Editor’s note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Relief.

The uninsured, underinsured, and those with private health insurance all have access to quality, affordable housing and integrated medical care in one of Denver’s oldest neighborhoods.

Through a multi-sector approach, a mixed-use structure of apartments, a healthcare provider, a pharmacy, and soon-to-be fresh produce grocery store are now offered in Denver’s Elyria- Swansea neighborhood. The structure is also two blocks away from the local light rail for those who use public transportation. In the coming year, affordable housing for people aged 55 and over and a community center are expected to open across the street. The cross-sector development approach is a nuanced solution to ongoing health and housing affordability issues in Denver’s growing metropolis.

In a 99-year land lease agreement with guaranteed renewal through Denver’s Urban Land Conservancy, the Tepeyac Community Health Center opened a new 24,500 sq. ft. building on Denver’s north side. The health center is connected to Viña apartments, a 150-unit complex with affordability options built by a Georgia-based developer.

In 2017, community survey data highlighted that 38% of respondents reported poor or fair health rather than good or excellent. Social determinants, like safe, quality housing, were a barrier to good health outcomes. At the time, residents said they lacked consistent transportation, employment opportunities and grocery stores that offered fresh food nearby. The new, commercial, mixed-use space grants the residents of Globeville and Elyria-Swansea areas access to affordable, healthy living without leaving their neighborhood.

So far, the new, integrated location has made all the difference.

When Janet Coupens had to leave work to fill a prescription by her doctor, it only took five minutes. The Community Manager at Viña Apartments said she only had to walk down a corridor to Tepeyac’s new health center for her prescription. In the past, it may have taken her an hour or more to travel and wait for care at a for-profit pharmacy.

Coupens said she’s seen the difference for her neighbors at Viña, too. When a child is sick, and a single mother must leave work to take them to the doctor, the ease of having a provider next door is helpful. Given that most of Viña’s residents don’t have cars, the ease of walkability increases the likelihood that residents will visit a physician when sick.

Tepeyac existed in the Globeville neighborhood for years, less than a 10-minute drive from their new location, which opened in February. The health center offers primary medical, behavioral, and dental services for free or at a reduced cost, and recently opened a pharmacy in September. Tepeyac’s President and CEO, Jim Garcia, said that moving to a new building was “years in the making” for their growing patient base.

Tepeyac served over 4,600 patients in 2022. Over 90% of their patients identify as Hispanic or Latino; most are best served in a language other than English. Garcia said that many are undocumented immigrants and, in the past, have not had access to healthcare. According to the 2017 community survey, Hispanic respondents reported being at-risk for diabetes at almost double the rate of non-Hispanics in the Denver area.

In 2020, state government approved a new program that offered subsidized health insurance to low-income, undocumented people called the Colorado Health Insurance Affordability Enterprise, or HIAE. At the time, the state only had enough funding to supplement healthcare for 10,000 undocumented immigrants, and policymakers have been working to expand access since the Senate bill passed.

There are over 3.2 million residents in the Denver metro area, and researchers anticipate over 900,000 more residents by 2050. According to the Denver Metro Chamber of Commerce, rapid population growth throughout the metro area and record increases in rental prices and property values, have caused a housing crisis, leaving few affordable options for working people. In a white paper published by the Chamber, researchers say they expect it will take 100 years to provide enough affordable housing for the metro area.

The Elyria-Swansea neighborhood is on the northern edge of Denver, and the area of single-family homes and the once prominent downtown area was divided by I-70, according to a 2018 Neighborhood Field Guide by the Neighborhood Association. Since the neighborhood’s heyday, the area was industrialized, causing environmental health concerns and limited employment opportunities.

Neighbors in the Globeville, Elyria-Swansea Coalition Organizing for Health and Housing Justice, say they have been promised equitable development solutions in the past that were supposed to provide employment opportunities but were only given empty promises.

The health center CEO agreed and said the area was “largely overlooked” for development opportunities for decades. He said only in the last few years has a “tidal wave” of high-rise apartments, cannabis dispensaries, and breweries opened in the neighborhood, neglecting the many ongoing needs of long-term residents. The increased tax base and gentrified area also threatened their ability to stay in the area.

However, the new Tepeyac building is a change for the better. Garcia said the partners involved held community meetings and asked for feedback about the development. Tepeyac also included a member of the GES Coalition on their board to ensure that the community was involved in decision-making processes.

Denver’s Urban Land Conservancy purchased the six-acre lot in 2015, and Aaron Miripol, the group’s CEO, said they wanted to work with a nonprofit to build something that would benefit the community. It took a year to change zoning requirements for the city to approve a mixed-use space. ULC chose Georgia-based Columbia Ventures to build and manage the apartments, which include one-, two-, and three-bedroom apartments.

Miripol said many of the apartments are secured for people earning at or below 30 to 80% of the Area Median Income. The partners used local funding repurposed through community development grants to subsidize the $57 million development.

“What was really critical was that we didn’t want to rely on vouchers,” he said. “There’s a large segment of that population that is undocumented, and because they are undocumented, they don’t have access to (housing) vouchers.”

As the Urban Land Conservancy worked to address zoning laws, Tepeyac and Columbia Ventures began conversations with the community to determine the wants and needs of the residents.

Dillon Baynes, co-founder and managing partner of Columbia Ventures, said there was a lot of mistrust among the community as the state made changes to widen the interstate, the construction of which had already divided the neighborhood, and additional neighborhood changes, like building a bridge and an amphitheater, that the residents had not asked for.

“There were a number of executions, and the neighborhood felt that it was being foisted upon them that they may not have desired that change at that level, so we came in at a time when they felt exhausted,” Baynes said.

Like their partners, Miripol said that including the community in the development phase was important to understand their wants and needs. He said that other developments had influenced involuntary displacement.

“There’s a number of communities that we’re seeing displacement and gentrification, and it kind of feels like this might be the epicenter,” Miripol said.

Even the structure of the building was important to the neighborhood. While the density of the number of apartments was important to offset costs, residents didn’t want a high-rise building looming over the existing single-family homes. The partners commissioned a local artist to add details on the building’s exterior and were intentional about how entry points to access the health center, pharmacy and grocery store.

Tepeyac stood as the trusted community partner throughout the development process. Garcia said their goal was to create a safe and welcoming environment that is echoed within the new building. The CEO said it’s best if patients want to see providers at Tepeyac simply because they offer quality, culturally competent care, and not just because it’s the only option.

“Sometimes if you don’t have insurance, you just look for the last option or you’re just trying to get by,” he said.

Baynes said that the health center had to be “neighborhood facing” and that the affordable rents at Viña are sustainable to the neighborhood.

So far, the apartment complex is at almost 95% capacity. Coupens said most are occupied by families, and in the year-and-a-half that Viña has operated, most residents have renewed their lease.

“Someone was thinking outside the box and they did a great job,” Coupens said.

Direct Relief supports hundreds of federally qualified health centers in the U.S., including Tepeyac Community Health Center.