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ABSTRACT Community health programs aimed at addressing the social determinants of health often face challenges demonstrating their impact through traditional economic evaluation methods of return-on-investment analysis, cost-effectiveness analysis, or cost-benefit analysis. Using a social-return-on-investment (SROI) analysis, we evaluated the broader social, environmental, and economic benefits of Bon Secours Hospital's Housing for Health program, an affordable housing program aimed at addressing the social and environmental determinants affecting its community's health in Baltimore, Maryland. Bon Secours currently has 801 units of affordable housing across twelve properties in West Baltimore. Results indicate the significant social value of the Bon Secours affordable housing program, generating between $1.30 and $1.92 of social return in the community for every dollar in yearly operating costs. These findings suggest that broader access to affordable housing could produce a positive social value and demonstrate the relevance of SROI for quantifying the impacts of community health programs.
Safe, affordable, and high-quality housing is considered an essential foundation for good health. However, such housing is often in short supply, with a large portion of families cost-burdened by housing, causing them to cut back on other basic household essentials such as food, medical care, or transportation.1 Hospitals and health systems, increasingly recognizing the complex links among housing, neighborhood environments, and health, have begun considering ways to invest in the creation of affordable housing and broader neighborhood development initiatives.2'3
However, building, rehabilitating, and operating affordable housing is expensive, and even programs targeting high-cost homeless populations with permanent supportive housing have not universally demonstrated cost savings.4 To continue to support the provision of such affordable housing programs in the context of increased scarcity of public resources, there is a heightened demand for demonstration of the value for money of interventions. Traditional methods of return-on-investment (ROI) analysis are ill suited for such analyses because ROI analysis only compares profits with capital invested, with no consideration of the value of the public good generated from the program.5 As a result, cost-benefit analysis has been advocated for measuring value for money because it measures in monetary terms all costs and benefits associated with the intervention, including its spillover effects across multiple sectors.6
Social-return-on-investment (SROI) analysis is a pragmatic form of cost-benefit analysis7 that measures the social value generated by an intervention...