Association for Public Policy Analysis & Management

Policymakers are increasingly concerned about the health effects of housing and are looking for rigorous research to help them understand the ways in which housing can shape health. Our study extends the current literature on housing and health by leveraging a natural experiment in New York City. Specifically, we study the effect of the partial sale and major renovation of six distressed housing developments owned by the New York City Housing Authority (NYCHA). We compare changes in the health and wellbeing of residents living in renovated buildings to changes in the health and wellbeing of comparable residents living in nearby, NYCHA buildings of similar baseline quality that were not renovated. We address two key research questions: (1) Does the improvement of housing quality cause improvements in tenants’ health, as measured either by a decline in hospitalization rates from asthma or other preventable diseases or by boosted school attendance rates?; (2) Are lower crime rates a potential mechanism through which health outcomes can be improved?

We rely on a variety of longitudinal administrative datasets to measure how these housing improvements affect the health of building residents. First, we use individual hospitalization records from 2009 to the present for the New York State Statewide Planning and Research Cooperative System (SPARCS) which records every hospital and emergency room admission and any ambulatory surgery visits in New York State. Second, we also use individual Medicaid claims data for New York City from 2009 to the present. These two health datasets allow us to track the incidence of specific disease patterns, like uncontrolled asthma or COPD exacerbations, in the control and treatment buildings before and after housing improvement. Third, our analysis draws on 2009-2017 student attendance records from the New York City Department of Education to capture children’s health and well-being. Finally, we test if crime reduction is a potential mechanism leading to better health and wellbeing, using point-specific crime data, i.e. data on the exact location and kind of all crimes reported in New York City between 2009 and 2017.

We are currently estimating regression results that compare health and school attendance outcomes of low-income residents who lived in NYCHA buildings at the time of sale with outcomes of comparable low-income residents who lived in NYCHA buildings in the same community district that were not sold and renovated. We are focusing on respiratory conditions, anxiety and depression and injuries.

Our findings should contribute to the ongoing discussion about using housing policy as a tool to address broader social problems. Further, residents of subsidized housing developments are disproportionately heavy users of the health care system. Improving health outcomes for this high cost population might provide a useful policy lever to reduce overall health costs.