In Camden and Atlantic City, health care systems are treating housing as a public health issue – WHYY

Report on Integrated Health and Housing Initiatives in Southern New Jersey and Alignment with Sustainable Development Goals

Executive Summary

Healthcare systems in Southern New Jersey, notably AtlantiCare and Cooper University Health Care, are implementing innovative strategies that integrate housing and community services into traditional medical care. This paradigm shift addresses the critical link between stable housing and health outcomes, directly contributing to several United Nations Sustainable Development Goals (SDGs), including SDG 1 (No Poverty), SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), SDG 11 (Sustainable Cities and Communities), and SDG 17 (Partnerships for the Goals). This report details the scope of the housing crisis in the region and analyzes the multi-faceted interventions being deployed by healthcare, government, and community organizations.

The Housing Crisis as a Public Health and Development Challenge

The lack of stable and affordable housing in New Jersey presents a significant barrier to achieving public health and sustainable development objectives. The crisis disproportionately affects low-income households and communities of color, exacerbating existing disparities and undermining community well-being.

Key Statistics and Impacts

• Housing Insecurity: Over 10% of New Jersey residents lack stable housing or are at risk of losing it.
• Cost Burden: More than half of renter households in the state are cost-burdened, spending over 30% of their income on rent, which directly impacts SDG 1 (No Poverty) and SDG 11 (Sustainable Cities and Communities).
• Regional Disparities: In Atlantic County, up to 40% of households are on the verge of housing insecurity. In 2023, over 60% of Atlantic City renters exceeded the 30% income-to-rent affordability benchmark.
• Foreclosure Rates: Atlantic City exhibits one of the highest foreclosure rates in the nation, at 0.62% of housing units.
• Health System Strain: Research indicates that unhoused individuals have exceptionally high rates of emergency department utilization, placing significant stress on healthcare providers and highlighting the need for interventions that support SDG 3 (Good Health and Well-being).

Strategic Interventions by Healthcare Systems

In response to the crisis, regional health systems are expanding their mandates to include social determinants of health, with a primary focus on housing. These initiatives are practical applications of SDG 3 and SDG 11 principles.

AtlantiCare Initiatives

1. Community Development Corporation (CDC): Launched its Midtown CDC in 2021 to directly address housing insecurity through neighborhood revitalization, aligning with SDG 11.
2. Funding and Rehabilitation: Secured $1 million in Neighborhood Revitalization Tax Credit funding in 2024 for housing rehabilitation, facade improvements, and community programs.
3. Employee Support: Offers down payment assistance and financial coaching for its own staff, acknowledging that healthcare workers also face affordability challenges.
4. Integrated Care: Screens all patients for housing insecurity at every point of entry. Medicaid-funded housing counselors are being integrated directly into care teams to provide immediate assistance.

Cooper University Health Care Initiatives

1. Digital Referral Network: The “Unite” program, launched in 2020, connects patients with community services. Within six months, 36% of social needs referrals were housing-related.
2. Targeted Support: Integrates housing support for vulnerable populations, including individuals with addiction, pregnant women, and those with chronic health issues.
3. Medical-Legal Partnership: Collaborates with the Camden Coalition to help patients navigate eviction proceedings and access benefits, a key strategy for promoting SDG 10 (Reduced Inequalities).

Multi-Sectoral Collaboration and Policy Support: Achieving SDG 17

The success of these programs relies on robust partnerships between public and private entities, a core tenet of SDG 17 (Partnerships for the Goals). State and local governments are creating a supportive policy environment for these health-related social needs (HRSNs).

State and Local Government Actions

• NJ FamilyCare Waiver: New Jersey’s Section 1115 Medicaid waiver allows reimbursement for addressing HRSNs, enabling health systems to fund housing support services through 2028.
• Atlantic City Housing Authority: Administers the Section 8 voucher program, providing housing for a year to help individuals achieve stability. The city also runs eviction prevention programs.
• Camden County’s “Functional Zero” Goal: In 2024, the county launched a plan to end chronic homelessness by 2030 by coordinating care, implementing rapid rehousing, and fostering partnerships with providers like Cooper and the Camden Coalition. This directly targets the ambitions of SDG 1 and SDG 11.

Conclusion: A New Model for Community Health and Sustainability

The initiatives in Southern New Jersey demonstrate a progressive model where healthcare systems act as anchor institutions for community stability. By addressing housing as a fundamental component of health, these organizations are not only improving patient outcomes but are also making substantial contributions to the Sustainable Development Goals. This integrated approach, which shifts focus from reactive treatment to proactive prevention, offers a scalable framework for building healthier, more equitable, and sustainable communities.

SDGs Addressed in the Article

1. SDG 1: No Poverty

   • The article addresses SDG 1 by focusing on homelessness and housing insecurity, which are key dimensions of poverty. It discusses initiatives like providing housing vouchers, down payment assistance, and rehabbing homes for low-income families, all aimed at alleviating poverty and ensuring access to basic services.

2. SDG 3: Good Health and Well-being

   • This goal is central to the article, which explicitly states that “Housing and health are deeply interconnected.” It details how healthcare systems are expanding their services to include housing support to prevent chronic health issues, improve mental well-being, and reduce the strain on emergency services caused by homelessness.

3. SDG 10: Reduced Inequalities

   • The article touches upon SDG 10 by highlighting the disproportionate impact of housing insecurity on vulnerable populations. It notes that “The situation is worse for people of color” and that housing challenges are linked to “economic and racial disparities.” The programs discussed aim to support these marginalized groups, thereby reducing inequality.

4. SDG 11: Sustainable Cities and Communities

   • SDG 11 is directly addressed through the article’s focus on ensuring access to “adequate, safe and affordable housing.” It discusses high renter cost burdens, foreclosure rates, and the lack of affordable housing supply. Initiatives like neighborhood revitalization, rehabbing vacant homes, and Camden County’s plan to end chronic homelessness are direct actions toward making communities more inclusive and sustainable.

5. SDG 17: Partnerships for the Goals

   • The article is a showcase for SDG 17, emphasizing the importance of collaboration. It describes partnerships between healthcare systems (AtlantiCare, Cooper), government bodies (Department of Community Affairs, NJ FamilyCare), community organizations (Midtown CDC, Camden Coalition), and universities (Drexel) to tackle the complex issue of housing and health. The concluding quote highlights this: “with the right resources and partnerships, we can shift from being the last line of defense to the first opportunity for prevention.”

Specific SDG Targets Identified

1. SDG 1: No Poverty

   • Target 1.4: By 2030, ensure that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources, as well as access to basic services, ownership and control over land and other forms of property…
     • The article connects to this target through programs that provide access to basic services (stable housing) and promote ownership. For example, AtlantiCare’s “homebuyer education and financial coaching for its staff” and its focus on “long-term stability through homeownership” directly support this target. The Section 8 voucher program also ensures access to the basic service of housing for vulnerable individuals.

2. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
     • The article links directly to this target by explaining how housing instability negatively impacts health. It states, “Poor housing conditions, such as mold, asbestos, and lead paint, can lead to chronic health issues,” and “The stress of not knowing where you’re going to live… affects mental health and emotional well-being.” By providing stable housing, these initiatives act as a form of preventative healthcare.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…
     • The initiatives described expand the definition of “health-care services.” The article notes that under the NJ FamilyCare waiver, Medicaid can “reimburse health systems for addressing health-related social needs, or HRSNs, including food access and housing.” Integrating housing counselors into clinical teams and screening all patients for housing insecurity are methods of expanding access to holistic health services.

3. SDG 11: Sustainable Cities and Communities

   • Target 11.1: By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums.
     • This is the core target addressed. The article provides extensive evidence of the lack of affordable housing, citing that “more than 60% of Atlantic City renters were paying over 30% of their income on rent.” The efforts by AtlantiCare’s CDC in “housing rehabilitation, facade improvements,” and Camden County’s goal to reach “functional zero” homelessness are direct actions to achieve this target.

Indicators for Measuring Progress

1. For SDG 3 (Good Health and Well-being)

   • Emergency department use, readmissions, and length of stay:
     • The article explicitly mentions these as traditional health outcomes that are being tracked. It notes that “people who are unhoused have extraordinarily high rates of utilization of emergency departments,” implying that a reduction in these rates would indicate program success.
   • Percentage of social needs referrals related to housing:
     • This is a direct indicator mentioned in the article. “In six months, 36% of social needs referrals in Cooper’s ‘Unite’ digital hub were housing-related.” This metric helps quantify the scale of the housing need among patients.

2. For SDG 11 (Sustainable Cities and Communities)

   • Housing stability and retention:
     • The article states that health systems are “now tracking whether patients have stable housing, [and] how long they retain it.” This is a direct indicator of progress towards providing sustainable housing solutions.
   • Proportion of income spent on rent (renter cost-burden):
     • The article provides specific data for this indicator: “more than half of renter households in the Garden State are cost-burdened, spending more than 30% of their income on rent,” and “more than 60% of Atlantic City renters were paying over 30% of their income on rent.” A decrease in these percentages would signify progress.
   • Foreclosure rate:
     • The article cites this indicator directly: “Atlantic City has one of the highest foreclosure rates in the country, with 0.62% of all housing units facing a foreclosure filing.” Tracking this rate over time would measure housing stability.
   • Number of people experiencing homelessness vs. number housed:
     • This is implied by Camden County’s goal to reach “functional zero,” which is defined as “the number of people experiencing homelessness won’t outpace how many are being housed each month.” This balance is a key indicator of success in ending chronic homelessness.
   • Number of housing vouchers administered:
     • The article provides a specific number: “About 50 people have been approved for vouchers this year.” This is a direct output indicator of housing assistance provided.

Summary Table: SDGs, Targets, and Indicators

Source: whyy.org