Health Equity: Tenant-Based Housing Voucher Programs

Tenant-based housing voucher programs help households with very low incomes afford safe and sanitary housing in the private market. Vouchers are tied to households rather than specific housing units, so that households can use vouchers to move to neighborhoods with greater opportunities. Tenant-based housing voucher programs pay a substantial portion of the rent, which leaves households with money to cover other needs.

Tenant-based housing voucher programs may vary in the following ways:

Eligibility criteria (e.g., family income level)
Rental process (e.g., time allowed to find and rent a property)
Assistance (e.g., counseling in finding rentals)
Relocation requirements (e.g., housing in low-poverty neighborhoods)
Availability of short-term payments for initial expenses (e.g., rental deposits)

The Community Preventive Services Task Force (CPSTF) recommends tenant-based housing voucher programs to improve health and health-related outcomes for adults based on sufficient evidence of effectiveness. Health-related outcomes include housing quality and security, healthcare use, and neighborhood opportunities (e.g., lower poverty level, better schools).

Children ages 12 years and younger whose households use vouchers show improvements in education, employment, and income later in life. Outcomes for adolescents vary by gender. Females 10-20 years of age whose families use tenant-based vouchers to live in lower poverty neighborhoods experience better health outcomes while males of the same age experience worse physical and mental health outcomes. Additional research is needed to better understand and address challenges faced by adolescent males.

CPSTF finds societal benefits exceed the cost of tenant-based housing voucher programs that serve families with young children who are living in public housing, provide pre-move counseling, and move families to neighborhoods with greater opportunities.

Tenant-based housing voucher programs give many people access to better housing and neighborhood opportunities, both of which are considered social determinants of health. Because these programs are designed for households with low incomes, they are expected to advance health equity.

The CPSTF finding is based on evidence from a systematic review of 7 studies in 20 publications (search period January 1999 to July 2019).

The systematic review included 7 studies.

Households who used vouchers experienced the following outcomes when compared with households who were eligible, but not offered, assistance from voucher programs.

Housing quality:
7.9 percentage point increase in the proportion of adults who rated housing conditions as excellent or good (2 studies, 3 study arms)
35.5 percentage point decrease in housing insecurity (1 study)

Income:
6.7 percentage points decrease in the proportion of households living at or below the poverty line (2 studies, 3 study arms)
7.2 percentage point decrease in the proportion of households who had difficulties securing enough food (2 studies, 3 study arms)

Health:
4.0 percentage point decrease in the proportion of adults who reported one of five conditions (asthma, obesity, diabetes, high blood pressure, mobility limitation; 1 study, 2 study arms)
3.4 percentage point decrease in the proportion of adults with a mental health condition (1 study, 2 study arms)
1.6 percentage point decrease in youth asthma-related emergency department use (1 study)
4.1 percentage point decrease in the proportion of adults with unmet medical needs (3 studies, 4 study arms)

Children who were aged 12 years or younger when their families joined the voucher program experienced the following outcomes during adulthood when compared to their counterparts who did not enter the program.
3.4 percentage point increase in the proportion attending college (1 study)
3.0 percentage point increase in the proportion employed (1 study)
20.6% increase in income (1 study)

Children aged 13-18 years when their families joined the voucher program experienced the following outcomes during adulthood when compared to their counterparts who did not enter the program.
7.9 percentage point decrease in the proportion attending college (1 study)
4.0 percentage point decrease in the proportion employed (1 study)
1% increase in income (1 study)