To Ensure Children's Health, Create Affordable Housing In High-Opportunity Neighborhoods
Unaffordable housing is often described as the single greatest economic burden on working-class Americans, with nearly half of renters spending more than 30% of their income on housing. Families with children are at particularly high risk, with a recent study showing that 1 in 6 American children experience unstable housing. As a well-established social driver of health, housing is known to have a significant influence on children’s health and opportunity for economic success. This is especially true for children with chronic medical conditions, such as asthma or autism, who are disproportionately likely to experience unmet housing needs.
President Trump’s plan to address the housing crisis -- to the extent that he’s hinted at such a plan in recent remarks -- relies on mass deportation to open existing housing units. However, this is unlikely to solve the crisis and may slow housing construction.
Nevertheless, there has been bipartisan recognition of a supply-side issue at the core of this crisis, and experts agree that the construction of new units is essential to address the root of the problem. Moreover, it is just as crucial to think through where new housing is built. Decades of research have found that relocating to high-opportunity neighborhoods is significantly associated with improvements in young children’s physical health, mental health, educational attainment, and ultimately long-term earnings, as well as decreased healthcare use related to conditions ranging from asthma to mental health.
Historically, policy makers have taken the opposite approach: Public housing and housing units for low-income families have been intentionally built in areas with concentrated poverty. This pattern has confined many households to living in lower opportunity environments, leading to persistently worse health and decreased economic mobility.
To break this cycle, prioritize the health of all children, and improve the trajectory of children’s lives (and in turn, their ability to contribute to the United States economy), we must commit to enabling families to live in quality, affordable housing in high-opportunity neighborhoods that support paths to their full potential. Impending devastating staffing cuts to the Department of Housing and Urban Development (HUD) jeopardize this mission and will undoubtedly worsen the housing crisis among working-class families.
Here, in addition to protecting vital HUD staffing and programs, we offer clear steps that different levels of government should take to address the housing crisis in ways that promote child health and success. In Exhibit 1 below, we provide a simple matrix: three columns represent policy goals while four rows represent different levels and branches of government that may employ specific tactics to achieve these goals. Although this matrix is not meant to be exhaustive, the unique and urgent policy pathways within are meant to inform a broadened housing agenda that centers children and their families.
Increase Funding To Support Affordable Housing In Opportunity Neighborhoods (Column 1)
State governments face significant challenges to constructing affordable housing in high-opportunity neighborhoods. Foremost is that land simply costs more in wealthier areas. States typically fund housing through different mechanisms, including federal HUD grants, housing trust funds amassed through real estate-related taxes, fees, and tax credits. Some states have explored ways to pool state reserves to direct unused funds toward affordable housing projects.
As children with chronic medical conditions account for the majority of pediatric Medicaid spending, attributed in part to increased social risks, there is growing interest in blending and braiding approaches to diversify funding streams that address adverse social drivers of health -- including housing instability and insecurity. Some states aim to leverage Section 1115 waivers to apply Medicaid funds and community reinvestment dollars to create affordable, quality housing. However, Medicaid alone cannot bridge this funding gap. Regardless of the tactic, substantial federal funding for affordable housing is needed as an upfront investment to reduce long-term health care costs, among many other cross-sector benefits.
Expanding the low-income housing tax credit (LIHTC) is among the most promising existing policy avenues for federal investment in housing. Through the LIHTC, tax credits serve as a financial incentive for private developers to build affordable housing. Participating developers can benefit from these credits annually for 10 years, covering up to 70% of qualified development costs depending on the type of construction and financing. This program has led to the production of over 3 million affordable units since 1987, more than any other federal investment, and is the largest contributor to addressing the massive imbalance of affordable housing supply and demand.
While Congress should increase funding for LIHTC, states should ensure child health is considered in creating their Qualified Action Plans (QAPs), which are state-specific documents that detail criteria for how LIHTCs are allocated. Through QAPs, states can also prioritize funding developments in high-opportunity neighborhoods with mandated mixed-income occupancy.
Decrease Barriers To Affordable Housing In Opportunity Neighborhoods (Column 2)
To fully realize the promise of LIHTC construction in high-opportunity neighborhoods, state and local governments must address exclusionary local zoning regulations. These restrictions place significant barriers on the construction of new subsidized housing in high-opportunity neighborhoods, which are often zoned only for single-family homes.
To address this barrier, some states, like Oregon, have enacted preemption laws to prevent exclusionary zoning regulations by their local jurisdictions. Several cities, such as Minneapolis and New York City, have revised zoning laws to allow more diverse ranges of homes to be built. These efforts seek to mitigate rent inflation. In the coming years, researchers should study the follow-on effects of these zoning revisions. We expect that their findings may help showcase the extent of the benefits of these policies on long-term health and opportunity outcomes for children. At the same time, other programs like inclusionary zoning can also be used to help encourage development of affordable units in opportunity neighborhoods.
The previous Trump administration recognized the challenges that regulatory barriers play in advancing affordable housing policy but did not take sufficient action to address them. Since then, the housing crisis has only gotten worse. So now is the time to further explore ways to incentivize inclusionary zoning to facilitate the creation of multi-family units in high-opportunity neighborhoods.
Support The Lowest Income Renters In Opportunity Neighborhoods (Column 3)
Even with an increased supply of affordable units, the lowest earners will still be priced out of competitive rental markets, especially in high-opportunity neighborhoods. To help mitigate these pressures, Congress should increase the total supply of vouchers available through the Housing Choice Voucher Program, as there is often a multi-year waitlist for eligible families to receive a voucher. Moreover, only 1 in 4 renters who are currently eligible for housing assistance actually receive it.
Congress should also support creative extensions of this program centered on child wellbeing. Unique housing voucher programs have been designed for select populations at particularly high-risk for deleterious effects of insecure housing, including veterans, foster youth, and persons living with HIV/AIDS. Recently, Senators Chris Van Hollen (D-MD) and Todd Young (R-IN) introduced the Family Stability and Opportunity Vouchers Act, which would expand the housing choice voucher program to prioritize pregnant women and families with children under 6 years of age. If this law were enacted, HUD could consider future extensions focused on serving low-income families of children with chronic medical conditions.
Nationwide, approximately 60% of households with vouchers are able to lease units; these units are disproportionately located in poorer neighborhoods. Small area fair market rent (SAFMR) voucher programs, introduced in select cities such as Dallas, Jacksonville, and Philadelphia, adjust voucher payment rates within jurisdictions to help families afford more in higher opportunity neighborhoods. In 2025, more cities are required to take up this new approach, while some Public Housing Authorities are voluntarily adopting the program. HUD is also currently running the Community Choice Demonstration which is testing tools that may help families more effectively use vouchers in lower poverty neighborhoods. We believe future interventions should consider focusing on SAFMR and learning from the Community Choice Demonstration.
Policy makers should also confront the fact that, in some jurisdictions, it is legal for landlords to refuse to accept tenants. Expanding source-of-income anti-discrimination laws represents an important tool.
A Critical Opportunity
While we have highlighted key housing policies to prioritize in the coming term, the scope of this article does not include many other important factors with growing evidence linked to child health, including improving housing quality in low-opportunity neighborhoods, advocating for tenant protections like right-to-counsel, and increasing access to health care and social services for families with housing insecurity.
Nevertheless, we know this is true: Housing has significant implications for children’s health, wellbeing, and economic security. Further, where affordable housing is located has an important influence on children’s lifelong success and the country’s economic potential.
As we enter this new era of political leadership, we have a critical opportunity to ensure vulnerable children are prioritized in housing policies. Decades of research suggest that, to protect children’s health, we must support policies that facilitate the construction of new, high-quality, affordable housing in high-opportunity neighborhoods. This can be accomplished by increasing investment in and use of LIHTCs for mixed-income housing, revising zoning laws, and protecting and expanding HUD programs. Together, these efforts can pave the way for the health and wellbeing of the next generation.
Exhibit 1: Housing policy recommendations for child health and success
Source: Authors’ analysis
Authors’ Note:
Dr. Luke currently receives funding from the National Institute of Child Health and Human Development. Dr. Sandel currently receives funding from MassMutual and Wagner foundations. She is an unpaid board member of National Low Income Housing Coalition and Enterprise Community Partners. Ms. Leo is employed by Supervisor Holly J. Mitchell in the Second Supervisorial District of Los Angeles County. Dr. Vasan currently receives research funding from the Agency for Healthcare Research and Quality. Dr. Pollack reports stock ownership in Gilead Pharmaceuticals. From September 2019 to July 2022, Johns Hopkins entered into a contract with HUD for Dr. Pollack to work part time on a temporary assignment assisting the agency on housing and health issues. The findings and conclusions in this report are those of the authors and do not necessarily represent those of HUD. Dr. Pollack is an unpaid member of the Board for the American Association of Service Coordinators. Dr. Beck currently receives research funding from AHRQ, NIH, PCORI, and Cincinnati Children’s Research Foundation.
