As the Covid-19 pandemic continues to reverberate, a healthy, affordable home is paramount, especially for seniors and other people who are especially vulnerable during this time.

How affordable housing is designed, built and operated all affect residents' health and quality of life. Thoughtful, informed decision making can make a profound difference in residents’ health and well-being.

Health Action Plans for affordable housing meet the pivotal moment we face, as affordable housing advocates, developers and practitioners seek to address health in ways that extend beyond the doctor’s office – and strive to engage and empower the communities they serve.

The Health Action Plan (HAP) process was developed in 2015 in partnership with U.S. Green Building Council and the Health Impact Project as part of the Enterprise Green Communities Criteria certification requirements. The plans offer developers a decision-making process for integrating health into the design, development and operations of affordable housing.

The HAP process pairs affordable housing developers with public health professionals to prioritize specific health needs and aspirations that are identified through data analysis and community engagement. The result: cost-effective strategies that support the development’s goals and can help improve residents’ health and well-being.

The Health Action Plan draws from well-recognized public health methods (including Health Impact Assessments, or HIAs). The plan’s framework allows project teams to identify and address important health issues. The process calls on developers to:

  • Make a commitment to embed health into the life cycle of a development
  • Partners with a public health professional
  • Collect and analyze community health data
  • Engage community stakeholders to prioritize health data and strategies
  • Identify approaches to address health issues
  • Create an implementation plan
  • Develop a plan to monitor progress (optional)

Where HAPs are in Place and Who They Serve

Adoption of HAPs has gained momentum over the past two years. To date, affordable housing developers have completed 25 HAPs across 11 states and Washington, D.C. In total, the HAPs have sought to enhance the health and well-being of residents in over 2,375 homes, with 33% of those homes designated for seniors.

HAPs underway in 11 states and Washington, D.C.
homes impactd by HAPs, with 33% serving seniors

Enterprise has championed the health action planning process to developers through a range of approaches. We have piloted and evaluated the process, developed tools and resources, and made the HAP an optional criterion in the Green Communities Criteria. We also incorporated the HAP into the Housing for Health Fund, a partnership with Kaiser Permanente.

Most developers used the HAPs as part of the Enterprise Green Communities certification process. In addition to mandatory criteria, Green Communities requires a threshold of optional points. Completing a HAP offers project teams a high number of those optional points. However, developers can administer health action plans independently of Green Communities certification. Several developers in California and Illinois have taken that pathway.

Engaging Residents in Health Action Planning

Project teams have found resident engagement more challenging during the Covid-19 pandemic. At the same time, they also exhibited a heightened sense of awareness and urgency to address health and housing.

Prior to the pandemic, in-person focus groups were the most common form of engagement to prioritize residents’ needs and aspirations, and co-develop strategies with residents or community members.

With the onset of the pandemic and social distancing, community engagement shifted toward surveys (electronic or paper), one-on-one conversations and engagement with community representatives (e.g., nonprofits and local clinics).

Affordable housing developers and public health professionals adapted their engagement to overcome technology barriers for residents. To support these efforts, Enterprise developed a guide on community engagement during times when social distancing is required.

No matter the type of engagement, Health Action Plans are never prescriptive. Instead, the plans center on community health data and residents’ prioritized needs and aspirations.

Certain trends have appeared in the types of health needs identified across HAPs. Of the 25 completed HAPs, Enterprise reviewed nine that were completed since the start of the pandemic in California, Illinois and Colorado. Five of the HAPs were completed at new developments; four were done at existing properties undergoing rehabilitation and ownership changes.

Uncovering Common Themes and Resident Stories

Health needs associated with healthy living and improved physical health emerged as common themes. The HAPs addressed these themes differently, based on the type of property and the resident population.

For example, multifamily properties with many children adopted strategies to expand access to a playground or safe green space. At other properties, the HAP called for improving access to fresh fruits and vegetables and offering linguistically and culturally appropriate group-based activities.

Each HAP tailored their approaches to these shared needs. For example, strategies to address social isolation ranged from increasing technology access and education to structural changes improving accessibility for seniors.

Additional needs referenced included lifelong education, financial stability, accident prevention and heart disease management.

The HAPs also identified assets that support residents health. For example, one resident shared: “My neighbors are very nice. We look after each other.” Another said: “It is affordable – not sure what I would do without this program.”

Ways to improve health also came up in the following references: “Knowledge of a safe evacuation would be comforting”; “People do not stop smoking when kids are outside”; and “People [come] in and out looking for drugs.”

These statements reveal specific ways to address needs around emergency preparedness, asthma and neighborhood safety. Public health professionals and developers are then able to draw on assets, like community connections, to identify ways to address the highest priorities.

Following the HAP process uncovers stories and viewpoints of residents and community stakeholders that provide the most valuable insight to tailoring health strategies. This approach supports the growing evidence that community-level involvement increases residents’ participation in the creation of health-promoting strategies. 

Start Early and Other Key Takeaways About the Health Action Plan

Organizations that perform the HAP say the process allows them to:

  • Build stronger relationships with residents
  • Prioritize health resources for the most critical needs
  • Expand their understanding of how they can impact residents’ health

Still, the need to bridge the gap between public health partners and affordable housing developers remains. The conversations and relationships that the HAPs help foster often require more time than is allocated or anticipated. Additionally, the pandemic has moved the process of relationship-building to virtual platforms almost exclusively.

It’s also important to note that the earlier the HAP is completed in the affordable housing development process, the more likely it is to have a positive impact on residents. When it occurs later, there are often more limitations to the HAP’s scope and budget. Unfortunately, a lack of sustainable resources prevents adoption of many health strategies, including community health workers, murals and public art, food boxes and playgrounds.

Next Steps: Refining the Health Action Plan Process

Enterprise remains optimistic about the potential of the HAPs to make a tangible difference for residents’ health and well-being.

Moving forward, Enterprise will continue to encourage adoption of the HAP in the affordable housing development process, with a focus on improving the process for developers and public health professional through a range of approaches. These include creating more networking and training opportunities and identifying sustainable funding streams to advance health-promoting strategies.

Have a question about Health Action Plans? Contact Mary Ayala.