SAEGERT

Journal of Social Issues, Vol. 59, No. 3, 2003, pp. 569--589

Poverty, Housing Niches, and Healthin the United States

Susan Saegert∗City University of New York Graduate Center

Gary W. EvansCornell University

Drawing on psychological, health, and social science literature, a housing nichemodel is developed that focuses on (a) housing markets and other societal processesthat constrain residential choice, (b) effects of residential environments on healthand access to human and social capital, and (c) family dynamic effects on healthand the intergenerational consequences of particular housing niches for futurehealth and housing choices. The model requires the examination of cumulativerisks, mediating and moderating processes, and the use of multilevel statisticalmodels. The health consequences of existing housing policies are explored andfuture directions for research and policy suggested.

Even as the life expectancy of U.S. residents reaches new highs, death comesmuch earlier to residents of some neighborhoods, for example, Harlem in NewYork City (McCord & Freeman, 1990). Harlem’s residents are mostly poor andlargely African American. Numerous studies demonstrate that both lowersocioeconomic and minority status are strongly related to worse health and ear-lier death (Aday, 1994; Adler et al., 1994; Geronimus, Bound, & Waidmann,

∗Correspondence concerning this article should be addressed to Susan Saegert, Environmen-tal Psychology, CUNY Graduate Center, 365 Fifth Ave., New York, New York, 10016 [e-mail:[email protected]].

We appreciate Terry Hartig’s and Gary Winkel’s critical feedback on this article. Preparation ofthis article was partially supported by a CUNY Collaborative Incentive Grant, the Edna McConnellClark Foundation Program for New York Neighborhoods, the John D. and Catherine T. MacArthurFoundation Network on Socioeconomic Status and Health, the Bronfenbrenner Center for the Study ofthe Life Course, Cornell University, and the National Institute for Child Health and Human Development(1 F33 HD08473-01).

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1999; Syme, 1994; Williams & Collins, 1995). Yet the higher mortality levelsreported in Harlem exceed those for poor African Americans in other environ-ments. Researchers are just beginning to examine the extent to whichthe concentration of poor and minority households in certain environmentscontributes to the health consequences of socioeconomic and minority status(Ellen, Mijanovich, & Dillman, 2001; Evans & Kantrowitz, 2002; Geronimuset al., 1999). This topic is particularly important since the spatial concentra-tion of poor, and especially poor minority, households has increased over thelast several decades (Jargowsky, 1997; Massey & Denton, 1993; Wilson,1987).

In this article we develop a conceptual model of housing niches that re-lates health to housing and neighborhood conditions, social dynamics in thefamily and community, and overarching societal structures and processes. Thepurpose of this model is to shed light on the processes that underlie social in-equalities in health and to understand their implications for policies designed toreduce these inequalities. In developing the model, we observe that (a) hous-ing markets, income distribution, and other societal processes constrain residen-tial choice; (b) environmental threats and assets in particular locations directlyand indirectly affect health; and (c) opportunities and constraints in those lo-cations also influence the residential choices and health of subsequent genera-tions. This model emphasizes structural and policy determinants that establishthe context within which people perceive choices related to residence and eval-uate the threats and opportunities in their residential environment. Once house-holds occupy particular housing niches, exposure to environmental threats andthe psychosocial benefits of resources available in the housing niche have conse-quences for health. Within this model, psychological stress independently affectshealth and well-being, beyond the health effects of specific threats and resources.In addition, the consequences of individual stress for family dynamics can ex-acerbate stress experienced by other family members and so further underminehealth.

In the following we first develop the housing niche model, describing thesocial production of housing niches; the effects of housing niches on health;cumulative, mediated, moderated, and multilevel risks in housing niches; andthe life trajectories of individuals and housing niches. We then discuss publicpolicy implications of the model. Although we emphasize the circumstances ofthose living in poverty as we proceed in our discussion, much of the literaturewe draw on reflects the fact that poverty is commonly confounded with raceand ethnicity. Numerous studies confirm the negative health consequences as-sociated with poverty for all populations and with minority status, especiallyAfrican Americans, across the socioeconomic status (SES) spectrum (Adler et al.,1994; Evans & English, in press; Geronimus et al., 1999; Williams & Collins,1995).

Poverty, Housing Niches, and Health 571

Housing Niches and Health

Two theoretical alternatives are usually posed to explain the differential spa-tial distribution of health (Ellen et al., 2001; Yen & Syme, 1999): Either people inworse health drift into certain areas, or particular places tend to breed ill health. Incontrast, an ecological approach directs attention to the multilevel social processesthat channel people to particular locations and also affect health (Bronfenbrenner& Morris, 1998). While personal choice and characteristics play a role in wherepeople live, housing markets and policies set the context in which choices can bemade. Subcultural and social network characteristics further affect the informationand resources available to individual households, and their perceived and actualaccess to particular housing and neighborhoods (Pendall, 2000; Popkin, Buron,Levy, & Cunningham, 2000; Turner, 1998; Varady & Walker, 2000). For exam-ple, in the United States, race and ethnicity powerfully affect access to housingmarkets (Massey & Denton, 1993). Once a household is located in a resource-richor resource-poor environment, exposure to the particular place has its own con-sequences (O’Connor, Tilly, & Bobo, 2001). Health and other consequences ofliving in a particular place in turn affect the assets that residents have for movingto better places (Ellen et al., 2001; Leventhal & Brooks-Gunn, 2000). Thus, inan ecological model, the correlation between residential environments and healthdevelops over time through processes of both selection and exposure to differ-entially health-promoting or -impairing conditions (Smith, Easterlow, Munro, &Turner, this issue). Resources, physical environmental characteristics, and socialprocesses shape each other in a dynamic relationship.

Social Production of Housing Niches

An ecological approach implies the existence of what we refer to here as“housing niches.” Housing niches are particular locations in the ecology of resi-dential settings that can be occupied by specific groups. For example, buying anapartment in the wealthiest section of Manhattan requires mobilizing high levelsof economic, social, and cultural resources. Adequate, moderately priced housingin areas more distant from the central city can be found through intense mobi-lization of social networks even if other resources are limited. Those with fewfinancial and social resources are usually left to find homes in negligently man-aged, lower priced housing, in neighborhoods characterized by disinvestment, orin worse cases, to become homeless. Population health varies enormously acrossthese different housing niches (Freudenberg, 2001).

The market-based provision of housing in the United States means that thekind of housing obtained is most dependent on the household’s accumulated wealthand disposable income. Poor households encounter problems related to both hous-ing quality and affordability. In 1995, 4.8 million U.S. households lived in housing


that was structurally inadequate or overcrowded. Low-income urban renters en-countered the highest number of deficits (Joint Center for Housing Studies, 1999).Such households find it increasingly difficult to access better quality housing.Housing costs for those in the bottom income quartile rose by 4.5% between1995 and 1997 (Joint Center for Housing Studies, 1999). During the same period,incomes of renters in the lowest income quartile dropped by 2.9%. Production andavailability of low-income units have also dropped. Compounding this problem,existing housing subsidy programs are expiring and many landlords are optingout (Dolbeare, 1999; Joint Center for Housing Studies, 1999; U.S. Department ofHousing and Urban Development, 1999). Accordingly, the number of poor renterswithout housing assistance is at an all-time high; for some, housing costs exceedminimum wage levels by a factor of two or more. Not all can manage the cost. In thelate 1990s, 5 to 10% of poor households experienced homelessness (Burt, 2002).

Racial segregation poses structural barriers to equal access to health-supportingresidential environments. Several studies show that African Americans are sortedinto housing niches characterized by both physical and social health hazards.Greenberg and Schneider (1994) found that residence in urban areas with haz-ardous land uses mediated an apparent association of violent deaths with race.LaViest (1989) documented higher Black infant mortality in more segregated com-munities that also had higher housing costs and lower wages for Blacks. Moreover,the housing stock in Black areas was older, and those neighborhoods were lesswell served by public services ranging from sanitation to health care. Disrespectamong groups, especially of Blacks by Whites, income inequality, and residentialsegregation have all been found to undermine the health of low-income, minoritypopulations (James, Schulz, & van Olphen, 2001; Kawachi, Kennedy, Lochner, &Prothrow-Stith, 1997; Subramanian, Kawachi, & Kennedy, 2001).

Wallace and Wallace (1998) trace the development of particularly disadvan-taged housing niches in the South Bronx and Harlem. Economic declines andout-migration of wealthier, Whiter populations in parts of New York City werefollowed by institutional disinvestment leading to social fragmentation and hous-ing insecurity for those who remained. As living circumstances got worse, theremaining resource-poor inhabitants were also most susceptible to homelessness,substance abuse, and violent crime. The fragmented social ties and deterioratedphysical conditions of these communities, combined with few public services,were a favorable climate for AIDS and drug-resistant tuberculosis to take root.

In most of the research described thus far, weak social integration and lowlevels of social capital are correlated with hazardous residential environments andpoor health. However, social capital itself is a factor that can affect access to partic-ular housing niches, and which can be mobilized to improve environmental qualityin these niches. Social capital is defined as a property of groups that facilitates theachievement of goals. It inheres in relationships characterized by trust, reciprocity,communication, shared norms, and consequences for norm violation (Coleman,1988; Putnam, 1995; Warren, Thompson, & Saegert, 2001).


Finding a better place to live is a goal often achieved through the mobilizationof social capital. For poor, minority, and immigrant households, the social groupswithin which they are embedded provide few resources of information, experience,contacts, or available financial capital for achieving this goal (Ratner, 1996). Oliverand Shapiro (1995) have argued that public policies and discriminatory institutionalpractices have worked against African American home ownership. Thus AfricanAmericans are often deprived of the major asset passed down across generations,the family home. Linguistic and cultural isolation of Latinos and Asians has alsoblocked access to home ownership (Listokin & Listokin, 2001; Ratner, 1996).However, some immigrant groups have used the strong norms, trust, reciprocity,and interdependence of their networks to accumulate financial capital to investin home ownership (Ratner, 1996). In other cases, ethnically defined communityadvocacy groups help members of the community obtain information, advice, andcredit to achieve home ownership (Listokin & Listokin, 2001).

Social capital within poor, minority communities can also be organized to im-prove existing housing and neighborhood environments. For example, mobilizationof social capital among residents of very low-income, inner-city neighborhoodscontributes to perceived housing quality (Saegert & Winkel, 1998) and less crimeas measured by police records (Saegert, Winkel, & Swartz, 2002). Social capitalalso has played a critical role in the decision of residents of polluted industrialneighborhoods to take actions to improve air quality (Wakefield, Eliott, Cole, &Eyles, 2001). The development of social capital that links residents to communityorganizations, and these organizations to institutions and their resources, improveshousing in poor communities and increases the supply of high-quality residentialenvironments (Keyes, 2001).

Thus economic capital and social capital have many functions. Their unequaldistribution contributes to the sorting of those with fewer resources into worsehousing niches. Institutional practices are enmeshed in the distribution of theseforms of capital and are critical in either routinizing this cycle of inequality or infinding ways out. Disadvantaged households, voluntary associations, and advocacygroups often try to use each form of capital to leverage others to improve accessto and the quality of residential environments.

Housing Niches’ Effects on Health

Housing niches may contribute to health inequities through a variety of paths,including exposure to environmental toxins and nuisances, accident risks, andviolence; the psychosocial dynamics of racism; access to environmental amenities;and levels of perceived control over life. These paths may exist on different levels,such as the physical housing unit and the neighborhood.

Despite relatively high housing standards, housing is receiving renewed at-tention in public health circles in the United States. Housing characteristics as-sociated with health problems include dampness, pests, a lack of safe drinking


water, a lack of hot water for washing, and inadequate food storage (Matte &Jacobs, 2000). Poorly built or poorly maintained housing contributes to accidents,fires, respiratory disease, and lead poisoning (Matte & Jacobs, 2000; Sharfstein& Sandel, 1998; Warner, Barnes, & Fingerhut, 2000), as well as poor mentalhealth (Evans, Wells, & Moch, this issue). Poor ventilation increases the risk ofasthma and bronchial infections (Institute of Medicine, 2000; Oie, Nafstad, Botten,Magnus, & Jaakkola, 1999). The design and maintenance of windows, roofs, andbalconies contribute to falls (American Academy of Pediatrics, 2001). Noisierhousing can affect physiological stress (Evans, 2001) and has well-documentedadverse impacts on reading acquisition in children (Evans & Lepore, 1993).

Many residential neighborhood characteristics can influence health. Crimeand safety problems in neighborhoods contribute to injuries and death (Sampson,Raudenbush, & Earls, 1997) and impede physical exercise, thus increasing riskof poor health from many causes (Weinstein, Feigley, Pullen, Mann, & Redman,1996). The siting of public parks, transportation policies, and other urban de-sign decisions also influence access to opportunities for exercise (Brownson,Baker, Housemann, Brennan, & Bacak, 2001) and opportunities for psychologi-cally restorative experiences (Hartig, Evans, Jamner, Davis, & Garling, in press).Although the epidemiological path is less clear, studies have also shown asso-ciations between residence in neighborhoods with deteriorated and abandonedhousing and gonorrhea (Cohen et al., 2000).

Disadvantaged populations occupy housing niches in which relatively highlevels of exposure to health risks and low levels of access to environmental ameni-ties can be seen at both the housing and neighborhood scale. Twenty percent oflow-income American families have substandard housing according to U.S. Cen-sus criteria, as compared to 7% of those above the poverty line (Sherman, 1994).Low-income families in the United States are significantly more likely to havehousing with inadequate plumbing systems, no central heating, and various struc-tural defects (Mayer, 1997). Their homes are more crowded (Myers, Baer, & Choi,1996) and they are exposed to greater levels of community noise (U.S. Environ-mental Protection Agency, 1977). American children in low-income homes havegreater exposure to allergens linked to asthma (Krieger, Song, Takaro, & Stout,2000; Sarpong, Hamilton, Eggelston, & Adkinson, 1996). At the extreme, manylow-income children are homeless, with seriously negative consequences for theirhealth (Wood, Valdez, Hayashi, & Shen, 1990). Parallel results for socioeconomicstatus and housing quality have been shown in the United Kingdom (Townsend,1979) and several Third World nations (Bartlett, 1999; Garza, 1996; Stephens et al.,1997).

Air quality in low-income and minority neighborhoods in the United States ispoorer (Brajer & Hall, 1992; Freeman, 1972), and disadvantaged families are sig-nificantly more likely to live near a hazardous waste source (Bullard, 1990; Mohai& Bryant, 1992; White, 1998). African American children living in inner-city areascarry a substantially higher body burden of lead (U.S. Environmental Protection


Agency, 1992). Low-income, ethnic minority adults and their children are exposedmore often to dangerous pesticides from multiple sources (Moses et al., 1993).Low-income neighborhoods are more hazardous for both children and adults. Dis-advantaged children confront more dangerous street traffic (Macpherson, Roberts,& Pless, 1998) and more hazardous playgrounds (Suecoff, Avner, Chou, & Drain,1999) than their more affluent counterparts.

Low social capital, which is more common in poor, minority neighborhoodsand among renters, also contributes to poorer residential environments (Rohe &Stewart, 1996). As noted above, socially fragmented low-income, minority neigh-borhoods have poorer municipal services (e.g., access to medical care, police andfire protection, sanitation; Wallace & Wallace, 1998). Residents of low-incomeneighborhoods also have poorer mass transit and are less likely to own a car(Macintyre, Maciver, & Sooman, 1993). Their neighborhoods have fewer retailstores and services (e.g., laundry and dry cleaning; Macintyre et al., 1993) and aremore apt to contain abandoned buildings and vacant lots (Joint Center for HousingStudies, 1999; Wandersman & Nation, 1998).

Low-income areas may not only have less social capital, they may also havepoorer prospects for the development of social capital. Residential stability isstrongly tied to income, with low-income families five times more likely to moveinvoluntarily (Federman et al., 1996). Consequently, not only do low-income fam-ilies themselves move more often, they live in neighborhoods with greater res-idential instability (Leventhal & Brooks-Gunn, 2000). It is not surprising thenthat poorer children experience greater instability in their peer relationships dur-ing childhood in comparison to middle- and upper-class children (Dodge, Pettit, &Bates, 1994). Also, they experience greater turnover in classmates at school (Rutteret al., 1974). Residential stability is also related to neighborhood homicide rates(Sampson et al., 1997). High crime rates and gang activity in urban low-income ar-eas impede community life, further weakening the development and maintenanceof social capital (Sampson et al., 1997).

Cumulative, Mediated, Moderated, and Multilevel Risks in Housing Niches

One goal of the housing niche model is to better understand the ways that psy-chological, social, and physical environmental factors contribute to health withina particular housing niche. Given adequate measurement, different conceptual andmethodological approaches can illuminate the confluence of these factors. Theseinclude the use of cumulative risk models that combine risk factors from multipledomains, mediation models that examine processes that link particular conditionsto outcomes, and moderation models that look at the interactions of individualcharacteristics and housing or neighborhood conditions, as well as interactionsbetween housing and neighborhood factors.

An ecological model of housing and health emphasizes the covariation ofenvironmental and social forces impinging on families. Rather than focusing on


single risk factors associated with the geography of poverty and minority status,an alternative strategy is to examine the accumulation of risk factors. Not onlydo disadvantaged individuals face higher levels of pollution, crowding, inade-quate housing, and neighborhoods with inadequate infrastructure, but also theyfrequently experience these social and environmental demands in concert. Forexample, low-income and minority children experience more severe and highernumbers of stressful life events and hassles than their more advantaged counter-parts (Attar, Guera, & Toaln, 1994; Brown, Cowen, Hightower, & Lotyszewski,1986; Dubow, Tisak, Causey, Hryshko, & Reid, 1991). Low-income families bothin Britain (Rutter et al., 1974) and in the United States face a greater array of riskfactors in their homes and neighborhoods (Evans & English, in press; Liaw &Brooks-Gunn, 1994; O’Campo, Gielen, Royalty, & Wilson, 2000; Repetti, Taylor,& Seeman, in press). Chronic exposure to a high level of largely intractable de-mands is a major risk factor for both psychological and physical morbidity (Lepore,1995).

Evidence increasingly shows that cumulative risk is more potent in accountingfor both psychological and physical morbidity than singular risk factors (Rutter,1981; Sameroff, 1998; Taylor, Repetti, & Seeman, 1997; Werner & Smith, 1982).Adults and children can often cope reasonably well with one or two adaptive chal-lenges, even if severe. However, when the pressure of multiple demands begins toaccumulate, the system is more likely to be worn down (McEwen, 1998; McEwen& Seeman, 1999).

Evidence suggests, also, that some of the well-known socioeconomic gra-dients in physical and mental health (Aber, Bennett, Conley, & Li, 1997; Adleret al., 1994; Chen, Matthews, & Boyce, in press; Duncan & Brooks-Gunn, 1997;Luthar, 1999; McLoyd, 1998) can be accounted for, at least in part, by incomeand class differentials in cumulative risk exposure. Here we can see the value ofmediational models for elaborating the influences of housing niches on health. Forexample, elevated physiological stress and psychological distress in low-incomerural elementary school children relative to middle-income children were largelymediated by cumulative exposure to multiple physical (e.g., poor housing quality)and psychosocial (e.g., family turmoil) stressors (Evans & English, in press). Low-income children relative to middle-class children residing in rural areas experiencemore crowding, noise, and inadequate housing in conjunction with elevated levelsof family turmoil, family separation, and exposure to violence. The greater theaccumulation of these multiple stressors, the stronger the adverse psychologicaland physiological consequences. Rutter (1981) demonstrated that combined risksat home and school substantially increased the likelihood of childhood pathologyrelative to risk in only one domain. He showed also that combined risk occurredmore often among low SES families than in working-class families.

Thus, disadvantaged families living in inadequate housing situated in neigh-borhoods lacking social capital and basic infrastructure are situated in an ecology


of cumulative risk. In addition, the cost of housing itself exposes poor householdsto unhealthy living conditions such as poor nutrition. It depletes financial resourcesfor health care and other forms of preventing and coping with disease. Housing isone of the largest expenditures in the budgets of low-income people (Edin & Lein,1997; Stone, 1993). The poor pay so much of their incomes for housing that theymust scrimp on other household needs.

Since the housing niche concept presumes the interdependence of people andenvironments, it suggests that characteristics of residents and of the residentialenvironment may moderate the relationships described above. Any genetic weak-nesses among poor populations may be more likely to express themselves in eitherpoor health or health-endangering lifestyles because the residential environmentprovides an eliciting context for damaging genetic predispositions (Rutter, 1997).Deteriorated or polluted environments can lead to worse mental health for peoplewho have other strains and stressful events in their lives, even when less taxed res-idents remain unaffected by the environment (Caspi, Bolger, & Eckenrode, 1987;Evans, Jacobs, Dooley, & Catalano, 1987).

Multilevel models are often the most appropriate way to examine interactionsbetween household, building, or neighborhood context and personal characteris-tics. The development of Hierarchical Linear Modeling (HLM) and other multilevelstatistical approaches has increased our ability to parse out the variance attributableto lower levels of analysis, for example, the individual, versus that attributable tohigher levels such as neighborhoods. For example, a study of African Americanwomen found that the interaction between aggregate-level community characteris-tics and individual psychological processes explained why some women prosperedor suffered more in particular community contexts (Cutrona, Russell, Hessling,Brown, & Murry, 2000). By employing multilevel models, the authors were able toovercome the bias created by the lack of independence of individual measures andthe larger units into which they are aggregated. They could demonstrate that whileaggregate-level ratings of neighborhood conditions were significantly related toindividual residents’ levels of distress, individual-level risk factors moderated therelationship.

Life Trajectories of Individuals and Housing Niches

Understanding housing niches and their effects on individuals and householdsrequires an examination of the mutual determination of housing niches, individ-ual opportunities, and health. How does residing in resource-rich housing envi-ronments, or the opposite, position residents to improve their life circumstances,including health and housing? How does good or poor health affect access to health-promoting environments? This perspective has implications for understanding theintergenerational transmission of both health and residential options. Householdswho live in safe, friendly neighborhoods with good housing, schools, services,


and amenities would be expected over time to increase their access to resourcesand choices by employing the human and social capital they accumulate in suchcircumstances. Resource-poor residents located in places with poor housing, poorschools and services, and socially fragmented neighborhoods would be likely toexperience ill health, lower levels of education and occupational attainment, and,over time, less access to resources and choices (Braconi, Louch, & Morse, 2000;Easterlow, Smith, & Mallinson, 2000).

Children growing up in these different environments are directly affected notonly by living conditions, but also by the obstacles or supports in the environ-ment for effective parenting (Leventhal & Brooks-Gunn, 2000). Parents in theseconditions may be less able to promote healthy development for their children.Coping processes that both parents and children develop may protect them fromthreats, for example, limiting social relationships and exploration in dangerousenvironments. But these forms of coping may also have negative consequences forsocial ties and access to better housing environments and opportunities (Brooks-Gunn, Duncan, & Aber, 1997; Greenberg, Lengua, Coie, & Pinderhughes, 1999;Klebanov, Brooks-Gunn, Chase-Landsdale, & Gordon, 1997).

The weathering hypothesis (Geronimus, 1992) addresses the intergenerationalimplications of high levels of cumulative disadvantage among African Americanwomen. While Geronimus focuses on birth outcomes, her argument has implica-tions for housing niche mobility as well. She documents that African Americanteen mothers have healthier babies than older African American women. She spec-ulates that better birth outcomes may motivate teen pregnancies. She reasons thatfirst, African American women’s health deteriorates faster and further than thehealth of White women; second, young mothers and their support networks arebetter able to cope with teens’ babies; third, grandmothers of teens’ babies aremore physically capable of providing assistance; fourth, when daughters completechildbearing earlier, they are freer to help their mothers with the problems of aging.Support for the weathering hypothesis comes from an ethnographic study of thelives of mothers in Harlem. Mullings and Wali (2001) trace how environmental de-privations and social burdens associated with poverty undermine the physical andmental health of African American women from a wide range of socioeconomiccircumstances and across the life span. Even the admirable norm among AfricanAmericans, to “give back” to their communities if their fortunes improve, exacts acost in this ecology of cumulative risk. Housing niche mobility across generationsis impeded by weathering itself, the interruption of education for childbearing, andthe strong intergenerational interdependence fostered by inadequate incomes andnonfamilial sources of support.

The weathering hypothesis emphasizes not only the social structural con-text that constrains the choices of African American women, but also the criticalroles of stress and risk behaviors within this set of constraints. The burden of cu-mulative risk and accumulated health problems may translate into less adequate


parenting, which may itself further undermine their children’s development. Stud-ies of African American and Latino mothers and children in New York City publichousing revealed that children’s reactions to two socioenvironmental stressors de-pended on their relationships with parents, and family dynamics more generally.Evans and Saegert (1999) demonstrated the critical role of parenting in deter-mining children’s vulnerability to psychological distress in the face of residentialcrowding. We found that children experienced more psychological distress andmore physiological stress under conditions of crowding and family turmoil. How-ever, when parents were able to avoid harsh treatment of children in these stressfulconditions, children did better. Similarly, Krenichyn, Saegert, and Evans (2001)found that while exposure to community violence took a very large toll on the men-tal health, physiological functioning, and social development of children in NewYork City’s public housing, parenting moderated these effects. Children exposedto both harsh parenting and community violence fared worse than those experienc-ing only one of those threats. Further, children exposed to violence in the contextof supportive parenting developed the highest level of self-reported competencein the sample. These studies suggest that when parents’ behavioral adaptationsto stressful environments affect children’s experience of stress, the ground maybe laid for the intergenerational transmission of disadvantage by interfering withhealthy development, thus making it more difficult for the next generation to findits way out of poor housing niches.

Public Policy and Housing Niches

The housing niche concept builds on Link and Phelan’s (1995) argument that tounderstand the relationship between poverty and health we need to contextualizerisk factors—that is, attempt to understand how people come to be exposed toindividually based risk factors such as poor diet, cholesterol, lack of exercise,or high blood pressure, and to view the social conditions that contribute to riskexposure as themselves fundamental causes of disease:

A fundamental cause involves access to resources. . . that help individuals avoid diseases andtheir negative consequences through a variety of mechanisms. Thus even if one effectivelymodifies intervening mechanisms or eradicates some diseases, an association between afundamental cause and disease will reemerge. As such, fundamental causes can defy effortsto eliminate their effects when attempts to do so focus solely on the mechanisms that happento link them to disease in a particular situation. (Link & Phelan, 1995, p. 81)

We argue that the economic and social processes that channel the poor intoinadequate housing niches are fundamental social causes of ill health because theycascade into multiple specific mechanisms that undermine health and reinforcedifferential access to healthy and unhealthy niches. One implication of this positionis that even public policies aimed at improving either housing or health are likely


to fail if they do not fundamentally change the underlying economic and socialdynamics.

Public housing in the United States provides a good example of how impover-ished housing niches develop and become entrenched (Newman & Schnare, 1997;Spence, 1993). From Lee Rainwater’s (1970) account of “life in a federal slum”through Alex Kotlowitz’s (1991) aptly titled book, There Are No Children Here,the dominant image of U.S. public housing is bleak. The National Commission onSeverely Distressed Public Housing (1992) concluded that the social isolation andinstitutional abandonment of public housing residents was an even greater prob-lem than the physical decay of public housing developments. Nationally, publichousing has been located in the most devastated neighborhoods and served themost destitute populations (Goering, Kamely, & Richardson, 1997; Newman &Schnare, 1997). Community violence has been a particularly dramatic problemfor public housing residents. In 1998, the U.S. Department of Housing and UrbanDevelopment (HUD) reported that an average of one gunshot-related homicide aday occurred in the 100 largest public housing authorities.

Recognition of the problems associated with public housing led to the creationof HUD’s Moving to Opportunities (MTO) Program. Implemented in Baltimore,Boston, Chicago, Los Angeles, and New York City, the MTO program relocatedpublic housing residents from areas of concentrated poverty into geographies ofgreater opportunity. Early evaluations reveal positive effects on the quality of lifeand the mental and physical health of public housing residents who were selected tomove and accepted this opportunity. Employing a randomized experimental design,MTO assigned families who volunteered to one of three conditions: (a) suburbanmovers, who were required to move to a suburban, low-poverty area and receivedassistance in finding housing; (b) free choice movers, who used their subsidies tofind housing without assistance; and (c) a control group who remained in publichousing. All were expected to pay no more than 30% of their income in rent.

Although evaluation methods and findings differed across cities, early resultspaint a fairly uniform picture of improvement in neighborhood quality for suburbanmovers. About 90% of suburban movers relocated to census tracts with less than10% poverty rates. About 75% of free choice movers went to tracts with povertyrates ranging from 10% to 39%. Most of the control group remained in tracts ofconcentrated poverty (over 40%). Evaluations from Boston, Chicago, and NewYork all found that both mover groups described their new neighborhoods asphysically better and safer (Katz, Kling, & Liebman, 2001; Leventhal & Brooks-Gunn, in press; Rosenbaum & Harris, 2001, 2002). The Chicago evaluation alsoassessed changes in housing conditions and found that while all movers reportedbetter housing conditions, those of suburban movers improved most. Housingcharacteristics that showed most improvement all had potential health and safetyimpacts: peeling paint, the presence of mice and rats, and problems with brokenlocks (Rosenbaum & Harris, 2002).


Comparisons of MTO baseline data with data gathered 2 to 3 years after mov-ing indicated improvements in the physical and mental health of parents and chil-dren. In Boston, both groups of movers reported improved health for the head of thehousehold. Children in the suburban group also experienced reductions in injury,asthma attacks, and victimization by crime (Katz et al., 2001). Chicago and NewYork mover households were much less frequently the victims of crime, includingreduced incidents of shooting, stabbing, and beating (Leventhal & Brooks-Gunn,in press; Rosenbaum & Harris, 2002). In New York, the physical and mental healthof both parents and children improved most for suburban movers and slightly forfree choice movers (Leventhal & Brooks-Gunn, in press). Parents in the NewYork experimental group reported less reliance on harsh parenting tactics afterthe move. Also in New York, both mover groups increased their levels of employ-ment, and the suburban movers improved the household’s overall level of economicresources.

Social capital is the one area in which findings are mixed regarding MTO.In Chicago, suburban movers reported the weakest neighborhood ties and moreisolation as a result of an absence of public transportation (Rosenbaum & Harris,2002). In New York, parental engagement with children’s school activities waslowest for the suburban movers although they participated more than nonmoversin school governance activities (Leventhal & Brooks-Gunn, in press). The impor-tance of social ties to public housing residents may be one reason that the majorityof MTO participants who were assigned to the experimental conditions did notactually move to wealthier, Whiter suburbs. These 52% had volunteered to par-ticipate in MTO but when they were chosen, they declined to move or failed tocomplete the move successfully (Goering et al., 1999). Those who did not take thetreatment, as well as those who did not participate in the study, are likely to havebeen embedded in stronger social networks.

When a program specifically attempts to overcome housing segregation byrace and class, the housing niches occupied by low-income and minority house-holds who choose to participate can significantly improve. But it is important totry to understand the social processes that helped the suburban movers gain accessto their new homes. The greater improvement of the suburban movers compared tothe free choice movers suggests that institutional assistance in overcoming hous-ing segregation does convey health benefits. This finding accords with the viewthat the cost of housing alone does not explain segregation by class and race intoless advantaged neighborhoods and worse housing. Discrimination and the limitedsocial capital of poor, minority households also figure in the problem.

The early results of the Moving to Opportunity Program suggest that it is pos-sible to find ways to equalize access to housing with consequent benefits for health.But deconcentration programs are expensive, do not reach many poor households,and do not always work (Pendall, 2000; Popkin et al., 2000; Turner, 1998; Varady &Walker, 2000). U.S. initiatives to increase home ownership among lower income,


minority, and female-headed households may also assist poor households in im-proving their housing niches. These changes in the provision and distribution ofhousing would have to reverse U.S. trends in the past two decades toward growinginequality in income and quality of life (Danziger & Gottschalk, 1994). Despitethe successes of federal programs to increase home ownership among minoritiesand immigrants, these groups still lag, with minority home ownership rates lessthan two thirds of those of Whites. Efforts to disperse recipients of housing assis-tance also have only partially succeeded, resulting in slightly better housing still inprimarily minority, low-income areas (Pendall, 2000; Popkin et al., 2000; Turner,1998; Varady & Walker, 2000).

The general broadening of the housing affordability gap (Dolbeare, 1999;Joint Center for Housing Studies, 1999; U.S. Department of Housing and UrbanDevelopment, 1999) may swamp the gains made by specific demonstration projectsand programs, thus contributing to greater health disparities. However, as Linkand Phelan (1995) point out, careful program planning, evaluation, and researchcan help us learn what puts people at risk for risk. If we truly seek to eliminatehealth disparities, their recommendations continue to be good advice: Programsshould give priority to interventions that affect multiple causes of ill health, whileregarding with skepticism interventions that focus on intervening mechanismswithout situating these in broader social and physical contexts (p. 89). Taxation,minimum wages, mortgage underwriting criteria, access to high-quality education,and discrimination (or its prohibition) in housing, work, and education are amongthe many policies and institutional practices that can increase or reduce inequalityin society. These policies and practices, perhaps as much as those directly relatedto health, are likely to affect social disparities in health. One of the major ways inwhich this occurs is through the sorting of the poor into disadvantageous housingniches that directly and indirectly threaten health.

Other articles in this issue suggest that public policy commitments to improvedhousing can benefit the health of populations. However, studies have shown thatlower SES is associated with poorer health even for those who are not at theextreme end of deprivation (Adler et al., 1994). Using the housing niche concept,it may be that even within SES groups, housing distribution systems translate smalldifferences in SES into significantly different residential ecologies.

Communities lower in social capital result in stronger gradients associatinglower status with poorer health (James et al., 2001), but social capital within poorcommunities can only go so far. Strong social ties, norms of trust and cooper-ation, and intergenerational closure can support physical and mental health andchild development. However, social capital has limited utility in connecting thesecommunities with more resources. For that to occur, poor households and com-munities must develop leaders, institutions, and organizations that make claimson the broader society (James et al., 2001; Saegert & Winkel, 1998; Warren et al.,2001). In addition, governmental programs and actions by mainstream financial


and social institutions must cease reinforcing, rather than reducing, the social andeconomic marginalization of poor communities and households (Duncan, 2001;Lopez & Stack, 2001). Public programs and institutional practices are needed thatsupport, rather than undermine, social and human capital and provide access tobetter housing, education, jobs, and opportunities.

Our housing niche model and the policy-related arguments based upon itsuggest the need for research on the following questions:

1. To what extent do poverty and racism lead to residence in environments thatexpose people to higher levels of environmental stressors and cumulative risks?To what extent do those exposures mediate health outcomes?

2. What multilevel social processes offset or magnify the negative consequencesof exposure to environmental stressors and risks?

3. How is access to housing environments mediated by the social and humancapital of poor people and by public policies?

Only longitudinal studies can determine the individual and intergenerationallife trajectories of residents in particular housing niches who vary in health, eco-nomic, and social status. The strengths families and social networks bring to over-coming ecological disadvantages also require study. These should include not justwell-studied factors such as personal resiliency and social support but also familydynamics and characteristics of social networks that not only resist damage butmove households and communities into more promising ecologies.

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SUSAN SAEGERT is Professor of Environmental Psychology and Director of theCenter for Human Environments (CHE) at the City University of New York Grad-uate Center. Her current research examines the linkages between urban housingand neighborhoods and health, and how community processes, especially thoserelated to social capital, contribute to better urban environments.


GARY W. EVANS is Professor of Design and Environmental Analysis, College ofHuman Ecology, Cornell University. He is an environmental and developmentalpsychologist primarily interested in the role of the physical environment in socioemotional development. Current research is focused on housing, noise, crowding,and the environment of poverty.

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