Is Public Housing the Cause of Poor Health or a Safety Net for the Unhealthy Poor?

Abstract

Research has shown that public housing residents have the worst health of any population in the USA. However, it is unclear what the cause of that poor health is among this population. The purpose of this paper is to investigate the association between public housing and health conditions: specifically, we ask if residents entered public housing already ill or if public housing may cause the poor health of its residents. The data used for this study come from the GSU Urban Health Initiative, which is a prospective, mixed-methods study of seven public housing communities earmarked for demolition and relocation (N=385). We used the pre-relocation, baseline survey. We found that, while health was not the main reason residents gave for entering public housing, the majority of public housing residents entered public housing already ill. Substandard housing conditions, long tenure in public housing, and having had a worse living situation prior to public housing were not associated with an increased risk of a health condition diagnosed after entry into public housing. Our findings suggest that public housing may have provided a safety net for the very unhealthy poor.

Health and social predictors of applications to public housing: a population-based analysis

“…Our study demonstrates that poor health precedes tenancy in public housing, and the unhealthy poor, arguably in high need of affordable low-income housing, are most likely to apply to public housing. Our results support the idea that public housing is a safety net 14 36…”

“…Rabins et al 7 hypothesised that for many, psychiatric illness predated residency in public housing given their short tenancies and reported lifetime illness. Ruel et al 14 found that the majority of public housing residents were diagnosed with chronic conditions, such as asthma, diabetes, arthritis and hypertension, prior to moving into public housing; although stroke was more common after moving in.…”

“…Finlayson et al 16 found that the most common reasons cited for applying to public housing were overcrowded current living conditions (26.4%) and an inability to afford current rent and/or utilities (25.2%). Affordability has also been cited as the primary reason for use of public housing 14. In Min et al 's17 study, receipt of welfare, being homeless at some point, and having a low household income were associated with use of public housing.…”

“Weathering” HOPE VI: The Importance of Evaluating the Population Health Impact of Public Housing Demolition and Displacement

“…12 Specific to HOPE VI, studies of public housing residents have found a population of adults and children in extremely poor health. [13][14][15] For example, prior to relocation, female African American residents at HOPE VI sites experienced rates of diabetes, depression, asthma, and hypertension that were nearly twice as high as those found in national samples of African American women. 14 Additionally, 9% of HOPE VI parents reported caring for a child in fair or poor health, which is three times the figure for children nationally.…”

Effect of a smoking cessation intervention for women in subsidized neighborhoods: A randomized controlled trial

“…Women in government subsidized housing report poor physical and mental health (Ruel et al, 2010; Krieger and Higgins, 2002), high rates of depression and substance abuse (Williams and Adams-Campbell, 2000; Andrews et al, 2007a), limited access to financial and health resources (Ruel et al, 2010), and neighborhoods with high crime and disorder (Andrews et al, 2014a; Yu et al, 2012; Turney et al, 2013; Haberman et al, 2013). Even with these challenges, women in subsidized housing want to quit smoking and promote a healthier life for their children and grandchildren (Grady et al, 1998; Manfredi et al, 1992; Andrews et al, 2007a).…”