In November 2015, we released a report examining the first five grantees in Boston, Chicago, New Orleans, San Francisco, and Seattle taking part in the US Department of Housing and Urban Development’s Choice Neighborhoods Initiative (Choice).This post is the first in a two-part series examining the well-being of residents living in these five Choice Neighborhoods. Background on Choice and our recently released report is available here.

People living in public and assisted housing tend to have poor health, for varied and interconnected reasons. Poor housing conditions and a lack of access to affordable medical care can cause or exacerbate physical health problems; neighborhood-level risk factors like crime and pollution can lead to chronic stress and mental health conditions. What’s more, 52 percent of public housing residents are elderly or people with disabilities, and therefore more vulnerable to health complications.

The severity and consequences of health problems for people in public housing were laid bare in a series of studies tracking the outcomes of the Department of Housing and Urban Development’s HOPE VI program, which redeveloped more than 250 distressed public housing developments into mixed-income communities. Urban Institute researchers tracked the health status of residents in select sites over five years. At baseline, residents were in far worse health than other low-income households, and after relocation, residents faced high rates of mortality. Even though HOPE VI improved housing quality, for example by abating mold and improving heating and cooling, such improvements were often not enough to improve residents’ health after they moved into the redeveloped units.

Enter HUD’s Choice Neighborhoods program, which replaces and expands on HOPE VI. Choice, launched in 2010, builds on lessons learned from HOPE VI by investing not only in affordable housing and services but also in the surrounding neighborhood. Choice also aims explicitly to support and improve resident health, which our recent brief shows could be a tough task.

As part of a study on the first five implementation sites for Choice Neighborhoods, Urban Institute fielded a baseline survey of residents living in the target developments and surrounding neighborhoods. Our brief on the baseline survey data we found striking similarities in the health conditions of Choice residents and HOPE VI residents.

A familiar picture of resident health

At baseline, residents of both the target developments and their surrounding neighborhoods report high rates of chronic health problems. In the three public housing sites (New Orleans, San Francisco, and Seattle) and in Chicago’ project-based Section 8 site incidences of chronic illness were comparable to or higher than the rate in the HOPE VI Panel Study (39 percent).

Like we found with HOPE VI, the Choice Neighborhoods survey shows health conditions are severely debilitating. Health issues are significant barriers to employment and training for working-age adults (18–62) living in both target developments and surrounding neighborhoods. More than 40 percent of unemployed, working-age respondents in the three public housing communities say they were not working because they have a short- or long-term disability.

What Choice Neighborhoods can do

Current Choice Neighborhoods should carefully monitor the health and well-being of residents and provide targeted supportive services before, during, and after the relocation. This is especially important for the most vulnerable: the elderly and people with physical or mental health disabilities. Relocating is highly stressful and even relatively minor relocations, such as when residents move to different on-site locations while units are redeveloped, can exacerbate existing health conditions.

Future Choice Neighborhoods should leverage the HUD investments they receive for additional funding and services from other local, state, and federal resources. HUD funding, which is primarily a housing investment, is likely insufficient to meet the health needs of residents. A comprehensive intervention—supportive services during and after relocation, improved housing units, a built environment that promotes health and walkability, increased public safety and improved health amenities—will be necessary to improve the health of residents who have serious, chronic health problems.

Will Choice Neighborhoods improve resident health? We don’t know yet. But based on our evidence from HOPE VI and the Choice Neighborhoods baselines survey, we should anticipate that the people living in public and assisted housing will need a comprehensive health approach.