Despite some efforts made by the
In 1842, Edwin Chadwick established an association between appalling living conditions and poor health. Nineteenth century physician-activist Rudolph Virchow recognized the link between rising rates of infectious disease and crowded, poorly maintained housing. In the absence of diagnostic tools and effective treatments for rampant infectious diseases, many of the advances in health of the 19th and early 20th century were a direct result of improvements in housing, sanitation, and water quality. The Great Depression and the post-World War II era brought increased interest in housing because of the massive influx of people moving to cities in search of jobs.
According to the Universal Declaration of Human Rights, “everyone has the right to a standard of living adequate for health…including food, clothing, housing and medical care.” The Housing Act of 1949 reflected the desire of the
Despite legislative efforts to address housing inequities, a shortage of affordable housing and homelessness remains rampant, and are important contributors to poor health. Over 7 percent of persons living in the
Consequences of Substandard Housing
Environmental Injustice: Affordable housing shortages and discriminatory housing practices plague many American communities. Low-income housing is frequently substandard, does not meet city inspection requirements, and is characterized by conditions that contribute to poor indoor air quality and adverse health. Such substandard accommodations are disproportionately concentrated in lower-income communities and communities of color. Segregation by income and race limit one’s access to grocery stores, neighborhood parks, and even medications.
Polluting industries are more frequently located in and around poor communities and communities of color, a phenomenon known as environmental injustice or environmental racism. Due to excessive exposure to air and water pollution, such communities bear a higher burden of many diseases. One study found that bad housing and poor neighborhood conditions in African-American communities in St. Louis, Missouri were associated with a 2.5 times increase in the odds of developing diabetes. In
Substandard Housing and Poor Health: Housing is an important social determinant of health not only because it provides safe shelter from the outdoor environment and from crime victimization, but also because Americans spend much of their time indoors. For some, the quality of indoor air that they breathe may exert a greater influence on their health than the quality of air outdoors. The elderly, pregnant women, young children, and the chronically ill are most vulnerable to poor indoor air quality, since they spend the most time indoors. Fetuses and young children are more susceptible to toxic substances because they have greater pound-for-pound exposures; immature, porous blood brain barriers; lower levels of chemical binding proteins, allowing more chemicals to reach target organs; rapidly developing organs which are especially vulnerable to damage; under-developed systems to detoxify and excrete industrial chemicals; and a long future lifespan, which allows more time for adverse effects to arise. The elderly experience increased risks from toxin exposures since they suffer from more co-morbidities, and because the ability to eliminate toxins decreases with age. Those with chronic illnesses are at increased risk of asthma, chronic obstructive pulmonary disease exacerbations, and hospital admissions for acute coronary syndrome and cerebrovascular accidents consequent to exposure to environmental pollutants.
Other characteristics of substandard housing contribute to morbidity and mortality. For example, poor heating or cooling systems can contribute to hypothermia or hyperthermia, respectively, during ambient temperature extremes. The high death toll from the
Affordable Housing: Just as poor housing can cause illness, poor health can lead to poverty, which limits one’s housing options. Those who are physically or mentally ill may be disabled, unable to work, and dependent on supplemental security income. Furthermore, one-fourth of
A literature review conducted by the Center for Housing Policy found a clear impact of housing on health, education and economic development. By investing in affordable housing, cities and communities can move toward a more equitable society. Achieving equality in housing access, cost, neighborhood conditions, and indoor air quality will help to create a more environmentally just and healthier
Contributing to Allergies & Asthma
Substandard housing is intimately linked to asthma, the most common chronic disease of childhood. Over 4 million children in the
The following subsections describe the major indoor air contaminants frequently found in substandard housing that contribute to asthma and allergies, (especially in the pediatric population), along with interventions to minimize exposures.
Pets: Pets produce dander, feces, urine and saliva, all of which can cause allergic reactions and contribute to asthma. Pet allergies and asthma frequently co-exist. To reduce exposure to animal allergens, health care providers should recommend keeping animals out of the home or at least out of the bedroom, and removing carpeting and “animal furniture” if possible. Washing hands and clothes after contact, frequent vacuuming, and bathing pets weekly can help as well.
Dust Mites: Dust mites are 0.15 mm long relatives of spiders, feed off dead skin cells, and thrive under conditions of high humidity. Dust mites live in bedding, pillows, mattresses, upholstered furniture, carpets, and drapery. Dust mites not only exacerbate existing asthma, but may cause asthma to develop in the first place. Dust mite control involves encasing pillows and mattresses in allergen-impermeable covers, moving mattresses off the floor, washing bedding weekly in warm water, and air drying or using a clothes dryer to remove all moisture. Keeping humidity in homes below 50 percent, removing carpets from the bedroom, and avoiding upholstered furniture can help to minimize dust mite exposures. Childrens’ stuffed toys should be washed weekly in hot water and dried thoroughly.
Cockroaches: Cockroach allergens arise from saliva, feces, and dead body parts. Over 60 percent of asthmatic children are allergic to cockroaches. When such children suffer from asthma and are exposed to cockroaches, they tend to get more severe asthma attacks and miss more school days than those not exposed. Homes with no sign of living cockroaches still may have measurable amounts of cockroach allergens. Minimizing cockroach and other pest infestations requires fixing plumbing leaks and other moisture problems, removing piles of boxes and newspapers from the home, sealing all entry points, storing garbage in containers with secure lids, and removing trash daily. If possible, poison baits, boric acid, and insect traps should be used in lieu of pestcides.
Mold: Molds have been linked to respiratory complaints, asthma, allergies, and eczema. Mold grows anywhere excess moisture exists, including on wood surfaces, within insulation materials, beneath carpets, and under bathroom tiles. Three causes of excess moisture can lead to mold: overall high humidity, cold walls, and water infiltration. Improving ventilation and increasing air circulation (such as through the use of ceiling fans), along with using a dehumidifier, can decrease humidity and prevent mold growth. Leaks and spills should be completely dried within 24-48 hours. The Environmental Protection Agency recommends scrubbing hard surfaces with detergent and water and drying completely to remove mold, but absorbent or porous materials, such as ceiling tiles and carpet, may have to be thrown away.
Household Appliances: Many household heating appliances emit smoke and gases, including particulate matter, sulfur dioxide (SO2), and nitrogen dioxide (NO2), which cause lung irritation and increase one’s sensitivity to other asthma triggers. Heating systems should be inspected annually and chimneys kept clean. Avoid using wood-burning fire stoves for heating, as they can increase a number of toxic air pollutants. Kitchen exhaust fans help to dissipate smoke pollution and control excess humidity.
Volatile Organic Compounds: Volatile organic compounds (VOCs) are found in a variety of household items, including cleaning supplies, fragrances, candles, and paint. Domestic exposure to VOCs may increase the risk of childhood asthma. Such items should be replaced by low VOC products. Consider a cotton ball soaked in vanilla as an air freshener, or heating water with lemon and cloves to provide a pleasant fragrance without emitting VOCs.
Other techniques to minimize indoor air pollutants include decreasing the amount of carpeting, vacuuming 1-2 times/week, drying after damp mopping, using air conditioners with clean filters, installing dehumidifiers in high-humidity areas, and using HEPA filters to reduce indoor allergens. Unfortunately, many of these interventions are expensive and require significant installation efforts or even structural changes.
Housing quality is an important social determinant of health and a marker of class- and race-based inequities in
Martin Donohoe MD is adjunct associate professor at the Cor