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Housing As a Pathway to Better Health and More Opportunity

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This entry was co-authored with HUD Assistant Secretary for Policy Development and Research Dr. Raphael Bostic.

The connection between housing and health is one that average families feel every day. More than 6.8 million American households pay more than half their income for rent. And the pressure of meeting that very basic need can directly endanger a family's ability to meet other needs. In fact, research has found that people who pay too much for housing often cannot afford to buy health insurance. The Affordable Care Act is helping to resolve the insurance issues that families face, but we have far more work to do bring more affordable housing options within reach.

For the country's lowest-income households, the balancing act is made even more challenging by the resources -- or lack thereof -- in our poorest communities. Poor quality and inadequate housing has been proven to contribute to health problems such as infectious and chronic diseases, injuries, asthma and other respiratory disease, allergies, and poor childhood development.

It is against this backdrop that the U.S. Department of Housing and Urban Development proposed a rental assistance demonstration (RAD), which focuses on renovating existing housing and improving conditions for households. Because many of the nation's public housing apartments are buckling under a $25.6 billion backlog of repair and replacement costs, public housing owners must often make tough choices between repairing roofs and replacing plumbing -- or worse, demolishing units altogether -- because there simply isn't enough money to go around. The demonstration tests new strategies to preserve HUD subsidized public and assisted housing by allowing owners to secure other public and private financing to address capital repair needs and in the process, transform distressed neighborhoods into safe, healthy communities.

A recent health impact assessment by Human Impact Partners and National People's Action took issue with this initiative, concluding that RAD would have a negative impact on the health of tenants and nearby residents and suggested it be significantly scaled back. Their analysis is incomplete, which has led them to draw conclusions at odds with some of the most recent rigorous research which showed that improving housing and neighborhood conditions actually have a positive impact on family health. This includes the seminal study, Neighborhoods, Obesity, and Diabetes -- A Randomized Social Experiment, which recently appeared in the New England Journal of Medicine. This study focused on HUD's Moving to Opportunity demonstration, a randomized controlled trial which tested the long-term impacts of providing households the chance to move to low-poverty neighborhood. The article featured several key health-related findings:

  • Providing families with the opportunity to move to better quality housing located in better neighborhood environments translated into important improvements in mental and physical health for adults, including lower rates of extreme obesity, diabetes, psychological distress, and major depression for adult women.
  • Female youth in families given the opportunity to move had lower prevalence of mood disorders, fewer serious emotional or behavioral difficulties and were less likely to have tried alcohol.
  • And while findings for boys concluded that they require more support than girls when given the opportunity to move to a new neighborhood, male youth in these families were less likely to have been arrested for drug sales.

Indeed, the Moving to Opportunity study supported wisdom long-accepted amongst housing advocates: simply moving family into a different neighborhood isn't the answer. Instead, we must continue to find innovative and strategic ways to connect families to the resources they need to break the cycle of poverty -- poverty that can literally make them sick. The rental assistance demonstration does this -- both through providing public and assisted housing with access to new private and public funding sources that improve housing conditions and, like in the Moving to Opportunity study, by providing families with the choice to move to a different neighborhood.

We at HUD are hopeful and expectant that this demonstration will ultimately be a positive force for change -- and for the health of the people and communities it touches. Ensuring it is requires HUD to conduct rigorous evaluations that determine its impact on housing conditions and quality of life, including health. The living conditions, health outcomes and economic prospects in neighborhoods that take advantage of the demonstration will be carefully studied and compared to the "before" picture in those communities. And we look forward to sharing and discussing this evidence with our stakeholders, community advocates, policymakers, and residents alike.

Ultimately, the Obama administration's rental assistance demonstration is about providing families who need help paying the rent with real choices. That means the choice to move to opportunities in a new neighborhood -- or the choice to stay, but in a neighborhood with quality housing, safe streets and a healthy outlook for the future. This demonstration represents an important step toward ensuring every family in America has the tools they need to make those choices for themselves.

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