The Public Housing and Primary Care Program

The Public Housing Primary Care (PHPC) Program, created under the Disadvantaged Minority Health Improvement Act of 1990 and administered by the Department of Health and Human Services' Health Resources and Services Administration (HRSA), enables 40 community health centers across the country to expand their primary care services to residents of public housing. These health centers are located on the premises of public housing, or at locations immediately accessible to residents. Public Housing Primary Care programs utilize partnerships with public housing authorities and resident/tenant organizations to facilitate the delivery of services, including collaboration with state and local managed care systems. Residents are actively involved in the design of services and program governance, and are routinely trained or employed as outreach workers and case managers. The goal of these partnerships is to have increased self-management skills in disease prevention and health promotion.

People living in public housing face complex social, economic, and physical stressors, and general safety concerns, which affect employment and educational opportunities, and contribute to the multiple health challenge. Carlos Manjarrez, a senior researcher at the Urban Institute, has looked at issues of neighborhoods and health outcomes and found that residents of public housing often keep children inside the home instead of taking them to a park for exercise and recreation due to personal safety concerns.¹ Such individual decisions can contribute to a reduction in physical activity and, thus, to obesity and related disease processes. Additionally, limited access to fresh fruit and vegetables, and the proliferation of small stores stocking processed foods, can contribute to poor health behaviors and outcomes.²

The majority of the 2 million residents in public housing fall below the federal poverty level. Many families in public housing comprise single-heads-of-households and children, and chronic diseases are commonplace among residents. The Association of Clinicians for the Underserved (ACU) has been working with North American Management over the past year on a needs assessment plan for health centers serving residents in public housing. "Place matters with respect to health," commented Urban Institute researcher Carlos Manjarrez at a PHPC strategic planning meeting held by the North American Management in December 2006.³ The ACU took Manjarrez's notion that health and place are inextricably bound together as a starting point in its work on the public housing health center needs assessment plan.

The links between an impoverished living environment and low socio-economic status have a profound impact on the physical and mental health status of residents of public housing.⁴ Medical providers and public housing authorities can benefit from understanding the relationship of both internal and external living environments to the health of their clients.

Just how are place and health connected? One way of imagining the interconnections is this: High quality health services for residents of public housing can have a positive effect on the health of the residents, which ultimately can lead to positive employment outcomes for a resident, which can improve socio-economic status, which ultimately can further improve health.

Clinicians serving residents of public housing understand the disparities in health conditions disfavoring their communities. The high rates of asthma, cancer, lead poisoning, oral health problems, depression, obesity, substance abuse, violence, along with HIV, hypertension and diabetes, are problems to be tackled from a curative and preventive point of view.

Endeavors that incorporate residents' beliefs, cultures, and strengths to decrease disparities are emerging. Some examples of these innovative programs in health centers supported by PHPC funding include:

• • At Grace Hill Neighborhood Health Centers, Inc. in St. Louis, Missouri, residents are trained using a National Health Lung and Blood Institute curriculum to provide education and outreach on prevention and treatment of heart disease.

• • Pediatric obesity prevention is a focus of the Starting Right program at Montefiore's South Bronx Health Center for Children and Families, where clinicians engage families in making healthy food choices and getting more physical activity. Recognizing the lack of opportunities for local residents to exercise safely outdoors, the health center participated in the South Bronx Active Living Campaign, a coalition led by Sustainable...