48– 50 Poor ventilation may increase exposure to smoke. The association of passive exposure to indoor tobacco smoke with respiratory disease is well documented. 47Įxposure to toxic substances found in homes can result in chronic health problems. 46 These health concerns have contributed to the development of standards for thermal comfort. 45 Living in cold housing has been associated with lower general health status and increased use of health services. 11ĭeviation of indoor temperature beyond a relatively narrow range has been associated with increased risk of cardiovascular disease. Dead spaces in walls harbor pests and permit circulation among apartments in multiunit dwellings. Inadequate food storage and disposal facilities provide them with opportunities for obtaining food. 44 Structural defects permit entry of cockroaches and rodents leaking pipes and other sources of water provide them with water to drink. 43 Mouse allergen also acts as a clinically important cause of allergy and asthma morbidity. Children with asthma who are sensitized and exposed to cockroaches are at elevated risk for hospitalization. Cockroaches can cause allergic sensitization and have emerged as an important asthma trigger in inner-city neighborhoods. Pest infestations, through their association with asthma, provide another linkage between substandard housing and chronic illness. 41, 42 Exposure to these agents can result in allergic, respiratory, neurological, and hematologic illnesses. Old, dirty carpeting, often found in substandard housing, is an important reservoir for dust, allergens, and toxic chemicals. 33– 39 Cross-sectional epidemiological studies have also established associations between damp and moldy housing and recurrent headaches, fever, nausea and vomiting, and sore throats. 32 Damp houses provide a nurturing environment for mites, roaches, respiratory viruses, and molds, all of which play a role in respiratory disease pathogenesis. 6 Overcrowding and inadequate ventilation also increase interior moisture. In 1999, eleven million occupied homes in America had interior leaks and 14 million had exterior leaks.
21– 31 Water intrusion is a major contributor to problems with dampness. Damp, cold, and moldy housing is associated with asthma and other chronic respiratory symptoms, even after potentially confounding factors such as income, social class, smoking, crowding, and unemployment are controlled for. In more recent years, epidemiological studies have linked substandard housing with an increased risk of chronic illness. In this article, we describe some of the evidence linking housing conditions to health, place public health's role in addressing housing issues in an historical context, provide examples of contemporary local public health activities in the housing arena, and conclude with suggestions for public health action in the next decade. 8 Elected officials and communities alike recognize that substandard housing is an important social justice issue that adversely influences health. The public is also concerned about the quality and accessibility of housing as affordable housing becomes scarcer. Housingrelated health concerns such as lead exposure and asthma are highly visible. Public health has a long (albeit intermittent) history of involvement in the housing arena, and this involvement is generally accepted by other housing stakeholders (e.g., building departments, community housing advocates). Public health agencies have valuable expertise and resources to contribute to a multisectoral approach to housing concerns. The public health community is developing, testing, and implementing effective interventions that yield health benefits through improved housing quality. An evolving body of scientific evidence demonstrates solid relations between housing and health.
The quality and accessibility of housing is, however, a particularly appropriate area for public health involvement. Responsibility for social determinants of health is seen as lying primarily outside the scope of public health. The public health community has grown increasingly aware of the importance of social determinants of health (including housing) in recent years, 7 yet defining the role of public health practitioners in influencing housing conditions has been challenging. 5 Two million Americans occupy homes with severe physical problems, and an additional 4.8 million live in homes with moderate problems. 4 One million young children in the United States have blood lead levels high enough to adversely affect their intelligence, behavior, and development. 1 Each year in the United States, 13.5 million nonfatal injuries occur in and around the home, 2 2900 people die in house fires, 3 and 2 million people make emergency room visits for asthma. Housing is an important determinant of health, and substandard housing is a major public health issue.
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