This article was originally published in Catalan in Espai Salut, a bulletin published by the Diputació de Barcelona
There is a direct relationship between the conditions of a dwelling and the health of the people who live there. This relationship has been demonstrated by a growing body of scientific evidence in recent years and is recognised by the World Health Organisation (WHO) and the European Foundation for the Improvement of Living and Working Conditions (Eurofound), among other entities. Housing affects our health in myriad ways—many relatively minor—that together constitute one of the key social determinants of health.
The WHO estimates that inadequate housing conditions cause more than 100,000 deaths and significant morbidity each year in Europe. Fifteen percent of the European population lives in homes with leaky roofs, damp patches in walls, floors or foundations, or deteriorated woodwork or structural elements. Twenty percent say they do not have a home that provides protection from excessive heat in summer, while 13% lack a home that provides sufficient heat in winter.
In fact, many homes combine multiple such factors, leading to harmful health outcomes, sometimes producing a synergistic effect that increases the overall risk. Examples include the effect of combined exposure to tobacco smoke and radon on the incidence of lung cancer and the effect of combined exposure to PM10 airborne particulate matter and low temperatures on the incidence of heart attack. A recent study showed that each additional poor housing characteristic is associated with poorer health, higher health care utilisation and a higher likelihood of hospitalisation.
The COVID-19 crisis has underscored the importance of healthy conditions in housing units and their immediate surroundings. Even before the pandemic, people spent around 70% of their time at home; the recent lockdown periods, however, have forced us to stay home practically around the clock. Furthermore, beyond the current context, we can expect to spend more time at home in the medium and long term as telecommuting and distance education become more widespread and big challenges such as the ageing population and climate change take centre stage.
Home confinement—albeit with varying degrees of strictness—has been one of the most common strategies used by national and regional governments to curb the spread of the virus. These lockdown measures have underscored the deficiencies of much of the existing housing stock and prompted calls for greater flexibility, more multipurpose spaces and better insulation.
Spain’s housing stock leads Europe in percentage of flats. It is no surprise, therefore, that the main problem with Spanish homes detected in the European Quality of Life Survey (EQLS) is lack of access to open or outdoor spaces. But Spain’s building stock also has other issues: small floorplans, lack of ventilation and natural light, poor indoor air quality, and accessibility problems both in homes and in common areas.
Inadequate housing conditions made confinement a particularly difficult experience for the most disadvantaged and vulnerable groups. People with inadequate dwellings are the ones who, by spending more time at home, also assume greater health risks
Inadequate housing conditions made confinement a particularly difficult experience for the most disadvantaged and vulnerable groups. People with inadequate dwellings are the ones who, by spending more time at home, also assume greater health risks. Overcrowding caused by the small size and inadequate layout of many homes—a problem more common in single-parent households —has often prevented occupants from practising social distancing, giving rise to the problem of intra-family transmission during lockdown.
Similarly, environmental conditions that mitigate viral spread—direct sunlight, indoor ventilation and hygiene, outdoor open spaces, etc.—are not available to everyone. Housing conditions and exposure to specific health risks are more than public health priorities; they are also priorities for health equity and environmental justice, since they have a profound impact on people’s everyday lives.
To truly address the complex relationship between housing and health, we need to do more than simply increase the energy efficiency of our building stock (an area in which Europe plans to make greater efforts in the wake of our current crisis). We must also introduce multi-faceted measures that involve residents by transmitting knowledge and providing incentives to renovate and improve various features and conditions of their homes that may be affecting their physical, mental and social health. Recent scientific evidence points to a crucial and indispensable concept that must be conveyed to all stakeholders: housing influences our health, so—crucially— improving the population’s health may not be possible unless housing deficiencies are solved at the same time.
*Since May 2020, ISGlobal’s Urban Planning, Environment and Health Initiative has been working with the Barcelona Provincial Council, within the framework of the Urban Environment and Health project, on a review of the scientific evidence on housing and health.