THE PHYSICAL STRUCTURE OF HOUSING
The physical structure of housing
is an important part of the built environment. It encompasses both building
materials and design, both of which can affect health. Examples of construction
material impacts are: formaldehyde emissions from fibre-board materials; the
release of asbestos from textured ceilings; and fibres from glass insulation
material, which are all hazardous for human health. Particular designs create
distinct problems of structural integrity, such as the apartments constructed from
concrete, with inadequate steel reinforcing, in the former communist countries
of Eastern Europe. Other design health effects include inadequate ventilation,
and damp and mould.
INDOOR ENVIRONMENT
The indoor environment refers to
the quality of air inside the dwelling which can be contaminated from a number
of different sources, principally from building materials; side effects of
heating; moulds and environmental tobacco smoke. In dwellings located besides
busy roads and intersections, outdoor air contaminants from motor vehicle
exhaust can pollute the indoors by being sucked in through windows or air
conditioning systems. Contaminants from work and waste sites can be tramped
inside on footwear. All these factors may influence the development of disease,
through inhalation or ingestion. In some areas radon is also a major problem.
LEAD POISONING
Increased blood lead
concentrations in children, which affect their kidneys, reproductive organs,
nervous system, and cognitive functioning have been linked to the ingestion of
flaking lead paint in poorly maintained housing. Lead contaminated water from lead
pipes is the other main source of lead intake in older homes. Recognition and
regulation have led to an abatement of this problem, so that blood lead
concentrations in children have declined dramatically,22 although there are
still areas where children are at high risk.
DAMP AND MOULD
Dampness in houses can be caused
by the location of the house, structural defects in the house construction or
maintenance, and the behaviour of the occupants, such as not airing the house
by opening windows or using extractor fans during showering and cooking. Both
subjective and objective measures of dampness in houses are used in research,
and criteria are being established for evaluating observations in relation to
exposure and adverse health effects, but it can be assumed that an estimate of
the size of moisture damage is a reasonable surrogate for the exposure. Damp
housing is clearly related to respiratory conditions in both adults and
children.
Mould is more likely to grow in
damp houses and is usually measured by the size of the visible mould patches, or
the mass of active colonies. A mouldy smell is a good indication of mould
activity. Mould and fungi have been shown to have a small, but significant
respiratory effect on children. There is a dose-dependent risk increase of
visible mould for respiratory infections, lower respiratory symptoms, and
asthma.
COLD AND SEASONAL DIFFERENCES
The temperature of the indoor
environment affects the health of occupants. The WHO recommends that indoor
house temperatures be no lower than 18° and 20° for the very old and very
young. There is strong evidence that there is a narrow comfort zone for humans
with mortality rates lower on days in which the average temperatures range
between 15° to 25° and rising progressively as the ambient temperature becomes
hotter or colder. Below these moderate temperatures there is some evidence that
cold is a risk factor in increasing asthma severity and COPD and may also delay
recovery after discharge from hospital.
Seasonal differences in
temperatures have a greater impact on avoidable mortality in winter in
temperate countries than in colder countries, where houses are more thermally
efficient and outdoor clothing is worn more systematically. In Great Britain,
for example, it is estimated that 40 000 extra winter deaths occur each year
because of housing and deprivation. In Great Britain an “inverse housing law”
has been shown—those areas where climate is colder tend to be those where
housing is worse. This maldistribution of good housing creates an additional
environmental risk for those people living in colder areas for long periods of
time and is associated with poorer respiratory health and diastolic
hypertension. More equal socioeconomic development61 and the improvement of the
thermal standards of housing have both been demonstrated to be effective
preventative interventions to curb excess deaths.
HOUSEHOLD CROWDING
Crowding in households refers to
the number of people per room and is measured in a number of different ways,
from simple measures of the number of people per bedroom to measures, such as
the Canadian Overcrowding Index, with underlying normative expectations of
social standards.
Crowding has long been known to
increase the risk of infectious diseases, such as meningoccocal disease,66
tuberculosis,67 and hepatitis B,68 but it also has an impact on mental health and
seems to be a contributor at an ecological level to premature mortality.
NOISE POLLUTION
Excessive noise in overcrowded
houses and from neighbouring houses and traffic is a common cause of sleep
disruption, which can lead to impaired concentration and irritability.
MULTIPLE HOUSING DEPRIVATION
Multiple housing deprivation
refers to the experience of poor housing over the course of a lifetime. Poor
housing conditions in infancy, childhood, and adulthood such as overcrowding
and damp, cold dwellings, have a cumulative detrimental effect on physical and
mental health. Multiple housing deprivation seems to pose health risks of
similar proportions to smoking and, on average, greater than that posed by
excessive alcohol consumption.
Children seem to be particularly
vulnerable to prolonged exposure to poor housing. A number of adult diseases,
such as Helicobacter pylori, have been traced back to exposure to crowding in
childhood. Associations between poorer housing conditions in childhood and
mortality from common diseases in adulthood are not strong, but are
distinguishable from other aspects of social and economic deprivation.
HOUSING CONDITION SURVEYS
A housing condition survey is a
systematic survey of the physical condition of a dwelling, which identifies
remediable hazards that otherwise have a negative impact on health and
wellbeing. Houses are usually categorised according to fitness standards by
environmental health officers or building inspectors so that local authorities
can monitor and enforce regulatory standards to promote acceptable healthy
housing. For example, the 1996 English House Condition Survey showed that that
1 522 000 UK dwellings did not meet the required fitness standards.
HOUSING TENURE
Tenure is the legal conditions
under which people live in their dwellings. Homes can be rented or owner
occupied. If they are rented they can be rented from a private or public
landlord.
Those who own their own home,
with or without a mortgage, are likely to be in better health than those who
rent their house, either from private or public landlords. There is a strong
relation between rental housing tenure and higher death rates even within
social classes. Several British studies have shown more variation in mortality
between owners and tenants within occupational social class groups than between
social classes within tenure classes. These relations are also related to self
perceived health, rates of long term illness, and general practitioner
consultation rates.
While home ownership may generate
a degree of security and control, particularly in countries where such
behaviour is financially rewarded through tax assistance, it may not always be
health promoting. Those households that fall behind on their mortgage payments
may suffer increased insecurity and poorer mental health.
SOCIAL HOUSING
Social housing is subsidised
public sector housing that is provided to tenants by local, state, or national
governments or not for profit trusts. Housing is usually allocated according to
a social allocation formula that takes account of the prospective tenants’
health and social circumstances. The rent may be determined as a proportion of
the household income, in which case tenants are likely to have more disposable
household income. Social housing can also be called affordable housing, council
housing, or state housing. In some countries, housing subsidies are provided by
welfare payments or vouchers as a way of offering those on low incomes greater
choice of whether to rent privately or publicly, or become owner occupiers.
The expansion of social housing
as part of state welfare policies was thought to have weakened the link between
housing and health. However, area effects remain whereby even in the same city,
there are “good” and “bad” estates. In the good estates the health of the
tenants is measurably better. This may be the result of health selection,
whereby the social allocation system filters people with poorer health into
certain estates, or it may be that the reputation of certain areas means that
people become less attached to these communities. This can lead to more
residential mobility, which further weakens these areas’ social structures and
organisations. The recent sale of better quality social housing under
neo-liberal governments may have reduced fiscal burdens, but has led in some
countries to a further concentration of tenants with low incomes and poorer
health in identifiably socioeconomically deprived areas.
IMPACTS OF HOUSING ON MENTAL
HEALTH
Housing has a moderately strong
effect on the mental health of the occupants, particularly women, who through
their child rearing roles spend more time at home on average than men. Some
designs of housing such as high rise housing often cause undue problems for
older people and women, carrying shopping and small children, and make it more
difficult for parents to supervise their children playing outside. There is
also a perception that high rise apartments are less safe from crime1and
housing height is associated with decreased levels of mental health.
There is a demonstrated
cumulative impact of poor housing on mental health. For example, women in damp
housing are more likely than men to experience emotional upsets because of
overcrowding leading to disturbed sleep and on-going frustration from attempts
to get repairs made, or failing that, rehousing, and in the meantime to keep
the dwelling clean.
HOUSING INTERVENTIONS
Insulating existing homes and providing
effective safe heaters have been shown theoretically and in practice, to
increase older people’s health and wellbeing and the health of children with
asthma. In some cases the intervention prevented only further deterioration in
health. The construction of new “passive” houses that are well insulated, have
no active heating or cooling systems and use passive solar energy even in
winter time, costs around 10% more but reduces energy running costs by a factor
of 10 over the building lifetime. Such sustainable housing can increase the
disposable income of the households and help to reduce inequalities.
Housing renewal is often carried
out on sub-standard housing in socioeconomically deprived neighbourhoods,
although it is likely to be less discriminating than selecting individual
houses through housing condition surveys. Several before and after studies have
shown that the mental health of tenants has improved after housing renewal or
community regeneration, although some have reported adverse effects on general
health after rehousing. Preliminary results of experimental relocation of
families from areas of deprivation to improved housing in middle income areas
have shown social and health gains and in another study, when the shift was to
private housing, an improvement in mental health.
HOUSING NEIGHBOURHOODS
The social and physical
characteristics of the area surrounding houses are important for maintaining
the good health of the occupants. Following the evidence that improving housing
alone is insufficient to greatly improve the health of occupants, the focus has
shifted to the health of the community and the local geographical
neighbourhood.
Neighbourhoods have a small but
consistent impact on health status. Various omnibus measures of area based
deprivation have been developed to rank the social and economic deprivation of
neighbourhoods. Some are census based, some rely on municipal or school
records.
Some are based on systematic
videotapes of street life and have been used to develop concepts such as
collective efficacy and structural constraints in order to explore different
neighbourhoods’ shared expectations for the social control of public space. Systematic
observational studies have also shown that both place and people, both the
context and the composition of neighbourhoods, are important in determining
health.
Multilevel analyses using area
based measures, and increasingly using geo-coding, have shown that
neighbourhood effects have a small, but significant impact on mortality and
premature mortality, self reported health status, diseases such as gonorrhoea,
as well as being risk factors for morbidity such as low birth weight. Aspects
of neighbourhoods that have been identified as having an impact on health are:
the presence or absence of local amenities, such as parks and sports
facilities; “incivilities” such as the presence of graffiti, boarded up houses,
garbage accumulation, abandoned cars and broken windows, and the signalling
effect of these physical features that no one cares102; the perception of
neighbourhoods as “safe” and under effective informal social controls; and the
number of local organisations.
Others have postulated that
neighbourhood conditions directly influence habits of privacy, child rearing,
house keeping, and study, which can have an indirect effect on health.
HOUSING AND NEIGHBOURHOOD
ATTACHMENT
Families who live for a long time
in a particular house can be categorised as attached to their house and local
community and contributing to residential stability. Neighbourhood attachment
is likely to have benefits for the health of the family and the stability of
the neighbourhood. Neighbourhood stability in childhood is associated with
better self reported health in mid-life, but as this stability is linked to
family stability, the effects are difficult to disentangle.
Residential stability refers to
the social reproduction of neighbourhood residential structures, when typically
population gains offset losses and home values appreciate. When longstanding
families and households leave a neighbourhood, there is the possibility of
destabilising social norms through the disruption of social networks. However,
the destabilising effects of high levels of mobility are likely to have
differential effects on different groups, depending on their social position
and life stage and the material, social, and cultural resources from which they
can draw. Many impoverished neighbourhoods have a high level of residential
stability, yet poorer health. However, if the location, such as an inner city
suburb becomes desirable and “gentrification” occurs, the in-migration of
affluent households to poorer neighbourhoods can improve the health status of a
neighbourhood simply through compositional changes.
Moving can be a normal part of
family formation or a planned sign of upward mobility, but it can also reflect
desperation and a downward spiral in health and welfare. This is one of the
areas where qualitative research is able to illuminate the interaction between
the increasing complexity of family life and residential mobility. The ability
to move houses is related to the distribution of wealth and income in a
population and the availability of social housing. Economic cycles and the
local housing market are an integral part of this process.
FUTURE HOUSING RESEARCH
DIRECTIONS
No comments:
Post a Comment