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New research found that young children from low-income families who moved to neighborhoods with less poverty through housing vouchers spent less on health care as adults.
Some housing conditions are clearly and immediately linked to health problems—like lead pipes and paint or a lack of heating and cooling during periods of extreme weather. The links between health outcomes and general neighborhood conditions, however, is less obvious, but researchers have in the past found that living in neighborhoods with low poverty rates can lead to outcomes like a reduction in the chance of extreme obesity and lower stress levels.
New research shows that the health impacts of a good neighborhood may last longer than previously thought. A recent study published in the Journal of the American Medical Association found that children aged 12 or younger whose families participated in a housing voucher program that moved them from public housing to a higher-income neighborhood were admitted to the hospital fewer times and had lower annual hospital spending as adults.
More than 95% of the participants in the study were black or Hispanic.
“A lot of our housing policies have a long history that has led to high levels of concentrated poverty and segregation along racial lines,” said Craig Pollack, a professor at Johns Hopkins University and the lead author of the report. “One potential solution to that is mobility programs.”
Over 21 years, researchers followed people in households who got moving vouchers through the U.S. Department of Housing and Urban Development’s Moving to Opportunity for Fair Housing Demonstration Project.
Over those two decades, children who moved when they were 12 years old or younger had 27% lower spending on hospitalizations and were hospitalized 18% less than children whose families didn’t move, staying in public housing. Strikingly, however, older children and adults didn’t experience the same benefits later on in life. In addition, children who moved with their families through the regular Section 8 program also didn't show significantly improved health outcomes later in life.
A study from 2015 found that moving to a lower-poverty neighborhood through a voucher program improves college attendance rates and adult earnings for children who were younger than 13 when their families moved. That study, led by Harvard economist Raj Chetty, found that the same moves “have, if anything, negative long-term impacts on children who are more than 13 years old when their families move, perhaps because of the disruption effects of moving to a very different environment.”
While Pollack’s study similarly found that children saw the greatest health benefits from moving to a neighborhood with less poverty, he didn’t discount the possibility that adults would see the benefits over time. “With adults, it’s possible the benefits will show up after 20 years,” he said. “The impacts of neighborhood environments on health may not happen right away—it’s not usually toxic exposure with immediate effects. The impacts of a neighborhood accumulate over time, and 20 years may not be enough to see changes.”
Pollack noted that most of the adults in the program were young—the average age at receipt of the housing voucher was 32— and that they may see the benefits of the move once they reach a period of their life marked by higher healthcare utilization. “It’s very possible it will matter more once they’re elderly,” he said.
As for why, exactly, a lower-poverty neighborhood led to less spending on healthcare, Pollack said researchers didn’t have a strong answer yet. The association in the study was clear: for every 10% reduction in the percentage of households in the neighborhood who lived below the poverty line, households spent an average of $152 less per year on health care for children under 18.
“There’s a lot of questions raised about what causes the disparity,” he said. “It’s a really important question. It could be that they’re spending less on conditions like asthma or mental health—things that are strongly related with home environment.”
But even without a concrete answer, Pollack said that policymakers are increasingly interested in policies that leverage housing programs to better the health of vulnerable children. “There’s a ton of interest in understanding how housing informs health,” he said. “Housing mobility programs provide a rare way to understand some of the potential health impacts of neighborhoods.”
Emma Coleman is the assistant editor for Route Fifty.