assessment of housing and health on the basis of european indicators in hungary t. málnási, a....
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Assessment of housing and health on thebasis of European indicators in Hungary
T. Málnási, A. Páldy, P. Rudnai
‘József Fodor’ National Centre for Public Health National Institute of Environmental Health
Fourth Ministerial Conference, Budapest, 2004
14. a), b), c) paragraphs of Declaration:
– The ministers understand that many environmental exposures occurring in the indoor and outdoor environment are linked to inadequate housing conditions,
– They are therefore committed to taking action to ensure that health and environmental dimensions are placed at the core of all housing policies and that healthy conditions are ensured and maintained in the existing housing stock.
Housing and health 10 recommendations:
– assess more carefully the health impact of the ongoing housingprogrammes and policies in countries
– data on housing and health should be made available to policy-makers and the general public
Exposure:
1. Crowding
2. Household hygiene
3. Mould / dampness
Effect:
1. Mortality due to household accidents / poisonings
2. CO poisoning (mortality, morbidity)
Indicators
Crowding
1. Objective:
– Living floor area/person: WHO EuroIndy
– Rate of persons living in crowded homes definition: >1 person / room (Eurostat)
a) % of people living in crowded conditions
b) ” among people living under poverty threshold
2. Subjective
Effects:increase of risk: mental diseases, stress, spread of infectious diseases, accidental injuries, dampness, mould
Living floor area per 1 person (m2) in some European countries
(WHO EuroIndy)
15
20
25
30
35
40
45
1996 1997 1998 1999 2000 2001
m2
Bulgaria Germany Hungary Lithuania Spain
Rate of persons living in crowded homes (> 1 person / room)(WHO LARES survey, 2003)
0
5
10
15
20
25
30
35
40
45
50
Angers Bonn Bratislava Budapest Ferreira Forli Geneva Vilnius
%
total surveyed population among persons indicated financial problems
Household hygiene
% of population living without suitable household hygienic circumstances:
a) without piped water in the home
b) without toilet with running water inside the home
c) without bathing facilities
Water and sanitation indicators acc. to settlement size, Hungary Census – Hungarian Central Statistical Office
0%
20%
40%
60%
80%
100%
Flats with pipedwater
Flats with flushtoilet
Flats connectedto sewage
system
Flats with homesewage
Flats withsemicomfort
Flats withoutcomfort
Temporaryaccommodation
<1000
1000-2999
3000-9999
10000-49999
>50000
Mould
a) Rate of persons living in homes with mould problems
b) Rate of homes with mould problems
Possible health effects:
– Irritation of eyes and respiratory tract
– Frequency of infections of respiratory tract
– Frequency of chronic respiratory symptoms and diseases: bronchitis, allergy, asthma
Rate of homes with mould problems WHO LARES survey, 2003
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Angers Bonn Bratislava Budapest Ferreira Forli Geneva Vilnius
contaminated area < 0,1 m2 contaminated area >= 0,1 m2
Rate of persons living in homes with mould problems and rate of homes with mould problems
WHO LARES survey, 2003
0%
10%
20%
30%
40%
50%
60%
70%
Angers Bonn Bratislava Budapest Ferreira Forli Geneva Vilnius
dwellings affected persons affected
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Dorog
Tata
Cegléd
Tata
bány
aEge
rAjka Baja
Békés
csab
a
Gyula
Kazinc
barc
ika
Kecsk
emét
Misk
olc ÓzdPáp
a
Sajósz
entp
éter
Százh
alom
batta
Tisza
újvár
os
Hódm
ezőv
ásár
hely
Sajósz
entp
éter
Salgót
arján
Szeks
zárd
Szere
ncs
Zalaeg
ersz
egGyő
r
Siófok
Veszp
rém
Gyöng
yös
Solym
ár
Budap
est-R
ákos
palot
a
Budap
est-P
este
rzsé
bet
Somog
y meg
ye
Nógrá
d m
egye
Győr-M
oson
-Sop
ron
meg
ye
Hajdú-
Bihar m
egye
Bács-
Kiskun
meg
ye
Szabo
lcs-S
zatm
ár-B
ereg
meg
ye
Csong
rád
meg
ye
Heves
meg
ye
Rate of homes with mould problems according to Hungarian surveys among schoolchildren grade 3-4
1996-2002
OR of chronic bronchitis symptoms among 8-10 year old children and its association with mould in the flats adjusted
for age and sex
1,46 1,44
1,83 1,83
2,12
0
0,5
1
1,5
2
2,5
3
CESAR 6 város 3 város 6 megye Heves m.
Es
ély
há
ny
ad
os
(O
R)
od
ds
ra
tio
CESAR 6 cities 3 cities 6 counties Heves county
OR of asthmatic symptoms among 8-10 year old children and its association with mould in the flats adjusted for age and sex
1,44 1,46 1,49
1,92
1,37
1,92
0
0,5
1
1,5
2
2,5
3
CESAR 12 város 6 város 3 város 6 megye Heves m.
Es
ély
há
ny
ad
os
(O
R)
od
ds
ra
tio
CESAR 12 cities 6 cities 3 cities 6 counties Heves county
Number of hospital admissions due to acuteCO intoxication (ICD-10: T58) in Hungary
1997-2002
0
50
100
150
200
250
1997 1998 1999 2000 2001 2002
ho
spit
al a
dm
issi
on
s
male female total
Number of deaths due to acute CO intoxication (ICD-10: T58) in Hungary, 1996-2003
0
20
40
60
80
100
120
140
1996 1997 1998 1999 2000 2001 2002 2003
nu
mb
er o
f d
eath
s
male female total
Domestic accidents, poisoning in children
Annual mortality rate due to the external causes: domestic accidents and poisoning in children under 5 years of age(ICD-10: W00.0 – Y34.0)
ICD fourth digit: place of occurrence0: home (flat, house) and the immediate environment (e.g. garden, garage, swimming pool)
Mortality due to external causes of death in < 5 years old children in some European countries (ICD-10: W00–Y34)
(WHO EuroIndy)
0
5
10
15
20
25
30
1996 1997 1998 1999 2000 2001
nu
mb
er o
f d
eath
s /
100.
000
Bulgaria Czech Rep. Finland Hungary Lithuania Spain
Tasks for the future, possibilities of intervention
Education, information:– general population: prevention of injuries, accidents at
home, mould prevention– designers – decision makers
Legislation: maintenance of heating equipment (CO) – regulation for new buildings (design, construction)– (enforcement of) legislation and subsidies for
existing dwellings
Rehabilitation campaigns:e.g. rehabilitation of flats with unhealthy conditions
(insulation, heating etc.)