesn’t mean we shouldn’t try.  Integration of these systems has the potential to change lives – creating better opportunities for vulnerable youth and families – and we simply cannot wait.

The truth is that housing and health care are may be siloed in how services are provided, but they are inextricably linked in the eyes and experiences of the people we serve. We see it in the data and we hear it in the stories from families who are struggling to make ends meet. 

Imagine, for example, if the services provided to rapidly re-housed families could be enhanced with Medicaid funding, offering an array of flexible supports that promote both health and well-being.  The results for families could be truly extraordinary.  The impacts on both the homelessness and health care systems could be equally significant, creating effective, efficient services that substantially reduce the costs of housing and health care over time.

Ambitious? For sure. It will be a long and complex journey. But we've already begun to build the essential partnerships across systems. Realizing audacious visions requires prolonged hard work, and a willingness to take significant risks in order to make tectonic shifts to the status quo.

At the end of our convening, we were joined by Melinda Gates, who offered personal perspectives on why taking risks is essential to achieving our goal of ensuring that everyone has the opportunity to lead a healthy and productive life. 

Changing the world – whether locally or globally – requires bold steps, even when it’s uncomfortable or unpopular to do so.  Even then, bold steps don’t always lead where you expect. We know that first efforts sometimes fail, or produce different results than intended, but to reach our goals we have to keep learning and adapting along the way.  

 “Don’t be afraid to fail,” Melinda advised us. “Be afraid not to try.”

We can already see the promise and benefits of fully integrating the many systems that support housing and health care from where we are now. This is what the future looks like, this is how we achieve greater impact for more people, and now is the time to advance efforts simultaneously on multiple fronts.

There’s too much to gain to not try.  Envision a future in which a patient walks into a health clinic, and after a brief conversation with a doctor, the physician reaches for her prescription pad and writes, “1 unit, permanent housing with flexible supportive services.”  She hands the scrip to her patient, who is able to have it filled as easily as an antibiotic. 

That’s a prescription for health that could truly save lives.

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