Is housing improvement a potential health improvement strategy?
The well-established links between poor health, poor housing and poverty suggest that housing improvements in disadvantaged areas or social housing may provide a population-based strategy to improve health and reduce health inequalities. Housing improvements that reduce exposure to specific hazards may lead to health improvements for current residents and prevent harmful exposure by future generations.
In countries where the hazards of carbon monoxide, lead, poor sanitation and unsafe access have been minimized through the enforcement of strict building regulations, the most serious hazards linked to adverse health are poor air quality, inadequate heat, dampness, radon, trips and falls, noise, house dust mites, tobacco smoke and fires. Few studies have actually evaluated the health impact of interventions to reduce exposure to these hazards, or the health impact of general housing improvement. However, available research suggests that general housing improvement appears to have the potential to improve health, especially mental health.
Housing improvements that ensure the provision of affordable warmth may have the greatest potential to reduce the adverse effects of poor housing. Optimal temperature is an essential component of domestic heating provision and may also affect levels of dampness and allergen growth. Energy efficiency improvements have led to improvements in general health and respiratory health among asthmatic children. The elderly and very young are particularly at risk from both low and high indoor temperatures. Sudden increases in air pollutants are also most detrimental to the health of the elderly and asthmatics.
The most common sources of domestic infestation that pose potential health hazards are lice, bedbugs, fleas, cockroaches, mites, rats and mice. Such infestations can be prevented through careful food and waste storage and good hygiene. Faecal pellets from house dust mites and mould spores are the most common domestic allergens. Well-ventilated, damp-free housing and household dust control are recommended to minimize growth of domestic allergens.
Poisoning, falls and fires in the home are preventable causes of death and injury, particularly among children and the elderly. Effective prevention measures for elderly people at risk include customized safety devices, exercise, balance training and hazard removal. Educational outreach and home visits are also essential if the potential for injury reduction is to be fully realized.
Improvements in mental health are reported consistently following housing improvements, and the degree of mental health improvement may be linked to the extent of the housing improvements. Increased housing satisfaction following housing improvements has been strongly linked to improvements in mental health. General housing improvements may also result in improvements in physical health and general well-being.
However, the potential that housing improvement has to generate health improvement cannot be considered separately from other changes that residents may experience as part of housing improvement, such as increased housing costs, relocation and more general neighbourhood changes. Some of these may have additional health impacts, either negative or positive.