In collaboration with the John D. and Catherine T. MacArthur
Foundation’s How Housing
Matters Initiative, Spotlight
on Poverty and Opportunity will be running a series of commentaries
for the next two months exploring the relationship between housing and three
topics: health, economic opportunity, and education. Please be sure to read Michael Stegman’s “An Introductory Note” to learn more.
This commentary is the fourth installment in
the series, which is entitled “How Housing Matters to Families and Communities.”
chronic health worsens nationally, the role housing plays in health is more
important than ever. The good news is that a recent study published in The New England
Journal of Medicine has
shown that housing can make a real difference in health.
the study represents a big step forward, a more expansive research agenda could
achieve even more.
The recently published Moving to Opportunity
(MTO) experiment was designed to compare living in neighborhoods where about
half of the households are poor to those where at most ten percent are poor. To do this, public housing
families were offered a housing voucher on the condition they moved to a
radically more affluent neighborhood for one year. About half of the randomly
assigned MTO families moved into better physical units in neighborhoods with
fewer poor families, less crime, and less fear of crime.
health results are heartening. For families offered
the chance to move, extreme obesity and diabetes decreased in adults over a 10-year
period. In analysis limited to those who actually moved, these two effects
roughly doubled in size and decreases were observed in anxiety and depression among
However, the study failed to uncover positive
effects on labor force participation, welfare use, and educational performance and
the crime results were unclear. After moving, MTO adults were victimized less,
but adult youths committed more crimes.
The positive health results provide a welcome
relief and suggest that voucher-based housing mobility programs may have their
biggest impact, and best justification, in promoting health.
Yet several factors limit the relevance of MTO
for justifying a health rationale for housing voucher policy.
First, the study targeted public housing
residents, a small fraction of all voucher eligible families.
Second, scaling-up the results could be
difficult because affordable rental housing is scarce in very affluent
neighborhoods and few poor families seem to want to make such radical moves.
About half of the MTO voucher families ultimately did not move though offered
the chance to do so. Of those that did move, within a decade most had relocated
to settings similar to those in which control group families without vouchers finished
MTO did not take into account some critical income effects. Families in the
private market are able to use their voucher to offset their current out-of-pocket
rental expenses, thus increasing their disposable income. But public housing
residents have to use their entire voucher for rent in the private sector.
itself to public housing residents, MTO ruled out disposable income as a
mechanism for improving health and instead emphasized neighborhood poverty. Yet
most families getting a voucher are already in the private housing market, and evidence
suggests that they use most of their voucher’s value to augment income rather
than upgrade dwellings or neighborhoods.
the medical research and policy communities appreciate biological measures, these
were only collected once in MTO. One biomarker related to obesity and diabetes showed
positive results, but the study fails to report others although information was
collected on a number of other biomarkers associated with cardiovascular
problems, including diabetes.
Fifth, MTO did not report health results for
children despite the fact that past, non-experimental work has led to claims
about lead paint, dust, and mites causing child respiratory problems. Additionally,
other studies have shown that biomarkers can change in children as young as two
because of family stressors linked to household income and the location of housing.
Researchers need to learn how much child and
adult health are affected, both by the real but limited neighborhood moves and
unit upgrades that most voucher winners from the private housing market make, and
also by the sometimes large income supplements a voucher allows.
Existing research provides some promising clues.
shows neighborhood effects on health, albeit with neighborhood moves more
dramatic than ordinarily take place. Since most
families convert much of their voucher’s value into disposable income, vouchers
should also affect health as sudden income shocks do. Studies have shown that income
shocks roughly equivalent to the monetary value of a voucher have improved some
indicators of mental health and body mass and have also influenced biological processes
linked to blood pressure, cardiovascular disease, obesity, and diabetes.
achieved what it set out to do for public housing residents and has begun to seed a health-based rationale for housing
mobility programs—a good thing for the field. Yet this rationale would be still
more compelling if we knew how vouchers affected biology and health in families receiving
a voucher while living in private housing, as well as whether vouchers impact health
through changes they cause in disposable income, housing quality, or neighborhood
a great start. Now is the time to enrich our understanding of the link between
housing and health further.
To print a PDF version of this document, click here.
Cook is the Joan and Sarepta Harrison Chair in Ethics and Justice, a professor
of sociology, psychology, education, and social policy at Northwestern
University, and a faculty fellow at the Institute for Policy Research.