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Quality of Housing

The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains:

  1. Economic Stability
  2. Education
  3. Health and Health Care
  4. Neighborhood and Built Environment
  5. Social and Community Context

Quality of Housing is a key issue in the Neighborhood and Built Environment domain.

Housing quality refers to the physical condition of a person’s home as well as the quality of the social and physical environment in which the home is located.12 Aspects of housing quality include air quality, home safety, space per individual, and the presence of mold, asbestos, or lead.1 Housing quality is affected by factors like a home’s design1, 2, 3 and age.45 Poor-quality housing is associated with various negative health outcomes, including chronic disease and injury and poor mental health.2467 The quality of a home’s neighborhood is shaped in part by how well individual homes are maintained, and widespread residential deterioration in a neighborhood can negatively affect mental health.7

Both home design and structure significantly influence housing quality and may affect mental and physical health.389 Steps, balconies, and windows are features of home design that may present a threat to safety, especially for individuals with physical disabilities.1210 Breakable glass, low windowsills, and poorly constructed stairs may increase the risk of injury from a fall.28

Lack of housing maintenance may lead to poor housing conditions inside the home (e.g., damaged appliances, exposed nails, or peeling paint) as well as poor housing conditions outside the home (e.g., damage to stairs and windows).7 These conditions may harm health by increasing exposure to hazards such as carbon monoxide,11 allergens,2 and lead in paint,1213 pipes, and faucets.14 Carbon monoxide has been shown to cause heart damage, neurological impairment, and death.14 Likewise, even low levels of lead exposure can have serious effects on children’s health and behavior.12

Inadequate plumbing and lack of air conditioning in homes may also impact health.1415 Corroded plumbing infrastructure (e.g., in Flint, Michigan) increases residents’ exposure to lead16 and their risk of lead poisoning.17 Living in a home without air conditioning may increase the risk of vector-borne diseases, like dengue fever, if people leave unscreened windows open for ventilation.1518

Low-income families may be more likely to live in poor-quality housing that can damage health.4618 These homes may be underinsulated, lack air conditioning, and cost more to heat, leaving homes either too hot or too cold, which has been linked to poorer health outcomes.2419 For example, spending time in a cold home may raise blood pressure or even lead to a heart attack.2021 In addition, residents of overcrowded homes may be at risk for poor mental health, food insecurity, and infectious diseases.2122223 Additionally, the homes of low-income families are more likely to have water leaks;5 these leaks are associated with mold growth,5 which has been shown to affect respiratory health24 and increase the likelihood of asthma, coughing, and wheezing.25

Children12 and older adults with physical limitations may be especially susceptible to negative health outcomes when living in poor quality housing.14 Inadequately vented appliances in the home may result in increased exposure to carbon monoxide in utero, which may affect fetal development or even result in fetal death.1112 Children’s behaviors, such as hand-to-mouth activity, may increase their exposure to home pollutants.1226 Older adults may experience serious injury from falls in the home, especially in homes with stairs, narrow doorways, or other obstacles.1427

Interventions to improve housing quality, such as restrictions on lead paint and renovations of older homes, have been shown to decrease certain health risks (e.g., through decreased rates of lead poisoning).12 Further research is needed to develop other effective interventions to improve housing quality. This additional evidence will facilitate public health efforts to address quality of housing as a social determinant of health.

Disclaimer: This summary of the literature on quality of housing as a social determinant of health is a narrowly defined review that may not address all dimensions of the issue.i, ii Please keep in mind that the summary is likely to evolve as new evidence emerges or as additional research is conducted.

Endnotes

i Terminology used in the summary is consistent with the respective references. As a result, there may be variability in the use of terms, for example, black versus African American.

ii The term minority, when used in a summary, refers to racial/ethnic minority, unless otherwise specified.

References

1 Bonnefoy X. Inadequate housing and health: an overview. Int J Environ Pollut. 2007;30(3):411-429. 2. Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health. 2002;92(5):758-68.

2 Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health. 2002;92(5):758-68.

3 Mitchell CS, Zhang JJ, Sigsgaard T, Jantunen M, Lioy PJ, Samson R, Karol MH. Current state of the science: health effects and indoor environmental quality. Environ Health Perspect. 2007;115(6):958-64. doi: 10.1289/ehp.8987

4 Hwang S, Fuller-Thomson E, Hurlchanski JD, Bryant T, Habib Y, Regoeczi WC. Housing and population health: a review of the literature. Sociology and Criminology Faculty Publications. 1999;126.

5 Adamkiewicz G, Zota AR, Fabian MP, Chahine T, Julien R, Spengler JD, Levy JI. Moving environmental justice indoors: understanding structural influences on residential exposure patterns in low-income communities. Am J Public Health. 2011;101 Suppl 1:S238-245. doi: 10.2105/AJPH.2011.300119

6 Office of the Surgeon General. The Surgeon General's Call to Action to Promote Healthy Homes. Rockville (MD): Office of the Surgeon General; 2009.

7 Kruger DJ, Reischl TM, Gee GC. Neighborhood social conditions mediate the association between physical deterioration and mental health. Am J Community Psychol. 2007;40(3-4):261-71.

8 Bonnefoy XR, Braubach M, Moissonnier B, Monolbaev K, Robbel N. Housing and health in Europe: preliminary results of a pan-European study. Am J Public Health. 2003;93:1559-63.

9 Weich S, Blanchard M, Prince M, Burton E, Erens B, Sproston K. Mental health and the built environment: cross-sectional survey of individual and contextual risk factors for depression. Br J Psychiatry. 2002;180:428-33.

10 American Academy of Pediatrics. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107:1188-91.

11 Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning--a public health perspective. Toxicology. 2000;145(1):1-14.

12 Weitzman M, Baten A, Rosenthal DG, Hoshino R, Tohn E, Jacobs DE. Housing and child health. Curr Probl Pediatr Adolesc Health Care. 2013;43(8):187-224. doi: 10.1016/j.cppeds.2013.06.001

13 Jacobs DE, Wilson J, Dixon SL, Smith J, Evens A. The relationship of housing and population health: a 30-year retrospective analysis. Environ Health Perspect. 2009;117(4):597-604. doi: 10.1289/ehp.0800086

14 Schnoor JL. Recognizing Drinking Water Pipes as Community Health Hazards. J Chem Educ. 2016;93(4):581-82.

15 Reiter P, Lathrop S, Bunning M, Biggerstaff B, Singer D, et al. Texas lifestyle limits transmission of dengue virus. Emerg Infect Dis. 2003;9:86-89.

16 Gostin LO. Politics and public health: the Flint drinking water crisis. Hastings Center Report. 2016;46(4): 5-6.

17 Gulachenski A, Ghersi BM, Lesen AE, Blum MJ. Abandonment, ecological assembly and public health risks in counter-urbanizing cities. Sustainability. 2016;8(5):491.

18 Hotez PJ. Neglected infections of poverty in the United States of America. PLoS Negl Trop Dis. 2008;2(6):e256.

19 Evans J, Hyndman S, Stewart-Brown S, Smith D, Petersen S. An epidemiological study of the relative importance of damp housing in relation to adult health. J Epidemiol Community Health. 2000;54:677-86.

20 Shaw M. Housing and public health. Annu Rev Public Health. 2004;25:397-418. doi: 10.1146/annurev.publhealth.25.101802.123036

21 Lloyd E. The role of cold in ischaemic heart disease: a review. Public Health. 1991;105:205-215.

22 Cutts DB, Meyers AF, Black MM, Casey PH, Chilton M, Cook JT, et al. US housing insecurity and the health of very young children. Am J Public Health. 2011;101(8):1508-14.

23 Stein L. A study of respiratory tuberculosis in relation to housing conditions in Edinburgh: I.-the Pre-War Period. Br J Soc Med. 1950;4(3):143-69.

24 Fisk WJ, Lei-Gomez Q, Mendell MJ. Meta-analyses of the associations of respiratory health effects with dampness and mold in homes. Indoor Air. 2007;17(4):284-96. doi: 10.1111/j.1600-0668.2007.00475.x

25 Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect. 2011;119(6):748-56. doi: 10.1289/ehp.1002410

26 Bearer CF. Environmental health hazards: how children are different from adults. Future Child. 1995;5(2):11-26.

27 Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701-07.