Panel Paper: The Health Impact of Subsidized Housing: A Systematic Review of the Section 8 Voucher Program

Saturday, November 10, 2012 : 10:55 AM
Baltimore Theatre (Radisson Plaza Lord Baltimore Hotel)

*Names in bold indicate Presenter

Dolores Acevedo-Garcia1, Pamela Joshi1, A. Susana Ramirez2, Lindsay Rosenfeld1 and Kimberly Geronimo1, (1)Brandeis University, (2)National Institutes of Health, National Cancer Institute

Background. Federal agencies recognize the importance of expanding affordable rental housing options in healthy neighborhoods as a platform to increase access to much needed high quality health care and educational settings.  Housing assistance is viewed as a “vaccine” that can help prevent health problems and save money on costly health care services down the road. (HHS, 2011). Reducing rental burdens, improving housing quality and providing supportive services can lead to positive health by improving residential stability, reducing overcrowding and ensuing contagion, decreasing exposure to allergens, improve safety, increase disposable income, and lower health costs (Cohen, 2011; Leventhal and Newman, 2010 Thomson, Sellstrom, and Petticrew, 2009). Providing safe and affordable housing has the potential to have multiplier effects across domains for parents, children and the neighborhoods they live in.

Objectives. We reviewed the literature on the health impacts of a key U.S. housing policy addressing affordability in the rental market, the Housing Choice Voucher program (known as Section 8), to inform policymakers, practitioners and interagency collaborators about evidence-based interventions to improve both housing and health outcomes. Policymakers are interested in replicating cost effective interventions that have demonstrated impacts in multiple domains.

Methods. A systematic review of the published and grey literatures from 1990 to 2011 identified 98 studies for consideration. The review team sifted studies based on identification of Section 8 voucher receipt, clearly defined health outcomes, and the quality of the experimental research design. Using a consistent template, studies were abstracted and then rated by at least 2 team members. To isolate the impact of Section 8, studies were excluded if vouchers were bundled with multiple housing subsidies or the description of housing assistance was unclear.

Results. Based on inclusion criteria, this review identified 9 studies of 5 Section 8 voucher interventions and 1 study of Section 8 administrative data that included a matched comparison group. Compared to the control group, receipt of Section 8 vouchers had a positive impact on Medicaid and SCHIP enrollment in low-income populations and decreased hospitalizations, institutional stays and ER visits in homeless clinical populations. Decreased health risk behaviors for adults and children in families receiving Section 8 were identified. For adults, Section 8 had some positive impacts on self-rated physical and mental health in homeless clinical populations, and some impacts on the physical health of low-income parents who are primarily single mothers. For children, one intervention showed strong Section 8 impacts on mental health and to a lesser degree physical health that varied by gender.

Conclusions. Subsidizing rent through vouchers improved health and health service use among economically vulnerable and homeless clinical and non-clinical adult and child populations in the U.S. One intervention negatively impacted boys’ health suggesting that voucher program should be tailored and target the needs of different subgroups. Future research should investigate the effectiveness of vouchers and different levels of support services provided that could further improve health impacts among vulnerable groups.  Implications for housing policy and new rental housing voucher programs such as RAD will be discussed.