PROBLEMS ASSOCIATED WITH POOR HOUSING AND HOMES

Housing is one of the traditional areas of concern for public health, though it has been relatively neglected over recent decades. However, housing is important for many aspects of healthy living and well-being. 

The home is important for psychosocial reasons as well as its protection against the elements, but it can also be the source of a wide range of hazards (physical, chemical, biological).  It is the environment in which most people spend the majority of their time. 

The local environment around the home is also important in terms of fear of crime, the accessibility of services, and the opportunity to be physically active. 

Increasingly in unstable economic conditions, the affordability of housing and the potential for individuals to lose their home because of debts they are unable to meet has become a problem for large numbers of people. 

HOUSING-RELATED HAZARDS

Housing and health

The relationship between housing and health is multi-faceted.  A healthy home needs to have sound structure, to be free of hazards, to provide adequate facilities for sleeping, personal hygiene, the preparation and storage of food, to be an environment for comfortable relaxation, for privacy and quiet, and to provide the facility for social exchange with friends, family and others.  The local environment is also important in determining such factors as fear of crime, access to local services and facilities and in promoting social interaction.

National Environmental Sanitation Policy & Guidelines, 2005 (NESPG)

One of the most innovative initiatives on housing, health and sanitation in recent decades has been the National Environmental Sanitation policy & guidelines, (NESPG) 2005, developed by the federal government of Nigeria through the Federal ministry of Environment. 

This is a health-based risk assessment / premises inspection procedure for residential properties, schools, offices, markets, abbatoir, regulated premises, etc... Environmental Health Officers conduct risk assessments on rented, social housing and Houses of Multiple Occupation (HMOs).

The NESPG is 'a means of creating policy direction and evaluating the potential effect of any faults on the environmental health and safety of occupants, visitors, neighbours and passers-by'.

The principles which underlie it are that:

1.) All dwellings should be free from both unnecessary and avoidable hazards; and where any hazard is necessary and unavoidable, then the likelihood of an harmful occurrence and the potential harm which could result should be reduced to a minimum.

The NESPG identified twenty-four categories of potential housing hazards.  Among the more important, such hazards are:

Cold/ inadequate energy efficiency

(1) COLD
In Nigeria, as in many other African countries, there are deaths and morbidity rates that are attributable to the direct effects of cold.  Although limited, there are some evidence (and good theoretical grounds) to suggest that vulnerability to cold is greater in homes with inadequate insulation / inadequate home protection mechanisms.  Measures to reduce natural indoor cold temperature shall go a long way in preventing mobidity and mortality due to cold in residential homes.  Such cold if not checked properly by the Environmental Health Officer. 

(2) HEAT
The relationship between dwelling characteristics and risk of heat mortality/morbidity is not accurately defined, but is becoming an increasingly important consideration given expectations of higher temperatures as a result of climate change. Houses that have  poorly-insulted and low roof space/ceilings are likely to develop higher indoor temperatures, and may carry greater risks to health.

It's also not advisable to use PVC as ceiling material as it is an excellent health conductor that wouldn't hold back heat but release heat from the roof as soon as as it comes from the roof. 

(3) FALLS AND ACCIDENTS
A high proportion of accidents occur inside the home, and they are a particular concern for the elderly and children. Falls on the level (tripping on smooth faced tiles and wet floors etc) account for over 11% of non-fatal accidents and 2% of deaths in home. Although it is difficult to attribute the risk to characteristics of the dwelling, poor design and maintenance is a factor in many falls.

There are around over 65,000 fires in dwellings a year, resulting in over 600 deaths, and over 15,000 non-fatal injuries.  Smoke alarms can help reduce deaths and injuries.

(4) DAMPNESS AND MOULDS
Interpretation of the epidemiological evidence about the health effects of damp and mould is made more complex because damp and mould tend to be worst in over-crowded dwellings, often occupied by families of low socio-economic status.

However, damp and mould have repeatedly been linked to a number of health outcomes, including respiratory symptoms, nausea and vomiting and general ill health. Humidity in the dwelling can cause condensation which encourages the growth of fungal spores. 

Dampness is also associated with an increase in house dust mites. Both of these are known allergens.  The prevalence of dampness varies considerably from country to country. In Europe, North America, Australia, India and Japan it is estimated that approximately between 10-50% of homes are affected by it.

(5)  CARBON MONOXIDE
Poisoning by carbon monoxide in homes occurs as the result of poorly ventilated and maintained combustion sources (especially generator fumes, fires etc).  In Nigeria there are believed to be around hundreds of deaths and hospital admissions yearly from CO poisoning especially from electric generators, but the burden of morbidity and mortality is probably under-estimated in official figures.  

Figures vary by country, however it is known that children and fetuses are particularly vulnerable. There is uncertainty in the burden of disease due to CO poisoning, however it is thought that there are likely to be significant adverse health effects such as certain neurological symptoms, from chronic low-level exposure to carbon monoxide in the indoor air. A paper by Croxford et al(2008) was the first study to quantify the association between the risk of CO exposure at low levels and the prevalence of community self-reported neurological conditions.

(6)  RADON

Radon is a radioactive, colorless, odorless, tasteless noble gas, occurring naturally as the decay product of radium. It is one of the densest substances that remains a gas under normal conditions, and is considered to be a health hazard due to its radioactivity. 

Radon represents one of the most important housing-related hazards.  It is a naturally-occurring, radioactive gas formed as part of the decay chain of uranium-238. It readily diffuses through air, is soluble in water and it can accumulate inside buildings.

It is a particular problem for dwellings in areas with particular geology (notably the areas with high rate of mining, exploration activities  in Nigeria). The health hazards are well characterised and result from the short-lived, chemically reactive isotopes of polonium, lead, and bismuth that are its daughter products. When inhaled or formed inside the lungs, these isotopes increase the risk of lung cancer.

Radon is thought to be the most important risk factor for lung cancer , especially after smoking, accounting for around one in 20 cases.  At the action level of 200 Becquerels/metre³, there is approximately a 3% lifetime risk of developing cancer as a result of radon exposure.  

Other malignancies resulting from these exposures may include leukemia (acute lymphatic leukemia in children) and skin cancer.  A number of Environmental Health solutions are possible to reduce radon levels inside the home.

Other risks

Other housing related hazards (mainly with rarer occurrence or small/uncertain health effects) include:

ASBESTOS and MAN-MADE MINERAL FIBRES (MMMF) – a common material in older dwellings, but usually causing low level exposure unless disturbed

ELECTROMAGNETIC FIELDS (EMF) – a ubiquitous exposure, though of variable intensity; uncertain epidemiological evidence

LEAD – mainly in old lead paint and water pipes/soldered joints

CHEMICALS in the home

Other indoor air pollutants (e.g carbon dioxide nitrogen oxides, volatile organic compounds and biomass burning products)

Noise

Electrical hazards

Structural failure

Entrapment or collision

Explosions

Uncombusted fuel gas

Entry by intruders

Hot surfaces and materials

Domestic hygiene, pests etc

Inadequate provision for food safety

Contaminated water

Inadequate lighting

Poor ergonomics

Crowding and space – a potentially very important factor that has bearing on the risks of accidents, fires, dampness and mould, mental well-being and a range of other adverse effects.

DESIGNING HOUSES FOR HEALTHY LIVING

There are many factors that contribute to healthy housing (partly governed by building regulation), but there are some trade-offs in design.  For example, in general,  increased electricity supply to homes and offices is good for health (especially for lower income families that may struggle with generator maintaince and fuel bills), but if such energy efficiency means reducing natural ventilation rates, there may be adverse effects on indoor air quality, condensation and mould growth.

AFFORDABILITY OF HOUSING

In addition to traditional risk factors associated with a dwelling, it should also be remembered that the home is one of the major areas of financial expenditure for families.  

The lack of affordable housing and threat to many families of losing their home because of debts they are unable to meet has become an increasing problem, and one which often has substantial negative bearings on mental and sometimes physical health.

FLOODING: 

THERE ARE MANY HEALTH risks to HOUSING FROM FLOODING:

• Physical risks, from drowning and injury, due to floodwaters, unstable buildings and debris

• Pest / vermins displacement by the flood could result in pests  attacks on humans during struggle for space or safe abode. 

• Mental health aspects, from being displaced, loss of property, possessions, despair, loss of community

• Contamination of water supplies, due to surface or groundwater flooding, by sewage

• Lack of drinking water, mains supply and services, e.g. electricity and gas supplies being cut off

• Disrupted access to services, e.g. transport, community services, schools, health services, postal deliveries, etc.

• Carbon monoxide poisoning, due to the use of standby generators in unventilated spaces, or heaters used to dry out property or effects.

• Increased risk of infectious diseases, especially water borne e.g. cholera, gastrointestinal diseases and from overcrowding and lack of fresh water supplies.

The health impacts of flooding are often underestimated due to the most severely affected population being displaced or moving out of the flooded area to displacement camps, for example due to hospitalisation and death, relocation and unreported mental health effects.

The flooding prompted research into quantifying and documenting the mental health impacts of the floods over generations.  

SOCIAL AND PSYCHOLOGICAL EFFECTS OF OVERCROWDING:

The social and psychological effects of overcrowding can be summarized as follows:

Health effects:

Overcrowding poses serious direct and indirect health risks to all segments of the population, particularly the elderly, young children, and the disabled:

overcrowding results in insufficient ventilation in homes, causing or exacerbating respiratory illness;

susceptibility to disease, the severity of diseases, the spreading of illness, and the mortality due to disease all increase as a result of social and physical overcrowding;

overcrowding exacerbates health risks related to insufficient and poor water supply and poor sanitation systems in the camps;

likelihood of accidents in the home and community increases;

overcrowding physically and emotionally overburdens mothers and other caregivers, increasing health risks of dependents;

lack of space and overcrowding directly impacts on the physicial development and psychological well being of disabled residents.

Social effects:

Overcrowding contributes to far-reaching social problems:

it places a strain on social relations within the home and community;

overcrowding in schools and homes is linked to substandard education and functional illiteracy, and may be related to increased child labour;

it is a ‘push factor’ in the decisions leading to girls’ early marriage (before the age of 18) which, in turn, leads to serious health and social ramifications for women and children;

overcrowding affects women’s access to social and economic resources; it increases their responsibilities in the home and burdens their time.

Psychological effects:

Direct and indirect psychological effects result from overcrowding:

lack of privacy is linked to depression and other negative psychological outcomes;

overcrowding contributes to psychological frustrations which, in turn, have a bearing on behavioural responses and residents’ ability to cope with the conditions;

In refugees/ displaced people's camps, the refugees’ perception of options and future prospects is detrimentally affected by overccrowding.