Association for Public Policy Analysis & Management

Housing has many attributes -- quality, affordability, stability and location -- that can have direct and indirect influences on health. Low-income families that spend more than 30 percent of their income on housing cut back on other expenditures including food, transportation, medical care, saving for retirement, and child enrichment activities compared to those who are not cost burdened (Joint Center 2015; Newman and Holupka 2014). This study examines whether federal housing assistance programs, such as public-housing, Section 8 housing and housing-choice voucher programs, impact health outcomes, food security, and unmet need for health care among low-income persons. We contribute toward a growing literature investigating the spillover effects of housing assistance on health and human capital (Fenelon et al. 2017; Newman and Holupka 2014; Chetty et al. 2016; Sandstrom and Huerta 2013)

Using survey data from the National Health Interview Survey (NHIS) linked to administrative records from the Department of Housing and Urban Development (HUD), we examine descriptive differences in health, food security, and unmet healthcare need between low-income individuals in a HUD program at the time of the survey and those who are not. Moreover, we estimate the association between housing and health along a series of margins including: 1) comparing individuals in housing at the time of the survey to observably similar individuals who are not receiving HUD assistance when surveyed but will receive HUD assistance in the near future and 2) estimating the association between the duration of housing assistance receipt and health. Using propensity score match methods and an instrumental variables approach, we further estimate the causal impact of housing assistance on health, food security, and unmet need for healthcare.

Preliminary findings suggest that for non-elderly, non-disabled adults, housing assistance is associated with a significant decline in the likelihood of using the emergency room in the past year and a reduction in smoking intensity relative to observably similar individuals who were not receiving housing assistance at the time of the survey but will eventually receive housing assistance. In samples comparing children who were either receiving housing assistance at the time of the survey to those were not receiving housing assistance at the time of the survey but will in the future, we find that housing assistance is associated with a decrease in the likelihood of not eating despite hunger but also an increased use of emergency room care last year. Relative to propensity score matched respondents who will eventually receive housing assistance (but are not receiving assistance at the time of the survey), we find that housing assistance is associated with reduced emergency use and increased diagnosis of diabetes for adults, and reduced likelihood of not eating despite hunger and increased diagnosis of attention deficit disorder for children. These early results suggest that for vulnerable low-income families, housing assistance may play a critical role in facilitating health and human capital development.