ArticleProviding affordable family housing and reducing residential segregation by income: A systematic review☆
Introduction
The social, physical, and economic characteristics of neighborhoods are increasingly recognized as having both short- and long-term consequences for residents’ physical and psychological well-being.1, 2 Among the most pressing health-related, neighborhood-level issues currently facing the nation are the inadequate supply of housing affordable to lower-income households and the increasing spatial (residential) segregation of households by income, race, ethnicity, or social class, as well as the related increase in poverty and impoverished areas within many of the country’s urban centers.3 Selected goals and objectives from the U.S. Department of Housing and Urban Development (HUD)4 and from Healthy People 2010,5 related to housing programs that reduce residential segregation by income, race, or ethnicity, are shown in Table 1.
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The inadequate supply of housing affordable to lower-income households
Housing and health are related in several ways. Housing is a basic necessity that provides shelter from the elements; facilitates the storage of food, water, and other essentials; and is the setting for the communal life of the household. Housing is an object of attachment and a source of identity and also has a significant relationship to psychological well-being.6 The World Health Organization’s Health Principles of Housing7 points to the association between housing and health as including
Socioeconomic segregation and the growth in central-city impoverishment
Over recent decades, metropolitan areas have seen a general trend of increased spatial segregation of poor households, as well as the associated increase in central-city poverty. Between 1970 and 1990, the percentage of poor metropolitan area residents living in extreme poverty neighborhoods (i.e., those with poverty rates at or above 40%) increased from 12.4% to 17.9%, while indices of the residential segregation of the poor also rose.16 At the same time, the population living in poverty
Interventions reviewed
The Task Force on Community Preventive Services (the Task Force) uses evidence from systematic reviews to make recommendations about the use of interventions to improve health. In the social environment and health logic model (described elsewhere in this supplement34) “neighborhood living conditions” serve as an intermediate indicator along a pathway linking resources in the social environment to health outcomes. Based on a priority-ranking process,34 the systematic review development team (the
Conceptual approach
A detailed description of the general methods used to conduct the systematic reviews for the Guide to Community Preventive Services (the Community Guide) has been published.35 The specific methods for conducting reviews of interventions to promote healthy social environments are described in detail in this supplement.34 This section briefly describes the conceptual approach and search strategy for interventions that provide affordable family housing and limit the spatial concentration of
Mixed-income housing developments
For this review, a mixed-income housing development is defined as a publicly subsidized multifamily rental housing development, in which the deliberate mixing of income groups is a fundamental part of the development’s operating and financial plans. A portion of a development’s units must be reserved for, and made affordable to, households whose incomes are at least below 60% of the area median, although there may be variation among developments in the income levels of all residents and the
Research issues
Systematic reviews are useful both for developing recommendations and for identifying important unanswered questions. The research questions posed below can be used to guide future research, both by government agencies and foundations in their allocation of research funding and by academic and other research organizations in their selection of research priorities.
Discussion
The importance of housing policy that attempts to deconcentrate neighborhood poverty while providing affordable housing to low-income families can be seen in the strong emphasis placed on income mixing within the HOPE VI Urban Revitalization Demonstration Program,64 the federal government’s program for the physical and social revitalization of distressed public housing. Such an emphasis is in sharp contrast to the public housing program’s record of concentrating poverty by routinely
Use of the recommendation
The Task Force recommendation for tenant-based rental assistance programs can be used by public health agencies in conjunction with local housing authorities to inform policy makers of the effectiveness of such programs for increasing family safety in the neighborhood environment.
Summary: findings of the task force
Evidence was insufficient to determine the effectiveness of mixed-income housing developments in improving family health and safety while providing affordable housing, because no studies compared groups of people exposed to the intervention with groups not exposed.
The use of tenant-based rental assistance programs is recommended for improving household safety, on the basis of sufficient evidence of reductions in exposure to crimes against person and property and decreases in neighborhood social
Acknowledgements
We thank the following individuals for their contributions to this review: Robert Filley, College of Architecture and Urban Planning, University of Washington; Todd Richardson, Department of Housing and Urban Development; Judie Feins, Abt Associates; Onnalee Henneberry, Research Librarian; Kate W. Harris, Editor; and Peter Briss for technical support.
Our Consultation Team: Regina M. Benjamin, MD, MBA, Bayou La Batre Rural Health Clinic, Bayou La Batre, Alabama; David Chavis, PhD, Association
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The names and affiliations of the Task Force members are listed at the front of this supplement, and at www.thecommunityguide.org.
Address reprint requests to: Community Guide Branch, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-73, Atlanta GA 30341. Website: [email protected].