The three housing problems that most affect your health | Society Professionals | The Guardian
THE RELATION BETWEEN HOUSING AND HEALTH. By ROLLO H. BRITTEN, Senior Statistician, United States Public Health Service. The United States Public . between specific housing factors and health, to act as a basis for changes in et al. investigated the relationship between health and different housing qualities. More health care organizations are making that connection between housing and health. Hospitals subsidize apartments for the homeless in.
Housing quality remains an important component of health disparities in America and around the world. The home environment, in particular, represents an important source of fetal and early childhood exposures to biologic, chemical, and physical agents, as well as a strategic opportunity for intervention Krieger and Higgins Many studies have linked housing-related factors and health, and we have learned much over the past decades about how to make homes healthier places to live Saegert et al.
Studies suggest that an integrated approach to housing and health needs to be developed e.
The Relationship Between Housing and Health | The Pew Charitable Trusts
In Novemberthe National Center for Healthy Housing, a national nonprofit organization dedicated to eliminating residential health hazards to children while preserving affordable housing, convened a 2-day workshop to review the state of knowledge and to help promote the paradigm shift to a healthy housing approach.
This forum was unique in that it focused solely on housing and the translation of research findings into practical activities to improve health through improved home construction, rehabilitation, and maintenance.
- The Relationship Between Housing and Health
- The three housing problems that most affect your health
- The Relationship between Housing and Health: Children at Risk
The purpose of this article is to present a summary of The Relationship between Housing and Health: This workshop had four objectives: The agenda was divided into four sessions. The first three dealt with housing factors associated with a childhood asthma and other respiratory diseases, b neurodevelopmental and behavioral problems, and c unintentional injuries.
The final session focused on how to implement healthy housing programs. During the conference, each session began with two or more invited presentations, a total of 15 presentations for all four sessions, followed by a panel discussion.
This format provided an opportunity for professionals in different topic areas to learn about causes, mechanisms, effects, remediation, and prevention for topics other than their own specialties. It also enabled exploration of possible application of learning from one area to others—identifying commonalities, overarching concepts, and ways to influence policy and guidelines.
The 60 participants included mainly administrators, managers, researchers, and technical experts from major universities and state and federal agencies related to health, housing, and the environment. Participants also included public health professionals, academics, and physicians specializing in allergens, neurotoxicants, pesticides, airborne pollutants, and injury prevention and control.
Other participants represented health and housing nongovernmental organizations, state and federal legislative staff, and a few representatives of related industries pharmaceuticals, construction. Asthma, a chronic inflammatory condition of the lung airways, is the most common chronic disease among children today.
Although asthma is thought to be caused by one or more mechanisms, there is general agreement that asthma is associated with airway inflammation and hyperresponsiveness. Both environmental and genetic factors are thought to play a role in asthma initiation and exacerbation.
In a sensitized individual, small amounts of allergen can result in a large inflammatory response. Asthma rates are higher in children who are sensitized to allergens Kattan et al. Unlike allergic asthma, in which specific immunoglobulin E antibody responses occur, some individuals have nonallergic asthma that is also characterized by inflammation and airway hyper-responsiveness.
It is important to note that once asthma has been established, a variety of exposures, including allergens, can trigger an asthma attack or exacerbate symptoms. Asthma often resolves as a child grows up; this happens for about half the children with asthma. However, the person will still have abnormal lung function later in life. In addition, asthma can recur in adulthood. Chronic exposure to allergens in the indoor environment from mold, pets, mice and rats, cockroaches, and dust mites is associated with asthma.
Indoor moisture sustains mold, pests, dust mites, and bacteria. There appear to be different patterns of sensitization due to varying allergens in different indoor settings.
For inner-city home environments, exposure to cockroaches, mice, and rats is also related to asthma and allergic morbidity. Indoor air pollutants have also been associated with the development and exacerbation of asthma. Because of cost and other practical limitations, there are relatively few data on personal exposure to common indoor pollutants. One of the most common indoor air pollutants is environmental tobacco smoke ETS. In a recent review of indoor air quality and asthma, the IOM concluded that there is sufficient evidence to associate ETS exposure with the development and exacerbation of asthma IOM According the IOM review panel, there is suggestive evidence that nitrogen dioxide can exacerbate asthma, but there is inadequate evidence to support an association with the development of asthma IOM The volatile organic compound formaldehyde has received research and public attention, but its role in the development or exacerbation of asthma is not clear.
Three outdoor pollutants—ozone, sulfur dioxide, and fine particles—are also known to exacerbate asthma. Indoors, SO2 and O3 are readily adsorbed onto surfaces and taken out of the air. Thus, there seems to be less of an indoor problem with these chemicals. The relationship between in-home particulate matter exposure and asthma is not well researched. Additional research is also needed on the combined effects of indoor and outdoor pollutants.
Best practices to address housing-related asthma risk factors. Because exposure to allergens has been identified as a major source of airway inflammation, asthma control efforts have focused on allergy avoidance.
Accordingly, the basic strategy to alleviate respiratory symptoms is to determine to which allergens a person is sensitive and then follow a set of steps to avoid those specific allergens. Because half of asthmatics have multiple three or more sensitivities Eggleston ; Huss et al. Efforts to control asthma require consistent application of various measures.
Factors affecting behavior change need to be understood and incorporated into the design of interventions. Interventions should be promoted that are most likely to give positive results i.
The Relationship between Housing and Health: Children at Risk
Examples include the Master Home Environmentalist program MHEP —a community-based program that focuses on indoor sources of pollution, pesticides, and moisture—as well as programs aimed at helping builders construct healthy homes, such as that of the American Lung Association and the Asthma Regional Council. Trainees can use the Home Environmental Assessment List questionnaire to assess the home environment and negotiate an action plan with the family Leung et al. Knowledge gaps and research needs.
The complex mixture of allergens in the home setting presents several challenges. There could be interaction effects among allergens to cause sensitization and attacks and worsen the condition. Presently, there is no indicator of total allergen burden, and if it is developed, it would have to correlate well with asthma development and exacerbation. Within the home, there are several measurement issues related to allergens. For example, the relationship between a surface allergen sample and the inhaled dose is not known.
Additionally, the location of sample measurements can give different levels, so there is need to give attention to sample site selection. Other research needs include the following: Environmental Neurotoxicants in the Home Current state of knowledge. The most significant neurotoxicants found in residential settings are lead, pesticides, and ETS Jordaan et al. Lead toxicity affects the brain and neurodevelopmental processes, and its effects are irreversible.
Lead paint dust is the primary source of exposure in homes, rather than pieces of lead-based paint or lead in soil.
Recent research suggests that there is probably no lower-level threshold of blood lead Bellinger and Needleman ; Canfield et al. The biologic mechanisms involved in lead poisoning are not yet well understood Silbergeldalthough it is known that lead disrupts processes regulated by calcium and changes synapse formation Bressler et al. Even at quite low levels 2. Exposure to tobacco smoke during and after pregnancy is associated with prematurity, low birth weight, low Apgar scores, poor growth of infants, and dysfunctional behavior Bauman et al.
Currently, evidence related to child development and behavior is stronger for prenatal than for postnatal exposure. Recent research using blood cotinine levels as an indicator of exposure to ETS shows a robust inverse relationship between postnatal cotinine levels and cognitive scores math and reading in 6- to year-old children. The relationship remains statistically significant after controlling for various characteristics Lanphear et al. The mode of action of most pesticides is to be neurotoxic to pests.
It is reasonable to assume, therefore, that they will also have neurotoxic effects on humans. There is a growing body of evidence suggesting that public exposure to cholinesterase-inhibiting pesticides organophosphates and carbamates is a health concern Whyatt et al.
The impact of organophosphate and carbamate exposure on children has not been extensively researched, particularly with respect to neuro-behavioral testing. In inner-city home environments, indoor exposures to some pesticide toxicants can be frequent and at high levels due to cockroach and rodent problems.
This study documented widespread pesticide use, and in the case of diazinon, the exposure for some women may have exceeded healthy levels based on the U. Eighty-four percent of the women questioned as a part of this study reported that pest control measures were used in the home during pregnancy.
Not surprisingly, a number of organophosphate both chlorpyrifos and diazinon and carbamate propoxur pesticides were detected in air samples, maternal blood, and cord blood samples Perera et al.
Best practices to address exposure to housing-related neurotoxicants. The steps needed to prevent childhood exposures to neurotoxicants are founded in core public health practice.
They include identifying sources of exposure, defining unacceptable levels of exposure, developing and testing interventions, and, finally, implementing effective policies and screening programs. Intervention strategies include in increasing order of effectiveness and cost education, enforcement, and engineering controls with an emphasis on primary prevention.
It is difficult to address detrimental effects on neurodevelopment when children are exposed to multiple neurotoxicants at the same time. It is common for inner-city children to be exposed to lead, ETS, and pesticides both prenatally and postnatally.
To be effective, intervention efforts should address these multiple exposures at the same time. In the case of childhood lead exposure, there is an extensive body of literature documenting the impact that various methods of lead hazard control have on dust and blood lead levels Galke et al.
To date, the published data on the effectiveness of specific lead hazard control treatments have been too limited to draw conclusions about the relative effectiveness of specific lead hazard control approaches e. Although pesticide use in the home is common, designing and implementing intervention strategies are difficult because of the lack of basic toxicity testing information specific to neurodevelopmental effects. Without adequate toxicity and human exposure data, it is not possible to target control strategies.
Basic toxicity testing for neurodevelopmental effects as well as aftermarket health and exposure surveillance should be mandated. Further, we need to shift programs away from screening of children to screening of homes.
This will require the development of health-based screening guidelines similar to those developed for lead. Besides the elimination of ETS, three methods of control—air filtration, ventilation, and smoke containment—could be used to reduce the presence of tobacco smoke in the home environment.
Although it is clear that eliminating smoking either by quitting or smoking outside and away from children will reduce ETS exposure Johansson et al.
A controlled pilot study of high-efficiency particulate air-carbon potassium zeolite filters has shown that they are able to reduce nicotine in the air Aligne CA et al. Unintended negative consequences of interventions must be considered. For example, it is not clear whether air purifiers that generate O3 present a health problem that might mitigate their effectiveness.
Nonetheless, education and smoking cessation programs are the most commonly used interventions for ETS exposure. Smokers must be educated about the impact of ETS on children and the need to avoid smoking in their presence. In addition, educational efforts should continue to target pregnant mothers to prevent prenatal exposure.
Further investigation is also needed to understand why some families take steps to reduce ETS exposure and others do not. Although there may be limitations, laboratory studies are needed to increase knowledge about the active toxicants found in complex mixtures present in the home environment, such as house dust and ETS. Basic laboratory studies can provide early indications about the likely effects of environmental toxicants such as pesticides and ETS because they are typically cheaper and faster than epidemiology studies.
However, issues inherent in studying animal models and extrapolating to human beings underscore the need for epidemiology studies. Consistent outcome measures across studies, such as what to measure and agreed-upon cutoff points, are needed. Also, interactions and synergistic effects of multiple toxicant exposures on neurodevelopment need additional research. Finally, premarket neurotoxicity testing of home pesticides and postmarket surveillance will help fill knowledge gaps.
Several measurement considerations were also raised during the workshop. These included appropriateness of measures of exposure and dose, ability to detect differences and interpret them, and comparability across studies. Scientific agreement on the best measures of specific exposures and effects would make it easier to compare results of different studies and to perform meta-analyses. Precise measurement of actual exposures in the home environment would improve the ability to find effects and draw clear conclusions.
Exploring the link between housing and health
Additionally, there is a need to develop new and less costly techniques to measure and analyze pesticide exposures. There is insufficient evidence that educational programs and other interventions about ETS and pesticides result in less exposure by pregnant women and after a child is born. Besides reported behavior, additional measures of the behavior effects of toxicants need to be developed.
Unintentional Injury of Children in the Home Current state of knowledge. Between andhome injuries accounted for almost two-thirds of all fatal unintentional injuries occurring to U. Injuries occurring in the home accounted for four million of these visits. Children in the youngest age groups had significantly higher ED visit rates, similar to rates for fatal injuries. Residential injuries leading to ED visits were highest for children 1—4 years of age.
In addition, males had higher ED visit rates than did females Phelan et al. Despite the decline, residential injury death rates are substantially higher for African-American children than for other race groups.
Unlike injury death rates, nonfatal residential injury rates by race were similar Nagaraja J et al. Injuries of differing severity may be associated with different risk factors. Falls are the leading type of residential injury for children; they account for an estimated 3 million visits to the ED. The primary residential hazards associated with falls are lack of safety devices such as grab bars, safety gates, or window guards; structural defects in the home; and insufficient lighting on stairs and other areas Battelle Memorial Institute Scalds, nonfire burns, and poisoning injuries occur among children fairly often.
Infants and toddlers are at higher risk of accidental poisoning requiring an ED visit than are children 5—19 years of age Phelan et al. Although large national sources of injury data provide some key insights into injury rates, there is a need to improve injury epidemiology and surveillance to collect data on injuries that do not result in hospital visits. In addition, better data are needed to evaluate the determinants of injury rate variability in order to design effective intervention strategies.Homelessness, Mental Illness, and Supportive Housing: Plymouth Housing Group 2014
Best practices to address housing-related injury risk factors. In contrast, homelessness and poor housing multiply inequalities and have a long-term impact on physical and mental health. The health effects of poor housing disproportionately affect vulnerable people: Cold Poor energy efficiency in existing homes and rapidly rising fuel costs make it unaffordable for low income households to adequately heat their homes.
Even after significant improvement to the energy performance of the UK's housing stock, there were 4. A cold home is bad for your health and increases the risks of cardiovascular, respiratory and rheumatoid diseases as well as the worsening mental health. Cold homes are a significant contributor to the level of excess winter deaths in the UK every year.
Overcrowding Overcrowding is one of the many tangible impacts of the housing crisis on households across the country. Data from the Office for National Statistics shows that homes with six residents are the fastest growing category of household and 3 million people in the UK now live in a home with at least five other individuals.
The 1 million children living in overcrowded homes are up to 10 times more likely to contract meningitis and three times more likely to have respiratory problems. Over a lifetime, overcrowded homes have been linked with slow growth in children which correlates with an increased risk of heart disease as an adult. Damp Damp and mould have been linked to respiratory problems, allergies and asthma. Research found people with asthma were twice as likely to live in homes with damp as those without.