Tenant-based housing voucher programs improve housing, health and health-related outcomes for adults, including housing quality and security, healthcare use, and neighborhood opportunities (eg, lower neighborhood poverty rate, and higher safety).

Tenant-based housing voucher programs improve housing, health and health-related outcomes for adults, including housing quality and security, healthcare use, and neighborhood opportunities (eg, lower neighborhood poverty rate, and higher safety). Children aged 12 years and younger whose households use vouchers show improvements in education, employment, and income later in life. Based on this evidence from a Community Guide systematic review, the Community Preventive Services Task Force recommends tenant-based housing voucher programs. This paper describes evidence from the Community Guide systematic review as well as considerations for implementing this intervention so that all members of eligible households can benefit.

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 when units are available. Vouchers pay a substantial portion of the rent, which leaves households with money to cover other needs.

The US Department of  Housing and Urban Development (HUD) administers the Housing Choice Voucher program—a tenant-based voucher program designed to assist households with very low incomes. From 1994 to 1998, HUD also sponsored the Moving to Opportunity experiment. This randomized study assessed the long-term impacts of moving households with children from public housing in high-poverty areas into neighborhoods with greater opportunities. HUD provided households in the experimental group with pre-move counseling and offered them tenant-based housing vouchers that could be used to move neighborhoods with <10% poverty rate for at least a year. 

This Community Guide systematic review included evaluations of the Housing Choice Voucher program and the Moving to Opportunity experiment. We wanted to know if tenant-based housing voucher programs improved health and health-related outcomes for voucher-using households.

In 2020, we completed a systematic review of 7 studies described in 20 publications (search period January 1999 to July 2019).

Major findings:

• Households who used vouchers reported greater housing quality and security, less poverty and food insecurity, and fewer physical and mental health conditions compared with households who were eligible, but not offered assistance from voucher programs.
• Children aged 12 years and younger whose households used vouchers showed improvements in education, employment, and income later in life. Adolescents whose families received vouchers reported fewer depressive symptoms.
• Outcomes for adolescents varied by gender. Females 10-20 years of age whose families used tenant-based vouchers to live in lower poverty neighborhoods experienced better physical and mental health outcomes while males of the same age experienced worse health outcomes.

Additional considerations:

Additional services that may help improve the rental process for households who have obtained vouchers are:

• Increasing the time allowed to find and rent a property,
• Assistance with finding housing (eg, pre-move counseling),
• Availability of short-term payments for initial expenses (eg, rental deposits).

Why this is important:

• There are neither enough affordable rental housing units nor available vouchers in the US to serve households with very low incomes (≤50% of their area’s median income).
• Tenant-based housing voucher programs give people access to better housing and neighborhood opportunities. As a result, they improve recipients’ health and health-related outcomes.
• Because tenant-based housing voucher programs are designed for households with low incomes, they can advance health equity.

Read our paper in the Journal of Public Health Management and Practice to learn more about our review and the systematic review evidence supporting tenant-based housing vouchers:

• Tenant-Based Housing Voucher Programs: A Community Guide Systematic Review