Key challenges of housing and health from WHO perspective

Abstract

Housing and health, often referred to in more general terms as ‘‘healthy buildings’’, is an area of work that is based on contributions from many technical and professional disciplines: housing, engineering and construction, public health, environment, social welfare, urban planning, and building management. The combination of actions from all these sectors is necessary to provide healthy housing and shows the complexity of the subject, as well as its great potential to increase the quality of life of citizens through providing adequate and safe homes. In historic perspective, the housing improvement campaigns undertaken in many European countries during the 19th century to respond to inadequate housing conditions in relation to crowding, hygiene and sanitation, and the lack of ventilation and light can be recognized as some of the early large-scale public health interventions of modern times. However, notwithstanding the large health improvements that were associated with the quality increase in housing and urban settlements, we still face large challenges in identifying and documenting the impact of housing on health, and especially in assessing health benefits associated with housing improvement schemes (see recently published WHO (2011) report on the environmental burden of disease associated with inadequate housing). Without doubt, housing and health has received increasing interest by the public health community in recent years, and is now considered one of the major environmental, as well as social determinants of population health. This increasing interest follows two recent trends in public health sciences (the rising concern on indoor exposures as a public health risk, and the rediscovery of setting approaches to target health action) and is further enhanced by the report of the WHO Commission on the Social Determinants of Health which identified daily living conditions as a major cause of inequalities (WHO 2008). Public health actors interested in this field will have recognized that during the last decade, the availability of housing and health information and the publication of associated evidence have increased significantly. National reports, reviews and surveys have added to the evidence base as have sophisticated academic research work and contributions from international agencies such as UN and EU. Most of the work on the health relevance of housing seems to be contributed from health-focused actors who are increasingly aware of the negative health impacts of inadequate housing conditions. In contrast, there seems much less evidence generated from the typical ‘‘building-related’’ professions such as engineering, construction, architecture etc., who are in a better position to shape a healthy building stock than the public health actors. However, the wealth of available evidence provides various new opportunities to the housing and health community, as it enables a more detailed housing and health risk assessment, which must form the basis for adequate and targeted risk management on technical as well as policy level. Based on the available evidence, we can identify and confirm a range of housing and health challenges that we This paper belongs to the special issue ‘‘Housing for health promotion’’.