Housing: Interventions – Healthy Cities Toolkit

Description

Defined as a building for human habitation, often the place of residence of a family [Oxford English Dictionary, 2022].

Impact

Most reviews found that housing interventions had a significant positive impact on a range of health outcomes.

Results

Six reviews examined the health impact of housing interventions from over 200 primary studies.

Interventions involved changing area characteristics [Gibson 2011], structural refurbishments and modifications [Kua 2021; Ige 2019], provision of adequate heating, improvements to ventilation and water supply, initiatives for prioritizing housing for vulnerable groups [Ige 2019], and the upgrading of slums [Henson 2020; Turley 2013] and informal settlements [Weimann 2019].

Overall, housing interventions decreased communicable and vector-borne diseases and improved general health, mental health, and well-being.

Most reviews considered all age groups or did not specify age. One review restricted its geographical scope to South Africa [Weimann 2019], and another to low- and middle-income countries [Henson 2020].

In one review, housing refurbishment and modifications, provision of adequate heating, and improvements to ventilation and water supply were associated with improved respiratory outcomes, quality of life and mental health [Ige 2019].

Interventions to improve deprived areas via employment, training, housing, crime reduction, environment and quality of life had a positive impact, improving standardised mortality rates [Gibson 2011]. Prioritization of housing for vulnerable groups also led to improved well-being [Ige 2019].

Heating and energy efficiency interventions positively impacted general health, respiratory health and mental health outcomes [Gibson 2011].

Modifying ceilings to close eaves, mosquito trapping systems, screening windows and doors, and netting covering gable ends reduced indoor vector densities of Aedes and Anopheles mosquitoes and had a significant effect on the incidence of clinical malaria in Southeast Asian homes [Kua 2021].

In slums, providing homes with cement flooring was associated with improved maternal mental health and satisfaction with the quality of life [Turley 2013]. Slum upgrading had a positive impact on rates of communicable disease, with a lower diarrhoeal incidence in intervention groups, which was associated with a lower incidence of nutritional deficiencies and a positive impact on general health and wellness [Turley 2013; Weimann 2019]. In informal settlements, upgrading housing types from “shacks” to “subsidised housing” was associated with improvements in noise, violent crime, safety and reductions in alcohol and substance use [Weimann 2019].

Strength of the evidence

There were four formal systematic reviews (one with meta-analysis, one using mixed methods, and one Cochrane review), one literature review and one overview of systematic reviews. Searches for evidence were conducted between 1998 and 2020 in a median of 8 databases. Four reviews used tools to assess the risk of bias or quality of their included studies, with two reviews having low quality and two reviews with moderate quality evidence, giving the overall score of low-quality evidence.

To improve the quality of the evidence, future research should:

Adhere to existing guidelines on the reporting of systematic reviews, e.g. PRISMA
Gather longitudinal data comparing change over time in the intervention and control communities
Evaluate the differential impact of housing interventions across different sub-groups
Develop and utilise reliable and comparable outcome measures to determine the effect of housing interventions on health

Resource implications

Resource implications for housing interventions were reported in four reviews, which overall were ranked as moderately high.

One review concluded that moving disadvantaged people to lower-poverty areas was cheaper than focused investment in deprived areas [Gibson 2011]. However, it does not help improve conditions in high-poverty areas. Therefore, focused investment would be more cost-effective due to assisting all populations.

The investment required to construct new housing for reducing vector-borne diseases was reported as significantly higher than insecticidal methods using insecticide-treated bed nets or indoor residual spraying [Kua 2021].

A cost-benefit analysis of slum upgrading on water expenditure was included in one review, with evidence that monthly water-related expenditure was reduced after intervention [Turley 2013]. The cost of further research on the effects of housing interventions in informal settlements on health was graded as high due to resource and logistical constraints resulting in challenges of evaluation [Henson 2020].

Recommendations

Recommendations from the literature include:

Collaboration between business, academia and the public sector to increase research and implementation
Governments should encourage homeowners and landlords to make housing modifications that will improve health by providing financial incentives and assistance
Development and implementation of building regulations that incorporate international guidance on practices in design and construction that support health and wellbeing

Related resources

WHO (2007): Large analysis and review of European housing and health status (LARES)
WHO (2018): Housing and health guidelines
BRE (2021): The Cost of Poor Housing in England
UK Parliament (2022): Housing
Crisis (2022): Housing
Designing Buildings (2021): Lifetime homes
National Housing Federation (2022)
Resolution Foundation (2022): Housing outlook
The Health Foundation (2022): Housing
The Health Foundation (2021): Relationship between health and number of housing problems
The Health Foundation (2020): Better housing is crucial for our health and the covid-19 recovery
The Health Foundation (2017): How does housing influence our health
The King’s Fund (2022): Housing – our work on housing and its role in people’s health
The King’s Fund (2018): Housing and health – opportunities for sustainability and transformation partnerships
The King’s Fund (2016): The economics of housing and health – the role of housing associations
The King’s Fund: Warmer and safer homes
US Department of Housing and Urban Development: Healthy Home Rating System (HHRS)

References to reviews

Gibson M 2011. “Housing and Health Inequalities: A Synthesis of Systematic Reviews of Interventions Aimed at Different Pathways Linking Housing and Health.” Health & Place 17 (1): 175–84.

Henson RM 2020. “Evaluating the Health Effects of Place-Based Slum Upgrading Physical Environment Interventions: A Systematic Review (2012-2018).” Social Science & Medicine 261.

Ige J 2019. “The Relationship between Buildings and Health: A Systematic Review.” Journal of Public Health 41 (2): e121–32.

Kua KP 2021. “Randomized Trials of Housing Interventions to Prevent Malaria and Aedes-Transmitted Diseases: A Systematic Review and Meta-Analysis.” PloS One 16 (1): e0244284.

Turley R 2013. “Slum Upgrading Strategies Involving Physical Environment and Infrastructure Interventions and Their Effects on Health and Socio-Economic Outcomes.” Cochrane Database of Systematic Reviews, no. 1 (January): CD010067.

Weimann A 2019. “A Systematised Review of the Health Impact of Urban Informal Settlements and Implications for Upgrading Interventions in South Africa, a Rapidly Urbanising Middle-Income Country.” International Journal of Environmental Research and Public Health 16 (19). https://doi.org/10.3390/ijerph16193608.