Housing quality and health: what do we know? -- Habitat for Humanity Int'l 1

Housing quality and health: what do we know?

By Lisa Heintz and Karan Kennedy

In our work building houses for people in need, we know instinctively that people with decent housing are healthier—happier, more secure and less susceptible to diseases that are endemic to the poor. In recent years, Habitat for Humanity has begun to look specifically at ways to design housing interventions to have the greatest positive impact on health.

In this effort our good instincts are aligned with emerging research and the information provided by world health organizations and conclusions of the United Nations Development Programme (UNDP).

What does research tell us?

Research into the health impacts of housing on poor families in developing countries is still relatively new, but we are able to glean insight from studies done in the United States and Europe. In the United States, research identifies many health problems for those living in inadequate conditions that arise from lead poisoning, rat bites, fires, asphyxiation from poorly ventilated heating systems, and electric shock to name a few. (Rosenstreich et al. 1997)

Many studies have demonstrated that poorly maintained housing is linked to injuries and lead poisoning in children. (Sandel et al. 1999, 25-26; see also Scientific American 1999, 19-20; Bernstein 1999; Perez-Pena 2003.)

Lead poisoning is so widespread that it has been declared “the most common and devastating environmental disease of young children.” (U.S. General Accounting Office 1993, 2) Structural issues are not the only influence on health; it has been shown in the US that overcrowding can exacerbate stress and disease as well. (Nossiter 1995.)

Additional studies in Great Britain and Scotland link housing to health problems and cold weather.

Housing with poor insulation and damp conditions caused by inadequate heating correlates with increased number of deaths reported in winter months among the poor. Air quality due to lack of proper ventilation also has a negative impact on health, particularly children, as they may be exposed to cigarette smoke, cooking, dust mites, and mould or fungi spores that thrive in damp conditions.

A controlled study carried out in England showed that residents in high-quality public housing in West London were less likely to experience illness than residents in lower-quality public housing in East London. (Hynes et al. 2000, 3)

Based on these findings, it can be inferred that the quality of housing in the developing world also has a profound effect on health.

In addition, there are some studies that a beginning to verify the connection. A recent study in urban slums by Professor Paul Gertler, University of California Berkley, concluded that replacing dirt floors with cement has a dramatic impact on the improved health of children. In fact, the change in housing conditions made a bigger difference in the health and cognitive development of children than nutritional supplements.

As an example, the study tracked an urban program in Mexico that began in the northern state of Coahuila in 2000.

In 2005, the following results were reported for homeowners in Torreon:

“A nearly 20 percent reduction in presence of parasite, and when compared to their neighbors, their children under the age of 6 showed the following improvements:

  • Almost 13 percent fewer episodes of diarrhea
  • 20 percent reduction in incidences of anemia
  • Higher scores of 30 percent on language and communication skills for toddlers ages 12 to 30 months
  • Scores 9 percent higher on vocabulary test for youths (ages 36 to 71 months).”


The researchers caution that the same results would not be achieved in rural areas where families do not have access to clean water. Clearly, the combination of cement floors and clean water makes a critical difference in the health and well-being of children.

What do health practitioners tell us?

According to statistics gathered by the World Health Organization, diarrheal diseases are the third leading cause of death in children under five years of age and malaria is number four. More than 1.7 million children die each year from diarrhea and more than 800,000 from malaria.

Leading Causes of Death in Children Under Five Years of Age, Estimates for 2000-2003

Source: World Health Organization, The World Health Report 2005

Lack of access to clean water and sanitation are directly related to the incidence of diarrhea.
According to the UNDP report 2006, Beyond Scarcity: Power, poverty and the global water crisis, “some 1.1 billion people in the developing world do not have access to a minimal amount of clean water. “ An acceptable level of water per person is about 20 liters per day.

Access to sanitation is an even greater problem.

“Some 2.6 billion people―half the developing world’s population—do not have access to basic sanitation.” The health effects are devastating, but the human development costs go beyond even that—here are the estimates quoted in the report:

  • Loss of 443 million school days each year from water-related illnesses
  • Millions of women spending several hours a day collecting water
  • Lifecycles of disadvantage affecting millions of people, with illness and lost educational opportunities in childhood leading to poverty in adulthood.

The Center for Disease Control (CDC) recommends three interventions to control malaria.
One of which is “vector control.” Vector control is reducing the incidence of contact between mosquitoes carrying the disease and humans. In other words, it is not essential to eliminate the parasite if the correct socio-economic improvements can be made. As an example, the CDC notes that houses with screened windows and air conditioning combined with effective treatment have eliminated the disease in North America and Europe.

Another disease carried by parasites that impacts rural areas in Latin America is Chagas.

The CDC estimates that 8 to 11 million people are infected with Chagas in Mexico, Central America and South America. The information goes on to say: “The triatomine bug thrives under poor housing conditions, for example, mud walls and thatched roofs.”

Incorporating what we know about the health impacts of housing into quality house designs and water and sanitation interventions clearly has a dramatic impact on the well-being of children and families.

Lisa Heintz is a specialist in the HFHI Learning and Organizational Development department. She stewards the Housing and Human Settlements course.

Karan Kennedy is director of international projects in International Field Operations and editor of The Forum.