Article
Providing affordable family housing and reducing residential segregation by income: A systematic review

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Abstract

Overview

The inadequate supply of affordable housing for low-income families and the increasing spatial segregation of some households by income, race, ethnicity, or social class into unsafe neighborhoods are among the most prevalent community health concerns related to family housing. When affordable housing is not available to low-income households, family resources needed for food, medical or dental care, and other necessities are diverted to housing costs. Two housing programs intended to provide affordable housing and, concurrently, reduce the residential segregation of low-income families into unsafe neighborhoods of concentrated poverty, are reviewed: the creation of mixed-income housing developments and the Department of Housing and Urban Development (HUD) Section 8 Rental Voucher Program. The effectiveness of mixed-income housing developments could not be ascertained by this systematic review because of a lack of comparative research. Scientific evidence was sufficient to conclude that rental voucher programs improve household safety as measured by reduced exposure to crimes against person and property and decreased neighborhood social disorder. Effectiveness of rental voucher programs on youth health risk behaviors, mental health status, and physical health status could not be determined because too few studies of adequate design and execution reported these outcomes.

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.

Section snippets

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

References (65)

  • P.A. Briss et al.

    Developing an evidence-based Guide to Community Preventive Services-methods

    Am J Prev Med

    (2000)
  • V.G. Carande-Kulis et al.

    Methods for systematic reviews of economic evaluations for the Guide to Community Preventive Services

    Am J Prev Med

    (2000)
  • A.V. Diez Roux et al.

    Neighborhood of residence and incidence of coronary heart disease

    N Engl J Med

    (2001)
  • I.F. Ellen et al.

    Neighborhood effects on healthexploring the links and assessing the evidence

    J Urban Affairs

    (2001)
  • D. Massey et al.

    American apartheid: segregation and the making of the underclass

    (1993)
  • U.S. Department of Housing and Urban Development. FY 2000–FY 2006 strategic plan. 2000. Available at:...
  • Healthy people 2010

    (2000)
  • M.T. Fullilove et al.

    What’s housing got to do with it?

    Am J Public Health

    (2000)
  • Health principles of housing

    (1989)
  • B. Thiele

    The human right to adequate housinga tool for promoting and protecting individual and community health

    Am J Public Health

    (2002)
  • L. Freeman

    America’s affordable housing crisisa contract unfulfilled

    Am J Public Health

    (2002)
  • The Urban Institute. A new look at homelessness in America. 2000. Available at:...
  • I.Y. DeOllos

    On becoming homeless: the shelterization process for homeless families

    (1997)
  • Homelessness, health and human needs

    (1988)
  • D.L. Wood et al.

    Health of homeless children and housed, poor children

    Pediatrics

    (1990)
  • P.J. Fischer

    Victimization and homelessnesscause and effect

    N Engl J Public Policy

    (1992)
  • Joint Center for Housing Studies of Harvard University. The state of the nation’s housing: 2001. 2001. Available at:...
  • J.D. Kasarda

    Inner-city concentrated poverty and neighborhood distress1970 to 1990

    Housing Policy Debate

    (1993)
  • J.D. Kasarda et al.

    Joblessness and poverty in America’s central citiescauses and policy prescriptions

    Housing Policy Debate

    (1996)
  • A.D. Downs

    New visions for metropolitan America

    (1994)
  • Fosburg LB, Popkin SJ, Locke GP. An historical and baseline assessment of HOPE VI: volume I, cross-site report....
  • M. Orfield

    Metropolitics: a regional agenda for community stability

    (1997)
  • D. Rusk

    Inside game, outside game: winning strategies for saving urban America

    (1999)
  • J.B. Hogan et al.

    Experiences with scattered-site housing

    Urban Resources

    (1985)
  • P. Jargowsky

    Poverty and place: ghettos, barrios, and the American city

    (1997)
  • A.V. Diez-Roux

    Bringing context back into epidemiologyvariables and fallacies in multilevel analysis

    Am J Public Health

    (1998)
  • J. Brooks-Gunn et al.

    Do neighborhoods influence child and adolescent development

    Am J Sociol

    (1993)
  • R.J. Sampson et al.

    How neighborhoods matter: the value of investing at the local level

    (2001)
  • J.D. Morenoff et al.

    Neighborhood inequality, collective efficacy, and the spatial dynamics of urban violence

    Criminology

    (2001)
  • A.V. Diez-Roux et al.

    Neighborhood environments and coronary heart diseasea multilevel analysis

    Am J Epidemiol

    (1997)
  • C.R. Wasserman et al.

    Socioeconomic statusneighborhood social conditions and neural tube defects

    Am J Public Health

    (1998)
  • I.H. Yen et al.

    Neighborhood social environment and risk of deathmultilevel evidence from the Alameda County Study

    Am J Epidemiol

    (1997)
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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].

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