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 can employ multiple strategies to improve housing, such as developing and enforcing housing guidelines and codes, implementing “Healthy Homes” programs to improve indoor environmental quality, 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.1 Each year in the United States, 13.5 million nonfatal injuries occur in and around the home,2 2900 people die in house fires,3 and 2 million people make emergency room visits for asthma.4 One million young children in the United States have blood lead levels high enough to adversely affect their intelligence, behavior, and development.5 Two million Americans occupy homes with severe physical problems, and an additional 4.8 million live in homes with moderate problems.6
The public health community has grown increasingly aware of the importance of social determinants of health (including housing) in recent years,7 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. An evolving body of scientific evidence demonstrates solid relations between housing and health. The public health community is developing, testing, and implementing effective interventions that yield health benefits through improved housing quality. Public health agencies have valuable expertise and resources to contribute to a multisectoral approach to housing concerns. Public health has a long (albeit intermittent) history of involvement in the housing arena, and this involvement is generally accepted by other housing stakeholders (e.g., building departments, community housing advocates). Housingrelated 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.8 Elected officials and communities alike recognize that substandard housing is an important social justice issue that adversely influences health.
HOUSING AS A DETERMINANT OF Health
An increasing body of evidence has associated housing quality with morbidity from infectious diseases, chronic illnesses, injuries, poor nutrition, and mental disorders. We present some of this evidence in the following section.
Infectious Diseases
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.9–11 Crowding is associated with transmission of tuberculosis12 and respiratory infections.13–16 Lack of housing and the overcrowding found in temporary housing for the homeless also contribute to morbidity from respiratory infections and activation of tuberculosis.17–20
Disparities in Housing, Disparities in Health
Exposure to substandard housing is not evenly distributed across populations. People of color and people with low income are disproportionately affected. For example, Blacks and low-income people are 1.7 times and 2.2 times more likely, respectively, to occupy homes with severe physical problems compared with the general population.6 People with low income are more likely to live in overcrowded homes. Disparities in asthma morbidity may be attributable, in part, to disproportionate exposure to indoor environmental asthma triggers associated with living in substandard housing.97,98 Injuries occur more commonly in low-income households because of substandard conditions and a lack of resources to repair them. Clutter stemming from lack of storage space and hazardous cooking facilities also contribute to increased risk of injury from fire.99 Homes of people with low income are more likely to be too warm or too cool because they are less well insulated, often have relatively expensive forms of heating such as electric baseboards, and frequently lack air conditioning.100,101 Additionally, occupants often cannot afford to pay for the energy needed to make their homes comfortable. As housing and energy prices continue to climb, low- and moderate-income households make tradeoffs between having enough food, staying warm, and living in adequate housing, with resultant adverse effects on health.
Source: American Journal of Public Health