Abstract
The Greensboro Housing Coalition was founded 27 years ago to advocate for fair, safe, decent, and affordable housing for low- to moderate-income individuals. We advocate in 4 primary service areas: foreclosure prevention/homeowner counseling, homelessness prevention/ rental housing counseling, healthy homes, and our Community Centered Health Initiative.
For years it has been widely acknowledged that environmental factors such as lead paint exposure can severely affect a child's mental and physical development. For more than 20 years, federal agencies, such as the Center for Disease Control and the Department of Housing and Urban Development (HUD), have funded Lead Hazard Control grants, which aim to prevent lead poisoning by eradicating it from children's environments. However, until recently, government agencies have not extended the approach used to mitigate the risks of lead poisoning to the abatement of other housing-centered factors such as mold and moisture, which increase the risk for respiratory conditions. Fortunately, in the past few years, we have seen this reluctance changing. Doctors have begun to recognize and document that positive changes in the natural and built environment can produce significant changes in their patients' health. In recent years, the efforts of the Greensboro Housing Coalition and other stakeholders to improve people's health by improving their housing conditions have been more fully recognized.
This simple principle—that housing conditions impact one's health and well-being—lies at the heart of the healthy housing initiatives that address the interactions between housing, disease, injury, and overall well-being. Identifying unhealthy housing conditions is a prerequisite to correcting them before they create negative impacts on health. HUD funded a study of 29 common household hazards using a risk-assessment methodology that resulted in a wider acceptance of the prevalence of mitigatable risk factors within our homes (see Table 1) [1].
Health Home Rating System (HHRS)—Categorization of 29 Hazards [1]
Funders such as The Kresge Foundation, Robert Wood Johnson Foundation, the Environmental Protection Agency, and Blue Cross Blue Shield Foundation of North Carolina have started funding environmental interventions. Furthermore, they have funded policy changes and system-enhancing tools that will impact both individual and community health. Both health systems and health care providers are referring patients to and collaborating with the Greensboro Housing Coalition in a variety of ways, from sharing data to planning health and environmental strategies. Consequently, an awareness of the social determinants of health, including housing and the built environment, is taking root in our community.
Our Work
The Greensboro Housing Coalition believes there are many variables that can shape an individual's life. For many residents of low income areas, housing is a variable with unfortunate effects. With this understanding, the Greensboro Housing Coalition now collaborates with other community resource agencies, funders, local governments, nonprofits, community leaders, and a host of other stakeholders to address these social determinants of health and overall quality of life. We believe this to be an ethical and prudent approach to improving our neighborhoods.
Asthma
In 2012, the Greensboro Housing Coalition began working on The Kresge Foundation's Advancing Safe and Healthy Homes for Children and Families Initiative (ASHHI). The initiative allowed the Greensboro Housing Coalition to physically work on eliminating hazards within homes in Greensboro, North Carolina identified as unhealthy. It also granted the opportunity for the Greensboro Housing Coalition to work with local governments and other stakeholders to advance policies that lead to healthier and safer homes, such as code enforcement ordinances. The ASHHI grant led to the publication of “Removing asthma triggers and improving children's health the asthma partnership demonstration project” [2] in conjunction with our partners at the University of North Carolina at Greensboro, Triad Healthcare Network, and Cone Health. Between 2013 and 2015 in Greensboro, North Carolina, the Asthma Demonstration Project worked on the home environments of 41 pediatric asthma cases in Greensboro, North Carolina to produce more trigger-free environments and educate families on the sources of potential asthma triggers. Interventions such as educating residents, repairing houses (eg, fixing leaks and improving ventilation), and providing certain products (eg, HEPA vacuums and mattress covers) successfully mitigated children's asthma. Observed effects of these interventions included improvements for children in sleep, school work, and performance of normal daily activities. Also noted was a reduced use of asthma medication, medication applications, and health visits. Additionally, households with return visits to the hospital had 50% lower hospital bills for childhood asthma treatment [2].
Collaborative Cottage Grove
In 2015, the Greensboro Housing Coalition built on these efforts by becoming the lead agency on a clinical community partnership to improve population health—a project utilizing a community-centered health and shared leadership approach. This model is based on a strategy to advance prevention and improve population health through collaborative efforts by community members, health care professionals, and community-based organizations. Blue Cross Blue Shield Foundation of North Carolina provided funding to 4 organizations—Greensboro Housing Coalition, Mustard Seed Community Health, New Hope Community Development Group, and the Cottage Grove Initiative—in 3 areas: Action Learning, Planning/Capacity Building, and Implementation. Formally called Collaborative Cottage Grove, these organizations began working together in this community-centered health initiative in communities most impacted by social determinants of health. The partnership opened up the opportunity for the Greensboro Housing Coalition to expand from focusing on healthy homes to also focusing on healthy neighborhoods and entire communities. Residents of the communities serve as experts on community changes that are needed to improve the quality of their lives. Collaborative Cottage Grove is operating under the premise that only 20% of health is medical treatment. The other 80% includes social, economic, and environmental concerns such as water, air, safety, housing, social interactions, jobs, and education.
The work of the Collaborative is currently focused on the Cottage Grove neighborhood on the east side of Greensboro. Once the location of the city dump, by 1950 Cottage Grove bustled with retail shops and business professionals. The city dump, in the central part of the community, was turned into Bingham Park. Today, Bingham Park is plagued with environmental issues because it still resides on top of the old landfill. Over the years business closings have been rampant and investments in the community have been sparse. All these factors have led to socioeconomic decline and overall deterioration in the community.
To create effective and sustainable change within communities with such difficult environmental histories, grassroots community engagement efforts and collaborations such as Collaborative Cottage Grove are vital. To broaden its reach in the community and enhance the representation of the community served, the Collaborative partnership has grown to include the University of North Carolina at Greensboro; Greensboro's Center for Housing and Community Studies; Guilford College; Epoch Renewal; NC Department of Health and Human Services; North Carolina Cooperative Extensions in Guilford County and with North Carolina A&T State University; Hospice Palliative Care; Cone Health; and neighborhood associations.
Collaborative Cottage Grove recognizes the importance of having the community's voice lead the initiative; therefore, residents are active participants and advisers who work in teams to address community needs. Partners are able to guide and support the advocacy and community change efforts of the residents, and address health priorities and environmental and socioeconomic concerns. In this particular neighborhood, those health priorities are asthma (as it relates to housing conditions) and diabetes. Community capacity and partnerships are strengthened as we maximize our assets through this collaborative, community-led structure. Although meaningful engagement is a product of such collaborations, it does not come without consistent hard work by organization partners and the residents who do this work.
Advocacy
The Greensboro Housing Coalition has a long standing reputation for advocating for decent and affordable housing for residents of low income communities. Crucial to our mission is supporting residents in advocating for themselves. Self-advocacy is often daunting for those who are not accustomed to it and who don't always trust that positive outcomes will happen for their community, even when favorable changes are attainable. By consistently supporting residents—who have often witnessed decisions being made that devastated their neighborhoods—organizations can build a sense of trust with residents. Community members must be empowered to have their voices heard and their concerns validated. Outcomes of this work become stronger and more sustainable when residents see organizations engaging and advocating with, and not only for, them.
Conclusion
Community leaders, residents, organizational leaders, and other stakeholders want to participate in the revitalization of communities at a range of levels. The Greensboro Housing Coalition is founded on the belief that community residents are not only the change agents, but a necessary part of sustaining improvements over time. The Greensboro Housing Coalition will continue to play an active role in the work of building resident leadership and power while advocating for equity and justice in housing and health. At Greensboro Housing Coalition, there is clear understanding that we must support residents who are active in dealing with their own concerns and that this collaboration is the foundation of a vibrant and healthy society.
Acknowledgments
Potential conflicts of interest. B.B. and J.W. have no relevant conflicts of interest.
- ©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.
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