Settling for Shelter: Exploring the Dynamics of Forced Mobility and Health in Mixed-Income Initiatives

Background & Purpose: Mixed-income initiatives provide comprehensive people, housing, and neighborhood programs to improve housing and neighborhood quality for families living in distressed public housing. These initiatives require a forced move for families living at the site targeted for redevelopment. Forced relocation heightens the potential for unintended health consequences, despite the intended benefits of housing and neighborhood quality improvement. However, little is known about how conditions of forced mobility influence housing choices in the context of mixed-income initiatives. We address these knowledge gaps by developing a dynamic conceptual model of forced mobility that explains how and why housing choices may reproduce health disparities. Thus, we address the following research questions: 1) What factors influence housing choices among families forcibly relocated through mixed-income initiatives? 2) What unintended health consequences exist based on housing relocation choices?

Methods: A systematic search was conducted to identify peer-reviewed publications of housing mobility in mixed-income initiatives. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines to develop the search protocol. Studies were included for review if they: a) examined housing relocation of families living in public housing targeted for mixed-income redevelopment in the United States, and b) included qualitative or mixed-methods study designs. Causal loop diagramming (CLD) was utilized to create a dynamic conceptual model to identify and visualize interactions between key variables identified in the review. Data extraction, analysis, and visualization occurred in Covidence, Atlas.ti, and Kumu.io.

Results: The systematic search yielded 1,348 studies and 46 studies were included for review. Studies included interviews, focus groups, and case studies across 35 mixed-income redevelopment contexts and represented the experiences of over 1,000 households. Findings indicated that forced mobility undermined health through each housing choice available to families. Relocation was marked by immense pressure to move and resulted in households prioritizing short-term goals to avoid housing precarity. This process, which we call settling for shelter, occurred through two dynamic feedback mechanisms where families confronted tradeoffs between: 1) forms of housing assistance, and 2) prioritizing housing versus neighborhood quality. Families confronted immediate tradeoffs between housing assistance decisions that included: a) moves to other public housing, b) moves using a housing choice voucher, and c) moves without assistance. Each mobility option included tradeoffs between housing and neighborhood quality, which were constrained by unique household needs. Primary pathways to adverse health effects included: 1) social network disruption, increased social isolation, and reduced self-sufficiency, 2) loss of institutional and community connections, heightened risks of exposure to community problems, reduced sense of safety, and increased stress, and 3) barriers to accessing opportunities in new environments, unaddressed health needs, and decreased quality-of-life. Each housing choice included pathways to additional forced moves that further jeopardized health.

Conclusions & Implications: Findings suggest that mixed-income initiatives rely on incomplete understandings of the dynamics of forced mobility that affect health. Centering the lived experiences of marginalized families is needed to improve mixed-income housing policies, mitigate adverse health consequences, and co-create solutions that advance social, economic, and racial justice and promote health equity.