Review of the Impact of Housing Quality on Inequalities in Health and Well-Being.

Housing quality is essential for population health and broader well-being. The World Health Organization Housing and health guidelines highlight interventions that protect occupants from cold and hot temperatures, injuries, and other hazards. The COVID-19 pandemic has emphasized the importance of ventilation standards. Housing standards are unevenly developed, implemented, and monitored globally, despite robust research demonstrating that retrofitting existing houses and constructing high-quality new ones can reduce respiratory, cardiovascular, and infectious diseases. Indigenous peoples, ethnic minorities, and people with low incomes face cumulative disadvantages that are exacerbated by poor-quality housing. These can be partially ameliorated by community-based programs to improve housing quality, particularly for children and older people, who are hospitalized more often for housing-related illnesses. There is renewed interest among policy makers and researchers in the health and well-being of people in public and subsidized housing, who are disproportionately disadvantaged by avoidable housing-related diseases and injuries. Improving the overall quality of new and existing housing and neighborhoods has multiple cobenefits, including reducing carbon emissions.

Injuries associated with housing conditions in Europe: a burden of disease study based on 2004 injury data.

BACKGROUND: The authors recently undertook a study for the World Health Organization estimating the European burden of injuries that can be attributed to remediable structural hazards in the home. Such estimates are essential for motivating injury prevention efforts as they quantify potential health gains, in terms of injuries prevented, via specific environmental interventions. METHODS: We combined exposure estimates from existing surveys and scenarios with estimates of the exposure-risk relationship obtained from a structured review of the literature on injury in the home and housing conditions. The resulting attributable fractions were applied to burden of injury data for the WHO European Region. RESULTS: This analysis estimated that two specific hazards, lack of window guards at second level and higher, and lack of domestic smoke detectors resulted in an estimated 7,500 deaths and 200,000 disability adjusted life years (DALYs) per year. In estimating the environmental burden of injury associated with housing, important deficiencies in injury surveillance data and related limitations in studies of injury risk attributable to the home environment were apparent. The ability to attribute proportions of the home injury burden to features of the home were correspondingly limited, leading to probable severe underestimates of the burden. CONCLUSIONS: The burden of injury from modifiable home injury exposures is substantial. Estimating this burden in a comprehensive and accurate manner requires improvements to the scope of injury surveillance data and the evidence base regarding the effectiveness of interventions.

Housing interventions and control of injury-related structural deficiencies: a review of the evidence.

Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect safety and injury outcomes, such as falls, fire-related injuries, burns, drowning, carbon monoxide poisoning, heat-related deaths, and noise-related harm, associated with structural housing deficiencies. Structural deficiencies were defined as those deficiencies for which a builder, landlord, or home-owner would take responsibility (ie, design, construction, installation, repair, monitoring). Three of the 17 interventions reviewed had sufficient evidence for implementation: installed, working smoke alarms; 4-sided isolation pool fencing; and preset safe hot water temperature. Five interventions needed more field evaluation, 8 needed formative research, and 1 was found to be ineffective. This evidence review shows that housing improvements are likely to help reduce burns and scalds, drowning in pools, and fire-related deaths and injuries.

Measuring the Effect of Housing Quality Interventions: The Case of the New Zealand "Rental Warrant of Fitness".

In New Zealand, as in many other countries, housing in the private-rental sector is in worse condition than in the owner-occupier housing sector. New Zealand residential buildings have no inspection regime after original construction signoff. Laws and regulations mandating standards for existing residential housing are outdated and spread over a range of instruments. Policies to improve standards in existing housing have been notoriously difficult to implement. In this methods paper, we describe the development and implementation of a rental Warrant of Fitness (WoF) intended to address these problems. Dwellings must pass each of 29 criteria for habitability, insulation, heating, ventilation, safety, amenities, and basic structural soundness to reach the WoF minimum standard. The WoF's development was based on two decades of research on the impact of housing quality on health and wellbeing, and strongly influenced by the UK Housing Health and Safety Rating System and US federal government housing standards. Criteria were field-tested across a range of dwelling types and sizes, cities, and climate zones. The implementation stage of our WoF research consists of a non-random controlled quasi-experimental study in which we work with two city-level local government councils to implement the rental WoF, recruiting adjoining council areas as controls, and measuring changes in health, economic, and social outcomes.

Home safety in the U.K.: review of the influence of human and housing factors.

Injuries and deaths from home accidents are a major public health problem. This paper describes how data on housing characteristics were matched with dwelling-related mortality and injuries data. As no single database provided sufficient accurate data on housing and occupiers, this task involved identifying datasets to create and validate a Housing and Population Database, which was matched with various datasets on injuries and fatalities that are associated with the home. Taking account of both frequency of accidents and severity of outcomes, analyses of the matched data showed the true rank order of type of home accidents. Also investigated was whether one age group was more vulnerable to a particular type of accident and the relation between different types of accidents and the age and type of dwelling. A literature review was carried out to look at the relation between the design and condition of dwelling features and accidents and between human behavior and accidents. The results showed that little work has been done in most areas on the different degrees of the contribution made by human behavior and building conditions. Even though more focused research would be useful, preventative actions could reduce the scale of the problem.

Assessing housing quality and its impact on health, safety and sustainability.

BACKGROUND: The adverse health and environmental effects of poor housing quality are well established. A central requirement for evidence-based policies and programmes to improve housing standards is a valid, reliable and practical way of measuring housing quality that is supported by policy agencies, the housing sector, researchers and the public. METHODS: This paper provides guidance on the development of housing quality-assessment tools that link practical measures of housing conditions to their effects on health, safety and sustainability, with particular reference to tools developed in New Zealand and England. RESULTS: The authors describe how information on housing quality can support individuals, agencies and the private sector to make worthwhile improvements to the health, safety and sustainability of housing. The information gathered and the resultant tools developed should be guided by the multiple purposes and end users of this information. Other important issues outlined include deciding on the scope, detailed content, practical administration issues and how the information will be analysed and summarised for its intended end users. There are likely to be considerable benefits from increased international collaboration and standardisation of approaches to measuring housing hazards. At the same time, these assessment approaches need to consider local factors such as climate, geography, culture, predominating building practices, important housing-related health issues and existing building codes. CONCLUSIONS: An effective housing quality-assessment tool has a central role in supporting improvements to housing. The issues discussed in this paper are designed to motivate and assist the development of such tools.

Экологическое бремя болезней, связанных с неудовлетворительными жилищными условиями: методическое руководство по количественной оценке влияния на здоровье некоторых факторов риска, связанных с жилищными условиями, в Европейском регионе ВОЗ: резюме доклада

В настоящем резюме содержатся основные выводы доклада «Экологическое бремя болезней, связанных с неудовлетворительными жилищными условиями». B нем приводятся фактические данные, свидетельствующие о том, что неудовлетворительные жилищные условия грозят серьезными нарушениями здоровья. Улучшение жилищных условий, при котором устраняются или снижаются до минимума негативные воздействия на здоровье и безопасность людей и стимулируется создание здоровых условий жизни, благоприятно как для отдельных жителей, так и для всего общества. Снижение нагрузки на системы здравоохранения, связанной с необходимостью удовлетворения нужд населения, обусловленных плохими жилищными условиями, – это не только очевидный приоритет общественного здравоохранения, но и несомненный фактор экономической целесообразности. Изложенные в полном докладе результаты обосновывают принцип, согласно которому в основе жилищной политики должны лежать интересы здоровья. Создание здорового, доступного и экологически безопасного жилья должно стать первостепенной задачей всех специалистов и руководителей, занятых в сферах, связанных с различными аспектами жилищных условий и здоровья. Обе публикации предлагают им необходимые сведения для выполнения этой задачи.

Environmental burden of disease associated with inadequate housing: a method guide to the quantification of health effects of selected housing risks in the WHO European Region

This guide describes how to estimate the disease burden caused by inadequate housing conditions for the WHO European Region as well as for subregional and national levels. It contributes to the WHO series of guides that describe how to estimate the burden of disease caused by environmental and occupational risk factors. An introductory volume to the series outlines the general methodology. In this context, the WHO Regional Office for Europe took up the challenge to quantify the health effects of inadequate housing and convened an international working group to quantify the health impacts of selected housing risk factors, applying the environmental burden of disease (EBD) approach. The guide outlines, using European data, the evidence linking housing conditions to health and the methods for assessing housing impacts on population health. This is done for twelve housing risk factors in a practical step-by-step approach that can be adapted to local circumstances and knowledge. It also summarizes the recent evidence on the health implications of housing renewal and provides a national example on assessing the economic implications of inadequate housing. The findings confirm that housing is a significant public health issue. However, to realize the large health potential associated with adequate, safe and healthy homes, joint action of health and non-health sectors is required.

Environmental burden of disease associated with inadequate housing: a method guide to the quantification of health effects of selected housing risks in the WHO European Region: summary report

This summary report presents key findings of the report “Environmental burden of disease associated with inadequate housing”. It provides evidence that the health consequences of inadequate housing are substantial. Improving housing in a way that removes or minimizes the negative impact on health and safety and promotes a healthier living environment is good for the residents and beneficial for society. Reducing the burden of responding to the demands on the health system attributable to inadequate housing is an obvious public health priority, but also something that makes economic sense. The findings set out in the full report provide ample justification for the principle that health should be at the centre of housing policy. Making housing healthy, affordable and sustainable should be a prime objective of all professionals and policy-makers involved in any aspect of housing and of health. This summary and its sister publication provide the evidence they need to make it so.