Does Poor Health Influence Residential Selection? Understanding Mobility Among Low-Income Housing Voucher Recipients in the Moving to Opportunity Study

Abstract

Housing-mobility programs and housing choice vouchers provide low-income families with a potentially transformative opportunity to move to low-poverty neighborhoods. However, families often face barriers to attaining upward residential mobility; poor health may be one important barrier, although few studies have examined this hypothesis. We used the experimental Moving to Opportunity for Fair Housing Demonstration Project (MTO) Study, constructed residential trajectories, and linked neighborhood opportunity measures to over 14,000 addresses of 3526 families across 7 years. We used latent growth curve longitudinal models to test how baseline health modified effects of MTO housing voucher treatment on neighborhood opportunity trajectories. Results show that poor baseline health adversely influenced how the voucher induced upward mobility. Voucher receipt strongly promoted residential mobility if families were healthy; moreover, the low-poverty neighborhood voucher plus counseling treatment promoted higher-opportunity neighborhood attainment than controls, regardless of the baseline health of the family. However, families with health vulnerabilities did not retain the same initial neighborhood gains conferred by the housing choice voucher (HCV) treatment as families without health vulnerabilities. These results suggest that housing counseling may be one necessary element to expand neighborhood choice into higher-opportunity neighborhoods for families with health challenges. Providing housing vouchers alone is insufficient to promote low-income-family high-opportunity moves, for families who have disabilities or special needs. The implications of these results point to scaling up housing-mobility programs, to provide tailored support for low-income families to use HCVs to make high-opportunity moves, which is particularly necessary for families with health challenges.

Keywords:

• Neighborhood
• residential mobility
• residential selection
• bias
• housing policy
• housing choice voucher
• special needs children
• health
• disability
• housing mobility

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Notes

1 Notably, a parallel literature has also documented patterns of health selection into housing insecurity, including into eviction (Schwartz et al., 2021), foreclosure (Houle & Keene, 2015), and homelessness (Curtis et al., 2010, 2013).

2 It bears reinforcing that discrimination based on disability, race, and family status is outlawed by Federal Fair Housing law. Although source-of-income discrimination (e.g., using a housing voucher for rental assistance) is not federally outlawed, over 13 states and 90 localities have outlawed it, which is estimated to cover about half of HCV US households (Tegeler, 2020).

Additional information

Funding

This research was supported by funding from the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development. This research was conducted as a part of the US Census Bureau’s Evidence Building Project Series. Any opinions and conclusions expressed herein are those of the author and do not represent the views of the US Census Bureau. The Census Bureau has ensured appropriate access and use of confidential data and has reviewed these results for disclosure avoidance protection (Project P-7504667: CBDRB-FY24-CES018-001).

Notes on contributors

Theresa L. Osypuk

Theresa L. Osypuk, SD, is the Director of the Minnesota Population Center, and Associate Professor of Epidemiology and Community Health at the University of Minnesota School of Public Health. Dr. Osypuk is a social epidemiologist and demographer examining why place influences population health equity, including residential segregation, neighborhood context, and social policies, particularly those in the housing sector.

Samantha Gailey

Samantha Gailey, PhD, was a Population Health Postdoctoral Fellow at the University of Minnesota at the time that this article was written. Her research examines social and natural environment determinants of health, including how neighborhood conditions “get under the skin” and shape maternal and perinatal health disparities. She is now an Assistant Professor at Michigan State University in Forestry and Public Health.

Nicole M. Schmidt

Nicole Schmidt, PhD, is a criminology researcher and business intelligence developer. Dr. Schmidt’s research investigates whether and how social exposures, and life course timing, shape successful early adulthood outcomes.

Dolores Acevedo Garcia

Dolores Acevedo-Garcia, PhD, is Samuel F. and Rose B. Gingold Professor of Human Development and Social Policy, and Director of the Institute for Child, Youth and Family Policy at the Heller School for Social Policy and Management at Brandeis University. Her research focuses on social determinants of racial/ethnic inequities in health, and the role of social policies in the well-being of children with special needs.