«Moving to opportunity voluMe 14, nuMber 2 • 2012 U.S. Department of Housing and Urban Development | Office of Policy Development and Research ...»
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The contents of this article are the views of the authors and do not necessarily reflect the views or policies of the U.S. Department of Housing and Urban Development, the Congressional Budget Office, the U.S. government, or any state or local agency that provided data.
Abstract 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
(continued) 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.
Introduction Adults living in disadvantaged neighborhoods have worse health and economic outcomes than people living in less distressed areas. Previous research has shown that living in a high-poverty or high-crime neighborhood is associated with an increased risk of poor overall health status, premature mortality, heart disease, obesity, serious mental illness, suicide, unemployment, and dropping out of school (Bagley, Jacobson, and Palmer, 1973; Diez-Roux and Mair, 2010; Kawachi and Berkman, 2003; Macintyre and Ellaway, 2003; Pickett and Pearl, 2001; Rezaeian et al., 2005;
Weinberg, Reagan, and Yankow, 2004; Whitley et al., 1999).
What remains less clear is the extent to which such variation in people’s well-being across neighborhoods reflects the causal influence of the neighborhood environments themselves, beyond the variation explained by the nonrandom sorting of individuals among residential neighborhoods.
People who are at elevated risk for adverse health or labor-market outcomes may face limited housing options and may be more likely to live in distressed neighborhoods. Observational (or nonexperimental) studies try to isolate the independent effects of neighborhoods on people’s well-being by statistically controlling for observable risk and protective factors of individuals and their families. Studies that control for a larger number of individual factors tend to find smaller neighborhood effects than do other studies (Pickett and Pearl, 2001). In addition, substantial concerns remain that some of the key variables that directly affect both neighborhood selection and health or economic outcomes are missing from or are imperfectly measured in standard data sets.
Observational studies may confound the influence of neighborhood environments with the effects of unmeasured individual or family attributes that directly affect outcomes and neighborhood selection, a problem that social scientists call selection bias.
110 Moving to Opportunity The Long-Term Effects of Moving to Opportunity on Adult Health and Economic Self-Sufficiency The existence, magnitude, and nature of any causal neighborhood effects on economic and health outcomes are of great relevance to housing policies that affect the geographic concentration of poverty in America. An understanding of neighborhood effects can inform policy choices related to: (1) whether to help low-income families meet their housing needs through project-based housing or, instead, through housing vouchers; (2) the types of relocation assistance and support to provide voucher holders; (3) where to locate new public housing projects; and (4) the potential value of mixed-income housing projects that subsidize nonpoor families to live near poor families.
The nature of neighborhood effects is also relevant to the design of other social policies, such as suburban zoning rules and education policies that sort children across different schools and influence how low-income families are distributed across social settings (Duncan and Murnane, 2011).
These choices also have important implications for health policy decisions, such as the degree to which governments allocate public health investments for low-income areas to traditional safetynet health care instead of changing “the context to make individuals’ default decisions healthy” (Frieden, 2010: 590). For example, policymakers could allocate investments to creating safe green space for walking and sports, which might lead people to choose more physical activities over sedentary activities.
To more convincingly identify the effects of neighborhood environments on low-income families and to overcome selection bias concerns that may have compromised previous studies, the U.S.
Department of Housing and Urban Development (HUD) launched the Moving to Opportunity (MTO) for Fair Housing demonstration, a residential mobility experiment, in the early 1990s. The MTO program targeted families living in public or project-based housing in highly impoverished neighborhoods. MTO was open to families living in Baltimore, Boston, Chicago, Los Angeles, and New York City. Between 1994 and 1998, more than 4,600 families enrolled in the MTO program (Goering, Feins, and Richardson, 2003; Goering et al., 1999). To be eligible, a family had to have at least one child younger than age 18 and live in public housing or project-based assisted housing in a high-poverty area, defined as a census tract in which the income of more than 40 percent of residents falls below the federal poverty threshold.
MTO randomly assigned eligible families to one of three groups: