Objectives: Few research studies have analyzed college students' attitudes of health reform caused by the Affordable Care Act (ACA). Specifically, no studies exist looking at undergraduate and graduate social work students' views on current health reform. The study will ask two questions: (1) What do Social Work students know about the components and potential impacts of the ACA, and (2) Are there any characteristics of students associated with their level of knowledge or attitudes about the Act? Methods: A 53-item survey questionnaire inquiring knowledge, attitudes, and perceptions related to health reform and the Affordable Care Act was dispersed to a convenience sample of 105 undergraduate and graduate social work students from the University of Central Florida School of Social Work in January-February 2014. Results: Students had favorable views on how the health reform will be funded and how health reform could support specific social issues such as acknowledging the need for reform and believing health care should be a basic right. There were fewer clear trends in students' attitudes about reform implementation and knowledge of specific ACA provisions. There were no significant associations between student's knowledge of the ACA and their insurance status or political affiliation. Conclusions: Students' beliefs on health reform are inconsistent. Ethnicity was the only demographic characteristic that affected students' views. This study advocates the need for more in-depth health policy education within the social work program curriculum.

Policy conflict plays an important role in shaping public policy—both as a process and as a product. The policy conflict framework—a theoretical framework, developed by Christopher Weible and Tanya Heikkila in 2017—considers position divergence among policymakers a key characteristic of policy conflict, which can be affected several factors including organizational and network affiliation of policymakers. This dissertation analyzes position divergence among local and regional officials over community sustainability policy, with a focus on affordable housing, which is a major concern of community sustainability. This research examines if, and how, local government officials' engagement with regional governance can play a role in shaping their policy positions. Understanding what influences officials' policy positions is essential in managing conflicts that arise in the making of sustainability policies in general and affordable housing policies, in particular. This study argues that local government officials' engagement with regional governance can lower policy position divergence among them by influencing their policy core beliefs and policy relevant knowledge. This analysis includes testing several hypotheses using data from a state-wide survey of local and regional policymakers. Employing cross-tabulation, multivariate regression, and ordered logit analysis, this study finds that (a) policymakers share a wide range of policy positions on community sustainability policies and (b) for local government officials engaged with regional governance, position divergence on community sustainability is lower than that among those who are not engaged with regional governance. Although position divergence on affordable housing among those engaged with regional governance is generally lower than those who are not engaged with regional governance, this finding is not robust. In some regions and localities, the relationship between position divergence and engagement with regional governance does not hold. Furthermore, this study finds that local government officials' engagement with regional governance is associated with higher levels of policy relevant knowledge, which can influence the policymakers' policy positions. The relationship, if any, between policymakers' core beliefs and their engagement with regional governance is weak and statistically insignificant. This cross-sectional analysis based on limited data suggests that local government officials' policy core beliefs are not related to their engagement with regional governance. However, future studies with better data may yield different results. / Doctor of Philosophy / Policy conflicts can impede the policymaking process; they usually influence and shape policy goals. Metropolitan governance is rife with policy conflicts. Especially in substantive policy areas such as community sustainability and affordable housing, policy conflicts are quite common. Policy conflicts emerge because of policy actors' divergent views, beliefs, priorities, preferences, and aspirations. To ensure a smoother policymaking process, mechanisms to handle conflicts are imperative. Regional governance can offer one such mechanism to handle policy conflicts that arise due to divergent policy positions of local government officials. This dissertation examines policy conflicts focusing on community sustainability policies. Analyzing survey data from Maryland, this study finds that (a) local government officials share a wide range of policy positions on community sustainability policies, (b) local government officials engaged with regional governance take policy positions that are more homogeneous compared to those who are not engaged with regional governance, and (c) officials engaged regional governance tend to have better policy relevant knowledge than others.

The premise of this study is that an understanding of catalysts and impacts of social and economic change in the Los Angeles Metro Green Line study corridor and an analysis of current planning policies can help identify how future planning policies may generate more ideal and positive outcomes for the study corridor. This study evaluated the conditions within the transit corridor with four selected station areas defined by a one-mile radius from each station. The stations that make up the transit corridor are along the Los Angeles Metro Green Line that runs east west between Redondo Beach and Norwalk. A mile radius buffer was chosen to fully capture the spacing between the stations linearly and use that to define the corridor’s primary area of influence. This study evaluated the changes in demographic composition, housing affordability, transportation affordability and job accessibility within the Metro Green Line corridor between the year 2000 and 2010. Trends in the corridor revealed that over a ten-year span, the corridor saw shifts in demographic composition, growth in job and housing densities and increases in the cost of housing. Over the ten years, the corridor has not yet developed to the standards of a location efficient environment. This study recommends that protection of vulnerable populations such as the high proportion of renter-occupied housing units is important because they are more likely to make up core transit riders that need public transportation. Preserving and building affordable housing near transit would enable households to save money on both transportation and housing expenditures and can work towards making the corridor more affordable. By understanding the three main variables in the context of social equity, a decision-maker can avoid the potential of negative gentrification, displacement, and promote economic viability in the corridor.

Community engagement in health assessment enables researchers to better understand and prioritize community needs. The value of community engagement is increasingly documented; however, few studies engage youth. Research and assessments are often done for youth, but not with youth. Youth bring a unique contextual lens to community issues; without engagement, the likelihood that resultant efforts would be accepted by or appropriate for youth decreases. This dissertation explores opportunities and methodological approaches for, and contributions and feasibility of engaging youth in non-profit hospital community health needs assessments (CHNAs) mandated through the Affordable Care Act. This study has three specific aims, utilizing multiple methodological approaches: • Aim 1: Assess the current level of youth engagement, and prevalence of youth-focused priority areas in Massachusetts CHNAs. CHNAs were reviewed and analyzed using the Community Health Improvement Data Sharing System’s community engagement template. • Aim 2: Compare assessment results of focus groups and participatory photo mapping (PPM) in documenting youth observations of Boston community conditions. Three focus groups and PPM processes engaged 46 high-school age youth. Data were qualitatively compared, with attention to youth-identified community assets, concerns, and recommendations. • Aim 3: Compare youth results with existing CHNAs and identify potential contributions of youth engagement. Using the social determinants of health framework, youth recommendations were compared to Boston hospital community health improvement (CHI) publications to observe the convergence and divergence of priorities. While all MA hospitals minimally complied with required CHNA community engagement criteria, there was no standard practice or approach. 20% of CHNAs engaged youth, primarily through focus groups; yet, 80% of CHNAs that identified priorities included youth-focused priorities. Youth-driven results focused upon social determinants of health factors; furthermore, PPM results provided more detailed and granular CHI recommendations. Youth-identified CHI recommendations complemented those identified by hospitals, indicating that youth engagement can potentially strengthen CHI priorities and identify salient strategies for addressing youth health, specifically. Findings can be extrapolated to the many institutions conducting assessments, including health departments and Community Action Agencies. Findings will be disseminated through a series of practice briefs that make recommendations to hospitals, assessment practitioners, and youth organizations to consider for future efforts.

While most cities in the developing world are undergoing a rapid urbanisation process, they are confronted with a heightened challenge to meet the housing needs of low-income populations. In these cities, millions of urban households are compelled to live in precarious conditions and sub-standard housing structures since they can hardly find better alternative housing that is decent and affordable. In Kigali in Rwanda, the scarcity of affordable housing has turned into a persistent crisis for income-constrained households. This thesis aims to find out how the affordable housing problem is addressed and why responses have been slow even if the government has portrayed the issue as a priority. The literature has mainly focused on describing the local housing needs or establishing links between urbanization trends and housing unaffordability. As a result, this dissertation applies a holistic approach to the affordable housing sector to examine the perspectives of key actors directly affected by the lack of or those involved in affordable housing responses. This way, the specific objectives for the study are to: (1) explore how housing affordability for tenant family households has evolved in recent years in Kigali city, (2) examine key actors in the affordable housing sector and how the underlying institutional framework supports their interests, objectives and strategies for affordable housing provision, and (3) identify institutional constraints hindering key affordable housing providers given the institutional environment. An institutionalist approach was adopted to guide the empirical study. More precisely, the New Institutional Economics conceptual tools of institutions and transaction costs form the theoretical basis for the study. Given the nature of the study and the research questions it raises, a case study research design was suitable. Kigali city in Rwanda was selected as a holistic single case study to investigate the phenomenon. Empirical data was gathered through semi-structured interviews with key actors in the affordable housing industry, documents and secondary data consisting of two household surveys. For research objective one, the changes in housing affordability for tenant family households between the 2010 and 2017 periods are analysed. The study found that the share of family households able to afford a standard two-bedroom house unit decreased by 1.1% during the same period considering a 30% rent-to-income affordability ratio. Besides this, the study also found that the share of tenant family households living in overcrowding conditions increased by 9.4% during the same period. Drawing on tenants’ perspectives, the difficulties to secure affordable housing are low income and informal employment conditions, regulatory challenges, and inability to afford and access houses provided under the state-funded affordable housing program. Concerning research objective two, the key actors, institutions and rules governing affordable housing provision were identified and analysed. The study found that the affordable housing sector attracts multiple actors aligned to the public, private and third sectors. The public sector ensures the industry’s coordination and regulation. In contrast, the private sector leads the building of affordable housing, which is in light of policies postulating the sector as an area with investment potential, yet hardly exploited. However, the state retains a strong influence on decisions thanks to hierarchical governance structures in place. Although policy acknowledges different strategies to deliver affordable housing, private sector-led housing remains the favourite approach by which the government is persuaded to achieve the best possible outcomes. Nevertheless, the disjuncture between policy and reality does not lure sufficient private investments, further undermines some fringe actors and, more importantly, diminishes the prospects of some strategies to have more impact and new solutions to emerge. Thirdly, the institutional constraints hindering interventions of the key affordable housing providers are examined. On the one hand, formal institutions-related constraints stem from legislations and policies that are either stringent, ambiguous or absent. These affect the smooth running of the housing building process, from registering housing cooperatives, land acquisition, acquiring building permits, and post-construction management. As a result of the above constraints, housing providers encounter different forms of transaction costs during the housing development process, namely: negotiation costs, information costs and enforcement costs that affect private developers, cooperatives, and public and private housing providers, respectively. On the other hand, informal institutions in the form of values and practices held in connection with house building negatively impact the marketability of developer-built houses. In this way, the alienation to single-family detached housing, susceptibility to unfamiliar construction materials, and prevalence of the self-building practice undermine developers’ endeavours in affordable housing provision. Overall, this thesis offers a fresh perspective about local institutional difficulties in responding to a global challenge of meeting the affordable housing needs of low-income populations. Applying a case study approach with mixed methods in Kigali city, the dissertation aims to contribute recommendations on how affordable housing policy and practice can be improved in other contexts with similar urban experiences and to the scholarly debates on the affordable housing institutions nexus.:Figures viii Tables ix Abbreviations xi Abstract xiii 1 INTRODUCTION AND PROBLEM STATEMENT 1 1.1 Background to the research problem 1 1.2 Problem statement and justification 3 1.3 Research questions, objectives and propositions 12 1.4 Thesis structure 14 2 AFFORDABLE HOUSING PROVISION: A LITERATURE REVIEW 17 2.1 Introduction 17 2.2 Defining affordability and affordable housing 17 2.3 Importance of housing affordability 21 2.4 Factors influencing the affordable housing challenge 23 2.5 Key strategies for affordable housing provision 26 2.6 Summary 42 3 CONCEPTUAL AND THEORETICAL FRAMEWORK 43 3.1 Introduction 43 3.2 Theoretical approaches for housing analysis 43 3.3 Theoretical choice for the study: New Institutional Economics (NIE) 47 3.4 Operationalization of the conceptual framework in Kigali (Rwanda) context 51 3.5 Summary 54 4 RESEARCH DESIGN AND METHODOLOGY 55 4.1 Introduction 55 4.2 Ontology and epistemological stances of the study 55 4.3 Research design 58 4.4 Data collection and analysis methods 67 4.5 Ethical considerations 73 4.6 Summary 74 5 HOUSING AFFORDABILITY SITUATION FOR LOW-INCOME TENANTS 75 5.1 Introduction 75 5.2 Changes in rental affordability between 2010/2011 and 2016/2017 75 5.3 Perceptions about constraints to secure affordable housing 77 5.4 Discussion 97 5.5 Summary 99 6 ACTORS, INSTITUTIONS AND AFFORDABLE HOUSING PROVISION STRATEGIES 100 6.1 Introduction 100 6.2 Key actors engaged in the affordable housing sector 101 6.3 Institutional framework for affordable housing provision 127 6.4 Affordable housing provision in policy versus the practice 141 6.5 Discussion 161 6.6 Summary 163 7 INSTITUTIONAL CONSTRAINTS FOR KEY AFFORDABLE HOUSING PROVIDERS 164 7.1 Introduction 164 7.2 Constraints related to formal institutions 165 7.3 Constraints related to informal institutions 187 7.4 Perspectives on conditions to enable affordable housing delivery 191 7.5 Discussion 194 7.6 Summary 196 8 CONCLUSION AND IMPLICATIONS 197 8.1 Introduction 197 8.2 Results summary 198 8.3 Research contribution 202 8.4 Implications of the study 205 Bibliography 208 APPENDICES 231

In 2001, The Institute of Medicine published its recommendations for bringing high quality care to all people of the United Sates. That solution involved fulfilling criteria expressed in the acronym, STEEEP. Care must be: Safe, Timely, Effective, Efficient, Equitable and Patient Centered (Institute of Medicine 2001). While improvements were made in terms of infant mortality, longevity, and deaths amenable to quality care, healthcare in the United States has remained fragmented with much work yet to be done. This leaves many uninsured individuals without access to affordable healthcare. Despite the implementation of policies such as the Affordable Care Act and the American Rescue Plan, which have expanded Medicaid and given access to many, it still falls short. Approximately 24.9 million people remain uninsured. The rising costs of healthcare in the U.S. have led to both insured and uninsured patients being exposed to medical debt, lower health status, and limited access to care. Safety net clinics, such as free clinics, have become essential for many uninsured individuals who rely on them to receive medical care. Free clinics are an example of safety nets that give medical access to the uninsured. These clinics have positive results on health outcomes and help to lower healthcare expenditures, particularly in emergency room visits. Studies have shown that uninsured individuals are more likely to use emergency services, which results in higher healthcare costs. Free clinics provide preventative care and early interventions that can help prevent costly emergency visits and hospitalizations. Moreover, free clinics serve as a place for volunteers to grow their skills and become better providers of medicine. Volunteers include physicians, nurses, medical students, and other healthcare professionals who dedicate their time and expertise to help those in need. Volunteers at free clinics are provided with a unique opportunity to enhance their skills by working with a diverse patient population that often has complex medical conditions. Free clinics are essential safety nets that provide medical access to the uninsured and underserved communities. Without these clinics, many uninsured individuals would be left without access to care, leading to poor health outcomes and higher healthcare costs. The importance of free clinics cannot be overstated, and unless there is a change in the current healthcare system, free clinics should be given the place they deserve, including more volunteer and funding support. As the U.S. healthcare system continues to evolve, it is critical to recognize the value of free clinics and the role they play in ensuring access to care for all individuals, regardless of their insurance status.

Vehicle miles traveled (VMT) and its relationship with the built environment has been extensively studied. Most notably, five D variables of the built environment including density, diversity, design, destination accessibility, and distance to transit are the key variables included in this research to explain VMT generation from housing developments. This thesis uses prior research that developed robust statistical models and findings to create a framework to estimate VMT reduction affected by infill housing developed using incentives provided by the state compared to a regional comparator. The regional comparator is typically a suburban single-family housing development in the region. The models recommended for future application of the framework are based on ease of finding the data on variables included in the model and statistical robustness. The application of the framework in the Central Coast and San Francisco Bay Area regions of California shows that infill prototypes developed can generate an 11-27% reduction in VMT per capita. The findings are specific to a synthetic household defined for this study. The research provides ways to apply this framework to other regions of the state along with ideas to consider for future work. These ideas include exploring the VMT reduction potential based on households with different income levels appropriate for the regions, future modeling efforts, and selection of existing models. The findings of this thesis support that the combination of the five D variables can help attribute to a larger VMT reduction than the VMT reduction caused by the change of a single variable. When destinations are clustered, and jobs are available at a reasonable distance to the residence, a significant reduction in VMT is more achievable. The results inform public agencies on which locations are ripe for devoting further resources for incentivizing housing development to reach climate and housing goals.

Urbanisation and growing populations are causing a lack of housing in many metropolitan areas such as Berlin, Germany. Especially tenants of rental units are affected by rapidly increasing housing prices that exhaust a growing share of their income. With a large proportion of its population living in rental units, in-creasing housing prices are a prominent challenge in Germany’s capital. To ap-proach this issue, the parliament of the city state of Berlin has passed a rent cap bill in February 2020. It states that rent prices for units built before 2014 are not allowed to be increased for the next five years, including some exceptions. Fur-ther, rents are not allowed to be higher than the average rent level from June 2019. The rent cap bill is controversial and strongly discussed by many stake-holders. Since the housing market is complex and includes many stakeholders with various opinions and motivations, this study aims to understand the differ-ent aspects of the controversy as it relates to this rent cap bill. By using Contro-versy Mapping by Venturini (2010, 2012), this work focuses on the investigation what stakeholder groups exist, which opinions and motivations they have, and if there is a common ground between them. As result, this study discloses actor-network constellations of Berlin’s rental housing market and untangles stake-holders’ opinions and motivations to enable a conversation.

“The right to one’s home” is a project that raises the issue of affordable housing, challenging this broad concept both in universal terms and later applied to specific condition of a site located in Warsaw, Poland. Beside the obviously economic dimension, affordability stretches out to urban politics by proposing new power relations and redefining neoliberal cities of today. By reclaiming centrally located, infrastructurally connected and potentially attractive sites it is a tool to counteract gentrification. Within the thesis, affordability is achieved with both organizational and spatial strategies – meaning that architectural solutions are accompanied by a simple administrative model that introduces different actors (municipality, private investors, housing cooperatives, non-profit organisations). Seeing the opportunity of reducing building cost in prefabrication, three panel systems were designed and placed on the site. Deriving from the history of concrete panels and shifting to more sustainable material – cross laminated timber – the author tried to reach harmonious balance between quantity, quality and affordability. The proposal was not radicalized with micro-apartments nor was intended to save on architectural values – on the contrary, individual and careful design of the outer skin that covers structural core was an important goal of the project. Standardised architectural solutions and organizational strategies on the municipal level were combined to enable socially sustainable housing environment.

In one of the world’s most dense cities, every piece of land holds value and potential. This thesis explores how citizens of Karachi have taken advantage of pockets of space that exist under bridges and flyovers, by informally inhibiting and occupying them. The illegal land use has resulted in evictions, causing the loss of homes, workplaces and social spaces that were created. The project investigates a method of mediating the needs and wants of users and land owners, to provide safe, legal and functional uses of these void spaces under a recently built structure. The project is reactionary, responding to built forms and use of space that currently exists. Ultimately, it seeks to open the discussion about how we should be anticipating the urban voids that are created, the next time infrastructure is planned.