Frederick J. Zimmerman

Prior research demonstrates that local government spending on social policies, excluding health care, is linked to improved population health. Whether such spending is associated with better access to primary care and reduced acute care utilization remains unclear.

In this study, authors evaluated the associations between county-level social spending and individual-level health care utilization among low-income Medicare beneficiaries, aged ≥65 years, from 2016 to 2018. Authors linked claims data to 4 categories of county-level government expenditures from the U.S. Government Finance Database, including (1) public welfare, (2) public transit, (3) housing/community development, and (4) infrastructure-related social services. The main outcomes were annual primary care visit rates, emergency department visits, and preventable hospitalizations.

Findings: After adjusting for patient and county characteristics, beneficiaries living in counties with higher spending on housing/community development had 11% higher primary care visit rates. Additionally, those living in counties with higher public transit and housing/community development spending experienced 6%–10% lower preventable hospitalization rates. Lower preventable hospitalization rates were especially pronounced among acute conditions.

These findings suggest that investments in social services that address the health-related social needs of low-income older adults may be an important factor to consider in population-level efforts to reduce acute care utilization.
 

Shared equity homeownership — a model in which low- and moderate-income households purchase homes at affordable prices on the condition that the houses remain affordable upon resale — has been shown to produce several health-enhancing housing outcomes. These include permanent affordability, housing stability, and modest wealth-building.

However, studies suggest low- and moderate-income households may sacrifice neighborhood quality when becoming homeowners, which can undermine the health benefits of homeownership. To understand the health impacts of the shared equity homeownership model more fully, it is important to evaluate participants' neighborhood health trajectories — how their neighborhood health environments change when they move into homeownership — and how these trajectories compare to those of similar households entering traditional homeownership and those continuing to rent.

Authors conducted difference-in-differences analyses comparing changes in neighborhood health characteristics (walkability, food access, socio-economic vulnerability, and life expectancy) for U.S. households moving into shared equity homeownership between 1997 and 2017 compared to households moving into traditional homeownership and those continuing to rent. Shared equity homeowner data was obtained through the Grounded Solutions Network HomeKeeper National Data Hub and households from the Panel Study of Income Dynamics served as matched controls for the analysis. All data on neighborhood characteristics were obtained from publicly available, census tract-level datasets.

Findings: Compared to households entering traditional homeownership, households entering shared equity homeownership experienced a relative increase in walkability, increase in food access, increase in socio-economic vulnerability, and similar life expectancy. Compared to households moving between rental units, households entering shared equity homeownership experienced similar trajectories in terms of walkability and food access but experienced a relative increase in socio-economic vulnerability and decrease in average neighborhood life expectancy.
Households entering shared equity homeownership avoid the sacrifices in neighborhood walkability and food access that are associated with moving into traditional homeownership, but they experience increased neighborhood socio-economic vulnerability.

While understanding the net impact of these factors on individual and household health requires further study, these results can inform the siting and design of shared equity homeownership units to maximize the health benefits of the model.
 

Summary: This study examines the impact of gentrification exposure on hypertension and diabetes control. Using data from adults in low-socioeconomic status (SES) areas in 2014, the authors analyze the influence of gentrification occurring between 2015 and 2019 on disease control in 2019, while considering factors such as residential moves, race, ethnicity, and age. 

Findings: Results show that gentrification is associated with improved hypertension control, particularly for non-Hispanic whites and adults over 65. Gentrification is not associated with diabetes control overall, but control improved in the Hispanic subgroup. Disease control outcomes remain consistent across residential moves for the overall sample but vary by race and ethnicity. 

Gentrification may have a positive or neutral effect on cardiometabolic health, depending on the population subgroup. The study recommends collaboration between city leaders and health systems to ensure that neighborhood development aligns with the health needs of all residents and does not worsen health disparities.

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• Journal Article: Association of Neighborhood Gentrification and Residential Moves with Hypertension and Diabetes Control in Los Angeles County, 2014-2019: A retrospective Cohort Study

Summary: U.S. housing policy places a high priority on homeownership, providing large homeowner subsidies that are justified in part by homeownership’s purported health benefits. However, studies conducted before, during, and immediately after the 2007–2010 foreclosure crisis found that while homeownership is associated with better health-related outcomes for white households, that association is weaker or non-existent for African-American and Latinx households. It is not known whether those associations persist in the period since the foreclosure crisis changed the US homeownership landscape.

Authors examine the relationship between homeownership and health and whether that relationship differs by race/ethnicity in the period since the foreclosure crisis.

Authors conducted a cross-sectional analysis of 8 waves (2011–2018) of the California Health Interview Survey. They included all US citizen respondents ages 18 and older. The primary predictor variable was housing tenure (homeownership or renting). The primary outcomes were self-rated health, psychological distress, number of health conditions, and delays in receiving necessary medical care and/or medications.

Findings: Compared to renting, homeownership is associated with lower rates of reporting fair or poor health, fewer health conditions, and fewer delays in receiving medical care and medication for the overall study population. Overall, race/ethnicity was not a significant moderator of these associations in the post-crisis period.

Homeownership has the potential to provide significant health-related benefits to minoritized communities, but this potential may be threatened by practices of racial exclusion and predatory inclusion. Further study is needed to elucidate health-promoting mechanisms within homeownership as well as potential harms of specific homeownership-promoting policies to develop healthier, more equitable housing policy.

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• Journal Article: The Relationship Between Homeownership and Health by Race/Ethnicity Since the Foreclosure Crisis: California Health Interview Survey 2011-2018