By 2050, the urban population of the world is expected to double with its associated benefits and risks. This population growth will place even more importance on addressing the social determinants of health. Housing is one of the best-studied social determinants of health and has consistently been found to improve health outcomes and decrease healthcare costs. A recent Health Affairs article suggested that the relationship between housing and health can be explained by “four pathways by which the former affects the latter”:
- Stability – Impact of not having a stable home
- Quality and Safety – Health impact of the conditions inside the home
- Affordability – Health impacts of the financial burdens resulting from high-cost housing
- Neighborhood – The environmental and social characteristics of where people live
Improving the overall health of communities through housing strategies is a monumental task that includes government, healthcare, businesses, and other community organizations, a task with compounding complexity as the urban population continues to skyrocket. In some of the most populated cities in the world, we see a preview of what issues will have to be confronted with exponentially-growing frequency:
- Hong Kong’s incredibly high population density drastically amplified and hastened the spread of the SARS virus, as one infected person could be easily confined in busses, trains, or even open streets and office buildings, with hundreds of other people.
- The human impact of natural disasters such as fires, earthquakes, and floods is greatly amplified, and humanitarian efforts are in turn greatly hampered by the increased complexity the dense population imposes on their efforts.
- Public safety measures become more difficult to implement and enforce with as more and more housing units are constructed to accommodate the increased population density. Issues such as carbon monoxide poisoning, fire hazards, and others become more difficult tasks as more buildings require inspections, struggle to adhere to regulations, and so forth.
To meet this challenge and at the request of member states, the World Health Organization (WHO) recently released the first guidelines regarding health and housing. These guidelines provide the foundation for developing whole person care strategies that take into consideration housing and the impact that housing has on the health of people across the world.
The WHO guidelines focus on four key areas: Living space, indoor temperatures, injury hazards, and accessibility:
- Living Space—Organizations should develop and implement strategies to prevent and reduce crowding.
- Indoor Temperatures—Regardless of outdoor temperatures, strategies should be developed that provide for relief and protection from temperature variations and extremes while also providing for safe and efficient insulation materials for new and existing housing.
- Injury Hazards—Safety devices—such as fire alarms, carbon monoxide detectors, and gates and railings—should be used to reduce and prevent injury risks.
- Accessibility—Functional impairments should be accounted for with appropriate steps taken to provide access to housing and adequate accommodations.
In addition to these four key elements, the new guidelines summarize existing recommendations regarding water and air quality, noise pollution, hazardous materials such as asbestos and lead, and other common standard-of-living issues.
Several studies have suggested that poor housing has a direct impact on several health conditions, including respiratory, cardiovascular, and infectious diseases. These guidelines provide for the development of coordinated community care plans that focus on housing—and the associated risks of poor housing—as a critical social determinant of health, and participating communities may recognize improved health and health outcomes in their populations.
