Housing is a key social determinant of health. According to the World Health Organization social determinants of health are:
The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.
The following video from Canada provides a brief overview of social determinants of health (which are based on social models of health).
Improving social determinants of health is a complex problem: the way forward is not always obvious. We need to address complex issues including social justice, access to resources and community engagement. At times it can feel overwhelming, but there are many examples of programs that are making a difference.
Healthabitat is an interesting example addressing housing. Its aim it to improve the health of people, especially those aged 0-5, by assisting them to have safe and well-functioning housing and an improved living environment. This TEDx talk by Paul Pholeros gives a good overview.
It focuses on nine basic improvements to living condition that can make a major difference to health (Healthabitat):
Washing people – ensuring there is adequate hot and cold water and that the shower and bath work.
- Washing clothes and bedding – ensuring the laundry is functional with separate taps for waste for the washing machine and tub.
- Removing waste safely – ensuring drains aren’t blocked and that the toilets are working.
- Improving nutrition – improving the ability to prepare and store food, making sure the stove works and improving the functionality of the kitchen.
- Reducing overcrowding – ensuring health hardware (particularly hot water systems and septic systems) can cope with the actual number of people living in a house at any time.
- Reducing the impact of animals, vermin or insects – on the health of people, for example, ensuring adequate insect screening.
- Reducing dust – to reduce the risk of respiratory illness.
- Controlling temperature – looking at the use of insulation and passive design to reduce the health risks, particularly to small children, the sick and the elderly.
- Reducing trauma – reducing hazards that cause minor injury.
Their approach is also important in that they train up local people to do the work rather than relying totally on outsiders.
It has some impressive results. For example in New South Wales between 1997 and August 2013, NSW Health delivered 78 Housing for Health projects (based on this model) with over 86,702 items being fixed in 2,995 homes, benefiting over 12,700 people (NSW Health).
The following graph shows the percentage of houses before and after the program where key “critical healthy living practices” were functioning effectively. Each of the practices has a number of criteria, ALL of which must be met before they are considered to be functioning. If they meet 6 out of 7 criteria they are not counted as functioning.
Clearly Healthabitat isn’t going to solve the issues of safe housing on its own, but it is certainly making a difference.
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