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HomeMy WebLinkAboutCOUNCIL - AGENDA ITEM - 02/16/2021 - FIRST READING OF ORDINANCE NO. 028, 2021, MAKING S Agenda Item 10 Item # 10 Page 1 AGENDA ITEM SUMMARY February 16, 2021 City Council STAFF Meaghan Overton, City Planner Paul Sizemore, Interim Director, Comm. Devt. & Neighborhood Serv. Sue Beck-Ferkiss, Social Policy and Housing Programs Manager Ingrid Decker, Legal SUBJECT First Reading of Ordinance No. 028, 2021, Making Supplemental Appropriations for Year 2 of the Home2Health Project. EXECUTIVE SUMMARY The purpose of this item is to complete the second and final appropriation of unanticipated grant revenue in the amount of $363,513 awarded by the Colorado Department of Public Health and Environment (CDPHE) through its Health Disparities Grant Program (HDGP). In 2019, Fort Collins was awarded a reimbursable grant of $795,657 from CDPHE to support the Home2Health initiative. The first appropriation of $397,828 was approved on consent via Ordinance No. 090, 2019. This item is listed on discussion to allow Councilmember Gorgol to recuse herself. STAFF RECOMMENDATION Staff recommends adoption of the Ordinance on First Reading. BACKGROUND / DISCUSSION The objective of the Home2Health initiative is to implement community -led policy, code, and regulatory changes to improve housing affordability in Fort Collins, particularly for community members who struggle to afford safe, stable, high-quality housing. The Centers for Disease Control, the World Health Organization, and Healthy People 2020 all state that housing affordability and quality are critical components in health outcomes, and this grant project seeks to reduce health inequities in our community by addressing housing as an “upstream” determinant of health. Funding for this grant comes from the CDPHE Office of Health Equity’s Health Disparities Grant Program (HDGP). This grant is funded through Amendment 3 5 (Tobacco Tax) revenues. A memo from the Office of Health Equity, outlines the background of the Request for Applications for this grant, the review process, and the funding recommendations made to the State Board of Health in March 2019. (Attachment 1) Amount and Timing: The City was awarded a total of $795,657 in reimbursable grant funding over a two -year grant cycle (State FY 2020-2021). This total award was reduced by approximately 8.5% ($34,316) in the second year of the grant cycle due to lower-than-expected tobacco tax revenues at the state level. A total of $397,828 has been appropriated to date, and the current appropriation of $363,513 will fulfill the remainder of the revised project budget of $761,341. Agenda Item 10 Item # 10 Page 2 Year 1 (July 2019-June 2020) focused on assessment, analysis and community engagement. Year 2 (July 2020-June 2021) is emphasizing code/policy writing and supporting the update and implementation of the City’s Housing Strategic Plan (HSP). Key Staff and Partners: The City is the lead agency on this grant and is responsible for overall management and coordination of all grant activities, including any tasks completed with consultant support. Departments involved in this effort include: • Planning - lead, convener, organizer, public engagement, code changes • Finance - grant management, financial expertise, purchasing assistance • Social Sustainability - topic area expertise, policy coordination, public engagement, code changes The grant also requires cross-sector collaboration with outside organizations or entities who receive funding through sub-grants with the City and play a key role in the project: • Larimer County Department of Health and Environment, Built Environment Group : $3,000 • The Family Center/La Familia: $5,000 • The Center for Public Deliberation at CSU: $45,000 • The Family Leadership Training Institute: $50,000 Each of these organizations has been formally committed to the grant project since its inception in the summer of 2019 and has submitted a letter of collaboration to CDPHE. Previous related Council Actions: Several policy documents adopted by Council within the last six years, including the City Strategic Plan (2018) and City Plan (2019), discuss the need for more affordable housing, both subsidized and unsubsidized. Further, several plans specifically mention a need to prevent displacement of vulnerable populations. This grant provides significant funding to conduct community engagement and implement policy direction contained in: • Affordable Housing Redevelopment Displacement Mitigati on Strategy (2013) • Housing Affordability Policy Study (2014) • Affordable Housing Strategic Plan (2015 with update beginning this year) • Social Sustainability Strategic Plan (2016) • City Strategic Plan (2018) • City Plan (2019) • Housing Strategic Plan (2021) This grant is closely aligned with community, City and Council priorities, particularly in the Neighborhood Livability and Social Health Outcome Area. CITY FINANCIAL IMPACTS This grant is administered on a reimbursement basis; funds are spent and reimbursed from the General Fund monthly. The amount of $363,513 in both revenue and expense will be appropriated in the City’s General Fund and does not require a local match. ATTACHMENTS 1. CDPHE Office of Health Equity Funding Recommendations Memo, 2019 (PDF) To: Members of the State Board of Health From: Maggie Gomez, Co-chair, Health Equity Commission Leslie Cook-Knerr, Co-chair, Health Equity Commission Web Brown, Director, Office of Health Equity Jami Hiyakumoto, Manager, Health Disparities Grant Program Through: Karin McGowan, Deputy Executive Director and Director, Community Relations and Legislative Services Division (KM) Date: March 18, 2019 Subject: Request for approval of the Health Equity Commission’s FY 2020-2021 funding recommendations for Health Disparities Grant Program grantee projects. The Health Disparities Grant Program (HDGP) respectfully requests approval of the enclosed funding recommendations for grant projects for the next two-year funding cycle, fiscal years (FY) 2020-2021, beginning July 1, 2019 and concluding June 30, 2021. Specifically, the grant program is seeking approval to provide a total of $2,934,570 in grant funding to five (5) grantee projects. Per statute, these recommendations were approved by the Health Equity Commission and are supported by the Colorado Department of Public Health and Environment (CDPHE). Enclosed with this memo is:  Background information and statutory requirements.  The HDGP FY 2020-2021 RFA (Request for Applications) and Strategic Framework.  Application review and funding recommendation processes.  List of the FY 2020-2021 recommended grant projects.  FY 2020-2021 HDGP projects recommended for funding. These funding recommendations expand the grant activities approved by the Board of Health in April and May of 2018. A summary of these grants is located in Appendix A. Please contact Web Brown, Director of the Office of Health Equity (OHE) at 303-692-2329 with any questions or requests for additional information. ATTACHMENT 1 Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 2 Background Information and Statutory Requirements The Colorado Assembly created the Health Disparities Grant Program (HDGP) to “provide prevention, early detection, and treatment of cancer and cardiovascular and pulmonary diseases to under-represented populations. These populations are currently identified by race, ethnicity, sexual orientation, gender identity, disability status, age, geographic area and socioeconomic status and experience poorer health outcomes.” Sections 25-4-2203(2)(b) and 25-20.5-302, C.R.S., and 6 CCR 1014-5 (HDGP rules promulgated by the State Board of Health) state grants for the HDGP shall meet at least one of the following criteria:  Provide evidence-based strategies for the prevention and early detection of cancer, cardiovascular disease and chronic pulmonary disease in health care, workplace and community settings;  Provide diagnosis and treatment services for anyone who has abnormalities discovered in screening and early detection programs;  Implement education programs for the public and health care providers regarding cancer, cardiovascular disease and chronic pulmonary disease; or  Provide evidence-based strategies to overcome health disparities in the prevention and early detection of cancer, cardiovascular disease and chronic pulmonary disease. The Colorado Department of Public Health and Environment (CDPHE) acknowledges that generations-long social, economic and environmental inequities result in poorer health. They affect communities differently and have a greater influence on health than either individual choices or a person’s ability to access health care. Reducing health disparities through policies, practices and organizational systems can help improve opportunities for all Coloradans. To address these issues, the overall purpose of the HDGP is to ensure all Coloradans have an equal opportunity to live in thriving communities and achieve their full health potential. To accomplish this (including preventing diseases such as cancer, cardiovascular disease and pulmonary disease and addressing health disparities), the OHE realizes we need to look at factors that affect where we are born, grow, live, learn, work, play and age. This includes social and economic factors that influence health and public health, such as unequal education, employment, social support, community safety, housing, transportation and environmental conditions. These factors are called “upstream determinants” because they begin to have a negative impact on a person’s health long before the person is diagnosed with a disease. Addressing these determinants presents an opportunity to prevent diseases from developing. By funding programs, policies and practices that address these upstream determinants, we can influence healthy social, economic and environmental conditions that give rise to health disparities and contribute to cancer, cardiovascular disease and chronic pulmonary disease. Section 25-4-2206, C.R.S. created a 15-member Health Equity Commission that serves as an advisor to the OHE issues, specifically focusing on alignment, education, and capacity-building for state and local health programs and community-based organizations. This commission makes recommendations to the office and the department on the health disparities grant program regarding financial support for local and statewide initiatives that address prevention, early detection, needs assessment, and treatment of cancer, cardiovascular Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 3 disease, including diabetes, and pulmonary disease in minority populations. In addition, pursuant to Section 25-4-2203, C.R.S. the commission appoints a review committee to review the applications received and make recommendations to the commission regarding the entities that may receive grants and the amount of the grants. The commission finalizes the recommendations for funding and provide them to the state board. Within thirty days (30) after receiving the commission’s recommendations, the state board awards grants to the selected entities, specifying the amount and duration of each award. Grants are not to exceed three years without renewal. Evaluation of the HDGP is required pursuant to Section 25-20.5-305, C.R.S. HDGP grantees will work with Kaiser Permanente Colorado, Institute for Health Research, Partners in Education Research Center (the state selected evaluation grantee) to develop evaluation plans and to seek assistance on evaluation strategies. Grantees are required to submit quarterly progress reports and report on project implementation and outcomes. The HDGP FY 2020-2021 RFA (Request for Applications) and Strategic Framework The Office of Health Equity developed a strategic framework after engaging community, governmental, statewide and rural agencies to gather input on the need for funding related to closing the gap on health disparities in Colorado. The HDGP seeks to fund lead agencies with existing partnerships to implement evidence-based strategies to overcome health disparities in the prevention, early detection, and treatment of cancer, cardiovascular and pulmonary diseases in underrepresented populations by: 1) working on systems and policy changes that are community led and address housing and land-use planning, 2) focus on affordability and reducing displacement, segregation and gentrification. These partnerships must include multisector collaborations (for example: education, transportation, environmental conditions, employment, community safety, etc.). The project must begin the process for making, or implementing approaches that make, changes to public and organizational practices, rules, laws and regulatory changes related to housing and land-use planning focused on anti- displacement and/or affordability that affect how systems operate and influence people’s health. With guidance from the Health Equity Commission, the Office of Health Equity released RFA #11545 on September 12, 2018 that reflected the HDGP FY 2020-2021 strategic framework. An applicant information webinar for the HDGP RFA was held on September 25, 2018. In addition, applicants had the opportunity to submit questions regarding the RFA to the program staff via email. Updates and responses to all questions received were posted on the program’s web page (https://www.colorado.gov/pacific/cdphe/hdgp-funding-opportunities) for public access. The deadline for all grant applications was October 30, 2018. Application Review and Funding Recommendation Processes Thirteen (13) applications for HDGP grants were receive by the RFA deadline totaling a request of approximately $3,900,000 per year. A four-stage review process was followed. The first stage involved a technical review by program staff for completeness in addressing major components of the RFA (e.g., did the application propose a system or policy change, are the partners from different sectors, etc.) and compliance with the legislation. Next, nine (9) applications totaling a request of Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 4 approximately $2,800,000 per year (a total of $5,600,000 for the 2-year grant period) moved to the remaining three-stage process on November 15, 2018. This included an independent scoring by individual reviewers comprised of community volunteers and program staff assigned applications based on their area of expertise. Conflicts of interest were disclosed and accounted for during the application review assignments. During the next stage which took place between January 2, 2019 and January 18, 2019, reviewers met as a team to discuss each application and agree on the overall team score for each application. Three (3) applications scored 86-100 points and were highly recommended for funding; two (2) applications scored 71-85 points and were recommended for funding if funds were available; and four (4) applications scored below 70 points and were not recommended for funding. Finally, a funding conference was held on February 6, 2019 where applications were discussed and a final list of recommended applications was forwarded to the Health Equity Commission. The Health Equity Commission met to review and finalize these recommendations on February 6, 2019 and again conflicts were disclosed. Individuals were asked to leave the room during review, discussion and voting on those applications as needed. Through a formal vote the Health Equity Commission moved five (5) applications totaling $2,934,570 for the two-year grant cycle for final approval by the Board of Health. These five (5) agencies represent both urban and rural counties; community-based organizations and local public health agencies. All projects focus on either housing or land- use planning with the goal of increasing housing affordability and reducing displacement, segregation and gentrification as outlined in the RFA. FY 2020-2021 HDGP Projects Recommended for Funding The following provides detail regarding the projects recommended for funding for the next 2- year funding cycle. Please note that all amounts listed are the total “not to exceed” 2-year funding amounts. The detailed project information is based on the information contained in the originally submitted grant applications and may vary from the final negotiated projects. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 5 Number of Recommended Applications by Upstream Determinants of Health Upstream Determinants of Health # Apps % Housing 3 50% Land-use Planning 3 50% Totals 6* 100% *Some applicants will work on both upstream determinants during their project. 50%50% UPSTREAM DETERMINANTS OF HEALTH Housing Land-use Planning Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 6 FY 2020-2021 Health Disparities Grant Program Projects Funding is contingent upon satisfactory performance and funding availability. Grantee Project Title Total Up-to Funding Chaffee County Public Health & Environmental Health Preventing Displacement of LMI Residents Through Strategic Policies $450,970 City of Fort Collins Making Policy Together: A Community-Driven Approach to Improving Housing Affordability in Fort Collins $795,657 Eagle County Public Health and Environment Healthy Housing Eagle County (HHEC) $797,945 Lake County Public Health Agency Leadville-Lake County Affordable Housing Project $400,000 United for a New Economy- GES Coalition Globeville Elyria Swansea Equitable Development Plan & Community Ownership and Stewardship $489,998 $2,934,570 FY 2020-2021 Health Disparities Grant Program Recommended Grant Project Summaries Funding is contingent upon satisfactory performance and funding availability. Grantee: Chaffee County Public Health and Environmental Health Project Title: Preventing Displacement of LMI Residents through Strategic Policies Upstream Determinant of Health to Address:  Land-use Planning Project Summary: With Chaffee County’s dramatic population growth, low and moderate income wage earners are being displaced due to skyrocketing housing costs. This project will provide the community with engagement, education, and analysis that will change the regulatory plans and policies to decrease the cost of housing production and include affordability. How project addresses CCPD Housing instability and related financial pressure is associated with stress and anxiety. “Chronic stress is associated with serious health conditions including asthma, arthritis and allergies, as well as other short and long-term physical and mental health problems. As the process of gentrification causes property values to increase and demand for housing to accelerate, rising housing costs place a disproportionate burden on lower income residents with limited household budgets. This leaves individuals and families struggling to afford housing at the expense of their health. Spending more to afford housing leaves fewer resources for basic health-promoting necessities such as food, healthcare, transportation, education or childcare.”1 1 The California Endowment; “Power, Place, and Public Health,” June 2017. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 7 The applicant states that rent costs in Chaffee County have risen 125% since 2009, according to the US Census American Community Survey, with the average rent asked in 2016 being $1,675. During that same time frame, wages earned have only increased by 19%, with the median household income for 2016 sitting at $50,993. Housing expenses at that household income, without being rent- burdened (that is, using no more than 30% of a household’s income for rent), should be around $1,275. In addition, homes that were previously occupied by wage-earning residents have been converted into short term rental units, where the owners are asking, and getting, close to $200 per night. Therefore, most wage earners, and specifically low to moderate income wage earners, in Chaffee County are managing their housing costs by one or more of the following:  Spending most of their income on housing costs, which “impacts health by limiting the income spent on health care, food, and other essential needs.”  Moving multiple times per year, particularly prevalent with 6 and 9 month leases, where the property owner relies on the short term rental market to capitalize on the tourist season. “Frequent moves increase the risk for mental and behavioral health problems, substance misuse, teen pregnancy, lower health ratings in adulthood, and poor school performance.”  Living in overcrowded environments, where multiple households share in the housing costs. This overcrowding is associated with “respiratory diseases, poor mental health, elevated stress levels, increased rate of infectious disease, and high blood pressure.”  Commuting to locations in other counties, over mountain passes in many instances, increasing the “stress of travel and more hours and money required” to commute to work and school.  Staying in places not meant for human habitation, where homelessness “increases ill health effects including chronic disease, infectious disease, hunger, injuries, stress, violence, disruption of medical and mental health care, and malnutrition.”  Accepting substandard housing, which often increases “exposure to lead poisoning and asthma attacks triggered by mold and other irritants.”2 This project will use community-organizing techniques to build strong coalitions and partnerships to help community residents advocate for changes in housing policy that will decrease barriers to accessing affordable, high quality, stable and safe housing. Community organizing is an evidence-based approach that uses various techniques—such as empowerment & coalition building—to increase the capacity of community residents to advocate for and 2 Colorado Department of Public Health & Enviro nment; “Housing Stability: Lack of Affordable Housing;” June 8, 2017. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 8 promote the interests of their community. The concepts of empowerment and community participation are considered the “twin pillars” of health promotion and well-being.3 The World Health Organization defines health promotion as “a process enabling people to increase control over and to improve their health.” Evidence also shows that the use of organizing approaches— including coalition building and the creation of effective partnerships—increases individual empowerment and social support and promotes health and well-being, in turn enhancing the prevention of chronic cardiovascular disease and diabetes.4 Intended Population: Low to moderate income wage earners Statewide or Targeted: Chaffee County Urban, Rural or Both: Rural Measures of Success: Proposed System or Policy Change: This project proposes working with multi-sector partners to influence housing affordability, regulatory procedures, and the county’s comprehensive plan. Anticipated Activities and Outcomes: Year 1:  Launch Learning Collaboratives to engage community members with facilitated educational opportunities and policy discussions around land-use planning strategies and additional interventions to increase housing affordability.  Obtain feedback on land-use strategies and affordable housing interventions through Learning Collaboratives.  Collect targeted community feedback from real estate professionals, development professionals, planners and the general public. Year 2:  Document existing short-term rental stock.  Recommend appropriate short-term rental policies.  Engage the Chaffee County Board of Planning and Zoning to modify land-use zoning and codes to increase housing affordability. Outcomes:  Increased community engagement.  Understanding community readiness.  Community input regarding land-use and zoning strategies to encourage affordable housing production, thereby increasing the supply of affordable housing opportunities.  Modified land-use zoning and codes to increase housing affordability.  A data dashboard to illustrate the goals for affordable housing production alongside the actual numbers of housing units produced to determine if the intervention changed the housing production ecosystem to produce more affordable housing opportunities. 3 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare . New Brunswick, NJ: Rutgers University Press. 4 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare. New Brunswick, NJ: Rutgers University Press. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 9 Financial Overview: Project Duration: July 1, 2019 - June 30, 2021 Recommended Up-to Funding Approval for 2-year Grant: $450,970 Grantee: City of Fort Collins Project Title: Making Policy Together: A Community-driven Approach to Improving Housing Affordability in Fort Collins Upstream Determinant of Health to Address:  Housing  Land-use Planning Project Summary: The City of Fort Collins seeks to decrease health inequities linked to limited housing affordability through a community-driven approach to land-use and housing policy change. Potential changes could include community land trusts, policies to preserve existing and incentivize new affordable housing, increases to allowable densities, and changes to impact fees. How project addresses CCPD Housing instability and related financial pressure is associated with stress and anxiety. “Chronic stress is associated with serious health conditions including asthma, arthritis and allergies, as well as other short and long-term physical and mental health problems. As the process of gentrification causes property values to increase and demand for housing to accelerate, rising housing costs place a disproportionate burden on lower income residents with limited household budgets. This leaves individuals and families struggling to afford housing at the expense of their health. Spending more to afford housing leaves fewer resources for basic health-promoting necessities such as food, healthcare, transportation, education or childcare.”5 The applicant states that despite the perception that Larimer County is one of the healthiest communities in the State, there is considerable room to improve chronic disease outcomes. Between 1995 and 2013, the two leading causes of death in Larimer County were heart disease and malignant neoplasms. Moreover, according to data from the Health District of Northern Larimer County (HDNLC) Community Health Survey (CHS, 2016), there has been a rapid increase in obesity during this same time frame. The county also has high rates of adults with elevated blood pressure (22%) and a diabetes prevalence rate of 6%. Both conditions are known risk factors for heart disease. When analyzing health outcomes and self-reported health data by income, evidence of health disparities becomes apparent. Respondents to the 2016 CHS who were 185% above the federal poverty level (FPL) were more likely to report a health status of 5 The California Endowment; “Power, Place, and Public Health,” June 2017. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 10 ‘excellent,’ ‘very good,’ or ‘good’ compared to residents who were at 185% or below the FPL (95% compared to 85%). Data from the same survey also shows that respondents report a lower rate of diabetes in individuals at 185% above the FPL compared to individuals at 185% or below the FPL (5% compared to 10%). Additionally, 21% of respondents who were below the FPL answered that they were ‘usually’ or ‘always’ worried or stressed about paying for their mortgage or rent. Through our work with City Plan and the development of the Fort Collins Health and Equity Index, we know that many of Fort Collins’ most vulnerable residents live in Census tracts north of the Poudre River. Residents in these Census tracts tend to earn lower incomes, have lower levels of educational attainment, and are more likely to be of Hispanic/Latinx heritage than residents in the city at large. We also know that the health outcomes included in the Health Equity Index (obesity, asthma, physical activity, and mental health) are worse for residents in these parts of our community. Well- respected organizations including the Center for Housing Policy, the American Planning Association, the American Public Health Association, and the Public Health Institute state that these kinds of social and environmental conditions (low incomes, limited English proficiency, low levels of educational attainment, stress, housing instability, etc.) put people at increased risk for health inequities. This project will use community-organizing techniques to build strong coalitions and partnerships to help community residents advocate for changes in housing policy that will decrease barriers to accessing affordable, high quality, stable and safe housing. Community organizing is an evidence-based approach that uses various techniques—such as empowerment & coalition building—to increase the capacity of community residents to advocate for and promote the interests of their community. The concepts of empowerment and community participation are considered the “twin pillars” of health promotion and well-being.6 The World Health Organization defines health promotion as “a process enabling people to increase control over and to improve their health.” Evidence also shows that the use of organizing approaches— including coalition building and the creation of effective partnerships—increases individual empowerment and social support and promotes health and well-being, in turn enhancing the prevention of chronic cardiovascular disease and diabetes.7 Intended Population: Low-income residents, including Hispanic/Latinx residents 6 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare . New Brunswick, NJ: Rutgers University Press. 7 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare . New Brunswick, NJ: Rutgers University Press. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 11 Statewide or Targeted: City of Fort Collins Urban, Rural or Both: Urban Measures of Success: Proposed System or Policy Change: Application identifies potential land use and housing policy changes such as community land trust, policies to encourage preservation of existing affordable housing, incentives for new affordable housing, increases to allowable densities in zoning and land codes, and changes to impact fees; it proposes to engage community to select those changes. Anticipated Activities and Outcomes: Year 1:  Organize a strategic planning retreat to develop the capacity of City staff and cross- sector partners to more fully understand the linkages between land-use, housing policy, economics/affordability and health by developing and leading a multi-sector Health in All Policies (HiAP) coalition.  Improve leadership understanding and capacity for action around health equity and housing affordability by providing training and involving City leadership throughout the project.  Improve community capacity to participate in policy processes and collaborate with local government on housing affordability and health issues.  Engage the community to evaluate and identify priority housing policy and land-use changes. Year 2:  Continue to build broad-based community support for change with the goal of adopting the identified priority housing policy and land-use changes into City ordinances, codes and policy documents.  Host a community summit to evaluate and recommend policy and land-use changes  Convene a minimum of five (5) planning meetings with the HiAP coalition to prepared housing policy and land use changes for adoption by City Council.  Continue bilingual langue justice civic leadership training with a two-generation cohort.  Draft ordinances and code changes to implement recommended policies. Outcomes:  Increase in capacity of staff, decision makers and residents around policies that impact health.  Increased collaboration among City of Fort Collins departments and between the City and partners.  Institutionalized HiAP approach.  Identification of policy solutions.  Increased efficacy of community members to participate in civic engagement opportunities.  Increased participation from a diverse range of stakeholders at public meetings.  Evaluate the project in a way that prioritizes cultural competence and humility. Financial Overview: Project Duration: July 1, 2019 - June 30, 2021 Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 12 Recommended Up-to Funding Approval for 2-year Grant: $795,657 Grantee: Eagle County Public Health and Environment Project Title: Healthy Housing Eagle County (HHEC) Upstream Determinant of Health to Address:  Housing Project Summary: HHEC decreases risk of chronic disease/cancer in mobile home communities by decreasing chronic stress and exposure to household hazards. HHEC increases homeownership through creation of a community land trust and changes policies to rectify long-standing injustices in the quality of affordable housing through stronger renter protections and grassroots advocacy. How project addresses CCPD Housing instability and related financial pressure is associated with stress and anxiety. “Chronic stress is associated with serious health conditions including asthma, arthritis and allergies, as well as other short and long-term physical and mental health problems. As the process of gentrification causes property values to increase and demand for housing to accelerate, rising housing costs place a disproportionate burden on lower income residents with limited household budgets. This leaves individuals and families struggling to afford housing at the expense of their health. Spending more to afford housing leaves fewer resources for basic health-promoting necessities such as food, healthcare, transportation, education or childcare.”8 The grantee states that prevention, early detection and treatment of cancer, cardiovascular disease, and chronic pulmonary disease disproportionately affect underrepresented populations in Eagle County. Evidence shows that “upstream determinants” are especially impactful on health outcomes because they influence a person’s health significantly in advance of the presentation of disease. Housing stability is an upstream determinant of health that disproportionately and negatively affects lower income and minority populations in our community. To overcome these health disparities, Eagle County Public Health and Environment (ECPHE) will implement policy and systems changes related to housing stability and affordability. Disadvantaged communities are at increased risk of cancer, cardiovascular, and pulmonary diseases when they live in substandard housing or are housing insecure. Substandard housing can expose residents to unsafe levels of mold, indoor air pollutants, pests, inadequate heat/cooling, and low quality water. Substandard housing in Eagle County lacks appropriate places for exercise, recreation, and is not properly connected to the wider community. 8 The California Endowment; “Power, Place, and Public Health,” June 2017. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 13 Housing insecurity is pervasive in Eagle County and is a contributor to chronic stress. Both chronic stress and exposure to household hazards are prevalent in our vulnerable populations living in mobile home communities. This project will meaningfully decrease these two risk factors, therefore increasing health equity and preventing cardiovascular disease, chronic pulmonary disease, and cancer. This project will use community-organizing techniques to build strong coalitions and partnerships to help community residents advocate for changes in housing policy that will decrease barriers to accessing affordable, high quality, stable and safe housing. Community organizing is an evidence-based approach that uses various techniques—such as empowerment & coalition building—to increase the capacity of community residents to advocate for and promote the interests of their community. The concepts of empowerment and community participation are considered the “twin pillars” of health promotion and well-being.9 The World Health Organization defines health promotion as “a process enabling people to increase control over and to improve their health.” Evidence also shows that the use of organizing approaches— including coalition building and the creation of effective partnerships—increases individual empowerment and social support and promotes health and well-being, in turn enhancing the prevention of chronic cardiovascular disease and diabetes.10 Intended Population: Lower income, Latinx, renters, mobile home communities Statewide or Targeted: Eagle River Valley with a focus on mobile home communities Urban, Rural or Both: Rural Measures of Success: Proposed System or Policy Change: Proposing affordable housing policies, such as right of first refusal, renter protections, exploring impact of accessory dwelling units (ADUs) and short term rentals, and looking at developing a community land trust. Application focused on housing, both on affordability and anti-displacement, building on a 2018 county-wide housing assessment, the public health improvement plan, and previous work completed by the health department. Anticipated Activities and Outcomes: Increase opportunities for home ownership.  Advocate for first right of refusal-type of policy at the county and town level.  Engage the Vail Valley Partnership (VVP) to lead an assessment on the distribution, abundance, quality and economic impact of Accessory Dwelling Units (ADUs) and short-term rentals.  Establish a community land trust (CLT). 9 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare . New Brunswick, NJ: Rutgers University Press. 10 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare. New Brunswick, NJ: Rutgers University Press. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 14  Advocate for stronger affordable housing guidelines at the county and municipal level. Change policies to address current and long-standing injustices around housing.  Fund additional Neighborhood Navigators to work with mobile home communities and build community led advocacy through leadership pipeline for emerging and minority leaders to grow and pursue positions of power and decision-making in the community.  Build a framework to comprehensively support renters and mobile home owners who rent land.  Improve mobile home communities by hiring legal consultant to assist in determining regulatory changes that could aid Eagle County Government in bringing difficult mobile home owners into compliance and good standing.  Explore microfinance as a means to home improvements so that individual owners can make much needed safety and energy efficiency upgrades.  Increase meaningful evaluation across community initiatives. Outcomes:  Increase number of residents protected by stronger renters’ rights ordinances.  Increase in price-capped units due to change in housing guidelines.  Identify new community leaders and retain their engagement.  Loosen up the competitive housing market by creating a community land trust. Financial Overview: Project Duration: July 1, 2019 - June 30, 2021 Recommended Up-to Funding Approval for 2-year Grant: $797,945 Grantee: Lake County Public Health Agency Project Title: Leadville-Lake County Affordable Housing Project Upstream Determinant of Health to Address:  Housing Project Summary: The Leadville-Lake County Affordable Housing Project will address housing as an upstream determinant of health. It will ensure the Leadville’s municipal code and Lake County’s land development code protect and expand affordable housing. It will also develop a system of education and counseling to help community members access affordable housing. How project addresses CCPD Housing instability and related financial pressure is associated with stress and anxiety. “Chronic stress is associated with serious health conditions including asthma, arthritis and allergies, as well as other short and long-term physical and mental health problems. As the process of gentrification causes property values to increase and demand for housing to accelerate, rising housing costs place a disproportionate burden on lower income residents with limited household budgets. This leaves individuals and families struggling to afford housing at the expense of their health. Spending more to afford housing leaves fewer resources for basic health-promoting Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 15 necessities such as food, healthcare, transportation, education or childcare.”11 The applicant cited that “although the body of research linking housing and health is still growing, researchers have also found that access to quality affordable housing in well-resourced neighborhoods has led to reduced chronic and infectious disease rates.”12 Not only does constructing affordable housing bring down chronic disease rates by reducing chronic stress, but it prevents people from being displaced into outlying communities. In Lake County, local residents are often displaced to outlying manufactured housing communities (which currently house nearly half the families enrolled in our local school district). Once here, community members are physically disconnected from community health amenities such as the grocery store, recreation facilities or preventative health care--further increasing risk of chronic disease. According to a RAND Health working paper, “The accumulated strain from stressful experiences may trigger the release of cortisol, cytokines, and other substances that can damage the immune defenses, vital organs, and physiologic systems, leading to more rapid onset or progression of chronic illness.”13 The lack of affordable housing in any community increases chronic disease rates by increasing chronic stress. In Lake County, community members (many of whom already are experiencing chronic stress) respond to the lack of affordable housing in ways that increase their chronic stress. For example, by cutting back on critical necessities such as food; moving in with other families or family members; choosing risky market-solution options such as manufactured housing (where they soon find that the lack of tenant protections put them at great disadvantage); or moving away either to outlying manufactured housing communities or out of Lake County altogether thereby further exacerbating stress through the loss of their support networks. This project will use community-organizing techniques to build strong coalitions and partnerships to help community residents advocate for changes in housing policy that will decrease barriers to accessing affordable, high quality, stable and safe housing. Community organizing is an evidence-based approach that uses various techniques—such as empowerment & coalition building—to increase the capacity of community residents to advocate for and promote the interests of their community. The concepts of empowerment and community participation are considered the 11 The California Endowment; “Power, Place, and Public Health,” June 2017. 12 ChangeLab Solutions; “Preserving, Protecting, and Expanding Affordable Housing, A Policy Toolkit for Public Health,” 2015. 13 RAND Health; “Understanding the Upstream Social Determinants of Health,” May 2015. (Nazleen Bharmal, 2015) Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 16 “twin pillars” of health promotion and well-being.14 The World Health Organization defines health promotion as “a process enabling people to increase control over and to improve their health.” Evidence also shows that the use of organizing approaches— including coalition building and the creation of effective partnerships—increases individual empowerment and social support and promotes health and well-being, in turn enhancing the prevention of chronic cardiovascular disease and diabetes.15 Intended Population: Rural, low- and middle-income residents (120% of AMI). The affected population includes a significant Latino community, though the grant does not exclusively focus on this population. Statewide or Targeted: Lake County Urban, Rural or Both: Rural Measures of Success: Proposed System or Policy Change: Identify a set of policy interventions and update local code, pass policy interventions at the local level, conduct assessment to better support community members’ access to affordable housing, and pilot a system of supports for families to ensure they can access affordable housing once it’s built. Anticipated Activities and Outcomes: Year 1:  Develop trainings to build understanding about affordable housing policy interventions.  Communicate possible policy interventions to a broader stakeholder group that includes planning commissions, elected officials, housing coalition, etc.  Develop policy recommendations for the City of Leadville and Lake County to preserve, protect and expand affordable housing.  Meet with community agencies to design a system of supports to help community members access affordable housing by identifying existing barriers to homeownership or renting and then preparing classes or counseling to address those barriers. Year 2:  Frame the issue and shape a campaign that will provide support for the passage of proposed code changes. Outcomes:  Develop policy changes at the City and County to promote affordable housing.  Develop a system of supports for community members to help them access housing. Financial Overview: Project Duration: July 1, 2019 - June 30, 2021 Recommended Up-to Funding Approval for 2-year Grant: $400,000 14 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare. New Brunswick, NJ: Rutgers University Press. 15 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare. New Brunswick, NJ: Rutgers University Press. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 17 Grantee: United for a New Economy-GES Coalition Project Title: Globeville Elyria Swansea Equitable Development Plan & Community Ownership and Stewardship Upstream Determinant of Health to Address:  Housing  Land-use Planning Project Summary: Through implementing an “Equitable Development Plan” and a Globeville, Elyria-Swansea (GES) “Community Land Trust,” we will prevent displacement of GES neighbors and build out an equitable community vision where housing is de-commodified to make health and stability the outcome. Community-wide health and organizing efforts will promote healthy community-led actions and stability. How project addresses CCPD Housing instability and related financial pressure is associated with stress and anxiety. “Chronic stress is associated with serious health conditions including asthma, arthritis and allergies, as well as other short and long-term physical and mental health problems. As the process of gentrification causes property values to increase and demand for housing to accelerate, rising housing costs place a disproportionate burden on lower income residents with limited household budgets. This leaves individuals and families struggling to afford housing at the expense of their health. Spending more to afford housing leaves fewer resources for basic health-promoting necessities such as food, healthcare, transportation, education or childcare.”16 The applicant stated that in 2014, the City and County of Denver’s Department of Environmental Health conducted a Health Impact Analysis for Globeville Elyria Swansea (GES) neighborhoods. This report noted distinct health challenges facing the GES neighborhoods including a legacy of soil and water contamination marked by two EPA Superfund sites, periodic noticeable spikes in poor air quality, odor pollution, noise levels sometimes exceeding recommended federal thresholds, a scarcity of green infrastructure and trees, physical barriers limiting the mobility and physical activity of residents, poor transit infrastructure, pedestrian hazards like heavy freight trucks and railways, and higher than expected cancer cases for several types of cancer.17 In addition to the presence of a number of environmental hazards impacting health, the community has long suffered from missing infrastructure for healthy living: “The residents, the majority of whom are Hispanic families with young children, suffer from some of the highest rates of cardiovascular disease, diabetes, obesity, and asthma in the City. These chronic diseases are associated with poor diet and lack of exercise, among other factors, which are shaped by a deficient pedestrian and bicycle infrastructure and a 16 The California Endowment; “Power, Place, and Public Health,” June 2017. 17 City of Denver Environmental Health; “How Neighborhood Planning Affects Health i n Globeville and Elyria Swansea,” September 2014 Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 18 lack of sources for healthy and affordable food. Opportunities for outdoor physical activity are also limited in the neighborhoods due to disconnected streets and sidewalks, lack of nearby goods and services, and concerns about crime and safety.18 For residents of GES, the built environment poses one of the greatest threats to their wellbeing both in its environmental hazards and in its missing infrastructure. Now that those infrastructure and environment improvements are started in GES; displacement of long term residents now persist as the most urgent threat to families health. Plans to develop the neighborhood now threaten further health impacts as 9 out of 10 families are at risk of displacement,19 adding to their stress and eroding access to essential support networks. Substantial scientific evidence gained in the past decade has shown that the built environment can have profound effects on physical and mental health outcomes—particularly in adding to the burden of chronic cardiovascular and pulmonary diseases, as well as diabetes, in low income and families of color.20 The built environment includes things such as the quality of the air we breathe, whether we can choose to exercise outside and whether we have stable and safe housing. Research from Alameda County Public Health show that development that does not embrace “development without displacement” causes “displacement of poverty”, rather than improving living conditions and health-outcomes of our neighborhood's most-vulnerable and housing insecure families.21 Public testimony on involuntary displacement, made by organized neighbors in GES, has shown that individual, family, and community-level health face a wide range of negative effects, including emotional and financial distress, loss of community services and institutions, and increase in overcrowded and substandard housing conditions. Reports from families who have been displaced show that they suffer major stress, high relocation costs, decreased disposable income, disruptions to employment and health care, fragmentation of community support networks including substantial loss of social capital, and direct impacts on mental and psychological well-being. Involuntary displacement has been shown to harm all of us--families, neighborhoods, cities and societies as a whole-- by exacerbating segregation, increasing social and health inequities, destroying social capital, and contributing to rates of chronic and infectious diseases. For children, involuntary 18 City of Denver Environmental Health; “How Neighborhood Planning Affects Health in Globeville and Elyria Swansea,” September 2014 19 FRESC: Good Job, Strong Communities; Globeville Elyria-Swansea Coalition: Organizing for Health and Housing Justice; “Globeville Elyria-Swansea: The Peoples’ Survey, A Story of Displacement,” July 2017. 20 Environmental Health Perspectives; “Dwelling Disparities: How Poor Housing Leads to Poor Health,” May 2005 (Hood, Ernie). 21 Causa Justa::Just Cause and Alameda County Public Health; “Development without Displacement, Resisting Gentrification in the Bay Area.” Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 19 displacement destabilizes their social networks and routines, and has been directly linked to declining school performance. This project will use community-organizing techniques to build strong coalitions and partnerships to help community residents advocate for changes in housing policy that will decrease barriers to accessing affordable, high quality, stable and safe housing. Community organizing is an evidence-based approach that uses various techniques—such as empowerment & coalition building—to increase the capacity of community residents to advocate for and promote the interests of their community. The concepts of empowerment and community participation are considered the “twin pillars” of health promotion and well-being.22 The World Health Organization defines health promotion as “a process enabling people to increase control over and to improve their health.” Evidence also shows that the use of organizing approaches— including coalition building and the creation of effective partnerships—increases individual empowerment and social support and promotes health and well-being, in turn enhancing the prevention of chronic cardiovascular disease and diabetes.23 Intended Population: Neighbors being displaced by lack of protections in a quickly “developing” neighborhood that is pricing out long term residents who are mostly Latinx families. Statewide or Targeted: The Globeville Elyria and Swansea neighborhoods in North Denver, with some support/sharing to/with surrounding and similar neighborhoods in Denver and Adams County. Urban, Rural or Both: Urban Measures of Success: Proposed System or Policy Change: Prevent displacement through a community land trust and equitable development plan. The project is entirely resident led. Anticipated Activities and Outcomes: Year 1:  Create the Equitable Development Plan which will be the primary planning activity to both guide the community land trust in its future efforts and hopefully guide other/current development in the areas. The Plan would contain both land-use and policy recommendations to address equity and look at the issues of displacement and health in the neighborhood through a racial and economic lens. The plan will map data around housing (affordable units being developed, government and commercial land, land used for small business) and also include policy recommendations that will be turned into an action plan.  Launch the GES-Community Land Trust by developing its community board, membership structure and ensuring that the homes are repaired or developed in health and energy efficient ways. 22 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare. New Brunswick, NJ: Rutgers University Press. 23 Minkler, M. (2010). Community Organizing and Community Building for Health and Welfare. New Brunswick, NJ: Rutgers University Press. Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 20  Advocate and organize around the needed policy changes to prevent displacement and shift cycles of poverty. Year 2:  Implement the Equitable Development Plan through the GES-Community Land Trust to include the development of Community Benefits Agreements that align with health and housing goals of the Plan.  Provide technical assistance for the fiscal independence of the GES-Community Land Trust. Outcomes:  Increase in number of families that are able to stay in the neighborhood in healthy and stable home situations.  Improvement of housing and health conditions.  Implementation of anti-displacement policy measures. Financial Overview: Project Duration: July 1, 2019 - June 30, 2021 Recommended Up-to Funding Approval for 2-year Grant: $489,998 Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 21 Appendix A FY 2019-2021 Health Disparities Grant Program Projects Grantee Project Title Total Up-to Funding Aurora Comprehensive Community Mental Health Center Aurora Together $749,442 The Civic Canopy East5ide Unified/Unido $632,761 Colorado Coalition for the Homeless Statewide Affordable Housing Policy $550,628 The Family Center/La Familia Vida Sana and the First 1000 Days: Addressing Toxic Community Stress and Housing Instability in Families with Young Children—A Two Generation Approach $745,870 Growing Home Collaborative for Healthy Adams County Families $749,221 Lake County Public Health Agency Resilient Lake County $750,000 Pueblo City-County Health Department Built Environment Action-Superfund Neighborhoods $613,761 San Juan Basin Public Health Equity in Emergency Preparedness (EEP) $692,276 Sisters of Color United for Education Promoting Balanced Health in Sheridan $723,125 $6,207,084 Amendment 35 Grant Programs Health Disparities Grant Program Board of Health Funding Recommendation March 2019 Page 22 -1- ORDINANCE NO. 028, 2021 OF THE COUNCIL OF THE CITY OF FORT COLLINS MAKING SUPPLEMENTAL APPROPRIATIONS FOR YEAR 2 OF THE HOME2HEALTH PROJECT WHEREAS, in 2019 the Colorado Department of Public Health and Environment (“CDPHE”) awarded the City a grant through its Health Disparities Grant Program (the “Grant”) to reimburse the City’s costs to update City codes, policies and regulations affecting the quality and quantity of affordable housing in the community (the “Project”); and WHEREAS, the Project focuses on health inequity with the goal of helping residents who may not be able to afford safe, stable, high quality housing and, as a result, are more likely to have health issues; and WHEREAS, the total amount of the Grant is up to $795,657 over two years (2019-2020 and 2020-2021); and WHEREAS, the City Council appropriated $397,828 in funds for the first year of the Grant through approval of Ordinance No. 090, 2019; and WHEREAS, if approved, this Ordinance will appropriate funds for the second year of th e Grant in the amount of $363,513; and WHEREAS, the Grant does not require the City to provide matching funds; and WHEREAS, the City sub-granted a portion of the Project funding to several outside organizations or entities that have been collaborating with the City on the Project, including Larimer County, the Family Center/La Familia, the Family Leadership Training Institute and Colorado State University; and WHEREAS, the City Manager entered into a grant agreement with CDPHE and sub- grant agreements with each entity receiving funds from the City for the Project; and WHEREAS, this appropriation benefits public health, safety and welfare of the citizens of Fort Collins and serves the public purpose of improving access to safe, stable, affordable housing; and WHEREAS, Article V, Section 9 of the City Charter permits the City Council, upon recommendation of the City Manager, to make supplemental appropriations by ordinance at any time during the fiscal year, provided that the total amount of such supple mental appropriations, in combination with all previous appropriations for that fiscal year, does not exceed the current estimate of actual and anticipated revenues to be received during the fiscal year; and WHEREAS, the City Manager has recommended the appropriation described herein and determined that this appropriation is available and previously unappropriated from the General Fund and will not cause the total amount appropriated in the General Fund to exceed the current estimate of actual and anticipated revenues to be received in that fund during this fiscal year. -2- NOW, THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF FORT COLLINS as follows: Section 1. That the City Council hereby makes and adopts the determinations and findings contained in the recitals set forth above. Section 2. That there is hereby appropriated from unanticipated grant revenue in the General Fund the sum of THREE HUNDRED SIXTY-THREE THOUSAND FIVE HUNDRED THIRTEEN DOLLARS ($363,513) for expenditure from the General Fund for year 2 of the Home2Health project. Introduced, considered favorably on first reading, and ordered published this 16th day of February, A.D. 2021, and to be presented for final passage on the 2nd day of March, A.D. 2021. __________________________________ Mayor ATTEST: _______________________________ City Clerk Passed and adopted on final reading on the 2nd day of March, A.D. 2021. __________________________________ Mayor ATTEST: _______________________________ City Clerk