The Cost of Stability: Affordable Housing and Health

Housing assistance programs are associated with reduced anxiety and stress, and increased feelings of control. But these programs alone cannot solve the health challenges associated with housing instability.

Historic housing buildings on the Upper West Side in New York City

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Much of the conversation around housing and health in the United States has centered around housing stability – how to guarantee shelter for those experiencing homelessness, how to prevent homelessness due to eviction. But it’s crucial to remember that the affordability of housing (or lack thereof) directly impacts housing instability.

People who spend more than 30% of their income on housing are considered “cost burdened,” running the risk of not having enough money each month to pay for other necessities like food and utilities. According to the Healthy People 2030 program, 35% of U.S. families were cost burdened in 2021.

A study by Atticus Jaramillo and William M. Rohe found that having financial aid for housing costs can make a big difference for these families and their mental health.

The authors examined data collected from young adults in 2008 and 2009, as part of the National Longitudinal Study of Adolescent to Adult Health (ADD Health). Respondents reported on mental health conditions, such as depression and anxiety, as well as psychological stress, mastery (i.e., sense of control over one’s life), and experiences of discrimination.

[H]ousing assistance alone is not enough to solve the mental health challenges that program recipients face.

The authors then analyzed administrative data from two housing assistance programs that are offered through the U.S. Department of Housing and Urban Development (HUD). First, they looked at conventional public housing, which establishes affordable rental units that are operated by local agencies. Second, they considered the Housing Choice Voucher program, which provides subsidies to private landlords who then rent to program recipients. Participating in these programs usually guarantees that recipients won’t pay more than roughly 30% of their monthly income to rent.

Jaramillo and Rohe identified people who had received HUD assistance at some point and compared these individuals with those who did not receive assistance. They found that housing assistance was associated with reduced anxiety and stress, and increased mastery.

The authors make clear that housing assistance alone is not enough to solve the mental health challenges that program recipients face. More research is needed to elucidate exactly how housing assistance impacts long-term mental health.

Unfortunately, part of the challenge is that there is not enough affordable housing across the U.S. Here in Boston, for example, inventory in the housing market is so low that it impacts the rental market as well, igniting bidding wars among renters. Boston has tried to address this shortage, but between high construction costs and strict zoning laws, luxury housing is still easier built than affordable housing.

So, what can cities do in the meantime?

One option is to maximize the housing that is available by encouraging more landlords to join assistance programs. Selena E. Ortiz and colleagues evaluated a strategy that could increase landlords’ participation in these programs.

Pittsburgh launched the Mobility Voucher (Location-Based) program in 2020, a unique aid program that allows families to rent in “mobility zones,” which are considered neighborhoods with low poverty rates, high job access, and quality transportation.

The research team surveyed more than 200 landlords between 2021 and 2023. Roughly half of the landlords were given “asset framing” narratives to read. These narratives present voucher recipients first as families who have strengths and goals and then discuss systemic barriers the families face trying to reach their aspirations.

They found that landlords who read these narratives were twice as likely to consider renting their properties to voucher recipients. This suggests that asset framing narratives – which challenges the negative perception that housing is an individual problem instead of a structural problem – might successfully encourage more landlord engagement in housing assistance programs.

By widening the availability of financial aid programs and making them known, housing advocates can help struggling families and individuals protect themselves from the experience of eviction and homelessness.

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