When it comes to health and wellness, we are learning that your Zip code is at least as important as your genetic code. Differences between neighborhoods in access to education, transportation, open space, food, etc. lead to differences in health outcomes including life expectancy. And since we can’t do anything to change the genetic code (at least not much), efforts at improving the social determinants of health are a reasonable target for reducing health disparities.
One market-based approach has been the use of housing vouchers. Providing rental subsidies for low-income families should allow them to move to neighborhoods with more resources. Such relocations have been shown to provide long-term benefits to children. Unfortunately, important barriers remain according to a new study from the Center on Budget and Policy Priorities, reported in the Washington Post. In nearly all the 50 largest US metro areas, families with housing vouchers were located primarily in low-opportunity neighborhoods, despite enough affordable housing in higher-opportunity areas. Overall, while 18% of all voucher-affordable rentals were located in high-opportunity neighborhoods, only 5% of families with vouchers lived in those areas. Moreover, minority families with vouchers are more likely to live in concentrated minority neighborhoods, even though most of the affordable housing units are located in more mixed neighborhoods. In most of the metro areas studied, this racial gap was on top of the income gap.
In other words, money does not equate to access. This is not dissimilar to health care: while Medicaid has markedly improved health insurance coverage for low-income children, many have trouble accessing health care due to a paucity of medical facilities in urban neighborhoods, among other factors. The research on housing vouchers does not elucidate the barriers, but several possible causes stand out, including historical patterns of racist housing policies, and local policies that do not tie the value of the voucher to local markets.
For the Twin Cities metro, there is a little bit of good news. We have among the highest percentage of low-income families living in high-opportunity neighborhoods (17%, 5th of 50 metro areas), one of the lowest percentages of voucher families of color living in minority-concentrated neighborhoods (50%, 7th lowest of 50), and a smaller than average gap between voucher-affordable housing available in higher-opportunity neighborhoods and the actual use of such housing.
Nevertheless, as cities face an increasing problem with affordable housing, we need to be aware that, as is so often the case, the market is a useful but imperfect tool, especially for eradicating ingrained disparities. It’s almost as if inequity is in our genes.