Study: Moving out of High-Poverty Area Is Good for Your Health
Between 1994 and 1998, the U.S. Department of Housing and Urban Development (HUD) conducted and evaluated a controlled, random-assignment housing relocation experiment called Moving To Opportunity. The purpose of the program was to determine the long-term impact of moving families from high-poverty to low-poverty communities.
Because the original evaluation did not include an examination of its health impacts, in 2001 the Robert Wood Johnson Foundation (RWJF) provided funding to the evaluation team led by Jeffrey Kling, Ph.D., of Princeton University's Woodrow Wilson School of Public and International Affairs to expand the evaluation to cover the health-related outcomes and well-being of children and adults.
- Urban residents of high-poverty neighborhoods have a high prevalence of health problems.
- There was a large and significant reduction in the prevalence of obesity in adults among both experimental and comparison families.
- There were improvements in mental health among adults in the experimental group families:
- A reduction in psychological distress.
- A reduction in depression.
- An increase in feelings of calm and peacefulness.
- Among children, the significant effects of Moving To Opportunity on health were confined to mental health measures:
- A moderately large reduction in psychological distress for girls in the experimental group.
- A substantial decrease in the incidence of depression among girls in the comparison group.
- Very large reductions in the incidence of generalized anxiety disorder among girls in both treatment groups.
RWJF supported this project through a grant of $748,572 to Princeton University's Woodrow Wilson School of Public and International Affairs.
In 2000, 3.5 million poor people across the United States lived in neighborhoods with poverty concentrations in excess of 40 percent. According to the project director, a growing social science literature suggests that such concentration has a variety of detrimental effects on the residents of these areas in terms of both their current well-being and their future opportunities.
The harmful effects of high-poverty areas are thought to be especially severe for children whose behavior and prospects may be particularly susceptible to a number of neighborhood characteristics, such as peer group influences, school quality and the availability of supervised after-school activities. Less has been written about whether and how other neighborhood environments exert positive influences on behavior and life changes.
To determine the long-term impact of moving families from high-poverty to low-poverty communities, Congress authorized HUD as part of the Housing and Community Development Act of 1992 to conduct a controlled, random-assignment housing relocation experiment. Called Moving To Opportunity, the experiment sought to determine the impacts of (1) mobility counseling on families' location choices and on their housing and neighborhood conditions; and (2) neighborhood conditions on employment, income, education and social well-being.
From 1994 to 1998, HUD enrolled about 4,600 families eligible for public housing from five cities (Baltimore, Boston, Chicago, Los Angeles and New York) in Moving To Opportunity. The families were randomly assigned to one of three groups:
- The experimental group received housing vouchers to relocate to private market housing in low-poverty areas, plus counseling and assistance in finding and renting private units.
- The Section 8 comparison group received relocation vouchers for private market housing without restriction on poverty level, and "usual care" briefings and assistance from HUD's local public housing authorities (Section 8 is the title of the federal rental subsidy program for disadvantaged people).
- The control group continued to receive previous project-based housing assistance.
The first interim evaluation in 19971999 found that 90 percent of Moving To Opportunity experimental group families moved to neighborhoods with poverty rates below 10 percent and none moved to neighborhoods with poverty rates above 40 percent. Families with standard Section 8 vouchers tended to move to moderate- or high-poverty neighborhoods.
In 2001, HUD hired Abt Associates to conduct a five-year interim evaluation of Moving To Opportunity. Abt Associates, a government and business research and consulting firm located in Cambridge, Mass., selected a group of investigators from multiple institutions, led by Jeffrey Kling, Ph.D., of Princeton University's Woodrow Wilson School of Public and International Affairs (see Appendix 2 for a roster of the research team), to develop the data collection protocol and analyze the data under a sub-contract. The core evaluation covered education, employment, income, public assistance, housing satisfaction, exposure to violence, civic engagement, and family rules and routines.
However, the coverage of health status in the core evaluation was very limited. People living in poverty or of low socioeconomic status have worse health, a higher prevalence of disease and disability and higher death rates than other people. There is controversy over the extent to which their high-poverty communities or neighborhoods contribute to their worse health.
RWJF funding enabled researchers to expand the evaluation to include health-related data on the well-being of children and adults, including items on social networks and isolation, general health, mental health, access to medical care and risky behavior.
This project derived from the concerns of RWJF's Population Health Science and Policy Team, which had as a major focus the multiple determinants of health that do not usually come within the traditional purview of the medical and health care fields, such as social conditions, economic conditions, and physical and environmental conditions. The team was disbanded after a major reorganization at RWJF, precipitated by a change in leadership in 2002.
Although some of the focus of the Population Health Science and Policy Team along with some staff members carried over into RWJF's new Public Health Team, the nontraditional, "upstream factors" of health are a lesser focus of the new team, and according to the program officer, Pamela Russo, a project like this would have a harder time fitting into RWJF's programmatic goals.
With additional funding from RWJF, Kling and his team designed as part of an interim evaluation at about the midpoint of the 10-year research period three surveys (for adults, youth ages 1219 and children ages 511) for the core and health-related well-being of children component of the evaluation. Staff also trained more than 100 staff members, who conducted 8,965 personal interviews with adults and youth and children. (The adult surveys and interviews also included questions about youth and children.)
In addition, staff conducted achievement tests on children and youth, and measured height and weight in children (December 2001 to September 2002).
The budget for the overall evaluation was $10.4 million, with RWJF contributing 7 percent of this amount. Major funders included HUD, the National Institute of Child Health and Development, and the MacArthur Foundation. (See Appendix 1 for a complete list of funders.)
- Researchers completed data collection on 3,825 adults and 5,140 youth/children, representing 89 percent of the adults and youth/children involved in Moving To Opportunity. Health data covered mental and physical health, including depression and generalized anxiety, obesity, exercise and nutrition, blood pressure, conditions and access to medical care.
The principal investigator reported the following findings in Moving To Opportunity for Fair Housing Demonstration Interim Impacts Evaluation, published by HUD in 2003.
- Urban residents of high-poverty neighborhoods have a high prevalence of health problems. The high rates of activity limitations, asthma, high blood pressure, obesity, psychological distress, depression and anxiety observed in the control group at the time of the interim evaluation bear out this expectation.
- There was a large and significant reduction in the prevalence of obesity in adults among both experimental and Section 8 families.
- There were improvements in mental health among adults in the experimental group families: a reduction in psychological distress, a reduction in depression, and an increase in feelings of calm and peacefulness. There were no significant mental health improvements among those in the Section 8 group and there were no significant effects on the other adult health measures among those in either the experimental or Section 8 group.
- Among children, the significant effects of Moving To Opportunity on health were confined to mental health measures: a moderately large reduction in psychological distress for girls in the experimental group; a substantial decrease in the incidence of depression among girls in the Section 8 group; and very large reductions in the incidence of generalized anxiety disorder among girls in both treatment groups.
The research team published a comprehensive report on the interim findings for the Moving To Opportunity project. Entitled Moving To Opportunity for Fair Housing Demonstration Interim Impacts Evaluation, it can be downloaded online. The research team also created a Web site which provides background information on Moving To Opportunity, along with information about research, publications and links to other Moving To Opportunity sites. See the Bibliography for details.
SIGNIFICANCE TO THE FIELD
From a policy perspective, these findings suggest that interventions that improve distressed neighborhoods or assist people in leaving them can have important public health benefits. Meanwhile, the fact that other components of the Moving To Opportunity demonstration showed no overall impacts on earnings or welfare usage suggests that health outcomes may be more sensitive than economic self-sufficiency outcomes to housing policies for low-income families. Taken together, the findings may return health concerns to the more prominent place in housing policy that they held 60 years ago, according to the principal investigator.
- When negotiating a large contract and when dealing with survey companies or subcontractors, hire a professional contract negotiator. The research team hired a consultant to serve as its contract negotiator. The cost of the negotiator more than paid for itself in contract cost savings alone, and working with the negotiator allowed researchers to focus on scientific issues. (Principle Investigator)
AFTER THE GRANT
The principal investigator, along with other researchers, is conducting an in-depth qualitative study of 120 Moving To Opportunity families in Chicago and Baltimore. The study focuses on adult economic self-sufficiency, adult mental health, child behavior problems and child physical health, areas that preliminary studies suggested were of the greatest policy and scientific relevance. A final impact evaluation on the Moving To Opportunity program will be conducted approximately a decade after the end of program operations.
GRANT DETAILS & CONTACT INFORMATION
Studying the Longitudinal Effects of Housing Policies on Health Indicators and Outcomes
Princeton University, Woodrow Wilson School of Public and International Affairs (Princeton, NJ)
Dates: September 2001 to August 2002
Jeffrey R. Kling, Ph.D.
Moving To Opportunity Evaluation Funders
|Source||Data Collection||Total Award|
|John D. and Catherine T. MacArthur Foundation||$1,000,000||$1,000,000|
|National Institute of Child Health and Development Youth||$708,895||$1,498,757|
|National Institute of Child Health and Development Child||$960,052||$1,453,807|
|Robert Wood Johnson Foundation||$748,572||$748,572|
|National Science Foundation||$724,900||$724,900|
|Russell Sage Foundation||$502,572||$502,572|
|Smith Richardson Foundation||$407,278||$407,278|
|W.T. Grant Foundation||$357,200||$500,000|
Moving To Opportunity Health-Related Well-Being of Children Evaluation Research Team
Jeffrey R. Kling, Ph.D.
Jeanne Brooks-Gunn, Ph.D.
New York, N.Y.
Greg J. Duncan, Ph.D.
Lawrence F. Katz, Ph.D.
Jeffrey B. Liebman, Ph.D.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Orr L, Feins JD, Jacob R, Beecroft E, Sanbonmatsu L, Katz LF, Liebman JB and Kling JR. Moving To Opportunity for Fair Housing Demonstration Interim Impacts Evaluation. Washington: U.S. Department of Housing and Urban Development, 2003. Available online.
"MTO Interim Evaluation Child Survey," Abt Associates, fielded December 2001 to September 2002.
"MTO Interim Evaluation Youth Survey," Abt Associates, fielded December 2001 to September 2002.
"MTO Interim Evaluation Household Survey," Abt Associates, fielded December 2001 to September 2002.
World Wide Web Sites
www.mtoresearch.org provides background information on the overall Moving To Opportunity project, along with information about research and publications specific to each of the Moving To Opportunity sites. Princeton, N.J.: Center for Health and Wellbeing, Princeton University, 2000.
Report prepared by: Robert Crum
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Pamela G. Russo