Housing activities pursued under the Community Development Block Grant: Do health impacts play a role?
Open AccessThe Community Development Block Grant (CDBG) is a flexible program from the U.S. Department of Housing and Urban Development (HUD) focused on improving the lives of low-income populations. While health is clearly outlined as a pursuable goal under CDBG guidelines, it is unclear whether grantees are considering population health or the health implications of their CDBG activities when determining their funding priorities during a grant cycle. The purpose of this study is to determine the role that health plays in driving the use of CDBG funding, and whether CDBG grantees collaborate with health officials to gain knowledge of community need, obtain data, or monitor and evaluate health indicators. This dissertation used a qualitative approach through a multiple case study design to explore the issue of CDBG grant administration and decision making. A purposeful sample of seven case studies were chosen based on their grant size, quality of housing stock, and known collaboration between community development activities and health. Interviews with multiple individuals involved in the CDBG process, including grant administrators, decision makers, and health officials, were conducted in order to present a wide range of perspectives that are key in determining CDBG funding priorities and housing-related activities. The data were analyzed using a constant comparative method and a within case and cross-case analysis are presented. Findings indicate most case study sites did not consider protecting the health of the community or promoting health protective activities a priority for CDBG. Case study sites prioritized the creation and preservation of affordable housing, homelessness prevention, and community and economic development activities. However, population health did indirectly influence CDBG decision making. All case study sites received input from a health organization during the CDBG planning stages. A cross-case and within case analysis determined six key factors that influenced the amount that population health shaped CDBG priorities: how CDBG administrators defined health, the types of collaboration between health and community development agencies, availability of data and evaluations, the organization of public agencies, the existence of different funding streams, and the passage of the Affordable Care Act. The Seattle/King County site displayed the strongest collaboration between community development and public health agencies, largely due to passage of the Affordable Care Act, which lead to a cross-agency collaboration that created new neighborhood data maps that allowed for the development of targeted place-based strategies to improve low-income neighborhoods. Other interesting models of collaboration, data gathering and evaluations, and mechanisms for promoting a stronger health influence in community development decision making are described, as well as recommendations for community development and public health agencies on how to develop maps, evaluate impacts, build cross-sector collaborations, and identify funding opportunities to achieve healthier low-income communities. Considering the current fiscal climate at the federal, state, and local levels, and the potential health costs incurred by populations that benefit from CDBG dollars, it is important to understand ways that decision makers can collaborate across sectors and leverage available funding to improve health of communities.
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