Housing and Health
As outlined at the beginning of this book, connections between housing conditions and health have long been recognised. The focus of health and sanitation reforms in the nineteenth and early twentieth centuries was on the squalid housing conditions and consequent ill health of the poor. While some of these concerns, such as the spread of epidemics or fire, have been generally alleviated, in many nations problems arising from poor quality housing stock continue to persist. Lower-income groups and those who are already vulnerable to the impacts of disease, such as children, the frail aged or people with a disability, are also most at risk from poor housing conditions such as overcrowding, damp or cold temperatures, indoor pollutants and disrepair.
However, by the late twentieth century, a new set of health concerns arising from the location and design of housing had also emerged (Frank and Engelke 2001; Frumkin et al. 2004). These include obesity and cardiovascular diseases associated with a sedentary lifestyle and poor nutrition, which in turn is linked to high rates of car-based commuting and inadequate access to sources of fresh food, or opportunities for physical activity, particularly in open space (Cutts, Darby et al. 2009; Garden and Jalaludin 2009). Additionally, respiratory diseases arising from exposure to air pollution (again a problem arising from traffic congestion) can affect all sectors of the population. Mental illnesses such as loneliness may also be connected to particular forms of housing design or tenure (Rauh, Landrigan et al. 2008).
Urban form—particularly the location and design of housing—are thought to have a significant influence on physical activity (Ewing and Cervero 2010). In particular, walking and cycling for transport is more prevalent in contexts which have good access to shops and services, and safe and interconnected street networks (Aytur, Rodriguez et al. 2007; Steinman,
Doescher et al. 2010; Moudon, Lee et al. 2007). Further, access to large and attractive areas of open space is thought to increase rates of walking and enhance mental well-being (Garden and Jalaludin 2009). In turn, increased walking is thought to encourage interactions between neighbours (Wood, Frank et al. 2010), contributing to a sense of community which is also associated with positive mental health benefits (Wen et al. 2007).
Higher- and medium-density housing with good access to public transport but reduced exposure to traffic and associated pollutants, as well as a quality public realm incorporating infrastructure for active transport and open space, is thought to offer a strong design framework for promoting public health through the built environment. There are clear parallels to current thinking on environmental sustainability and housing.