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Ziersch A, Walsh M, Due C. Housing and health for people from refugee and asylum-seeking backgrounds: findings from an Australian qualitative longitudinal study. BMC Public Health 2024; 24:1138. [PMID: 38654272 DOI: 10.1186/s12889-024-18616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND For people from asylum-seeking and refugee backgrounds, housing and the re-establishment of home are key social determinants of health. Research highlights the inequities faced by asylum seekers and refugees in the housing markets of high-income resettlement countries, resulting in their overrepresentation in precarious housing. There is also emerging evidence of the relationship between housing and health for this population relating to lack of affordability, insecurity of tenure, and poor suitability (physical and social). The mechanisms by which housing impacts health for this group within these housing contexts, is however, understudied - especially overtime. This qualitative longitudinal study aimed to address this gap. METHODS Semi-structured interviews were conducted with 25 people from asylum-seeking and refugee backgrounds in South Australia, recruited through a community survey. Thematic analysis of interview data across three time points over three years identified four material and psychosocial mechanisms through which housing contributed to health outcomes via psychological and physical stressors - physical environment; stability; safety; and social connections, support and services. The study also identified additional health promoting resources, particularly elements of ontological security. The dynamics of these indirect and direct mechanisms were further illuminated by considering the impact of international, national and local contexts and a range of intersecting social factors including gender, country/culture of origin, family circumstances, immigration status, language skills, income, and health status. CONCLUSIONS Rebuilding a sense of home and ontological security is a key resettlement priority and crucial for wellbeing. More comprehensive strategies to facilitate this for refugees and asylum seekers are required.
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Affiliation(s)
- Anna Ziersch
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia.
| | - Moira Walsh
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia
| | - Clemence Due
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia
- School of Psychology; University of Adelaide, Adelaide, Australia
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Singh GK, Lee H, Kim LH. Housing and Inequalities in US Life Expectancy, Child and Youth Mortality, and All-Cause and Cause-Specific Mortality, 1979-2020: Results from the National Longitudinal Mortality Study and the National Vital Statistics System. Int J MCH AIDS 2023; 12:e653. [PMID: 38312495 PMCID: PMC10753405 DOI: 10.21106/ijma.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Limited research exists on the association between housing, life expectancy, and mortality disparities in the United States (US). Using longitudinal individual-level and pooled county-level mortality data from 1979 to 2020, we examine disparities in life expectancy, child and youth mortality, and all-cause and cause-specific mortality in the US by several housing variables. Methods Using the 1979-2011 National Longitudinal Mortality Study (N=1,313,627) and the 2011-2020 linked county-level National Mortality Database and American Community Survey, we analyzed disparities in life expectancy and all-cause and cause-specific disparities by housing tenure, household crowding, and housing stability. Multivariate Cox proportional hazards regression was used to analyze individual-level mortality differentials by housing tenure. Age-adjusted mortality rates and rate ratios were used to analyze area-level disparities in mortality by housing variables. Results US homeowners had, on average, a 3.5-year longer life expectancy at birth than renters (74.22 vs. 70.76 years), with advantages in longevity associated with homeownership being greater for males than for females; for American Indians/Alaska Natives, non-Hispanic Whites, and non-Hispanic Blacks than for Asian/Pacific islanders and Hispanics; and for the US-born than for immigrants. Compared with renters, homeowners had 22% lower risks of all-cause mortality, 15% lower child mortality, 17% lower youth mortality, and significantly lower mortality from cardiovascular diseases, all cancers combined, stomach, liver, esophageal and cervical cancer, diabetes, influenza and pneumonia, COPD, cirrhosis, kidney disease, HIV/AIDS, infectious diseases, unintentional injuries, suicide, and homicide. Conclusion and Global Health Implications Several aspects of housing are strongly associated with life expectancy, child and youth mortality, and all-cause and cause-specific mortality in the US. Policies that aim to provide well-designed, accessible, and affordable housing to residents of both developed and developing countries are important policy options for addressing one of the most fundamental determinants of health for disadvantaged individuals and communities and for reducing health inequities globally.
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Affiliation(s)
- Gopal K Singh
- The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., Riverdale, MD 20738, USA
| | - Hyunjung Lee
- Department of Public Policy and Public Affairs, John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, 100 William T Morrissey Blvd., Boston, MA 02125, USA
| | - Lyoung Hee Kim
- Institute on Health Care Systems, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
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Mishra SR, Wilson T, Andrabi H, Ouakrim DA, Li A, Akpan E, Bentley R, Blakely T. The total health gains and cost savings of eradicating cold housing in Australia. Soc Sci Med 2023; 334:115954. [PMID: 37672848 DOI: 10.1016/j.socscimed.2023.115954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Cold indoor temperature (<18 °C) is associated with hypertension-related and respiratory disease, depression, and anxiety. We estimate total health, health expenditure and income impacts of permanently lifting the temperature in living areas of the home to 18 °C in cold homes in South-eastern Australia (N = 17 million). METHODS A proportional multistate lifetable model was used to estimate health adjusted life years (HALYs), health expenditure and income earnings, over the remainder of the lifespan of the population alive in 2021 (3% discount rate). Multiple data were integrated including the prevalence of cold housing (5.87%; mean temperature 15 °C), the effect of temperature to hypertension-related, respiratory disease, depression and anxiety. FINDINGS Eradicating cold housing was predicted to lead to 89,600 (95% UI 47,700 to 177,000) lifetime HALYs gained over the population's remaining lifespan, nearly half of which occurred from 2021 to 2040. Respiratory disease (32.4%) and mental illness (60.6%) made large contributions to HALYs gained, but also had large uncertainty (95% UI 30.0%-42.9% and 45.1%-64.6%, respectively) due to uncertain estimates of their magnitude of causal association with cold housing. Health gains per capita were 6.1 times greater (95% UI 4.7 to 8.1) among the most compared to least deprived quintile. From 2021 to 2040, health expenditure decreased by AUD$0.87 billion (0.35-1.98) and income earnings increased by AUD$4.35 billion (1.89-9.81). INTERPRETATION Eliminating cold housing would lead to substantial health gains, reductions in health inequalities, savings in health expenditure, and productivity gains. Next steps require research to reduce uncertainty about the magnitude of causal associations of cold with mental and respiratory health.
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Affiliation(s)
- Shiva Raj Mishra
- Scalable Health Intervention Evaluation (SHINE), Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Tim Wilson
- Scalable Health Intervention Evaluation (SHINE), Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Hassan Andrabi
- Scalable Health Intervention Evaluation (SHINE), Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Centre for Brain, Mind, and Markets, Department of Finance, University of Melbourne, Melbourne, Australia
| | - Driss Ait Ouakrim
- Scalable Health Intervention Evaluation (SHINE), Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ang Li
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Edifofon Akpan
- Centre for Health Economics and Development, Abuja, Nigeria
| | - Rebecca Bentley
- Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Tony Blakely
- Scalable Health Intervention Evaluation (SHINE), Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Rana K, Page A, Kent JL, Arora A. Pathways Linking Housing Inequalities and Health Outcomes among Migrant and Refugee Populations in High-Income Countries: A Protocol for a Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16627. [PMID: 36554503 PMCID: PMC9779591 DOI: 10.3390/ijerph192416627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Several high-income countries are currently experiencing an unprecedented and multifaceted housing crisis. The crisis is escalating rapidly, and its negative ramifications are shared disproportionately by migrant and refugee communities. Although housing is often cited as an important social determinant of health, the relationship between housing inequalities and health outcomes in the context of migrant and refugee populations remain under-explored, particularly in high-income countries. This paper presents a protocol for a mixed-methods systematic review which will synthesize the evidence on the key housing and health inequalities faced by migrant and refugee populations in high-income countries. It will inform the identification of pathways linking housing inequalities to health outcomes. The protocol for this systematic review was developed with guidance from the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews using a convergent integrated approach to synthesis and integration, and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. Quantitative, qualitative and mixed-methods studies reporting the association of housing inequalities with physical and mental health outcomes among refugee and migrant populations in high-income countries will be included. Medline, Web of Science, Embase, PsycINFO, Scopus and CINAHL will be searched for peer-reviewed literature. This will be supplemented by gray literature searches using Google Scholar, MedNar and WHOLIS. Two reviewers will independently screen and select studies, assess the methodological quality and conduct data extraction. This systematic review will elucidate the different pathways linking housing inequalities and health outcomes, which may guide the development of targeted housing and public health interventions to improve the health and wellbeing of migrant and refugee populations. The review is registered with PROSPERO (CRD42022362868).
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Affiliation(s)
- Kritika Rana
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Jennifer L. Kent
- The University of Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2008, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia
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Fan Q, Nogueira L, Yabroff KR, Hussaini SMQ, Pollack CE. Housing and Cancer Care and Outcomes: A Systematic Review. J Natl Cancer Inst 2022; 114:1601-1618. [PMID: 36073953 PMCID: PMC9745435 DOI: 10.1093/jnci/djac173] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Access to stable and affordable housing is an important social determinant of health in the United States. However, research addressing housing and cancer care, diagnosis, and outcomes has not been synthesized. METHODS We conducted a systematic review of studies examining associations of housing and cancer care and outcomes using PubMed, Embase, Scopus, and CINAHL. Included studies were conducted in the United States and published in English between 1980 and 2021. Study characteristics and key findings were abstracted and qualitatively synthesized. RESULTS A total of 31 studies were identified. Housing-related measures were reported at the individual level in 20 studies (65%) and area level in 11 studies (35%). Study populations and housing measures were heterogeneous. The most common housing measures were area-level housing discrimination (8 studies, 26%), individual-level housing status (8 studies, 26%), and individual-level housing concerns (7 studies, 23%). The most common cancer outcomes were screening (12 studies, 39%) and mortality (9 studies, 29%). Few studies assessed multiple dimensions of housing. Most studies found that exposure to housing insecurity was statistically significantly associated with worse cancer care (11 studies) or outcomes (10 studies). CONCLUSIONS Housing insecurity is adversely associated with cancer care and outcomes, underscoring the importance of screening for housing needs and supporting systemic changes to advance equitable access to care. Additional research is needed to develop and test provider- and policy-level housing interventions that can effectively address the needs of individuals throughout the cancer care continuum.
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Affiliation(s)
- Qinjin Fan
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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Kock L, Brown J, Shahab L, Tattan-Birch H, Moore G, Cox S. Inequalities in Smoking and Quitting-Related Outcomes Among Adults With and Without Children in the Household 2013-2019: A Population Survey in England. Nicotine Tob Res 2022; 24:690-698. [PMID: 34634112 PMCID: PMC8962729 DOI: 10.1093/ntr/ntab211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Smoking among those who live with children is an important influence on smoking initiation among children. This study assessed socioeconomic inequalities in smoking and quitting-related outcomes among all adults with and without children in the household. AIMS AND METHODS Monthly repeat cross-sectional household survey of adults (16+) from 2013-2019 in England (N = 138 583). We assessed the association between cigarette smoking and quitting-related outcomes and having children in the household, and whether these relationships were moderated by occupational social grade (categories AB-E from most to least advantaged). Trends in smoking prevalence among adults with and without children in the household were explored. RESULTS In adjusted analysis, the association of having children in the household with smoking prevalence depended on social grade: smoking prevalence was between 0.71 (95% confidence interval 0.66-0.77) and 0.93 (0.88-0.98) times lower among social grades AB-D with children in the household relative to those without. Conversely, it was 1.11 (1.05-1.16) times higher among social grade E. Yearly prevalence declined similarly among those with and without children (both prevalence ratio: 0.98, 95% confidence interval 0.97-0.99). Motivation to stop smoking was higher among those with children than those without, but lower among disadvantaged than more advantaged groups. Social grades D-E had greater heavy smoking, but higher prevalence of past-month quit attempts. CONCLUSIONS Among the most disadvantaged social grade in England, smoking prevalence was higher in those with children in the household than without. To attenuate future smoking-related inequalities, there is an urgent need to target support and address barriers to quitting and promote longer-term quit success. IMPLICATIONS In the most disadvantaged occupational social grade, having children in the household was associated with higher smoking prevalence compared with not having children. This contrasts with all other social grades in which there was lower comparative smoking prevalence among those with than without children in the household. Without attention this disparity could exacerbate existing and future health inequalities related to smoking.
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Affiliation(s)
- Loren Kock
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Graham Moore
- SPECTRUM Research Consortium, Edinburgh, UK
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
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7
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Umishio W, Ikaga T, Fujino Y, Ando S, Kubo T, Nakajima Y, Hoshi T, Suzuki M, Kario K, Yoshimura T, Yoshino H, Murakami S. Disparities of indoor temperature in winter: A cross-sectional analysis of the Nationwide Smart Wellness Housing Survey in Japan. INDOOR AIR 2020; 30:1317-1328. [PMID: 32573794 PMCID: PMC7689703 DOI: 10.1111/ina.12708] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/15/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
The WHO Housing and health guidelines recommend a minimum indoor temperature of 18°C to prevent cold-related diseases. In Japan, indoor temperatures appear lower than in Euro-American countries because of low insulation standards and use of partial intermittent heating. This study investigated the actual status of indoor temperatures in Japan and the common characteristics of residents who live in cold homes. We conducted a nationwide real-world survey on indoor temperature for 2 weeks in winter. Cross-sectional analyses involving 2190 houses showed that average living room, changing room, and bedroom temperatures were 16.8°C, 13.0°C, and 12.8°C, respectively. Comparison of average living room temperature between prefectures revealed a maximum difference of 6.7°C (Hokkaido: 19.8°C, Kagawa: 13.1°C). Compared to the high-income group, the odds ratio for living room temperature falling below 18°C was 1.38 (95% CI: 1.04-1.84) and 2.07 (95% CI: 1.28-3.33) for the middle- and low-income groups. The odds ratio was 1.96 (95% CI: 1.19-3.22) for single-person households, compared to households living with housemates. Furthermore, lower room temperature was correlated with local heating device use and a larger amount of clothes. These results will be useful in the development of prevention strategies for residents who live in cold homes.
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Affiliation(s)
- Wataru Umishio
- Department of Architecture and Building Engineering, School of Environment and SocietyTokyo Institute of TechnologyMeguro‐kuTokyoJapan
- Department of System Design Engineering, Faculty of Science and TechnologyKeio UniversityYokohamaKanagawaJapan
| | - Toshiharu Ikaga
- Department of System Design Engineering, Faculty of Science and TechnologyKeio UniversityYokohamaKanagawaJapan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuFukuokaJapan
| | - Shintaro Ando
- Department of Architecture, Faculty of Environmental EngineeringUniversity of KitakyushuKitakyushuFukuokaJapan
| | - Tatsuhiko Kubo
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan
| | - Yukie Nakajima
- School of Science for Open and Environmental Systems, Graduate School of Science and TechnologyKeio UniversityYokohamaKanagawaJapan
- Japan Society for the Promotion of ScienceChiyoda‐kuTokyoJapan
| | - Tanji Hoshi
- Tokyo Metropolitan UniversityHachiojiTokyoJapan
| | - Masaru Suzuki
- Department of Emergency MedicineTokyo Dental College Ichikawa General HospitalIchikawaChibaJapan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineShimotsukeTochigiJapan
| | - Takesumi Yoshimura
- University of Occupational and Environmental HealthKitakyushuFukuokaJapan
| | | | - Shuzo Murakami
- Institute for Building Environment and Energy ConservationChiyoda‐kuTokyoJapan
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Ziersch A, Due C. A mixed methods systematic review of studies examining the relationship between housing and health for people from refugee and asylum seeking backgrounds. Soc Sci Med 2018; 213:199-219. [PMID: 30142501 DOI: 10.1016/j.socscimed.2018.07.045] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/28/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022]
Abstract
Housing is an important social determinant of health and a key element of refugee integration into countries of resettlement. However, the way in which housing may affect mental and physical health for refugees and asylum seekers has not been systematically examined. This systematic review aimed to explore the effects of housing on health and wellbeing for this population, in order to identify key pathways for public health interventions. The review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Social Care Institute for Excellence (SCIE) guidelines. We identified publications through a search of Medline, PsychInfo, Scopus, Web of Science, Embase, CINAHL, Cohrane Library, Google, ProQuest, OpenGrey, MedNar and WHOLIS. Eligibility criteria included: publication in English between 1997 and 2017, with findings pertaining to the relationship between housing and health for refugees and/or asylum seekers. Out of 2371 items, 25 papers were included with a further five identified through reference lists. Eleven of the papers explored housing and health for those refugees and asylum seekers living within refugee camps, with 19 focusing on countries of resettlement. All studies identified housing issues for refugees and asylum seekers, with physical housing conditions particularly poor in refugee camps, and issues of affordability, suitability, insecure tenure and mobility as well as difficulties securing housing also highlighted in countries of resettlement. Consistent relationships were found between physical aspects of housing and physical and mental health, with other aspects of housing such as safety and overcrowding linked to mental health. There were a number of methodological issues with most of the studies, making it difficult to specify precise pathways. However, improvements to housing quality particularly in refugee camps, and targeted housing interventions more generally for refugees and asylum seekers would likely have an important public health benefit.
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Affiliation(s)
- Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, SA, 5001, Australia.
| | - Clemence Due
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, SA, 5001, Australia; School of Psychology, University of Adelaide, SA, 5001, Australia.
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9
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Exploring the Relationship between Housing and Health for Refugees and Asylum Seekers in South Australia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091036. [PMID: 28885594 PMCID: PMC5615573 DOI: 10.3390/ijerph14091036] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 02/08/2023]
Abstract
Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.
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Marí-Dell'Olmo M, Novoa AM, Camprubí L, Peralta A, Vásquez-Vera H, Bosch J, Amat J, Díaz F, Palència L, Mehdipanah R, Rodríguez-Sanz M, Malmusi D, Borrell C. Housing Policies and Health Inequalities. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 47:207-232. [PMID: 28030990 DOI: 10.1177/0020731416684292] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A large body of literature shows the link between inadequate housing conditions and poor physical and mental health. The aim of this paper is to summarize the research on the impact of local housing policies on health inequalities, focusing on the issues of access to housing and fuel poverty as studied in the SOPHIE project. Our case studies in Spain showed that people facing housing insecurity, experienced intense levels of mental distress. We found that access to secure and adequate housing can improve the health of these populations, therefore, public policies that address housing instability and their consequences are urgently needed. Housing conditions related to fuel poverty are associated with poorer health and are unevenly distributed across Europe. We found possible positive effects of façade insulation interventions on cold-related mortality in women living in social housing; but not in men. Policies on housing energy efficiency can reduce the health consequences of fuel poverty, but need to be free to users, target the most vulnerable groups and be adaptable to their needs.
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Affiliation(s)
- Marc Marí-Dell'Olmo
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana M Novoa
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Lluís Camprubí
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Andrés Peralta
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain
| | - Hugo Vásquez-Vera
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain.,5 Universidad de La Frontera, Temuco, Chile
| | - Jordi Bosch
- 4 Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Amat
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Laia Palència
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Roshanak Mehdipanah
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,7 University of Michigan School of Public Health, Michigan, USA
| | - Maica Rodríguez-Sanz
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain
| | - Davide Malmusi
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Carme Borrell
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain
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Badland H, Foster S, Bentley R, Higgs C, Roberts R, Pettit C, Giles-Corti B. Examining associations between area-level spatial measures of housing with selected health and wellbeing behaviours and outcomes in an urban context. Health Place 2016; 43:17-24. [PMID: 27894015 DOI: 10.1016/j.healthplace.2016.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/04/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
Abstract
Adequate and affordable housing is a major social determinant of health; yet no work has attempted to conceptually map and spatially test area-level measures of housing with selected health and wellbeing outcomes. Sourcing data from 7,753 adults from Melbourne, Australia, we tested associations between area-level measures of housing density, tenure, and affordability with individual-level measures of neighbourhood safety, community satisfaction, and self-rated health. Compared with the reference groups, the odds of: feeling unsafe was higher for residents living in areas with less affordable housing; community dissatisfaction was ~30% higher in those living in areas with >36% residential properties assigned as rentals, and was significantly higher in the least affordable areas (OR =1.57). Compared with the reference groups, as dwelling density, proportion of rental properties, and housing unaffordability increased, the odds of reporting poorer self-rated health increased; however these associations did not always reach statistical significance. This work highlights the benefits of evidenced-based planning spatial measures to support health and wellbeing.
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Affiliation(s)
- Hannah Badland
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Sarah Foster
- Centre for the Built Environment and Health, The University of Western Australia, Perth, Australia.
| | - Rebecca Bentley
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Carl Higgs
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Rebecca Roberts
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Christopher Pettit
- City Futures Research Centre, University of New South Wales, Sydney, Australia.
| | - Billie Giles-Corti
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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Novoa AM, Bosch J, Díaz F, Malmusi D, Darnell M, Trilla C. [Impact of the crisis on the relationship between housing and health. Policies for good practice to reduce inequalities in health related to housing conditions]. GACETA SANITARIA 2015; 28 Suppl 1:44-50. [PMID: 24863993 DOI: 10.1016/j.gaceta.2014.02.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 02/18/2014] [Accepted: 02/18/2014] [Indexed: 11/16/2022]
Abstract
Housing conditions can impact on physical and mental health through 4 interrelated dimensions: 1) the home (the emotional housing conditions), 2) the physical housing conditions, and 3) the physical environment, and 4) the social (community) environment of the neighborhood where the house is located. In Spain, the use of the construction market as an engine for economic growth and the promotion of private property as the main type of housing tenure has led to the use of housing as a speculative good instead of its being considered a first-necessity good. While Spain is the Organisation for Economic Co-operation and Development (OECD) country with the largest housing stock per inhabitant, this stock is highly underutilized, thus excluding the most deprived sector of the population from access to housing. The impact of the current economic crisis on housing has mainly been due to a reduction in household income, which has increased the number of families or persons struggling to cover their housing costs or being evicted. Evidence indicates that this type of problem has a negative impact on health, especially on mental health, but financial problems also make it difficult to meet other basic needs such as eating. There are several instruments to reduce the impact of the economic crisis, such as debt financing or deed of assignment in payment. In the long-term, the creation of a social housing stock should be promoted, as well as rental assistance mechanisms.
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Affiliation(s)
- Ana M Novoa
- Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, España.
| | | | | | - Davide Malmusi
- Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | | | - Carme Trilla
- Cáritas Diocesana de Barcelona, Barcelona, España
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Badland H, Whitzman C, Lowe M, Davern M, Aye L, Butterworth I, Hes D, Giles-Corti B. Urban liveability: Emerging lessons from Australia for exploring the potential for indicators to measure the social determinants of health. Soc Sci Med 2014; 111:64-73. [DOI: 10.1016/j.socscimed.2014.04.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/06/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
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Thomson H, Thomas S, Sellstrom E, Petticrew M. Housing improvements for health and associated socio-economic outcomes. Cochrane Database Syst Rev 2013:CD008657. [PMID: 23450585 DOI: 10.1002/14651858.cd008657.pub2] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The well established links between poor housing and poor health indicate that housing improvement may be an important mechanism through which public investment can lead to health improvement. Intervention studies which have assessed the health impacts of housing improvements are an important data resource to test assumptions about the potential for health improvement. Evaluations may not detect long term health impacts due to limited follow-up periods. Impacts on socio-economic determinants of health may be a valuable proxy indication of the potential for longer term health impacts. OBJECTIVES To assess the health and social impacts on residents following improvements to the physical fabric of housing. SEARCH METHODS Twenty seven academic and grey literature bibliographic databases were searched for housing intervention studies from 1887 to July 2012 (ASSIA; Avery Index; CAB Abstracts; The Campbell Library; CINAHL; The Cochrane Library; COPAC; DH-DATA: Health Admin; EMBASE; Geobase; Global Health; IBSS; ICONDA; MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; NTIS; PAIS; PLANEX; PsycINFO; RIBA; SCIE; Sociological Abstracts; Social Science Citations Index; Science Citations Index expanded; SIGLE; SPECTR). Twelve Scandinavian grey literature and policy databases (Libris; SveMed+; Libris uppsök; DIVA; Artikelsök; NORART; DEFF; AKF; DSI; SBI; Statens Institut for Folkesundhed; Social.dk) and 23 relevant websites were searched. In addition, a request to topic experts was issued for details of relevant studies. Searches were not restricted by language or publication status. SELECTION CRITERIA Studies which assessed change in any health outcome following housing improvement were included. This included experimental studies and uncontrolled studies. Cross-sectional studies were excluded as correlations are not able to shed light on changes in outcomes. Studies reporting only socio-economic outcomes or indirect measures of health, such as health service use, were excluded. All housing improvements which involved a physical improvement to the fabric of the house were included. Excluded interventions were improvements to mobile homes; modifications for mobility or medical reasons; air quality; lead removal; radon exposure reduction; allergen reduction or removal; and furniture or equipment. Where an improvement included one of these in addition to an included intervention the study was included in the review. Studies were not excluded on the basis of date, location, or language. DATA COLLECTION AND ANALYSIS Studies were independently screened and critically appraised by two review authors. Study quality was assessed using the risk of bias tool and the Hamilton tool to accommodate non-experimental and uncontrolled studies. Health and socio-economic impact data were extracted by one review author and checked by a second review author. Studies were grouped according to broad intervention categories, date, and context before synthesis. Where possible, standardized effect estimates were calculated and statistically pooled. Where meta-analysis was not appropriate the data were tabulated and synthesized narratively following a cross-study examination of reported impacts and study characteristics. Qualitative data were summarized using a logic model to map reported impacts and links to health impacts; quantitative data were incorporated into the model. MAIN RESULTS Thirty-nine studies which reported quantitative or qualitative data, or both, were included in the review. Thirty-three quantitative studies were identified. This included five randomised controlled trials (RCTs) and 10 non-experimental studies of warmth improvements, 12 non-experimental studies of rehousing or retrofitting, three non-experimental studies of provision of basic improvements in low or mIddle Income countries (LMIC), and three non-experimental historical studies of rehousing from slums. Fourteen quantitative studies (42.4%) were assessed to be poor quality and were not included in the synthesis. Twelve studies reporting qualitative data were identified. These were studies of warmth improvements (n = 7) and rehousing (n = 5). Three qualitative studies were excluded from the synthesis due to lack of clarity of methods. Six of the included qualitative studies also reported quantitative data which was included in the review.Very little quantitative synthesis was possible as the data were not amenable to meta-analysis. This was largely due to extreme heterogeneity both methodologically as well as because of variations in the intervention, samples, context, and outcome; these variations remained even following grouping of interventions and outcomes. In addition, few studies reported data that were amenable to calculation of standardized effect sizes. The data were synthesised narratively.Data from studies of warmth and energy efficiency interventions suggested that improvements in general health, respiratory health, and mental health are possible. Studies which targeted those with inadequate warmth and existing chronic respiratory disease were most likely to report health improvement. Impacts following housing-led neighbourhood renewal were less clear; these interventions targeted areas rather than individual households in most need. Two poorer quality LMIC studies reported unclear or small health improvements. One better quality study of rehousing from slums (pre-1960) reported some improvement in mental health. There were few reports of adverse health impacts following housing improvement. A small number of studies gathered data on social and socio-economic impacts associated with housing improvement. Warmth improvements were associated with increased usable space, increased privacy, and improved social relationships; absences from work or school due to illness were also reduced.Very few studies reported differential impacts relevant to equity issues, and what data were reported were not amenable to synthesis. AUTHORS' CONCLUSIONS Housing investment which improves thermal comfort in the home can lead to health improvements, especially where the improvements are targeted at those with inadequate warmth and those with chronic respiratory disease. The health impacts of programmes which deliver improvements across areas and do not target according to levels of individual need were less clear, but reported impacts at an area level may conceal health improvements for those with the greatest potential to benefit. Best available evidence indicates that housing which is an appropriate size for the householders and is affordable to heat is linked to improved health and may promote improved social relationships within and beyond the household. In addition, there is some suggestion that provision of adequate, affordable warmth may reduce absences from school or work.While many of the interventions were targeted at low income groups, a near absence of reporting differential impacts prevented analysis of the potential for housing improvement to impact on social and economic inequalities.
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Affiliation(s)
- Hilary Thomson
- Social and Public Health Sciences Unit, Medical Research Council, Glasgow, UK.
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Roy B, De Koninck M. [The qualitative research on social inequalities in health: the life courses]. Canadian Journal of Public Health 2013. [PMID: 23618209 DOI: 10.1007/bf03405680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Adopting a lifecourse perspective is more and more frequent in the health inequalities research field. This article describes such an approach, as applied in a study on poverty and social exclusion. METHODS In this study, life histories were collected through open interviews and focused on the meaning of lived experiences. An original analysis table was used, in which words are grouped within categories identifying the different components of a lifecourse. RESULTS Whether it refers to experiences lived in childhood or adulthood, the life history enables the placing of these within the individual's lifecourse. The horizontal analysis of different individual stories makes it possible to identify experiences that have harmful, or conversely, beneficial effects. When transferring results, reporting the experiences lived by the populations using the same words they did to describe them can help those responsible for program development or implementation understand the genesis of social health inequities. CONCLUSION The analysis of life histories, based on the different components of a lifecourse, allows the identification of key moments in the interviewees' life evolution and, in an action perspective, to do so while taking health and social intervention fields into account. Such results make it easier to design actions to counter social health inequities - and above all their chronic nature - that are suited to the realities encountered.
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Affiliation(s)
- Bernard Roy
- Faculté des sciences infirmières, Université Laval, Québec, QC
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Tello JE, Bonizzato P. Social economic inequalities and mental health II. Methodological aspects and literature review. Epidemiol Psychiatr Sci 2011; 12:253-71. [PMID: 14968484 DOI: 10.1017/s1121189x00003079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SummaryObjective - This study provides a framework for mental health inequalities beginners. It describes the methods used to measure socio economic inequalities and the inter-relations with different aspects of mental health: residence, mental health services organisation and main diagnostic categories. Method - Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch usingand relating the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002 (June). The articles selected were integrated with manual search (publications of the same authors, cross-references, working documents and reports of international andregional organisations). Results - Inequality is not an absolute concept and, mainly, it has been changing during the last years. For example, the integration and re-definition of variables that capture, in simple indices, a complex reality; the accent on social more than on economic aspects; the geo-validity and time-reference of the inequality's indices. Moreover, the inequalities could be the result of individual preferences, in this case, the social selectionand social causation issues will raise the suitability for a public intervention. Conclusions - Up to now, research has been mainly concentrated in describing and measuring health inequalities. For designing effective interventions, policy makers need to ground decisions on health-socioeconomic inequalities explanatory models.Declaration of Interestthis work was partly funded by the Department of the Public Health Sciences “G. Sanarelli” of the University of Rome “La Sapienza” and the Department of Medicine and Public Health of the University of Verona.
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Affiliation(s)
- Juan Eduardo Tello
- Istituto Superiore di Sanità, Aula Missiroli, Segreteria per le Attività Culturali, Viale Regina Elena 299, 00161 Roma.
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Braubach M, Fairburn J. Social inequities in environmental risks associated with housing and residential location--a review of evidence. Eur J Public Health 2010; 20:36-42. [PMID: 20047933 DOI: 10.1093/eurpub/ckp221] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthias Braubach
- WHO Regional Office for Europe, European Centre for Environment and Health, Bonn, Germany.
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Thomson H, Thomas S, Sellstrom E, Petticrew M. The health impacts of housing improvement: a systematic review of intervention studies from 1887 to 2007. Am J Public Health 2009; 99 Suppl 3:S681-92. [PMID: 19890174 PMCID: PMC2774202 DOI: 10.2105/ajph.2008.143909] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We conducted a systematic review of the health impacts of housing improvement. METHODS Forty-two bibliographic databases were searched for housing intervention studies from 1887 to 2007. Studies were appraised independently by H. T. and S. T. or E. S. for sources of bias. The data were tabulated and synthesized narratively, taking into account study quality. RESULTS Forty-five relevant studies were identified. Improvements in general, respiratory, and mental health were reported following warmth improvement measures, but these health improvements varied across studies. Varied health impacts were reported following housing-led neighborhood renewal. Studies from the developing world suggest that provision of basic housing amenities may lead to reduced illness. There were few reports of adverse health impacts following housing improvement. Some studies reported that the housing improvement was associated with positive impacts on socioeconomic determinants of health. CONCLUSIONS Housing improvements, especially warmth improvements, can generate health improvements; there is little evidence of detrimental health impacts. The potential for health benefits may depend on baseline housing conditions and careful targeting of the intervention. Investigation of socioeconomic impacts associated with housing improvement is needed to investigate the potential for longer-term health impacts.
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Affiliation(s)
- Hilary Thomson
- MRC Social & Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, UK, G12 8RZ.
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19
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Türkkan A, Aytekin H. Socioeconomic and Health Inequality in Two Regions of Turkey. J Community Health 2009; 34:346-52. [DOI: 10.1007/s10900-009-9160-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Walker JJ, Mitchell R, Platt SD, Petticrew MP, Hopton J. Does usage of domestic heating influence internal environmental conditions and health? Eur J Public Health 2005; 16:463-9. [PMID: 16157615 DOI: 10.1093/eurpub/cki186] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Housing conditions are recognised as an important determinant of health. In the UK, interventions to improve domestic heating are in place with the expectation that they will improve health. As a component of evaluating such policies, this study assesses whether specific health outcomes are significantly associated with the extent and duration of domestic heating use, either directly or via a possible mediating effect of internal environmental conditions. METHODS Baseline data from a prospective controlled study evaluating the health effects of a publicly-funded programme of heating improvements in Scotland were used to assess associations among heating use, internal conditions, and three specific health outcomes. RESULTS There were significant associations (P < 0.01) between measures of heating use and the presence of environmental problems in the home, such as mould and condensation. The presence of such problems was, in turn, found to be significantly predictive of two health outcomes derived from the SF-36 (P < 0.01) and of adult wheezing (P < 0.05). The direction of significant associations was highly consistent: greater levels of heating were associated with reduced likelihood of environmental problems, and the presence of environmental problems was linked to poorer health status. Heating use was not directly associated with the health outcomes considered. CONCLUSIONS The study findings are consistent with a conceptual model in which health may be influenced by usage patterns of domestic heating, via the mediating effect of poor internal environmental conditions. Since these findings are based on cross-sectional data, interpretation must be carried out cautiously. However, if confirmed by planned future work they have important implications for policy initiatives relating to domestic heating and fuel poverty.
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Affiliation(s)
- Jeremy J Walker
- Research Unit in Health, Behaviour and Change, The University of Edinburgh, Edinburgh, UK.
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Yassi A, Fernandez N, Fernandez A, Bonet M, Tate RB, Spiegel J. Community participation in a multisectoral intervention to address health determinants in an inner-city community in central Havana. J Urban Health 2003; 80:61-80. [PMID: 12612097 PMCID: PMC3456101 DOI: 10.1093/jurban/jtg061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It is increasingly acknowledged that the process of community involvement is critical to the successful implementation of community-based health interventions. Between 1995 and 1999, a multisectoral intervention called Plan Cayo Hueso was launched in the inner-city community of Cayo Hueso in Havana, Cuba, to address a variety of health determinants. To provide a better understanding of the political structures and processes involved, the Cuban context is described briefly. The interventions included improvements in housing, municipal infrastructure, and social and cultural activities. A qualitative study, consisting of interviews of key informants as well as community members, was conducted to evaluate the community participatory process. Questions from an extensive household survey pre- and postintervention that had been conducted in Cayo Hueso and a comparison community to assess the effectiveness of the intervention also informed the analysis of community participation, as did three community workshops held to choose indicators for evaluating effectiveness and to discuss findings. It was found that formal leaders led the interventions, providing the institutional driving force behind the plan. However, extensive community involvement occurred as the project took advantage of the existing community-based organizations, which played an active role in mobilizing community members and enhanced linkage systems critical to the project's success. Women played fairly traditional roles in interventions outside their households, but had equivalent roles to men in interventions within their household units. Most impressive about this project was the extent of mobilization to participate and the multidimensional ecosystem approach adopted. Indeed, Plan Cayo Hueso involved a massive mobilization of international, national, and community resources to address the needs of this community. This, as well as the involvement of community residents in the evaluation process, was seen as resulting in improved social interactions and community well-being and enhanced capacity for future action. While Cuba is unique in many respects, the lessons learned about enhancing community participation in urban health intervention projects, as well as in their evaluation, are applicable worldwide.
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Affiliation(s)
- Annalee Yassi
- Institute of Health Promotion Research, University of British Columbia, Vancouver, Canada.
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