Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. This article highlights the influence poor housing conditions have on Public health.
Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. Addressing housing issues offers public health practitioners an opportunity to address an important social determinant of health. Public health has long been involved in housing issues. In the 19th century, health officials targeted poor sanitation, crowding, and inadequate ventilation to reduce infectious diseases as well as fire hazards to decrease injuries. Today, public health departments in developed countries can employ multiple strategies to improve housing, such as developing and enforcing housing guidelines and codes, assessing housing conditions, and advocating for healthy, affordable housing. Now is the time for public health to create healthier homes by confronting substandard housing.
Housing is an important determinant of health, and substandard housing is a major public health issue.
The public health community has grown increasingly aware of the importance of social determinants of health (including housing) in recent years, yet defining the role of public health practitioners in influencing housing conditions has been challenging. Responsibility for social determinants of health is seen as lying primarily outside the scope of public health.
The quality and accessibility of housing is, however, a particularly appropriate area for public health involvement. Public health has a long (albeit intermittent) history of involvement in the housing arena, and this involvement is generally accepted by other housing stakeholders. Housing related health concerns such as lead exposure and asthma are highly visible.
The public is also concerned about the quality and accessibility of housing as affordable housing becomes scarcer. Elected officials and communities alike should recognize that substandard housing is an important social justice issue that adversely influences health.
An increasing body of evidence has associated housing quality with morbidity from infectious diseases, chronic illnesses, injuries, poor nutrition, and mental disorders. Let’s take a look at some anomalies that can be attributed to poor housing conditions under these headings.
Features of substandard housing, including lack of safe drinking water, absence of hot water for washing, ineffective waste disposal, intrusion by disease vectors (e.g., insects and rats) and inadequate food storage have long been identified as contributing to the spread of infectious diseases. Overcrowding is associated with transmission of tuberculosis and respiratory infections. Lack of housing and the overcrowding found in temporary housing for the homeless especially in IDP camps also contribute to morbidity from respiratory infections and activation of tuberculosis.
The importance of designing homes to prevent injuries has received long-standing attention in developed countries especially with regard to reducing burns and fall. Attributes of substandard housing that increase the risk of injury include exposed heating sources, unprotected upper-story windows and low sill heights, slippery surfaces, breakable window glass in sites with a high likelihood of contact, and poorly designed stairs with inadequate lighting. Building design and materials influence the risk of injury from fires. These hazards are frequently present in temporary accommodations provided to homeless women and young children.
Childhood Development and Nutrition
Lack of affordable housing has been linked to inadequate nutrition, especially among children. Relatively expensive housing may force low-income tenants to use more of their resources to obtain shelter, leaving less for other necessities such as food.
Substandard housing may also adversely affect mental health, although the evidence is more tentative. Excessive indoor temperature has been linked with irritability and social intolerance. Damp, moldy, and cold indoor conditions may be associated with anxiety and depression.
Beyond the condition of the housing unit itself, the site of the home may be a determinant of health. Intentional injury, poor birth outcomes, cardiovascular disease, HIV, gonorrhea, tuberculosis, depression, physical inactivity, and all-cause of mortality are common in neighborhoods of low socioeconomic status, independent of individual-level risk factors. Several features of these neighborhoods may contribute to poor health. Air quality may be poor because of their proximity to sources of vehicle exhaust emissions such as major roads, bus depots, airports, and trucking routes. These sources also create substantial noise exposure, which may be associated with a range of adverse health effects. Sites of improper waste disposal can harbor pests, which can then infest homes. Yet it is possible to design neighborhoods to promote health by considering sidewalk and street design, the presence of green spaces and recreational sites, and the location of schools, work, and shopping within walking distance of homes.
Today, several issues drive the housing and health agenda: increased asthma morbidity, unaffordable urban housing, urban sprawl, and a renewed interest in social determinants of health. This new era of unaffordable housing and the health and social disintegration that accompanies it will demand further public health attention.
We have learned much in the past decade about how to make homes healthier places in which to live. Public health has a long history of promoting healthy housing and reducing poor housing conditions. We have been less engaged for too long. It is time for us to build on this groundwork and do our share in ensuring that everyone has a safe and healthy home