Housing and Health 2004

8/9/2019 Housing and Health 2004

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HOUSING &

HEALTH

Dr Virginia MacNeill

Health ServicesResearch Unit

Department of PublicHealth

October 04


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Making connectionsBroad connections

Common-sense view (Joe Public)

that poor housing may affect health

Inequalities in health

The effect of housing status onaccess to health care

The effect of health status on

housing opportunities


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Proving that poor housingis detrimental to mental orphysical health

The need for OBJECTIVE proof


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Commonsense connections

WHO (1961) Concept of health:

A state of complete physical,

mental and social well-beingand not merely the absence ofdisease and infirmity.

WHO (1961) Residentialenvironment:

The physical structure that Manuses for shelter and the environsof the structure including all

necessary services, facilities,equipment and devices neededor desired for the physical andmental and the social well-beingof the

individual.


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Can commonsenseconnections bescientifically proven?

it seems axiomatic that poor

housing should lead to poor

health , yet there is little hard

data on the links betweenhousing per se and physical

and mental illness

Heginbotham (1985, 218)


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Disentangling one effect

from many

The Condition of the Working

Classes in England in 1844

(Engels, date?)

The interrelation of

socioeconomic facts with housing,

on the one hand, and with health,on the other, would make

impossible any clear-cut

determination of the effects of

housing per se on health (Britten,1942, 193)

The social complex (Stein 1952)


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But these assumptionscan be challenged

Poor housing conditions is

not always associated with

multiple deprivation

e.g. problems of radon or

electromagnetic radiation inthe home.

Not everyone is multiplydeprived


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ackling the pr

oblem ofconfounding variables

Define housing

Clarify exposure

Construct studies

Examine associations

Consider causal processes


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BROAD ASSOCIATIONS

Housing deprivation and health

Housing and health

SPECIFIC RELATIONSHIPS

Specific aspects of housing and health


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Housing deprivation &

health

Housing and social class(Townsend & Davidson, 1982)

Infant mortality in public andprivate Housing (Spivey &Radford, 1979)

Lower and higher housingstandards (Burt, 1945)

BUTHousing definitions too broad

Cant be divorced from othersocial factors that couldinfluence health


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BROAD ASSOCIATIONS


Housing and health




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Housing and health

Studies relying on:

Changes to the housing location

and/or

Controlling for age, sex, smoking,

income, type of housing etc.

These May show a decrease in

disease/improvements in

health

But fail to examine specific

aspects of ousing which may

contribute to ill health


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BROAD ASSOCIATIONS


Housing and health




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Specific aspects of housing

& health

Examples of two different

approaches, using housingdampness as a specifichousing factor:

1. Studies that eliminateconfounding variable.

2. Studies that distinguishrelationships by means ofmultivariate analysis.

NB. Approach A and approach Bare often combined.


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Establishing causality in

housing dampness andhealth

Pragmatic concept ofcausality

Epidemiological research

methods

Criteria applied

Experimental techniques

Observational studies


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Pragmatic concept of

causality

A causal relationship would be

recognised to exist wheneverevidence indicates that the

factors form part of the complex of

circumstances that increases the

probability of the occurrence ofdisease and that a diminution of

one or more of these factors

decreases the frequency of that

disease.

Lilienfeld & Lilienfeld, 1980, 295)


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Establishing causality in

housing dampness andhealth

Pragmatic concept ofcausality

Epidemiological research

methods

Criteria applied

Experimental techniques

Observational studies


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Biological plausibility Lack of evidence that damp

(relative humidity) has a direct

negative effect on health

damp housing not the same as

dampness alone.

BUT Housing + dampness

= potentially harmful agents that

would not arise with damp alone

= propagation of house mites and

fungal spores


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Respiratory Health

Indirect effects of higher

humidity on house dust mites

and moulds

Associations between housedust mites and moulds with

allergic diseases (e.g. rhinitis,

asthma, dermatitis


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Other health effects

observations requiringmore research

Non-respiratory symptoms and

dampness/mould

Relationship betweendamp/mould & diarrhoea,

vomiting, aches and pains

Relationship between organic

toxic dust & muscular pain,chest tightness, cough andheadaches


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Consistency of association

If the same results are found

in laboratory beagles,vegetarian Trappist monks,

cannibals and Welsh males,

you know you are on to

something.

(Jones & Moon, 1987, 133)


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Str

ength of association

No studies showing a

significant association using

objective measures for bothhealth and dampness.

Studies show significant

association between:either: Objectively measured

dampness and reported health

or: Objectively measured

health and reported dampness


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Specificity of association

Epidemiological argument re:

causal relationships

but damp housing associated

with more than one healthproblem so how useful is

specificity of association ( see

James and Moon, 1987)


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Dose-response

Increase severity of dampness =

greater prevalence of poor health

symptoms

(See studies: Hyndman 1990;Dales, Burnett & Zwanenbug,

1991; Spengler et al, 1994)


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Cold and damp

Damp housing is usually, but

not always, associated withcold housing

Effects of cold air onrespiratory health


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Conclusions

Establishing causal links betweenhousing and health

Impact on: Housing supply and improvement

Benefits to:

health Savings to health service

Better quality of life for the individual


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HOUSING &

HEALTH

Dr Virginia MacNeill

Health ServicesResearch Unit

Department of PublicHealth

[email protected] 04

Documents

Housing and Health 2004