Changes in Health Following Housing Improvement in a Vulnerable Population in Spain: A Follow-up Study.

The objective of this study is to compare changes in health among a sample of families living in substandard dwellings or with housing affordability problems assisted by Caritas Diocesana de Barcelona, according to the improvement of their socioeconomic and housing situation during the study period. A quasi-experimental study was performed, including 232 families assisted by Caritas who were interviewed in 2012 and one year later. Participants could have received a set of interventions, including relocation and different types of economic subsidies. Regression models were fitted to identify the association of participants' changes in self-rated general health and mental health between baseline and follow-up with improvements across three dimensions: socioeconomic situation and housing affordability, physical housing characteristics, and neighborhood. An improvement in self-reported health status was associated with having found a job and reporting fewer problems in meeting monthly housing costs. Mental health improved among participants with an increased household income, with a reduction in the perceived risk of losing their house, and with reduced housing-related material deprivations. The study shows that health gains can derive from improvements in housing conditions, especially those related to housing affordability.

How substandard dwellings and housing affordability problems are associated with poor health in a vulnerable population during the economic recession of the late 2000s.

INTRODUCTION: Given the increasing number of people in Spain struggling to pay housing-related costs during the economic recession, it is important to assess the health status of these communities as compared to the general population and to better understand the different housing dimensions that are related with poor mental health. This study aims to describe the housing conditions and health status of a sample of people assisted by Caritas Barcelona (Spain) and living in inadequate housing and/or struggling to pay their rent or mortgage, to compare the health outcomes of this population with those of the overall population of Barcelona, and to analyze the association between housing dimensions and mental health. METHODS: We used a cross-sectional design. The participating adults (n = 320) and children (n = 177) were those living in the dioceses of Barcelona, Sant Feliu and Terrassa (Spain) in 2012 and assisted by Cáritas. They were asked to answer to three questionnaires on housing and health conditions. Eight health related variables were used to compare participants with Barcelona's residents and associations between housing conditions and poor mental health were examined with multivariate logistic regression models. RESULTS: In Barcelona, people seeking Caritas's help and facing serious housing problems had a much poorer health status than the general population, even when compared to those belonging to the most deprived social classes. For example, 69.4 % of adult participants had poor mental health compared to 11.5 % male and 15.2 % female Barcelona residents. Moreover, housing conditions were associated with poor mental health. CONCLUSIONS: This study has shown how, in a country hit by the financial recession, those people facing housing problems have much worse health compared to the general population.

El impacto de la crisis en la relación entre vivienda y salud. Políticas de buenas prácticas para reducir las desigualdades en salud asociadas con las condiciones de vivienda / Impact of the crisis on the relationship between housing and health. Policies for good practice to reduce inequalities in health related to housing conditions

Las condiciones de vivienda pueden repercutir sobre la salud física y mental a través de cuatro dimensiones interrelacionadas: 1) el hogar (condiciones emocionales relacionadas con la vivienda), 2) las condiciones físicas de la vivienda, 3) el entorno físico y 4) el entorno social (comunidad) del barrio donde está situada la vivienda. En España, la utilización del mercado de la construcción como motor de crecimiento económico del país y la promoción de la propiedad privada como régimen de tenencia mayoritario han comportado que la vivienda sea utilizada como bien especulativo en lugar de ser considerada un bien de primera necesidad. Mientras España es el país de la Organización para la Cooperación y el Desarrollo Económicos (OCDE) con el mayor parque de viviendas por habitante, éste se encuentra altamente infrautilizado y la población con menos recursos queda excluida del acceso a la vivienda. El impacto de la actual crisis económica sobre la vivienda se ha debido sobre todo a la reducción de los ingresos de los hogares, con el consecuente aumento del número de familias o personas con problemas para afrontar los gastos de la vivienda o desahuciadas. Existe evidencia de que estos problemas tienen un impacto negativo en la salud, en especial en la salud mental, pero también las dificultades económicas para satisfacer otras necesidades básicas como la alimentación. Existen distintos instrumentos para reducir el impacto de la crisis económica, como la financiación de la deuda o la dación en pago. A largo plazo, debería promoverse la creación de un parque de vivienda social y sistemas de ayudas al pago del alquiler (AU)

Housing conditions can impact on physical and mental health through 4 interrelated dimensions: 1) the home (the emotional housing conditions), 2) the physical housing conditions, and 3) the physical environment, and 4) the social (community) environment of the neighborhood where the house is located. In Spain, the use of the construction market as an engine for economic growth and the promotion of private property as the main type of housing tenure has led to the use of housing as a speculative good instead of its being considered a first-necessity good. While Spain is the Organisation for Economic Co-operation and Development (OECD) country with the largest housing stock per inhabitant, this stock is highly underutilized, thus excluding the most deprived sector of the population from access to housing. The impact of the current economic crisis on housing has mainly been due to a reduction in household income, which has increased the number of families or persons struggling to cover their housing costs or being evicted. Evidence indicates that this type of problem has a negative impact on health, especially on mental health, but financial problems also make it difficult to meet other basic needs such as eating. There are several instruments to reduce the impact of the economic crisis, such as debt financing or deed of assignment in payment. In the long-term, the creation of a social housing stock should be promoted, as well as rental assistance mechanisms (AU)

[Impact of the crisis on the relationship between housing and health. Policies for good practice to reduce inequalities in health related to housing conditions]. / El impacto de la crisis en la relación entre vivienda y salud. Políticas de buenas prácticas para reducir las desigualdades en salud asociadas con las condiciones de vivienda.

Housing conditions can impact on physical and mental health through 4 interrelated dimensions: 1) the home (the emotional housing conditions), 2) the physical housing conditions, and 3) the physical environment, and 4) the social (community) environment of the neighborhood where the house is located. In Spain, the use of the construction market as an engine for economic growth and the promotion of private property as the main type of housing tenure has led to the use of housing as a speculative good instead of its being considered a first-necessity good. While Spain is the Organisation for Economic Co-operation and Development (OECD) country with the largest housing stock per inhabitant, this stock is highly underutilized, thus excluding the most deprived sector of the population from access to housing. The impact of the current economic crisis on housing has mainly been due to a reduction in household income, which has increased the number of families or persons struggling to cover their housing costs or being evicted. Evidence indicates that this type of problem has a negative impact on health, especially on mental health, but financial problems also make it difficult to meet other basic needs such as eating. There are several instruments to reduce the impact of the economic crisis, such as debt financing or deed of assignment in payment. In the long-term, the creation of a social housing stock should be promoted, as well as rental assistance mechanisms.