Housing is an important determinant of health, and substandard housing is a major public health issue. 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. One million young children in the United States have blood lead levels high enough to adversely affect their intelligence, behavior, and development.5 Two million Americans occupy homes with severe physical problems, and an additional 4.8 million live in homes with moderate problems.
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. Responsibility for social determinants of health is seen as lying primarily outside the scope of public health. The quality and accessibility of housing is, however, a particularly appropriate area for public health involvement. An evolving body of scientific evidence demonstrates solid relations between housing and health. The public health community is developing, testing, and implementing effective interventions that yield health benefits through improved housing quality. Public health agencies have valuable expertise and resources to contribute to a multi sectoral approach to housing concerns. 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, and community housing advocates). Housing-related health concerns such as lead exposure and asthma are highly visible. The public is also concerned about the quality and accessibility of housing as affordable housing becomes scarcer.8 Elected officials and communities alike recognize that substandard housing is an important social justice issue that adversely influences health. In this article, we describe some of the evidence linking housing conditions to health, place public health’s role in addressing housing issues in a 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.
In more recent years, epidemiological studies have linked substandard housing with an increased risk of chronic illness. 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.21–31 Water intrusion is a major contributor to problems with dampness. In 1999, eleven million occupied homes in America had interior leaks and 14 million had exterior leaks.6 Overcrowding and inadequate ventilation also increase interior moisture.32 Damp houses provide a nurturing environment for mites, roaches, respiratory viruses, and molds, all of which play a role in respiratory disease pathogenesis.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. Old, dirty carpeting, often found in substandard housing, is an important reservoir for dust, allergens, and toxic chemicals.41,42 Exposure to these agents can result in allergic, respiratory, neurological, and hematologic illnesses.