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Quality housing is essential for health and well-being. As the public health community has broadened its understanding and recognition of the social determinants of health (SDOH), affordable housing has become a top priority to advance health equity. However, despite emerging tools for this effort, improving healthy, affordable housing is often a new role for health departments.

When the Benton County Health Department embarked on working in the area of housing, we could never have imagined the challenges we would face in helping our community understand the link between health and affordable housing. Trying to bridge these sectors highlighted that we didn’t know each other’s language, organizational cultures, funding and program mandates, or the numerous barriers to ensuring that everyone in our community has a place to call home.

The number of people experiencing homelessness in Benton County, Oregon has increased by 44 percent from 2016 to 2017. And, like communities throughout Oregon and the United States, affordable housing is also a serious concern. Over half of the employees who work in the City of Corvallis commute from outside the county due to housing costs. Two-thirds of households below the median income ($50,000 per year) are burdened by the high cost of housing.

Benton County—home to Oregon State University—is also notable for having the highest income inequality in Oregon, making it a unique context in which to address homelessness. Perennially ranked at the top in Oregon in County Health Rankings & Roadmaps’ County Health Rankings, Benton County has dropped to third partly due to our increasingly serious housing affordability crisis. Longer commutes from more affordable areas increase the time people spend in their cars with impacts on both individual and environmental health. Our homeless population is increasingly older, more disabled, and living with serious chronic health conditions. And we are becoming a less economically and racially diverse community as more low and middle income people are unable to afford housing in the county.

People without homes form a community of high need within a region that has significant public and private resources that could ideally be leveraged to address housing. Starting in 2016, the Benton County Health Department (BCHD) was asked to lead a year-long community engagement, assessment, and planning process to update the Ten Year Plan to Address Homelessness and reactivate community response to the growing homeless and housing affordability crisis. BCHD’s community engagement experience and credibility as a facilitator of the county Community Health Improvement Plan (CHIP) led to this new role as an affordable housing convener.

The engagement process included diverse community partners and stakeholders representing sectors such as housing, social services, health care, education, and community development. The process also involved over 300 people who experience homelessness and housing instability. Using a Health in All Policies approach, we worked to address the root causes of housing affordability and homelessness by engaging the whole community in ensuring safe, healthy, and affordable housing for all in Benton County.

Updating the Ten Year Plan was a challenging but powerful experience. The funding and policy realms of affordable housing and homelessness proved to be a steep learning curve for us. We were caught off guard by the tensions and stressors that local non-profits face as they struggle to maintain resources for their own operations (which often pits them against each other). Policy makers also face enormous pressure to “do something” despite the widespread recognition that solving homelessness is not a task that can be easily accomplished overnight.

We also struggled to develop a shared vision across so many disciplines. Some didn’t understand why public health would help lead an affordable housing effort. Whenever possible, we used Thomas Frieden’s Health Impact Pyramid, combined with our local data, to show how housing directly impacts both individuals and a community’s health. Using the socio-ecological model also helped to illustrate why we reached out so broadly to better understand and address housing.

And some partners were frustrated by our methodical and comprehensive approach to the planning process, saying that it “was taking too long.” We consistently communicated that engaging the community in decision making—particularly people experiencing homelessness and chronic housing stress—was just as important as writing and publishing an updated plan.

We believe that this intentional process, our skills, and our public health toolbox will help Benton County address homelessness and housing affordability and will advance health equity over time. And we encourage health departments and other public health advocates to look beyond obvious health concerns to the critical root causes of poor health in your communities.

Image: Benton Habitat for Humanity mural in Corvallis, OR.