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.

Brote de tos ferina con elevada tasa de ataque en niños y adolescentes bien vacunados / Outbreak of whooping cough with a high attack rate in well-vaccinated children and adolescents

Introducción La tos ferina es una enfermedad reemergente. Describimos la investigación de un brote de tos ferina y las medidas de control adoptadas. Métodos Se reconstruyó el evento a través de un estudio longitudinal de incidencia. Además de los casos notificados, se realizó una búsqueda activa a partir de la lista de asistentes a las colonias a través de llamadas telefónicas. A todos los casos se les aplicó la encuesta epidemiológica, se confirmó sus antecedentes vacunales con la historia clínica informatizada y se les propuso la obtención de muestras para confirmación analítica. La descripción del brote se realizó a través de la curva epidémica, las tasas de ataque, el riesgo relativo, la prueba de tendencia lineal por edades y la cobertura vacunal. Resultados De los 30 casos que se diagnosticaron 22 (73,3%) correspondían a los integrantes de las colonias. En éstas, la tasa de ataque fue del 21,8%, del 26,7% entre los niños y preadolescentes respectivamente, aumentando linealmente con la edad. El 86,4% de este último grupo estaban correctamente vacunados incluyendo la quinta dosis a los cuatro-seis años de edad. El 90% de los casos del brote fueron detectados a partir del estudio minucioso de los primeros casos y las llamadas telefónicas a los asistentes a las colonias. Conclusiones La búsqueda activa de casos permitió el estudio de un brote de tos ferina con elevada tasa de ataque en niños y preadolescentes y elevada cobertura vacunal y la aplicación de medidas de control que contribuyeron a la detención del brote (AU)

Introduction: Whooping cough is a re-emerging disease. We describe the investigation of an outbreak of whooping cough and the measures of control adopted. Methods: The event was reconstructed through a longitudinal study of incidence. In addition to the notified cases, an active search from the list of those who attended summer camps was made through telephone calls. An epidemiological survey was applied to all cases; vaccination history was confirmed with computerised clinical history and the obtaining of samples for analytical confirmation was proposed. The description of the outbreak was made through the epidemic curve, the attack rates, the relative risk and the linear trend by ages and the vaccination coverage. Results: Of the 30 cases that appeared, 22 (73.3%) were among the members of the summer camps. In these, the attack rate was 21.8%, 26.7% among the children and adolescents increasing linearly with the age. The large majority (86.4%) of this last group were correctly vaccinated, including the fifth dose at the age of 4-6 years. Through the meticulous study of the first cases and the telephone calls to those who attended the summer camp, 90% of the cases of the outbreak were detected. (.. )(AU)

[Outbreak of whooping cough with a high attack rate in well-vaccinated children and adolescents]. / Brote de tos ferina con elevada tasa de ataque en niños y adolescentes bien vacunados.

INTRODUCTION: Whooping cough is a re-emerging disease. We describe the investigation of an outbreak of whooping cough and the measures of control adopted. METHODS: The event was reconstructed through a longitudinal study of incidence. In addition to the notified cases, an active search from the list of those who attended summer camps was made through telephone calls. An epidemiological survey was applied to all cases; vaccination history was confirmed with computerised clinical history and the obtaining of samples for analytical confirmation was proposed. The description of the outbreak was made through the epidemic curve, the attack rates, the relative risk and the linear trend by ages and the vaccination coverage. RESULTS: Of the 30 cases that appeared, 22 (73.3%) were among the members of the summer camps. In these, the attack rate was 21.8%, 26.7% among the children and adolescents increasing linearly with the age. The large majority (86.4%) of this last group were correctly vaccinated, including the fifth dose at the age of 4-6 years. Through the meticulous study of the first cases and the telephone calls to those who attended the summer camp, 90% of the cases of the outbreak were detected. CONCLUSIONS: The active search of cases allowed an outbreak of whooping cough with a high attack rate to be studied in children and adolescents with a high vaccination coverage, and the application of control measures that contributed to stop the outbreak.