Housing refers to the shelters or buildings in which people live, but sometimes to the types or conditions of the housing. For example, poor housing conditions can cause a number of health problems for occupants. Housing sometimes refers to public housing, which is provided and operated by a government body and offered at a rent that is more affordable for occupants than commercial properties.
As early as the 1800s, public health professionals in the United States and Europe identified a relationship between people's housing conditions and public health. The problem had arisen when industrialization occurred and people streamed into cities for employment, but not enough housing had been built to accommodate them. When builders rushed to make money off of the need for homes, they often built housing that was substandard in urban areas that already were congested. This situation resulted in the working poor living in housing that was crowded and lacked adequate sanitation facilities, light, or air.
There were documented reports in the late 1800s in New York and England of entire families, or up to 30 people, living in single rooms. The conditions prompted public health response, particularly regarding sanitation and the link between housing and public health. The American Public Health Association first became involved with housing issues in 1937 by forming a committee that addressed hygiene.
For most people, their home is the place where the family gathers for shelter and where individuals feel safest and most secure. When a family can afford a home that is large enough for them, is located in a safe and healthy neighborhood, and that is built well and with safe materials, it generally promotes the health of its occupants. Some individuals and families live in homes that are too small for the number of occupants, are in unsafe or unhealthy neighborhoods, or that are substandard in condition. A home also might expose its occupants to the elements, such as heat or cold, or mold, or to higher risk of injuries or health problems from toxic materials such as lead. In the worst cases, some individuals and families cannot afford homes and instead must sleep in unsheltered areas, in their cars, or in shelters provided by local governments or private organizations.
Increasingly, overcrowding is a problem in urban areas of the world. When people live in close proximity without adequate sanitation, diseases increase. Migrants and refugees often must live in camps with makeshift housing. The quality of makeshift housing varies greatly, and poor ventilation and conditions can lead to both infectious and chronic disease. Clusters of tuberculosis (TB) have been discovered in crowded and poor housing conditions. For example, reports surfaced early in 2018 of TB among people in a refugee camp south of Tripoli, Libya. The camp was known for poor hygiene and unhealthy living conditions. Migrants in Europe were found to have a drug-resistant form of TB, which they most likely acquired while on crowded refugee boats. Areas of Kenya had cholera outbreaks in the 1990s and from 2007 to 2010, caused mostly by urbanization and poor sanitation.
Problems such as high unemployment rates, concentrated neighborhood poverty, and health disparities are some of the factors that contribute to the growing population of people who cannot afford housing. These people often live for years in overcrowded conditions with family members, substandard housing, public housing, or homelessness.
When people live in substandard housing, they face increased risk of chronic health problems. For example, poor ventilation in crowded housing units can increase exposure to toxic substances, such as indoor tobacco smoke that leads to respiratory disorders. If poorly ventilated buildings have volatile organic compounds (VOCs) from paint and materials, people can have sick building syndrome. Lead exposure can lead to developmental disabilities in children, and lead often is present in old paints. Old, dirty carpeting can harbor pesticide residue or other toxic chemicals, dust, and allergens that can increase risk of a number of illnesses. Other air quality issues are radon, carbon monoxide, mold, and formaldehyde. Buildings that are substandard can be unsafe in the event of fires or can lead to increased injuries among occupants because of poor construction, clutter, disrepair, or poor lighting.
Climate change is also affecting housing. Native people who live near the Arctic face seasonal changes from earlier springs due to global warming, and some nomadic and native people are forming small urban areas. Others are facing loss of their homes to coastal erosion, flooding, and declining animal populations, a shrinking food source on which they have depended for food. These changes have required creating movable homes for some native people. The melting ice caps also are threatening homes in coastal communities around the world from rising sea levels and greater risk of flooding. Several island nations in the Pacific, where settlers have lived for at least 3,500 years, could be completely covered by water in the near future. Some Pacific islanders have already relocated one or more times.
Having poor or substandard housing can have many effects on physical and mental health. Conditions within or just outside an individual's or family's home can cause diseases or long-lasting problems with occupants' mental health or children's development.
INFECTIOUS DISEASES. People can develop infectious diseases when substandard housing fails to provide safe drinking water or water needed for hygiene. If housing does not provide adequate waste disposal, safe food storage, and prevention of rats or insects that spread disease, infectious disease can spread. Overcrowding itself can lead the development of infectious diseases such as tuberculosis.
CHRONIC DISEASES. Chronic respiratory diseases such as asthma have been linked to substandard housing that is cold, damp, and even moldy. The problem might be lack of ventilation or even leaking inside or outside the housing that is not repaired. Infestations of cockroaches can cause allergic reactions and asthma. If occupants of substandard housing have heart conditions, they might be more likely to have problems from their disease because of inadequate heating and cooling that causes temperature extremes in cold or hot weather. Toxic substances have been found to cause chronic headaches, nausea, respiratory problems, and even lung cancer.
INJURIES. Lack of safety devices such as window guards can lead to falls from high floors, and poor fire prevention devices such as smoke detectors, fire barriers, or appropriate exits can cause injuries or deaths from fires. Temporary housing for homeless people often has poor building design with additional hazards that can cause injuries.
POOR NUTRITION AND DEVELOPMENT. When children have chronic diseases caused by substandard housing, they often experience disability and extremely poor health well into adulthood. When families have to spend more money than they can afford on housing, it can affect other important aspects of living, and they might not have enough money left each month to purchase adequate food.
MENTAL HEALTH. There is less evidence that correlates substandard housing and poor mental health, but studies have shown that crowding can cause distress. Children can experience behavioral problems while homeless or living in substandard temporary housing. Being extremely cold, hot, or living in damp and otherwise poor housing conditions can cause stress. Living in neighborhoods with good support systems and trust can help people, but when people live in areas with high concentrations of substandard housing, many socioeconomic barriers are reinforced.
About 15 million children, 21% of all children in the United States, live in poverty. This costs society about $500 billion per year. People who live in concentrated neighborhood poverty tend to be isolated from the economy at large and generally are more likely to struggle at school or be unemployed or be involved in crime or affected by it. Of course, substandard housing that causes infectious or chronic disease and otherwise preventable injuries or health problems can cost society when people who cannot afford health care or do not have insurance must receive services for their care at emergency rooms.
Designing buildings to meet local codes can help protect the health and safety of residents in times of emergency. Codes often are based on national models, but enforcement of housing regulations usually is up to local governments. Public health agencies often can intervene when there is an emergency public health concern. Public health and relief organizations assist with evacuation and support efforts and take steps to prevent any potential infectious disease in the crowded conditions of temporary shelters. Policies in many countries toward accepting refugees have not helped the problem, however. The American Public Health Association has emphasized the need for more public health representation on national and international building standard and code committees. Public health workers also act as advocates for individuals and communities that need better housing and often collaborate with organizations, community groups, and government agencies to improve housing conditions.
Many public health, government, private, and nonprofit efforts have taken place over the years to address health problems associated with housing. Habitat for Humanity was founded in 1976 and grew substantially after former president Jimmy Carter and his wife Rosalynn Carter became involved in 1984. The organization has built more than 800,000 houses around the world. The Centers for Disease Control and Prevention developed the Healthy Homes program to assist people in improving the quality and safety of their housing. Many states have funded programs and projects that help people and communities address hazards and substandard living conditions in their housing. These efforts might range from helping to rid buildings of cockroaches to arranging grants for low-income homeowners.
The World Health Organization (WHO) has announced healthy housing as a public health issue to reduce disease and injuries to people around the world. WHO publishes guidelines for healthy housing. In addition, housing is at the center of the UN Sustainable Development Goals, which aims to improve health, wellbeing, and sustainable living by 2030. Several goals, including safe and sustainable cities, elimination of poverty, equity, and addressing climate change affect or depend on improving housing and public health.
Developing and enforcing adequate local building codes can help prevent substandard housing. The codes must address problems that affect public health of occupants, such as ventilation, dampness, mold, lighting, presence of toxic substances, and potential injury hazards. Public health workers can continue to be involved in advocating for high standards in housing, particularly in temporary and public housing.
Efforts to improve public health among occupants of public housing can go even further by promoting healthy building and living practices. For example, community gardens that promote occupants' involvement in growing and eating fresh vegetables can help improve nutrition and increase physical activity. When housing units are remodeled or new units are built, green materials that are low in VOCs can replace those that are toxic, and building managers can take steps to reduce use of chemicals by applying integrated pest management and green approaches to pest control and cleaning practices.
See also Cholera ; Communicable diseases ; Public Health Service ; Sick building syndrome .
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National Law Center on Homelessness and Poverty, 2000 M Street NW, Ste. 210, Washington, DC, 20036, (202) 638-2535, (202) 628-2737, http://www . nlchp.org.
Teresa G. Odle