Health Policy$ense

Neighborhood Matters, Block by Block

Immediate environment affects subsidized housing residents

The Flint water crisis is a stark and grim reminder of the connections among housing, neighborhoods, and health. But neighborhoods influence health and well-being in more subtle ways that do not often make the national news. Living amidst poverty and violence can affect individuals and their life-course in ways that are hard to measure, yet important to discern.

In a new study in Housing Policy Debate, Laura Tach, a former RWJF Health & Society Scholar at Penn (and now at Cornell), with Penn researchers Therese Richmond, Douglas Wiebe, and Sara Jacoby, and Terry Guerra (formerly of ACHIEVEability) shed light on how a neighborhood affects educational outcomes among participants in an affordable housing program in West Philadelphia. The ACHIEVEability Program requires participants to enroll in post-secondary education in exchange for subsidized housing. Taking advantage of a quasi-random assignment of participants to housing units, and variability in the characteristics of block groups within West Philadelphia, the researchers found significant differences in educational achievement by the levels of poverty, violence, and education within the neighborhood.

These differences are meaningful. For example, participants assigned housing in areas with 15% poverty earned 27 college credits over two years, compared to just 18 credits in areas with 45% poverty. Similar effects were found for more violent areas and areas with fewer residents with college degrees.

College credits earned by block-group poverty rate

College credits earned by block-group rate of violent crime

The divergent environments created what the authors called “divergent trajectories” for participants who happen to be placed in poorer, more violent, and less-educated block groups.  These participants were more likely to exit the program without meeting their educational and self-sufficiency goals.

This study is important for a number of reasons. First, it overcomes selection bias because the participants are quasi-randomly assigned to neighborhoods regardless of their personal characteristics. Thus, the findings are not explained by correlations between participants and the neighborhoods they end up in. Second, it looked at differences in educational achievement at the block group level (usually containing just a few thousand people in them), allowing the researchers to look at neighborhood effects with more granularity. And third, it suggests that the immediate neighborhood influences individual outcomes, even within broader contexts of spatial and personal disadvantage.

The authors acknowledge that their study is limited to a sample from one urban environment and may not generalize to other populations or geographies. But the relationships among housing, neighborhoods, and well-being are evident in both small, intervention-based studies and large-scale econometric studies. We are learning that these relationships go beyond environmental health hazards such as lead poisoning, which lowers intelligence; indoor allergens that lead to asthma; low temperatures that increase cardiovascular disease; air pollutants that cause cancer; structural deficiencies that cause injuries; and crowding which can spread infectious disease. We are broadening our understanding of how neighborhood characteristics influence outcomes, from the availability of grocery stores and parks to the incidence of poverty and crime.

States are increasingly looking at strategies to improve health and well-being through housing assistance, particularly for individuals who are homeless or at risk of becoming homeless. This study suggests that the environments immediately surrounding residents of subsidized housing matter, and that the efficacy of interventions could be improved by locating housing in somewhat more advantaged neighborhoods. More importantly, it indicates that that cities should focus on the microenvironment and have an impact by improving blocks one at a time.

May 31, 2016 UPDATE: See excellent coverage of this study in The Atlantic and The Science of Us.