Community Land Trusts and Improving Health

I have spent decades working in urban planning, housing, and public health, in a variety of roles in community, government, and nonprofit settings. Our housing problem is simple enough: We don’t have enough housing, and the resulting shortage and inflation hit the poorest families hardest. Yet for the past 60 years, since the beginning of the War on Poverty, we have largely agreed that the poorest people still struggle to afford housing in America. One obvious but politically difficult solution is to eliminate zoning and other local rules and regulations to make it easier to produce housing. Another is to expand the reach and scale of community land trusts and cooperative ownership.

I spoke with Kevin Campbell, executive director of the Raleigh Area Land Trust, and Dr. Rasheeda Taliaferro Monroe, a pediatrician at WakeMed Hospital and a member of the Raleigh Area Land Trust board. The Raleigh Area Land Trust (RALT) is based in Raleigh, North Carolina, and describes itself on its About Us page as “a market-based solution that offers the opportunity to truly lower the cost of homeownership, permanently.” In short, a community land trust (CLT) is typically a nonprofit organization that acquires land and manages it for the benefit of the community. For housing, this means building homes, selling them using a leasehold mortgage, and limiting the equity investment at the time of resale. Because the CLT owns and controls the land, it can set the terms for buying and selling homes and can add subsidies up front to create and keep prices lower.

The conversation focuses on the ongoing issues of homeownership disparities between black and white households, the relationship between housing and health, and the challenges CLTs face in acquiring a central ingredient: land. I have edited the following for length and clarity. My comments are in English. italics all along.

Dr. Monroe, could you tell us about your “Beyond Our Walls” program and its connection to housing and health?

As a board-certified pediatrician with WakeMed Physician Practices—Pediatrics and a board member of the Raleigh Area Land Trust, I know the importance of housing as a social determinant of health. I previously served as medical director of WakeMed’s pediatric outpatient clinics, where I developed several educational programs for medical students and residents. “Beyond our Walls,” WakeMed’s health equity curriculum, explores how issues like housing are critical drivers of public health.

Our work has revealed that the quality of properties and even the location of neighborhoods are the result of historic local and federal policies that deliberately segregated and marginalized communities and continue to have a significant impact on the health and well-being of minority communities today. This is why we must address the physical, psychosocial, and historical aspects of housing in public health interventions.

Mr. Campbell, the second word for community land trusts is LAND, but land is often difficult to obtain. Can you describe RALT’s strategy for acquiring land? What has been the biggest obstacle to acquiring land? How does RALT overcome this obstacle? (Kevin Campbell)

As a nonprofit, the primary barrier to acquiring land is high cost, driven by market demand and competition from private developers. To overcome this challenge, we have focused on building strong relationships with local governments, developers, and philanthropic organizations. These relationships help us secure financing and access land that might otherwise be out of reach. Additionally, we educate community stakeholders about the long-term benefits of land trusts, which can lead to greater community support and collaboration to identify and secure land.

For example, RALT is also partnering with the City of Raleigh on a project called Cottages of Idlewild, which will provide 18 affordable housing units for families living at 30-80% of AMI. We plan to continue creating and preserving affordable housing for low- and moderate-income families in Wake County, with a goal of preserving and providing 100 affordable housing units over the next five years.

Many states west of the Mississippi have strict limits on land donations to private entities, even for affordable housing. This is a result of the railroad era, when many states and localities gave public funds, land, and money in exchange for promises of investment from the railroads. When those promises didn’t come to fruition, taxpayers were left to shoulder the debt and damages. Some states, such as New Mexico, have amended their constitutions to allow this practice, and others have made provisions for land donations for affordable housing.

What is the role of state and local governments in funding RALT? How important are local grants? Does CLT receive federal funding? Does this add complications that don’t exist with local funding? (Kevin Campbell)

State and local governments play a critical role in financing our projects. Local grants are important because they often provide the initial capital needed to acquire land and begin development. These grants can come in the form of direct grants, low-interest loans, or tax incentives.

While CLTs receive federal funding through the Community Development Block Grant (CDBG) program or the HOME Investment Partnerships program, it often comes with additional compliance and reporting requirements. These federal funds are essential but can add administrative complexity and require more rigorous oversight than local funding. At RALT, we rely on federal, private, regional, and state partnerships to streamline our processes and maintain flexibility in our operations.

Our federal funding comes from the U.S. Environmental Protection Agency, facilitated by our local Congressman, to address stormwater costs for the upcoming Cottages of Idlewild development in Raleigh.

Today, the solution to developing CLTs and co-op housing solutions won’t come from the federal government. As Campbell points out, the money is simply too costly in terms of time and compliance. Local governments, developers and non-profits will have to lead the way.

How does a CLT uniquely contribute to better health outcomes? (Dr. Monroe)

CLT homes uniquely contribute to better health outcomes by providing stable, quality housing, a fundamental determinant of health. Research shows that stable housing reduces stress, improves mental health, and enhances physical well-being. CLT homes are built or renovated to a higher standard, mitigating health risks associated with lower-quality housing, such as respiratory problems from mold and pests.

We found that stable housing allows residents to maintain continuity of health care, which is essential for managing chronic conditions and achieving better long-term health outcomes. Additionally, RALT’s focus on community engagement and support services helps residents manage their finances and reduce financial stress, helping to improve their health.

The CLT strategy is gaining momentum nationally, but it still needs philanthropic funding. With over 300 organizations adopting the model, CLTs have proven their adaptability and effectiveness in diverse contexts, demonstrating their potential to address systemic housing inequities.

Is there a specific collaboration or alignment between healthcare providers and CLTs that offers a replicable model?

Successful collaborations have been established between health care providers and CLTs that offer replicable models. Partnerships with local health departments to deliver wellness programs and preventative health services directly within CLT communities have shown promising results.

You’re probably familiar with the Healthy Neighborhoods Equity Fund, which is based in Boston. Boston Medical Center is a major investor, and I’ve read quite a bit about the program. I think affordable housing should be part of the mission of anchor institutions, and I’ve found their work impressive.

Ultimately, we are at a time when “everyone has to do their part” on housing affordability. Over the years, I have encountered many cases where substandard housing has exacerbated health issues, ranging from respiratory problems due to mold to stress-related illnesses resulting from precarious housing. By integrating health services with housing support, these collaborations create a holistic approach to community wellness. We are actively seeking new ways to build similar partnerships to improve the health benefits of our residents.