Housing Interventions Research Articles

Transformation through training: application of emancipatory methods in a housing education programme for rural women in South Africa

The role of education in the development of communities has been receiving increasing attention from the South African Government. The purpose of this study was to determine how community developers could contribute to transformative learning in community groups. Using an emancipatory teaching approach, a housing education programme was presented to a group of women who had recently been allocated subsidized housing in a rural Northern Cape town in South Africa. During the implementation of the housing intervention, the emancipatory method encouraged participants to question and alter their distorted assumptions. Guidelines are provided for community developers for applying the emancipatory teaching method to facilitate transformative learning.

Toddlers with autism: A sensory tree house intervention for recreation therapy

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Normality or care – an inventory of Swedish municipalities’ responses to unstable accommodation for vulnerable groups

This article presents an inventory of policies and housing support interventions to the homeless and those at risk of becoming homeless in a representative sample of Swedish municipalities. Two types of intervention are included: various types of accommodation for those who are already homeless and daily life support for those at risk, either provided or financed by the social services in the municipality. Data were collected in 2004–2005 through a questionnaire e-mailed to local authority officials, in a stratified sample of about half of the Swedish municipalities (n=147). The results show that two types of housing intervention dominate the field: daily life support and sublet contracts, both of which have a relatively high normality factor, with a setting in normal housing. Daily life support includes care and is usually implemented before the tenant is evicted. The level of care related to various interventions fluctuates more between the municipalities than normality does. The more densely populated municipalities were more engaged in developing housing policies and administrative bodies to handle these. However, the implementation of housing policies does not seem related to improvements in the qualities of the interventions. On the contrary, the local authorities that have housing policies and administrative tools adapted to these policies provided a lower degree of both normality and care in the interventions. The results suggest that aspects of normality and care in the same type of housing interventions vary depending on the type of municipality, while the existence of policies has no influence on care and a negative effect on the degree of normality provided through the interventions.

Revitalizing environmental assessment

Those of us who have been involved in the development of ecological risk assessment are entitled to be a little self congratulatory. The framework for ecological risk assessment developed in the 1980s and 1990s has been widely adopted in the United States and elsewhere (Power and McCarty 1998; Suter 2008), has been adapted to human health risk assessment (Risk Assessment Forum 2003; Suter et al. 2003), and a recent review considered it to be a success (Dale et al. 2008). So? Does it matter? Although we are doing good risk assessments using a consistent framework, we have relatively little influence. Even when the effects are large, involve charismatic species, and are clearly related to the contaminants by extensive data and high quality models, decision makers often ignore ecological risk assessments (National Research Council 2006). We believe that every one of you who has performed more than one ecological risk assessment has experienced the frustration of seeing your work ignored while less realistic human health assessments or technological standards drive the decision. Or, equally frustrating, nothing was decided and no attempt was made to improve the situation. We believe that there are two principal reasons for this situation. First, ecological assessors have not done a good enough job of providing appropriate information to decision makers. Second, decision makers have not been appropriately concerned with ecological endpoints. Ecological assessors have been legitimately concerned with producing quality assessment documents. However, we have been much less concerned about the ultimate goal of preserving and protecting the environment by providing scientific input to good environmental management decisions. This is exactly the problem identified by the National Research Council (2006) in their review of the ecological risk assessments performed for the Coeur d'Alene Superfund site. To begin to address this problem, we have developed a theory of environmental assessment (Suter and Cormier 2008a) and a fully integrated assessment framework that puts ecological risk assessment in a wider context of assessment and decision making (Cormier and Suter 2008). In addition, we incorporated the setting of criteria and other “bright lines” into the ecological risk assessment framework, which should provide a better means to deal with cases in which decision makers simply want a defensible number (Suter and Cormier 2008b; Cormier et al. 2008). The common theme of these papers is that all environmental assessors must know how their work can best contribute to resolving a problem. This includes everyone from scientists who monitor the condition of the environment to members of a decision maker's staff who balance risks against benefits. While addressing this first problem will put us in the game, it will not make us influential until the environment is influential. For years, environmental decision makers have learned that they will be punished by the public and advocacy groups for not protecting human health, and, in most cases, they can focus on health and economic concerns without considering ecological risks. Consider the recent flap over revision of the atmospheric ozone standard in the United States. Environmental advocacy groups complained that the primary standard for human health was not low enough and complained of White House interference. None complained that the White House intervention blocked protection of crops, forests and other plant populations and communities. This relative indifference to environmental risks can be addressed professionally by educating decision makers concerning the importance of services of nature. However, it must also be addressed in our personal lives by being advocates for protecting the environment. Any organization that you belong to can be a forum for spreading the message that protecting humans will not result in protection of the environment. It is time to try again. It is time to revitalize the practice of ecological risk assessment. We know how to do good ecological assessments, now we need to show that we can consistently do assessments that matter.

Government Intervention in Housing: Convergence and Divergence of the Asian Dragons

This paper compares housing policies among the Asian Dragons and explains their convergence and divergence from the perspective of government intervention and the historical contingencies of the housing policies themselves. It argues that before the regional economic crisis, the four Little Dragons diverged over a spectrum within the liberalist type, whereas China constituted a marketised socialist system. Since the crisis, government intervention generally retreated, except South Korea, in order to resolve housing problems ensued by past policies and the changed economic circumstances. Overall, the intensity of subsidy is determined by the socio-political and economic roles of housing in the development processes, whereas regulatory and supply controls are attributable to supply and demand imbalance and the state ownership of land and development rights.

The Dynamics of Unhealthy Housing in the UK: A Panel Data Analysis

There is an abundance of evidence supporting a cross-sectional association between poor housing and poor health, but relatively few studies have examined the relationship between housing and health over time. Using contemporary longitudinal data from seven yearly waves (1996–2002) of the British Household Panel Survey, summary statistics and multivariate first-differences regression models, this study provides robust evidence of a dynamic relationship between housing conditions and health. Worsening housing conditions, measured in three domains, are independently associated with deterioration in health, especially the number of reported health problems in women. These findings add to the longitudinal evidence of the effect of housing conditions. It is concluded that improvements in housing conditions produce health benefits and the findings are important for proposed housing interventions to maximise health benefits and prioritise areas of housing investment.

A Framework for Widespread Replication of a Highly Spatially Resolved Childhood Lead Exposure Risk Model

BackgroundPreventive approaches to childhood lead poisoning are critical for addressing this longstanding environmental health concern. Moreover, increasing evidence of cognitive effects of blood lead levels < 10 μg/dL highlights the need for improved exposure prevention interventions.ObjectivesGeographic information system–based childhood lead exposure risk models, especially if executed at highly resolved spatial scales, can help identify children most at risk of lead exposure, as well as prioritize and direct housing and health-protective intervention programs. However, developing highly resolved spatial data requires labor-and time-intensive geocoding and analytical processes. In this study we evaluated the benefit of increased effort spent geocoding in terms of improved performance of lead exposure risk models.MethodsWe constructed three childhood lead exposure risk models based on established methods but using different levels of geocoded data from blood lead surveillance, county tax assessors, and the 2000 U.S. Census for 18 counties in North Carolina. We used the results to predict lead exposure risk levels mapped at the individual tax parcel unit.ResultsThe models performed well enough to identify high-risk areas for targeted intervention, even with a relatively low level of effort on geocoding.ConclusionsThis study demonstrates the feasibility of widespread replication of highly spatially resolved childhood lead exposure risk models. The models guide resource-constrained local health and housing departments and community-based organizations on how best to expend their efforts in preventing and mitigating lead exposure risk in their communities.

URBANISATION AND INFORMALITY IN AFRICA'S HOUSING MARKETS

Urbanisation is a growing phenomenon in Africa. Across the continent cities are drawing more and more people in search of economic opportunity. The majority of these people end up living in informal settlements: slums. As Africa's slums expand, international organisations, NGOs, and governments themselves call for strong public‐sector action to deal with the problems in these settlements and to limit their expansion. However, government intervention in African housing markets may have contributed significantly to the growth of informal settlements. A maze of regulations and administrative barriers has imposed high transaction costs on formal‐sector housing entrepreneurs. By raising the costs of providing low‐income housing, African governments bear much responsibility for driving formal‐sector entrepreneurs out of the housing market and for driving their citizens into slums.

Housing and home-making in low-income urban settlements: Sri Lanka and Colombia

Enabling the making of home is central to the practices of housing, but constructing home is more than building adequate shelter. It is about establishing, nurturing and managing social relationships and bringing together spaces, objects and elements to represent and celebrate desired relationships, events and memories. Drawing on empirical data from Sri Lanka and Colombia, this paper examines in detail the practices of home-making in low-income settlements. By focussing on people’s conceptions of home and by identifying key social and societal practices, the paper offers insights into the processes of home-making among ordinary dwellers in developing countries and calls for culturally sensitive and holistic housing interventions which support and complement these processes.

Future Directions in Housing and Public Health: Findings From Europe With Broader Implications for Planners

Problem: Chronic diseases such as asthma are rising at alarming rates in the United States and worldwide. Housing environments play an important, underappreciated role in these trends. Purpose: In this article, we document the magnitude of the association between housing conditions and asthma and related respiratory symptoms, present examples of new systems for addressing adverse effects of housing on health, and discuss how planners might require or encourage such innovations. Methods: We use logistic regressions based on household survey data from seven European cities to show the magnitude of the association between housing conditions and noise annoyance and the exacerbation of asthma and related respiratory symptoms. To support our argument that new housing intervention systems show great promise for alleviating current housing-related health challenges, we offer several different examples of green building criteria that incorporate health measures. Results and conclusions: After taking into consideration individual-level characteristics, we found that respondents across a range of cities who were strongly annoyed by general neighborhood noise had twice the odds of a doctor-diagnosed asthma attack or related respiratory symptom than those not at all annoyed. Those strongly annoyed by traffic noise had 68% higher odds. Drainage problems at the housing unit were associated with 54% higher odds of experiencing respiratory symptoms, building structural problems with 27% higher odds, and a leaky roof with 35% higher odds. We identify healthy housing development, construction, and housing rehabilitation systems as promising initiatives for addressing the web of associations between housing and health. We suggest that funds such as Community Development Block Grants or housing trusts could subsidize such efforts, and various existing planning processes could incorporate health requirements or scoring criteria. Takeaway for practice: There is compelling evidence that housing conditions are associated with poor health. Planners should inform themselves about these and identify opportunities to incorporate health considerations into planning that affects housing. Research support: None.

Effects of housing circumstances on health, quality of life and healthcare use for people with severe mental illness: a review

Individuals with severe and persistent mental illness (SPMI) identify housing as an important factor in achieving and maintaining their health. However, many live in substandard accommodations that are physically inadequate, crowded, noisy and located in undesirable neighbourhoods. In much of the research on housing for persons with SPMI, the central outcome of interest is remaining housed; however, it is worth investigating whether housing has other benefits. This paper is a systematic review of studies that investigated the relationship between housing-related independent variables and health-related dependent variables. Ten online databases were searched for studies published since 1980 that had study populations of adults with SPMI, analysed primary or secondary empirical data, and measured housing-related independent variables and health-related dependent variables. Clearly defined epidemiological criteria were used to assess the strength of evidence of the selected studies. Twenty-nine studies met the suitability criteria, of which 14 reported healthcare utilisation outcomes; 12 examined mental status outcomes; and 9 reported quality-of-life outcomes. The findings of the review suggest that there is good evidence that housing interventions benefit the homeless population; however more research is needed about housing solutions for individuals with SPMI who are housed, but in precarious or inappropriate housing situations. Study methodologies could be improved by emphasising longitudinal designs that focus on participant retention and by implementing matched control groups or randomised interventions to strengthen internal validity. Ensuring that a person is adequately housed upon discharge from hospital should be a treatment priority. When housing eligibility is not dependent on psychiatric treatment compliance and sobriety, providing permanent housing minimises harm and may free people to voluntarily seek treatment. Housing that offers an unlimited length of stay is recommended because SPMI is a chronic and fluctuating condition that requires stable surroundings to maintain health.

Cost and Threshold Analysis of Housing as an HIV Prevention Intervention

The Housing and Health study examines the effects of permanent supportive housing for homeless and unstably housed persons living with HIV. While promising as an HIV prevention intervention, providing housing may be more expensive to deliver than some other HIV prevention services. Economic evaluation is needed to determine if investment in permanent supportive housing would be cost-saving or cost-effective. Here we ask -- what is the per client cost of delivering the intervention, and how many HIV transmissions have to be averted in order to exceed the threshold needed to claim cost-savings or cost-effectiveness to society? Standard methods of cost and threshold analysis were employed. Payor perspective costs range from $9,256 to $11,651 per client per year; societal perspective costs range from $10,048 to $14,032 per client per year. Considering that averting a new case of HIV saves an estimated $221,365 in treatment costs, the average cost-saving threshold across the three study cities is 0.0555. Expressed another way, if just one out of every 19 Housing & Health intervention clients avoided HIV transmission to an HIV seronegative partner the intervention would be cost-saving. The intervention would be cost-effective if it prevented just one HIV transmission for every 64 clients served.

HIV and Housing Assistance in Four U.S. Cities: Variations in Local Experience

This paper provides an account of how young, HIV-positive women manage their lives on limited budgets in four United States cities: New York City, New Orleans, Miami, and Chicago. The study findings elucidate city-to-city variability in housing assistance, and how this manifests in locality specific differences in the experience of HIV. Our research suggests that the receipt of housing assistance has ramifications for women's engagement in care, and for their health. Women not receiving aid often move frequently in and out of homelessness, or "double up" with others in complex household arrangements to share costs. Women with long-term housing assistance, while still struggling financially, possess a stable base from which to approach daily life and HIV care. This account suggests a need for empirical research assessing the impact of local variations in housing assistance on specific health outcomes for those with HIV. It also highlights the importance of understanding local contexts when designing housing interventions at both the individual and structural levels.

Flood risk management for the RUA of Hanoi

PurposeThis paper aims to investigate reasons for unusual overdevelopment of floodplain areas outside river dyke, provide an insight into the importance of community perception of catastrophic flood risk in the riverside urban areas (RUA) of Hanoi and establishes the need for participatory disaster management planning and disaster management education in the study location.Design/methodology/approachStructured survey was conducted in five wards in the RUA to understand how residents perceived flood risk.FindingsThe low perception of catastrophic flood risk among communities was found to be an important factor in the continued development of the RUA and led to the trust in their houses as a prominent protective solution. Moreover, the flood vulnerability of the areas has been increasing due to the missing link between local authorities and community.Research limitations/implicationsThis paper examines community perception of flood risk as one of main factors. Other factors such as availability of options for housing, public participation and relevant policy interventions are beyond the scope of the paper and need to be studied in the same location.Practical implicationsTo regulate the development of the RUA, community perception of catastrophic flood risk should be changed and community leaders should be motivated, with involvement of local authority at ward offices, to conduct comprehensive hands‐on community education programs.Originality/valueFew researches have been done on the overdevelopment and community perception in the flood‐prone areas. This paper not only reaffirms the few studies made in the past but also suggests broad interventions for enhancing the flood risk perception among the community members.

Poverty reduction through the creation of a liveable housing environment

PurposeThe purpose of this research is to show that initiatives to adequately address poverty reduction through the provision of housing units in rural communities in Ghana have come from both local and offshore resources. However, very little has been done to assess the impacts of these initiatives so that best practices can inform public policy to enhance the quality and quantity of rural housing in Ghana. This paper explores the impact of one such initiative, namely the Habitat for Humanity International Ghana's (HHIG) intervention in the rural housing subsector.Design/methodology/approachTo understand and appreciate HHIG's intervention, field data collection and community interfaces were organised. Extensive use was made of the case study approach or narratology. Under this approach, six of the 29 local HHIG affiliates were studied using an exploratory approach for in depth probing.FindingsThis study shows that the provision of housing units through HHIG's initiative has had a positive impact on poverty reduction through an enhanced housing environment, formation of micro enterprises, enhanced access to social services, skills transfer and improved security.Practical implicationsAs an object of consumption, the introduction of housing into rural economies in Ghana can have tremendous significant and positive impacts; implying that it can be used as an entry point in efforts aimed at reducing rural poverty in Sub Saharan Africa.Originality/valueThe study is the first of its kind to reveal HHIG's immense contribution towards the creation of more liveable housing environments in rural Ghana and its link with poverty reduction.

A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless.

A review of 16 controlled outcome evaluations of housing and support interventions for people with mental illness who have been homeless revealed significant reductions in homelessness and hospitalization and improvements in other outcomes (e.g., well-being) resulting from programs that provided permanent housing and support, assertive community treatment (ACT), and intensive case management (ICM). The best outcomes for housing stability were found for programs that combined housing and support (effect size = .67), followed by ACT alone (effect size = .47), while the weakest outcomes were found for ICM programs alone (effect size = .28). The results of this review were discussed in terms of their implications for policy, practice, and future research.

Public Health Care Utilization in a Cohort of Homeless Adult Applicants to a Supportive Housing Program

Supportive housing is subsidized housing with on-site or closely linked services for chronically homeless persons. Most literature describing the effects of supportive housing on health service utilization does not describe use across multiple domains of services. We conducted a retrospective cohort study of 249 applicants to a supportive housing program; 114 (45.7%) were housed in the program. We describe the pattern of service use across multiple domains (housing, physical health care, mental health care, substance abuse treatment). We examine whether enrollment in supportive housing was associated with decreased use of acute health services (emergency department (ED) and inpatient medical hospitalizations) and increased use of ambulatory services (ambulatory medical and generalist care, mental health, and substance abuse treatment) as compared to those eligible but not enrolled. Participants in both groups exhibited high rates of service utilization. We did not find a difference in change in utilization patterns between the two groups [those that received housing (intervention) and those that applied, were eligible, but did not establish residency (usual care group)] comparing the two years prior to the intervention to the two years after. The finding of high rates of maintenance of housing is, in itself, noteworthy. The consistently high use of services across multiple domains and across multiple years speaks to the level of infirmity of this population and the costs of caring for its members.

Désinstitutionnalisation, «communautarisation» des services et formation des intervenants

The "deinstitutionalization" of services and their community uses imply important modifications in our professional practices. The citizen, the parent and the community resources become necessary partners in the care of the person maladjusted to his family and community environment. This change means that our social values have to undergo important modifications so that parents and citizens are recognized the abilities and resources to assist the actions of the professional services'networks. We have to study what professional abilities need to be developed in the different community environment to respect and give value to these new resources of the human and social ecology. A pedagogy of services has to be thought of in order to prepare both parent and citizen to be responsible for certain needs in the family and community. The training and the specialization of the personnel is in need of pedagogical strategies that will trancend the theoretical knowledge and will take account the environment's know how. In other words, strategies that will blend the theoretical knowledge with the Empirical one. Two training experiences are presented: one implies the initial training (Research project and in the house intervention) and the other is involved with the training of network's helpers (Community integrated services). Those experiences are two among others which illustrate the need to define the relationship between power and knowledge in order to help the growth of true institutional alternatives in education, psychiatry, social work. Finally, we should ask what type of society facilitates the collaboration between alternative professional resources and mutual aid?

Improving housing, improving health: the need for collaborative working

The impact of poor housing on health was recognized 150 years ago, and doing something about it was the first real public health initiative. Today, standards in much of the older housing stock continue to fall and, exacerbated by the current free market boom in fuel costs, many people cannot afford to heat or maintain their homes. In response to this crisis, there is an increasing amount of housing help available which would directly improve the health of patients but, apart from pockets of exemplary practice, most health practitioners seem to do little about it. Yet housing issues feature prominently in nurse training, as well as receiving increasing emphasis through the current national and regional fuel poverty initiatives. In exploring this paradox the author examines the mixed fortunes of an innovative project which tried to stimulate collaborative working between professions by providing a successful combined health and housing intervention. Drawing on his evaluation of this project over five years, he considers what some of the barriers to collaboration might be, how they arise and what needs to be done to overcome them.

The Age of Commodity: water privatization in southern Africa, and: Unlawful Occupation: informal settlements and urban policy in South Africa and Brazil (review)

Reviewed by: The Age of Commodity: water privatization in southern Africa, and: Unlawful Occupation: informal settlements and urban policy in South Africa and Brazil Bill Freund (bio) David A McDonald and Greg Ruiters (eds) (2005) The Age of Commodity: water privatization in southern Africa. London and Sterling VA: Earthscan. Marie Huchzermeyer (2004) Unlawful Occupation: informal settlements and urban policy in South Africa and Brazil. Trenton NJ and Asmara: Africa World Press. The ANC has pinned its justification for consideration as the friend of the poor in South Africa on 'delivery' —the diffusion to the whole nation of services once overwhelmingly confined to white households. But for many this is its Achilles' heel. The so-called social movements, generally focussed on particular settlements and townships or small town municipalities, are in essence protest manifestations triggered off by struggles over evictions or water supply or local corruption blocking delivery —what Ebrahim Harvey calls 'low intensity conflicts' (in McDonald and Ruiters 2005:124) but another contribution on Cape Town sees as making urban areas at times ungovernable, borrowing a term from the 1980s struggle years. Radical activists have written numerous papers denouncing the GEAR-driven ANC as a tool of the World Bank and allied institutions with failures over delivery as the proof of the pudding. Battles have raged over the statistics of what has been delivered, by whom and when, how many cut-offs have occurred and what the poor have been forced to pay for services. The two books reviewed here shed considerable light rather than just heat on the subject through much more sustained analytical treatment. Their very [End Page 138] considerable value has unfortunately to be counterbalanced with their scarcity; both, astonishingly, are only published outside South Africa. Huchzermeyer, an academic in the Wits Housing Programme, gives us an entire book devoted to the housing question. She gets to the heart of the state housing initiative by characterising it as being based on the 'project linked subsidy' —greenfields development focussed on land planning, building of identical small properties to scale and the availability of subsidies to new owners who then take freehold title. The core of this, which fits what Huchzermeyer considers a neo-liberal approach, was modelled by the business orientated Urban Foundation and then the Independent Development Trust before 1994 and then extended on a massive scale by the Ministry of Housing, but it also represents continuity with the late apartheid orderly urbanisation philosophy. The failure to get significant bank involvement has meant that the quality of housing has often been minimal and the quality of land dependent on what was available for a small price. Community initiatives have been pushed aside; they tend to be considered as 'exploitative, corrupt and self-seeking obstacles to government delivery' (Huchzermeyer 2004:153). Huchzermeyer sees this programme as essentially a failure; she contrasts it with the situation in Brazil where equivalent practices were abandoned in favour of upgrade programmes that called on community organisation to provide a social context and alternatives. In Brazil, radical state and municipal governments began to grasp that informal settlements were social entities and housing interventions needed to respond to that. The Brazilians focus on what they call the urbanisation of the favela or slum settlement, in which needed improvements are gradually and co-operatively introduced. In South Africa, the aim is to bulldoze such settlements and resettle people, perhaps at a long distance, in state-organised if private sector-built housing. Based on various examples given, Huchzermeyer believes that the Brazilians are much more likely to be constructing viable neighbourhoods that can help mould a better life generally for their inhabitants. She would like to see the continued growth of contacts between dwellers of informal settlements internationally as a process of learning and pressurising for grassroots derived needs. Numerous examples of potential and past initiatives in South Africa, which have held promise in improving the lives of those in informal settlements but were generally stifled, are presented. This thought-provoking critique has much to be said for it. It certainly [End Page 139] demonstrates how much can be learnt if South Africans try to develop some serious comparative knowledge of social conditions. In particular it...