The Broader Impact of Housing on Health

Home Matters Most to American Families and Children

The Importance of the Connection between Home and Health

The Connection between Health and Home

Adults living in high-poverty neighborhoods often fare worse than adults in more advantaged neighborhoods on their physical health, mental health, and economic well-being. Although social scientists have observed this association for hundreds of years, they have found it difficult to determine the extent to which the neighborhoods themselves affect well-being versus the extent to which people at greater risk for adverse outcomes live in impoverished neighborhoods. In this article, we examine neighborhood effects using data from the 10- to 15-year evaluation of the Moving to Opportunity (MTO) for Fair Housing demonstration, which offered randomly selected families a housing voucher. The experimental design of MTO allows us to isolate the effects of neighborhoods from selection bias. We find that, 10 to 15 years after enrolling participants, the program had very few detectable effects on economic well-being but had some substantial effects on the physical and mental health of adults. For adults whose families
received the offer of a housing voucher that could be used to move only to a low-poverty neighborhood, we find health benefits in terms of lower prevalence of diabetes, extreme obesity, physical limitations, and psychological distress. For adults offered a Section 8 voucher, we find benefits in terms of less extreme obesity and lower prevalence of lifetime depression.

Obesity is a major health problem in the United States and around the world. To date, relationships between obesity and aspects of the built environment have not been evaluated empirically at the individual level. Land-use mix had the strongest association with obesity (BMI≥30 kg/m2), with each quartile increase being associated with a 12.2% reduction in the likelihood of obesity across gender and ethnicity. Each additional hour spent in a car per day was associated with a 6% increase in the likelihood of obesity. Conversely, each additional kilometer walked per day was associated with a 4.8% reduction in the likelihood of obesity. As a continuous measure, BMI was significantly associated with urban form for white cohorts. Relationships among urban form, walk distance, and time in a car were stronger among white than black cohorts.

This case study, one of three prepared by the Center for Housing Policy presented at the National Building Museum’s How Housing Matters Conference, describes a program that uses secure and affordable housing to improve health outcomes and health care access for older adults.

Residents in poor neighborhoods have higher body mass index (BMI) and eat less healthfully. One possible reason might be the quality of available foods in their area. Location of grocery stores where individuals shop and its association with BMI were examined. Individuals have higher BMI if they reside in disadvantaged areas and in areas where the average person frequents grocery stores located in more disadvantaged neighborhoods. Those who own cars and travel farther to their grocery stores also have higher BMI. When controlling for grocery store census tract socioeconomic status (SES), the association between residential census tract SES and BMI becomes stronger. Where people shop for groceries and distance traveled to grocery stores are independently associated with BMI. Exposure to grocery store mediates and suppresses the association of residential neighborhoods with BMI and could explain why previous studies may not have found robust associations between residential neighborhood predictors and BMI.

Collective efficacy, i.e., perception of mutual trust and willingness to help each other, is a measure of neighborhood social capital and has been associated with positive health outcomes including lower rates of assaults, homicide, premature mortality, and asthma. Collective efficacy is frequently considered a “cause”, but we hypothesized that environmental features might be the foundation for or the etiology of personal reports of neighborhood collective efficacy. We analyzed data from the Los Angeles Family and Neighborhood Study (LAFANS) together with geographical data from Los Angeles County to determine which social and environmental features were associated with personal reports of collective efficacy, including presence of parks, alcohol outlets, elementary schools and fast food outlets. We used multi-level modeling controlling for age, education,
annual family income, sex, marital status, employment and race/ethnicity at the individual level. At the tract level, we controlled for tract-level disadvantage, the number of off-sale alcohol outlets per roadway mile, the number of parks and the number of fast food outlets within the tract and within 1/2 mile of the tract’s boundaries. We found that parks were independently and positively associated with collective efficacy; alcohol outlets were negatively associated with collective efficacy only when tract-level disadvantage was not included in the model. Fast food outlets and elementary schools were not linearly related to collective efficacy. Certain environmental features may set the stage for neighborhood social interactions, thus serving as a foundation for underlying health and well-being. Altering these environmental features may have greater than expected impact on health.   

Nearly half of Americans do not meet the Surgeon General’s recommendation of > or =30 minutes of physical activity daily. Some transit users may achieve 30 minutes of physical activity daily solely by walking to and from transit. This study estimates the total daily time spent walking to and from transit and the predictors of achieving 30 minutes of physical activity daily by doing so. Walking to and from public transportation can help physically inactive populations, especially low-income and minority groups, attain the recommended
level of daily physical activity. Increased access to public transit may help promote and maintain active lifestyles. Results from this study may contribute to health impact assessment studies (HIA) that evaluate the impact of proposed public transit systems on physical activity levels, and thereby may influence choices made by transportation planners.