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Key Issues

Public housing residents have a unique set of needs. According to UDS data, patients served at PHPC clinical sites were more likely to be diagnosed with asthma, diabetes, and depression and other mood disorders compared to patients served at all Health Center Programs.  

NCHPH is currently working on the following goals that are key to improving health outcomes for public housing residents:

  • Goal 1: Increasing access to care by increasing the number of special and vulnerable population patients served by health centers
  • Goal 2: Improving health outcomes by decreasing the percentage of patients with uncontrolled diabetes
  • Goal 3: Improving health outcomes for cervical cancer screening
  • Goal 4: Promoting health equity by increasing the number of health centers providing services or engaged in partnerships that address social determinants of health (SDOH)

Through our discussions with PHPC grantees, findings from needs assessments, and meetings with PHPC leaders at PHPC regional conference, we have identified a list of the top issues affecting health equity and access to care for patients seen at PHPCs in 2017.

Issue 1: Counting Public Housing Residents in the Uniformed Data System (UDS)

Starting with the 2014 Uniform Data System (UDS), the Health Resources and Services Administration (HRSA) requires ALL Health Center Program award recipients and look-alikes, regardless of targeted special population-based funding, to report on the total number of patients served in sites located within or immediately accessible to public housing (Line 26 of UDS Table 4 – Selected Patient Characteristics).  In the past two years, many health centers have accessed training and technical assistance to understand this “location-based” methodology and to make a careful determination of whether they operate sites that are immediately accessible to public housing. As a result, over 1.5 M individuals were reported on this line in the 2015 UDS. However, it is critical to note this is NOT a count of the number of public housing residents served.

One of the new goals for health centers is to increase access to care for public housing residents. Doing so will require growing existing and creating more sites that are determined to be accessible to public housing. At the same time, simply encouraging more existing sites to determine that they are immediately accessible will increase this reporting measure. However, increasing this measure will not necessarily reflect improved access. NCHPH and partners will continue to work with HRSA to improve standardization and accuracy of how this measure is collected, and to consider alternate methods to gauge access among vulnerable public housing communities.

Issue 2: HUD’s Final Rule to Ban Smoking in Public Housing

On December 5, 2016, HUD published a final rule requiring all Public Housing Agencies (PHAs) administering low-income, conventional public housing to initiate a smoke-free policy. The Rule becomes effective on February 3, 2017 with an 18-month implementation period. Currently, more than 600 PHAs and Tribally Designated Housing Entities (TDHEs) have already voluntarily adopted smoke-free policies, resulting in 228,000 public housing units that are smoke free. Once the Rule has been implemented, another 940,000 public housing units, including more than 500,000 units inhabited by elderly residents and 760,000 units with children, will become smoke free.

Smoking and tobacco-related injuries and deaths are a particular problem in public housing. Public housing residents exhibit high rates of tobacco-related illnesses; health problems that could be exacerbated by secondhand smoke, such as heart disease, diabetes, and asthma; and injury or death due to smoking-related fires.  Health Centers located in or immediately accessible to public housing are the primary source of health care for this special population. When the smoking ban goes into effect, it is likely that many public housing residents will attempt to quit tobacco products, resulting in a higher need for smoking cessation and counseling services.  See our brief Public Housing is Going Smoke Free here. 

Additional Resources from the American Lung Association

Additional Resources from HUD's Office of Lead Hazard Control and Healthy Homes:

Issue 3: Health Data Collection and Analysis

Health Center Programs are measured by clinical performance standards to determine whether patients are receiving the appropriate care once they are diagnosed with a health condition. UDS data indicate that all Health Center Programs, health centers located in or immediately accessible to public housing, and PHPCs are failing to meet Healthy People 2020 goals. For example, only 58.27% of women at PHPCs are getting the appropriate screening for cervical cancer and 53.9% of patients with depression are getting the follow-up care they need.

While PHPCs are abiding by the new HRSA guidance on reporting public housing residents and gathering the data that shows the high numbers of patients with these clinical conditions, they are also working on their clinical quality performance measures to address the needs or meeting the goals and standards set forth by Healthy People 2020. Adaptation requires knowledge of the emerging problems in the patient base and the flexibility to address those issues. NCHPH is working with its partners to help PHPCs address this need.