Public housing relocations and reduced spatial access to safety net primary care in a vulnerable population of public housing residents

Background: The federally-funded HOPE VI policy is one of the largest planned relocation initiatives in the US, and disperses residents of public housing complexes to privately-owned voucher-subsidized housing; new housing may be scattered across neighborhoods in the target city. Relocations usually take residents to less impoverished neighborhoods. Many relocaters are in poor health before moving. We investigate pre-/post-relocation changes in spatial access to safety net primary care in this vulnerable population; spatial access to care strongly determines service utilization. Methods: We geocoded pre- and post-relocation addresses of a cohort of Black adults (N=172) relocating from seven public housing complexes in Atlanta (GA) via HOPE VI, and applied gravity-based models to assess pre- and post-relocation spatial access to safety net primary care clinics. Hierarchical linear models were applied to assess changes in access, and to examine whether changes varied by baseline health status, assessed using the SF-12; a screen for drug/alcohol dependence; and self-reported HIV status. Results: Preliminary analyses indicate that access to care declined by 50% across the sample, regardless of health status. Discussion: After relocating, participants experienced substantial declines in spatial access to safety net primary care. Housing complexes were sites of entrenched poverty which had attracted healthcare services for low-income populations. Despite the benefits of moving to less impoverished communities, relocations took residents to neighborhoods with lower spatial access to safety net care. In cities targeted by HOPE VI, intersectoral collaboration between public housing authorities and safety-net care systems may be needed to facilitate post-relocation continuity of care.