The Power of Place
Housing relocation programs aim to address health inequities linked to decades of discrimination.
In the 1995 landmark fair housing lawsuit Thompson v. HUD, the American Civil Liberties Union argued that the U.S. Department of Housing and Urban Development violated the Fair Housing Act of 1968 by concentrating Black public housing residents in poor, segregated areas of Baltimore City.
As part of the case settlement, finalized in 2012, the Baltimore Regional Housing Partnership (BRHP) has helped more than 5,200 households move with a housing voucher from public housing and areas of poverty to affordable housing in less poor neighborhoods.
“Housing mobility programs are designed to address a long history of racial discrimination, and it is increasingly clear that they have a substantial public health benefit,” says Craig Pollack, MD, MHS, MSc, associate professor in Health Policy and Management and the inaugural chair of the Katey Ayers Endowed Professorship in the School of Nursing.
For nearly five years, Pollack and his colleagues have been following a cohort of children with asthma who participated in the BRHP to track their asthma symptoms and allergen exposures.
“Most programs focus on remediating specific triggers, for example, through air purifiers and extermination. This is incredibly challenging in Baltimore’s row homes,” says Corinne Keet, MD, PhD ’14, MS, associate professor of Pediatrics in the School of Medicine and co-principal investigator on the project. “Housing mobility dramatically changes the allergens that children are exposed to and the level of stress that kids experience,” says Keet, who holds a joint appointment in Epidemiology.
Other studies underscore the link between housing mobility programs and health.
Starting in 1994, the Moving to Opportunity study recruited families living in Baltimore public housing in high-poverty neighborhoods and followed them for 21 years. Based on the families’ Medicaid and hospital records, Pollack and other Hopkins researchers showed that children whose families received vouchers and moved to less poor neighborhoods were less likely to be hospitalized and had lower hospital spending.
Other analyses of Moving to Opportunity found that children who moved tended to have higher earnings and were more likely to attend college—findings that have led to new investments in housing mobility programs. In 2019, based on the economic benefits and with bipartisan support, Congress allocated $50 million to start a new housing mobility demonstration program.
Pollack, who also consults for HUD, believes that a better understanding of the intersection of housing and health should inform the work of both health care providers and government agencies. “Coming up with creative ways to address issues of housing insecurity and its neighborhood context can have broad impacts—especially for children.”