The federal government’s recognition of the connection between housing and health predates
HUD’s existence as an agency. The United States Housing Act of 1937 created the
United States Housing Authority within the U.S. Department of Interior with a mission “to
remedy the unsafe and insanitary housing conditions and the acute shortage of decent,
safe, and sanitary dwellings for families of low income, in rural or urban communities, that
are injurious to the health, safety, and morals of the citizens of the Nation.”
When HUD became a cabinet-level agency in 1965, improving health and sanitary housing conditions was part of its mission. Over the past five decades, the agency has made great progress in reducing the number of Americans living in substandard housing, and HUD’s Office of Healthy Homes and Lead Hazard Control supports a wide range of research and grantmaking to promote health and reduce lead-based paint and other household hazards — the office’s great work can be seen throughout this issue.
In the Office of Policy Development and Research (PD&R), our evaluation of the Moving to Opportunity for Fair Housing (MTO) demonstration has been a landmark case in using research to better understand the links connecting housing and neighborhoods with health. MTO was a random assignment study designed to help very low-income families with children in public housing or Section 8 project-based housing in neighborhoods with extremely high poverty rates relocate to “opportunity neighborhoods” with vouchers and additional housing counseling services. Researchers found that 10 to 15 years after moving, adult MTO participants in the treatment group generally lived in better neighborhoods, had a lower prevalence of extreme obesity and diabetes, and had fewer self-reported physical limitations than did those in the control groups, although youth in the treatment group did not show significantly different outcomes in physical health measures. Compared with the control groups, adults in the treatment group had significantly lower levels of psychological distress, anxiety, and depression, and girls in the treatment group experienced significant positive effects on a range of mental health measures. Boys, however, fared worse on several mental health measures, including a higher prevalence of posttraumatic stress disorder.
The MTO demonstration not only taught us critical information about neighborhood mobility that informs HUD’s policies, but it also set a precedent that we should consider health outcomes whenever we do research. In the years following the report’s release, PD&R has integrated health measures into a wide range of projects and datasets.
To expand our ability to integrate health measures into housing work, HUD has pursued several data matching projects. A particularly fruitful partnership is our recently announced linked data product with the National Center for Health Statistics (NCHS) at the U.S. Department of Health and Human Services. This NCHS-HUD data matching analysis connects data from the National Health Interview Survey and the National Health and Nutrition Examination Survey to HUD’s administrative records from its three largest housing assistance programs, which will help researchers explore interactions between housing and health and better understand the social determinants that affect health outcomes. This collaboration took a great deal of staff time and skill and will serve as a model for future efforts to integrate HUD’s data with other sources to allow more comprehensive evaluation.
Matched administrative data will be used as part of PD&R’s evaluation of the Supportive Services Demonstration for Elderly Households in HUD-Assisted Multifamily Housing Program, a recently announced and very timely topic. These grants make funding available for supportive services in Section 202 multifamily (and other federally assisted) senior housing to examine how a supportive services model can affect the ability to age in place, the transition to institutional care, and the health outcomes and health care utilization of assisted seniors. The supportive services model that will be tested in the demonstration includes a full-time enhanced service coordinator and a part-time, onsite wellness nurse. The evaluation of this demonstration will further our understanding of best practices for assisting the aging at a time when the proportion of senior Americans is growing rapidly.
These are just a few examples of the body of work that PD&R, and HUD as a whole, is building to show the critical connection between housing and health.
— Katherine M. O’Regan, Assistant Secretary for Policy Development and Research
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