Is Where We Live More
Important Than How?
A growing body of literature is renewing interest in the
connection between living in poverty and serious detrimental
effects on a person’s health, well-being, and opportunities.
In a recent New York Times Magazine article, author Helen
Epstein reports that Ana Diez-Roux, an epidemiologist at the
University of Michigan, has shown that people who live in
disadvantaged neighborhoods are more likely to have heart
attacks than people who live in middle-class neighborhoods,
even taking income differences into account. In addition,
researchers at the Rand Corporation found that neighborhoods
where many buildings are boarded up and abandoned have higher
rates of early death from cancer and diabetes than neighborhoods
with similar poverty rates and similar proportions of uninsured
people, but intact housing.
In the Housing and Health issue of their 2003 Advocates’
Guide to Housing and Community Development Policy, The National
Low Income Housing Coalition reports on the findings of a
2001 study of families on the voucher waiting list in Boston,
where participant families were exposed to significantly higher
levels of health hazards in their current housing in comparison
to those in the general population. In a similar vein, a study
of infant mortality and low-income mothers in Philadelphia
found that housing stability is a statistically significant
factor in determining whether children lived past one year,
and that the influence of housing stability was found to be
more important, in fact, than the mother’s health and
social behaviors in determining birth outcomes. Doubling up
in someone else’s home, or moving two or more times
while pregnant, made women twice as likely to lose a child
to death before one year of age than women who were stably
housed.
But how do we really know that housing and neighborhood are
truly to blame and not the attributes of the families themselves?
In an effort to answer this question, for the past 10 years,
HUD has been conducting an experiment designed to test the
long-term effects on adult and child well-being when families
move from public or project-based assisted housing in very
poor areas to private-market rental housing in areas with
much lower poverty rates. Section 152 of the 1992 Housing
and Community Development Act authorized this experiment,
known as the Moving to Opportunity demonstration (MTO). The
Act provided funding for tenant-based rental assistance and
supportive counseling services to test and evaluate the effectiveness
of metropolitan area-wide efforts to increase housing mobility.
HUD’s Offices of Policy Development and Research, Fair
Housing and Equal Opportunity, and Public and Indian Housing
jointly administer MTO.
The MTO program grew in part out of research on the Chicago
Gautreaux Program, which was established in the late 1970s
as part of a court-imposed public housing desegregation remedy.
African American families, who were residents of public housing,
or eligible to move into public housing, received Section
8 certificates that had to be used to move to predominantly
white or racially mixed neighborhoods. Participants also received
screening, counseling, and home referral services. Professor
James Rosenbaum of Northwestern University found that adults
in the Gautreaux program who moved to suburban communities
experienced notable improvements in employment experience,
and that the prospects for children who moved improved dramatically.
Although the causal link between the new residential locations
and the improvements was not certain, the findings sparked
significant interest among housing advocates and policy makers.
In March of 1994, five sites were selected for participation
in MTO: Baltimore, Boston, Chicago, Los Angeles, and New York.
Public housing authorities (PHAs) and non-profit and local
organizations implemented MTO between 1994 and 1999. Among
those who applied for the program between June 1994 and July
1998, 4,608 families were found to be eligible. Of those,
3,169 families were offered vouchers, and 1,676 were able
to find a unit and successfully move.
The experimental design randomly assigned each family to
one of three groups:
- The experimental group—offered housing vouchers
that could only be used in low-poverty neighborhoods (less
than 10 percent of the population was poor).
- The Section 8 group—offered vouchers in accordance
with the regular rules and services of the Section 8 program
at that time, with no geographical restriction and no special
assistance.
- Control group—not offered vouchers, but continued
to live in public housing or received other project-based
housing assistance.
The study is longitudinal in that it follows families over
a period of 10 years, collecting data on various aspects of
the adults’ and childrens’ lives, and comparing
the experiences of each group to that of the control group.
The current interim findings assess the program at about the
midpoint of the 10-year research period. A final impact evaluation
will be conducted approximately a decade after the end of
program operations. The interim evaluation assessed MTO’s
effects in six study domains:
- Mobility, housing, and neighborhood;
- Adult and child physical and mental health;
- Child educational achievement;
- Youth delinquency and risky behavior;
- Adult and youth employment and earnings; and
- Household income and receipt of public assistance.
The findings suggest that MTO has substantial positive effects
on the mobility of families in the treatment groups and on
the characteristics of the housing and residential environment
in which they lived. Adults in the experimental group experienced
a large reduction in the incidence of obesity and a reduction
in psychological distress (but not for the Section 8 Group).
The number of adults working more than doubled for both the
treatment and control group members. Research also shows that
the AFDC/TANF receipt rates have fallen by half across the
entire sample. However, participation in MTO did not affect
incomes in either of the treatment groups.
Girls in the experimental group experienced a substantial
decrease in psychological distress. Girls in the Section 8
group experienced a substantial decrease in the incidence
of depression and girls in both treatment groups experienced
reductions in the incidence of generalized anxiety disorder.
Participation in MTO resulted in a large reduction in the
proportion of girls age 15–19 in the Section 8 group
who had ever been arrested for violent crimes. There were
no effects on the incidence of arrests for other crimes for
girls. Girls age 15–19 in the experimental group, but
not in the Section 8 group, experienced reductions in risky
behavior but boys this age in both groups had significant
increase in smoking (one type of risky behavior). Boys experienced
very substantial increases in the proportion ever arrested
and the frequency of arrests for property crimes in the experimental
group. However, this increase may be attributable to more
stringent policing.
While not representative of public housing nationwide, the
conditions of distress and concentrated poverty where the
families were living when they joined MTO were not uncommon
in big city public housing across the country. By offering
tenant-based subsidies (vouchers) to such families, MTO provides
a test of what difference it might make to switch very low-income
families from place-based to mobile subsidies. At the present
time, these are the major forms of low-income rental assistance
with about 1.1 million families and individuals living in
public housing, 1.5 million households in privately owned
assisted projects, and 1.8 million households using vouchers.
However, many households receiving vouchers are confronted
by an array of barriers — market conditions, discrimination,
lack of information and/or transportation among others —
that force them to rent housing in neighborhoods of intense
poverty. This is why the counseling aspect of MTO is so critical.
If the long-term results of MTO research show significant
improvements in the wellbeing and life changes of experimental
group members, it is reasonable to assume that, when administered
in tandem with mobility counseling, housing vouchers can provide
access to meaningful opportunities for poor families.
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