housing and health 2004
TRANSCRIPT
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HOUSING &
HEALTH
Dr Virginia MacNeill
Health ServicesResearch Unit
Department of PublicHealth
October 04
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Making connectionsBroad connections
Common-sense view (Joe Public)
that poor housing may affect health
Inequalities in health
The effect of housing status onaccess to health care
The effect of health status on
housing opportunities
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Proving that poor housingis detrimental to mental orphysical health
The need for OBJECTIVE proof
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Commonsense connections
WHO (1961) Concept of health:
A state of complete physical,
mental and social well-beingand not merely the absence ofdisease and infirmity.
WHO (1961) Residentialenvironment:
The physical structure that Manuses for shelter and the environsof the structure including all
necessary services, facilities,equipment and devices neededor desired for the physical andmental and the social well-beingof the
individual.
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Can commonsenseconnections bescientifically proven?
it seems axiomatic that poor
housing should lead to poor
health , yet there is little hard
data on the links betweenhousing per se and physical
and mental illness
Heginbotham (1985, 218)
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Disentangling one effect
from many
The Condition of the Working
Classes in England in 1844
(Engels, date?)
The interrelation of
socioeconomic facts with housing,
on the one hand, and with health,on the other, would make
impossible any clear-cut
determination of the effects of
housing per se on health (Britten,1942, 193)
The social complex (Stein 1952)
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But these assumptionscan be challenged
Poor housing conditions is
not always associated with
multiple deprivation
e.g. problems of radon or
electromagnetic radiation inthe home.
Not everyone is multiplydeprived
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ackling the pr
oblem ofconfounding variables
Define housing
Clarify exposure
Construct studies
Examine associations
Consider causal processes
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BROAD ASSOCIATIONS
Housing deprivation and health
Housing and health
SPECIFIC RELATIONSHIPS
Specific aspects of housing and health
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Housing deprivation &
health
Housing and social class(Townsend & Davidson, 1982)
Infant mortality in public andprivate Housing (Spivey &Radford, 1979)
Lower and higher housingstandards (Burt, 1945)
BUTHousing definitions too broad
Cant be divorced from othersocial factors that couldinfluence health
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BROAD ASSOCIATIONS
Housing deprivation and health
Housing and health
SPECIFIC RELATIONSHIPS
Specific aspects of housing and health
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Housing and health
Studies relying on:
Changes to the housing location
and/or
Controlling for age, sex, smoking,
income, type of housing etc.
These May show a decrease in
disease/improvements in
health
But fail to examine specific
aspects of ousing which may
contribute to ill health
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BROAD ASSOCIATIONS
Housing deprivation and health
Housing and health
SPECIFIC RELATIONSHIPS
Specific aspects of housing and health
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Specific aspects of housing
& health
Examples of two different
approaches, using housingdampness as a specifichousing factor:
1. Studies that eliminateconfounding variable.
2. Studies that distinguishrelationships by means ofmultivariate analysis.
NB. Approach A and approach Bare often combined.
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Establishing causality in
housing dampness andhealth
Pragmatic concept ofcausality
Epidemiological research
methods
Criteria applied
Experimental techniques
Observational studies
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Pragmatic concept of
causality
A causal relationship would be
recognised to exist wheneverevidence indicates that the
factors form part of the complex of
circumstances that increases the
probability of the occurrence ofdisease and that a diminution of
one or more of these factors
decreases the frequency of that
disease.
Lilienfeld & Lilienfeld, 1980, 295)
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Establishing causality in
housing dampness andhealth
Pragmatic concept ofcausality
Epidemiological research
methods
Criteria applied
Experimental techniques
Observational studies
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Biological plausibility Lack of evidence that damp
(relative humidity) has a direct
negative effect on health
damp housing not the same as
dampness alone.
BUT Housing + dampness
= potentially harmful agents that
would not arise with damp alone
= propagation of house mites and
fungal spores
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Respiratory Health
Indirect effects of higher
humidity on house dust mites
and moulds
Associations between housedust mites and moulds with
allergic diseases (e.g. rhinitis,
asthma, dermatitis
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Other health effects
observations requiringmore research
Non-respiratory symptoms and
dampness/mould
Relationship betweendamp/mould & diarrhoea,
vomiting, aches and pains
Relationship between organic
toxic dust & muscular pain,chest tightness, cough andheadaches
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Consistency of association
If the same results are found
in laboratory beagles,vegetarian Trappist monks,
cannibals and Welsh males,
you know you are on to
something.
(Jones & Moon, 1987, 133)
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Str
ength of association
No studies showing a
significant association using
objective measures for bothhealth and dampness.
Studies show significant
association between:either: Objectively measured
dampness and reported health
or: Objectively measured
health and reported dampness
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Specificity of association
Epidemiological argument re:
causal relationships
but damp housing associated
with more than one healthproblem so how useful is
specificity of association ( see
James and Moon, 1987)
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Dose-response
Increase severity of dampness =
greater prevalence of poor health
symptoms
(See studies: Hyndman 1990;Dales, Burnett & Zwanenbug,
1991; Spengler et al, 1994)
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Cold and damp
Damp housing is usually, but
not always, associated withcold housing
Effects of cold air onrespiratory health
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Conclusions
Establishing causal links betweenhousing and health
Impact on: Housing supply and improvement
Benefits to:
health Savings to health service
Better quality of life for the individual
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HOUSING &
HEALTH
Dr Virginia MacNeill
Health ServicesResearch Unit
Department of PublicHealth