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Creating Healthy Neighborhoods from the Ground Up

For years, a conservation-focused legal foundation and a nonprofit housing financier have partnered with local governments, investors, researchers and developers to lay the foundation for healthy neighborhoods.

1463 Dorchester Ave., a Healthy Neighborhoods Equity Fund investment, will include 29 workforce rental housing units and 1,300 square feet of ground floor retail space. Within walking distance of public transit and public parks, its energy-efficient features include a rooftop solar PV system. (CLF)
In Brief:
  • Urban infrastructure can have significant impacts on health.
  • For years, the Conservation Law Foundation and the Massachusetts Housing Investment Corporation have worked with local governments to develop a holistic approach to development, addressing health and climate concerns.
  • This work is guided by an innovative research program.

  • Local governments have their hands full dealing with the consequences of past development — energy-wasting buildings, poor ventilation, green space lost to impermeable surfaces, urban design that favors cars over pedestrians and public transportation. There is a growing recognition that new projects must not repeat mistakes that have the potential to harm health and the environment for decades.

    Since 2014, the Conservation Law Foundation (CLF) has partnered with the Massachusetts Housing Investment Corporation (MHIC) to bring investors and developers together for projects that make the most of opportunities to improve community health and address climate concerns.

    It can be hard for planners to connect the dots between housing, environment and health, says Gina Foote, director of impact investment for CLF. The nonprofit is drawing on expertise in law, science and finance to make these connections and to change behavior.

    “We want to see equitable access to affordable housing, healthy food, public green space and public transit,” Foote says. “We are trying to get investors to invest in an equitable way and to pair those investments with rigorous screening metrics to ensure all of those outcomes.”

    To drive progress toward this goal, CLF and MHIC created the Healthy Neighborhoods Equity Fund (HNEF). In part, the HNEF was a response to a study by the Boston Metropolitan Area Planning Council (MAPC) that highlighted a need for funding to develop transit-oriented projects.

    CLF and MHIC raised $22 million for HNEF and invested it in nine developments. This enabled the construction of 586 new mixed-income housing units and close to 50,000 feet of new commercial space and generated 110 permanent jobs in low- and moderate-income neighborhoods.

    The strategies that led to this success, including an innovative research component, are being brought forward for HNEF II. At $42 million, HNEF II is almost twice the size of the original fund and is available for projects in Connecticut and Rhode Island as well as Massachusetts.

    Each step forward further refines a blueprint that can guide health-centered development work in the region and beyond.
    Bartlett Station.jpg
    A former site for a mass transit maintenance facility, Bartlett Station is being redeveloped. Building B, a HNEF investment, was completed in 2019. Thirty-two of its 60 residential units are set aside for lower-income residents. The first floor includes commercial space.

    Filling a Funding Gap

    The HNEF was necessary to unlock new sources of capital for projects that take long-term health and environmental impacts into account, Foote says. “There’s just not enough public subsidy to achieve what we need to achieve.”

    MHIC, a nonprofit, has financed community development and affordable housing in New England for more than three decades. It also provides loans to small businesses and enterprises that serve low-income communities.

    The HNEF was built using a “blended capital” approach, bringing investors willing to accept lower-than-average returns on investment together with private-sector investors. Grants from national and community foundations, the state and the Treasury Department's Community Development Financial Institutions (CDFI) Fund provided the “concessional capital” necessary to lower the risk for other partners.

    Some investors value the non-monetary benefits possible from the kinds of projects the HNEF was created to support, says Beth O’Donnell, director of community investment at MHIC. The fund also provides an opportunity for federally insured commercial banks to fulfill the obligation to help low- and moderate-income communities established by the Community Reinvestment Act.

    “It is not uncommon for the projects that HNEF supports to have other innovative financing tools within them,” O’Donnell says. “There might be a loan associated with workforce housing units, so you’re pairing this special equity with a special debt product.”

    A Massachusetts program to incentivize affordable homeownership has been a resource for two HNEF projects. Developers don’t always know about government subsidies for such things as installing solar arrays or building efficiency into the design of a building envelope.

    According to MHIC, the $22 million invested by the first HNEF leveraged “an additional $144 million of private and public investment in low- and moderate-income neighborhoods.”

    The success of the HNEF made things much easier when it came time to put HNEF II together, Foote says. A national health plan, a hospital and commercial banks invested enough to reduce the need for “philanthropic” investors to meet a $44 million goal.

    MHIC requires developers to meet its standards for inclusion of minority workers and minority-business enterprises, says O’Donnell. “The projects are intended not just to benefit the people who will live there or work there in the future, but also the people who work on them while they're under construction — it's an advancement program all the way through.”

    It's not just a matter of good intentions. From the outset, CLF and MHIC have collaborated to develop evidence-based criteria for the projects HNEF supports.
    Nubian Markets.jpg
    Nubian Markets, located in Bartlett Building B, brings a cafe, a halal butcher, a grocery store offering healthy food and community space to a neighborhood where such amenities are scarce. The Market received seed funding from the Kresge Foundation and the Boston Medical Center.

    Multilayered Development

    In 2013, CLF partnered with the Massachusetts Department of Public Health, and the MAPC to conduct an assessment of the potential relationships between planned transit-oriented development (TOD) and health. The intent of this work was to develop criteria that could guide decisions about HNEF investments.

    In its recommendations, the health impact assessment (HIA) identified 12 determinants of health associated with TOD, the types of projects that could address them and the potential health impacts of such projects. It also identified data sets that could be used to monitor whether the expected positive health impacts were being achieved in the real world.

    The HIA was updated in 2020 to help guide the work of HNEF II. It expanded the original 12 health-related “pathways” to 15 and provided a literature review and recommendations for each.

    This work has ensured that CLF and MHIC have a playbook for guiding “multilayered” development that backs up public-sector investments in public transit with equitable access to housing, food and parks. “We also want to incent developers to build in a way that is greener and lower-carbon that code currently requires, putting solar arrays on rooftops, using heat pumps, installing EV charging stations and bike racks,” Foote says.

    Barry Keppard, director of the MAPC Public Health Department, was part of the team for the initial health impact assessment (HIA). A regional agency in a state where county-level government is not the norm, MAPC serves 101 cities and towns.

    Local governments are under pressure to balance demands from residents and fiscal responsibility, he says. Many default to thinking that creating equal conditions will give residents equal opportunities for well-being.

    But simply making things “equal” doesn’t account for variability among the people themselves, whether language, disability or community culture. (Or unintended consequences such as gentrification or displacement.)

    As it has worked to clarify how the built environment can foster health, CLF has explored the human side of healthy development through a parallel research effort in partnership with MIT’s Department of Urban Studies and Planning.
    The neighborhood and project criteria behind more than 100 metrics that comprise a scorecard used to determine eligibility for HNEF funding.

    Ownership of Change

    Any development project comes to life in a complex urban ecosystem. This adds to the difficulty of establishing a causal relationship between it and the lives of the people who live in and around it.

    The Healthy Neighborhoods Study was conceived as a way to gain deeper understanding of the effects of neighborhood change on health, says Andrew Seeder, a research scientist for the study. “Not just change in terms of the presence or absence of new social services, but feelings of belonging, sentiments of having ownership over the change that you’re seeing in the neighborhood.”

    The early phases of the study led to the development of a screening tool, HealthScore, that enables CLF and MHIC to form a more complete picture of the health, equity and resilience impacts of a project — and the likelihood that they will be achieved. The scorecard is used to determine eligibility for HNEF funding, and for performance reviews five and 10 years after construction has been completed.

    The HealthScore tool was a big step forward in assessing the potential for a development to improve health in a neighborhood. But its metrics didn’t capture everything.

    “They are indicators of the distribution of certain material resources, but not indicators of what the presence or absence of those things mean for people in their lives,” says Vedette Gavin, director of research for CLF. There weren’t secondary data sets that could reflect changes in things such as self-determination, relationships or a sense of well-being.

    The research team took on the challenge of identifying the pathways through which a change in a neighborhood resulted in a change of health, and the metrics that could reflect this. This work is proceeding through a participatory action study (PAR), an approach in which researchers collaborate with stakeholders affected by a problem.

    The decadelong study is being conducted in partnership with residents and community organizations from nine communities in the Boston area where a surge of new development is anticipated. The research, supported by the Robert Wood Johnson Foundation, draws on stories collected in interviews with residents as well as data sets to develop both evidence and action strategies.

    One of the important new measures that has come out of this work is “ownership of change.” A person’s sense that they don’t have control over their life can have an adverse effect on health. If neighborhood residents aren’t consulted during the development process, they can experience feelings of displacement or dispossession from a project, no matter how many benefits may be intended.

    Members of the study team talk about the importance of including resident voices in development projects.

    Heading North

    CLF hopes to expand its Healthy Communities work to include states in Northern New England, says Foote. “Vermont, New Hampshire and Maine all have terrible housing crises, and health and socioeconomic disparities.” In more rural areas, this will be less a matter of development around public transit access and more focused on creating walkable, climate smart communities.

    It's also had funding to conduct trainings in other parts of the country to emphasize the importance of designing a theory of change and a framework of metrics to inform development investments. CLF has worked directly with the Colorado Housing and Finance Authority to develop such tools.

    “The thing that continues to just amaze me is how much potential there is for greater civic involvement and action through processes like these,” Keppard says. “I'm not sure if I had blinders on, or I didn't look at things correctly, but where we pull down barriers to people being involved in how their communities can change, it unlocks incredible things.”
    Carl Smith is a senior staff writer for Governing and covers a broad range of issues affecting states and localities. He can be reached at or on Twitter at @governingwriter.
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