Urgent Issue #2 - Health
Health Hazards:
The Link Between Poor Housing and Ill Health
By Yasmin von Schirnding and Rebecca Dodd
Disease, structural problems push the poor toward sickness.

	Poverty housing often means limited access to clean water, a situation that can carry serious health implications. This polluted river and surrounding shacks are located in Manila, the Philippines. —Photo by Kim MacDonald

Old…leaking…unsafe…badly built…cold…infested with vermin…dangerous. Hundreds of millions of people describe their homes in this way. Most understand, very clearly, that living in such conditions presents a health hazard that threatens their physical and mental well-being.

A disproportionate share of the world’s population has seen its living conditions deteriorate over the last decade. This is particularly so in rapidly urbanizing developing countries, where a growing percentage of the population lives in informal settlements or slums, often on the outskirts of major cities.

Location—in particular, proximity to basic services such as sanitation—is important when it comes to health. Housing sites may be dangerous; for example, they may be on floodplains, on steep hillsides, near traffic or industrial activity, or on solid waste dumps. Storm and surface water drains may be absent, exacerbating the risks from flooding and overflowing latrines.

Inadequate housing frequently is constructed from flammable materials such as wood, plastic or cardboard. Open fires, gas stoves, and paraffin/ kerosene burners used for cooking, heating or lighting pose a significant fire hazard. Burns and scalds are common in crowded, precarious housing, as are injuries from falls, particularly among young children and the elderly.

In developed and developing countries, poor housing is associated with vector-borne diseases. Fleas, cockroaches, mosquitoes, flies or bedbugs may breed in the house or in waste containers and sewage. Diseases caused by such vectors include Chagas, dengue fever, malaria, filariasis, leishmaniasis, and diarrheal diseases.

Chagas, a debilitating parasitic disease widespread in Latin America, is a good illustration of the link between poor housing and ill health. Caused by infection from the bloodsucking triatomid bugs, Chagas is a leading cause of heart disease in several Central and South American countries; many millions of people are at risk. Infection typically occurs in low-income families in areas where poor housing conditions provide breeding sites for the bugs. Regular spraying with insecticides and plastering of walls to reduce resting and breeding sites can help prevent infection.

The incidence of malaria is affected by the proximity of vector breeding sites in and around households, and also is associated with the condition of housing itself. Studies have found a lower incidence of malaria among inhabitants of well-constructed houses, and one study found significantly higher numbers of “indoor resting” mosquitoes in poorly constructed houses. Housing conditions have also been implicated in dengue transmission, in both urban and rural areas. Poverty exacerbates all these problems, as poor people may not be able to afford medicines or doctors’ fees, or there may not be a health center nearby.

Housing-related health problems are not confined to developing countries. In richer, industrialized countries, poor people often live in the inner city, in old, decaying housing stock, where they are exposed to a wide range of health hazards. Health problems linked to unsafe or dangerous building structures include lead poisoning from lead-based paint or lead water pipes, electrocution by faulty wiring, and collapse of building structures.

A “leaky” house can lead to damp and mold, which may result in respiratory illness and allergic reactions, while use of unsafe building materials (such as asbestos), inadequate ventilation, lighting and heating also pose health problems.

Structural problems are compounded by lack of access to safe water, sanitation, waste-disposal facilities and clean energy sources—all crucial determinants of health. Dirty water and poor sanitation are associated with diarrhea in young children, while use of dirty household fuels for cooking and heating can cause respiratory infections such as pneumonia. Also, crowded, cramped housing conditions facilitate the spread of airborne infections such as measles and tuberculosis. For example, a high incidence of tuberculosis tends to occur among populations living in the poorest areas, where families are large and housing is inadequate and crowded, facilitating rapid transmission to household members.

A range of social problems may be associated with poor housing and living conditions. These include depression, alcohol and substance abuse, child and spouse abuse, delinquency and violence. Many such problems are associated with poor quality housing, insecure tenure, and the threat or reality of eviction. Excessive noise, overcrowding, and high-rise buildings also have an influence on mental disorders. Social networks and cultural factors can diminish the impact of inadequate housing, even when such realities as structural problems, risk of disease and lack of services are present. Strong support systems provide a needed link to a community and, often, hope for those in precarious circumstances.

—Yasmin von Schirnding is the World Health Organization focal point for Agenda 21 (a global program of action on sustainable development). Rebecca Dodd works in the Strategy Unit of the World Health Organization in Geneva, Switzerland.

Making a Difference: Habitat and Health When David Stevens, M.D., executive director of the Christian Medical Association, arrived in Kenya in 1981 to work as a missionary doctor, he quickly realized the importance of housing in health care. Water from the river had to be boiled over a fire using scarce firewood in order to be safe, but if a family had a house with a metal roof, they could collect rainwater in barrels. Burns were a frequent menace as cooking fires in the middle of the floor proved dangerous to sleeping adults and active children. The rodents, spiders and snakes that live in thatched roofs often bit children and adults. Stevens found that improved housing can make a substantial difference in a family’s level of health through clean water, protection from insects and a simple latrine. In addition, the tradition of community responsibility already present in much of Africa progresses as homeowners take pride in their accomplishment. “That’s one of the things that Habitat can help with,” he says. Just the Facts 1.3 billion: Number of people lacking access to clean water. (Global Issues) 2.6 billion: Number of people lacking access to sanitation. (UNICEF) 11 million: Number of children under age 5 who die each year from preventable diseases such as pneumonia, diarrhea, malaria and measles. (UNICEF)