Our homes and the immediate environment surrounding them—the building, the block, the neighbourhood—can play a large role in determining our health.
[This text was originally published in Catalan in the Barcelona Provincial Council’s EspaiS@lut bulletin.]
According to one pre-pandemic estimate, we spend around 70% of our time at home. With the rise of remote work and distance learning, this figure has probably increased in recent years. Older people typically spend a larger share of their time at home—and our society is ageing rapidly. We also know with increasing certainty that the environment we inhabit influences our health. So why not start by addressing the environment to which we are most exposed?
The relationships between housing and health are complex and involve multiple factors. However, a growing body of evidence suggests that our dwellings are important determinants of our health. In fact, according to recent studies, the impact on our health from living in inadequate housing conditions could be comparable to that of other well-established risk factors such as hypertension, sedentariness, or obesity. We are also learning more about the synergistic and cumulative effects of combined exposures, as well as about how the accumulation of risks or inadequate housing conditions is associated with poorer health status, higher medical usage and greater likelihood of hospitalisation for inhabitants.
A growing body of evidence suggests that our dwellings are important determinants of our health. In fact, according to recent studies, the impact on our health from living in inadequate housing conditions could be comparable to that of other well-established risk factors such as hypertension, sedentariness, or obesity
Moreover, the immediate environment surrounding our homes—the building, the block, the neighbourhood—can also play a large role in determining our health, our opportunities to thrive, and our overall quality of life. Recent studies have indicated that an inadequate physical and community environment can lead to psychological distress, mental problems, risky behaviours and even higher rates of all-cause mortality. Thus, neighbourhoods with high levels of air, noise or light pollution, lack of access to green spaces, barriers to physical activity, food deserts, spaces perceived as unsafe or areas that lead to social isolation threaten the population’s health by increasing the risk of mental illness, cardiovascular disease, type 2 diabetes, chronic lung disease and various types of cancer.
Rich neighbourhood, poor neighbourhood
Conditions can vary greatly between neighbourhoods within the same city. People living in the most deprived areas are more exposed, bear the brunt of adverse conditions and face the triple jeopardy of social, health and environmental inequalities. Recent studies in Europe found major differences in life expectancy between residents of rich and poor neighbourhoods within the same city. In Barcelona, for example, this difference can be as much as 11 years.
Improving housing conditions and residential environments is a tool for environmental and social justice, as well as an opportunity to advance health equity
Improving housing conditions and residential environments is therefore a tool for environmental and social justice, as well as an opportunity to advance health equity. Moreover, at the community level, investing in better housing leads to significant savings on health services. Bearing all this in mind, especially after the experience of COVID-19 lockdowns, the need for action on this front appears indisputable.
What is adequate housing?
The right of every person to adequate housing—and, by extension, to housing that protects their health and promotes their well-being—implies much more than just having four walls and a roof. It entails having safe, functional indoor conditions that are suited to the needs of the inhabitants. Adequate housing must also be located in a well-connected environment, close to basic resources and services, as well as mobility, education and employment opportunities. The dwelling must also be a suitable place for establishing social connections and actively participating in the community. Finally, adequate housing also implies being able to access housing in an equal and non-discriminatory way, without the associated costs forcing you to do without other basic needs, such as education, health care or healthy food.
The right of every person to adequate housing—and, by extension, to housing that protects their health and promotes their well-being—implies much more than just having four walls and a roof.
In short, this issue of housing encompasses multiple dimensions that must be considered with regard to health. The World Health Organisation (WHO) has identified four such dimensions: the home, the physical dwelling, the immediate environment and the community. Addressing the various risk factors associated with these four dimensions via public policy involves multiple sectors with a wide range of competencies. Hence the need for a cross-cutting approach based on the best available scientific evidence.
Applying Science to Housing Policy and Residential Environments
As part of the Urban Environment and Health project, the Barcelona Provincial Council and the Barcelona Institute for Global Health (ISGlobal) have been working together since 2020 to translate scientific knowledge into public policies on housing and residential environments that integrate health as a cross-cutting theme. A multidisciplinary working group was created by the Housing Office, the Public Health Service and the Coexistence, Diversity and Lifecycle Service of the Barcelona Provincial Council, as well as the Urban Planning, Environment and Health Initiative at ISGlobal.
The health criteria derived from scientific reviews are gradually being incorporated into various housing rehabilitation policies as well as bidding processes for new construction projects
Under the umbrella of this collaborative project, the working group has conducted reviews of the recent scientific literature on the links between health and a broad range of housing-related determinants and elements—first those related to the physical dwelling (Phase 1, 2020) and then those related to the home, the immediate environment and the community (Phase 2, 2021). The findings of these reviews have been published in two open-access reports. In parallel, the health criteria derived from these reviews are gradually being incorporated into various housing rehabilitation policies as well as bidding processes for new construction projects.
This line of work has evolved to focus on the neighbourhood scale. The same multidisciplinary group is currently engaged in compiling and reviewing more than 70 tools applicable to neighbourhood transformation plans for vulnerable neighbourhoods. This review aims to integrate the “health perspective” in the design and evaluation of neighbourhood transformation plans within the framework of the Barcelona Provincial Council’s Neighbourhoods and Communities Project, while also serving as a useful guide/resource for similar programmes in the future. In 2023, some of the reviewed tools will be applied to a selection of ongoing projects in various municipalities throughout Barcelona province.