Housing Markets and Health Outcomes

TitleHousing Markets and Health Outcomes
Publication TypeThesis
Year of Publication2023
AuthorsSportiche, N
Academic DepartmentHealth Policy
UniversityHarvard University
CityCambridge, MA

This dissertation consists of three chapters on the relationship between housing markets
and health outcomes.
Chapter 1. Can Fair Share Policies Expand Neighborhood Choice? Evidence from Bypassing Exclusionary Zoning under Massachusetts Chapter 40B
Opening up neighborhoods that offer greater opportunities for social mobility to low-and
moderate-income households remains a challenge in the United States. Exclusionary zoning
practices act as a barrier to current efforts by restricting the supply of affordable housing. In
this paper, we examine whether fair share policies which seek to bypass these restrictive zoning practices offer a potential solution. Focusing on Massachusetts Chapter 40B, we find clear
evidence that such policies expand the types of neighborhoods currently available to low- and
moderate-income households. Leveraging novel data on 40B development addresses linked to
a wide range of public and administrative records, we find that 40B housing is located in neighborhoods with greater economic mobility, better schools, greater social capital, less pollution,
better health outcomes, and lower incarceration rates than both the typical Massachusetts resident and to the beneficiaries of the state’s Low-Income Housing Tax Credit, Housing Choice
Voucher, and Public Housing programs. Consistent with previous research on policies that
have segregated affordable housing and opportunity, we also find that 40B neighborhoods are
substantially whiter and wealthier than both types of comparison areas. Differences between
40B neighborhoods and those with other program beneficiaries – which are on the order of 1
to 2 standard deviations – are striking large. An examination of underlying policy mechanisms
suggests that bypassing exclusionary zoning plays a central role in explaining these differences
in neighborhood conditions.
Chapter 2. Early-Life Impacts of Affordable Housing in High-Income Areas: Evidence
from Massachusetts Chapter 40B
Desegregation-focused housing policies aimed at reducing disparities in neighborhood
conditions may also reduce disparities in health outcomes. This paper examines the effects
of one such policy on the health of pregnant people and their newborn infants. Specifically,
I study the impact of Massachusetts Chapter 40B, a major civil rights-era housing policy that
increases the supply of affordable ownership and rental housing in higher-income areas to facilitate moves for lower-income households to those areas. Using a difference-in-differences
approach that compares the health outcomes of birthing parents who move to 40B housing
to those of demographically-matched birthing parents who move from similar origin neighborhoods, I find that moving to 40B housing produces meaningful improvements in birth outcomes
and some gains in birthing parents’ health only among 40B renters. I find no evidence of health
effects among 40B owners. Among renters, improvements in birth outcomes are largest among
Black beneficiaries, and are driven largely by people moving from neighborhoods with higher
levels of poverty, more Black residents, and higher male incarceration rates. These results
suggest that desegregation-focused housing policies like 40B could help improve racial and
economic disparities in early-life health among certain populations.
Chapter 3. Economic Crises and Mental Health: Effects of the Great Recession on Older
We examine the effect of the Great Recession of 2007-2009 on the mental health of older
adults, using longitudinal Health and Retirement Study data linked to area-level data on house
prices. We use a variety of measures to capture mental health and rely on the very large crosssectional variation in falling house prices to identify the impact of the Great Recession on those
outcomes. We also account for people who moved in response to falling prices by fixing each
person’s location immediately prior to the house price collapse. Our central finding is that the
Great Recession had heterogeneous effects on health. While mental health was not affected for
the average older adult, mental health declined among homeowners with few financial assets,
who were therefore more vulnerable to falling house prices. Importantly, health impacts in this
group differed by race and ethnicity: depression and functional limitations worsened among
Black and other non-white homeowners and medication use increased among white homeowners. There were no measurable impacts for Hispanic homeowners. These results highlight the
importance of examining heterogeneity across multiple dimensions when examining the health
impacts of economic conditions.

Citation Key13313