Health begins at home: Is your house making you sick?

The right to housing is recognized in the Universal Declaration of Human Rights and International Covenant on Economic, Social and Cultural Rights. But the right to housing is more than simply a right to shelter. It is a right to have somewhere to live that is adequate.

The World Health Organisation (WHO) is keenly interested in the housing and its role in enabling healthy productive lives, and provides  Housing and health guidelines and recommendations to reduce the health burden due to unsafe and substandard housing.

The Australian Centre for Housing Research (ACHR) at the University of Adelaide is actively contributing to international research and policy evidence on housing and its impact on physical and mental health. Work in the Centre is helping to answer questions for Australia and other nations, such as how can housing better protect our physical and mental wellbeing?  How can dwellings be better designed to meet the challenges of climate change and energy efficiency? And how can governments ensure property renters are no less supported than property owners?

Across the world, housing proved to be an invaluable public health asset during the height of COVID-19. It enabled many of us to isolate, work and school our children in relative comfort, free from the risk of viral exposure. “The COVID-19 pandemic made the link between health and housing abundantly clear – high density apartments, and poor ventilation systems in aged care homes are just two examples that come to mind,” says Emma Baker, Professor of Housing Research and Director of the ACHR.

 

Cold housing

The stereotypical perception of Australia as a sun-drenched and warm country masks a surprising research finding that as many as four out of five Australian homes fail to meet the WHO minimum standards for warmth (18°C/64°F). Our winters may not be as cold as in Europe and North America, but our health statistics are a wake-up call. Our winter death rates are over 20% higher than in summer.

The study also showed that cold isn’t just a problem that affects low-income households but included homes that were owned outright, mortgaged and rented, across all income levels. However, people who are elderly, have a disability or chronic health condition, and those facing housing insecurity are most at risk of suffering ill-effects of cold homes. A combination of poor housing conditions, inadequate heating and not being able to afford the cost of heating leaves many struggling to stay warm.

Living in a home that you can’t keep warm enough affects your physical health – for example, colder temperatures suppress the immune system and can exacerbate the effects of cardiovascular and respiratory disease. But cold indoor temperatures can also make other problems, such as mould, worse and can even affect our mental health.

A recent study of households in the UK found that when people’s homes became cold, their risk of severe mental distress significantly increased. For people who previously had no mental health problems, the odds of severe mental distress doubled when they had a cold home, while for those who had some (but not severe) mental health symptoms, the risk tripled.

“We found these effects were evident even after taking into account many other factors associated with mental health, including income, says Emma Baker.

 

Renting

Unhealthy housing is the combined result of multiple housing problems – such as affordability, poor quality of condition, or damp – acting together. Another ACHR study found that those most likely to be affected by their housing were those already at risk within Australian society—for example, low-income public tenants, young people establishing themselves, persons with a disability, the widowed, and the never married.

“We also found that the unhealthiest housing tends to be located in the major urban centres — the more urban the region, the greater the incidence of unhealthy housing,” says Emma. This is likely a reflection of ongoing housing affordability crisis in Australia with 20-plus years of high housing costs pushing many vulnerable people into poor quality homes.

A housing affordability crisis is an international phenomenon. Working in the Netherlands, ACHR’s Adjunct Professor Richard Ronald’s work explores new housing forms and modern alternatives to good quality home ownership for young people.  

Roughly one in three Australians rent their homes but renting is increasingly unaffordable and this sector is where the worst housing accommodates the poorest Australians with the worst health. Insecure housing due to short lease terms, poor building quality and unhealthy conditions – 43% of renters report problems with damp or mould – mean that renters are almost twice as likely as mortgage holders to have poorer general health.

“Housing insecurity has a clear impost on renters’ mental health,” says Emma. “The good news is our results show the gap between renters and home-owners can be closed through longer rental tenure.”

Similar impacts have been shown in the social housing sector. Social housing plays a pivotal role in meeting the housing needs of people whose employment, health, or social circumstances mean that they are unable to access housing through typical market mechanisms. Work by the ACHR has found that Australians use social housing in many different ways and more than one in four people who enter social housing use it as a launchpad to more stable employment and market housing.

Recent work from the Centre has established a link between people’s housing and epigenetic ageing. Using longitudinal data and DNA analysis, this work indicates that epigenetic ageing is faster for private renters than home owners. 

 

Housing for healthy outcomes

The links between housing and health are clearly demonstrated, and despite the challenges of bringing housing and health policy together, there are obvious benefits to doing so.

Housing-focused policy interventions such as minimum rental housing standards, insulation to maintain indoor temperature and increase energy efficiency, and help with fixing problems for people in poor-quality housing are some simple examples. Improving housing security through longer rental tenures and more stable forms of social housing would also have a positive impact on mental health.

Regardless of whether we own our home, rent or live in social housing, delivering healthier housing is one of the best ways to improve quality of life and wellbeing.

 

Researcher profile:

Professor Emma Baker leads the University of Adelaide’s Australian Centre for Housing Research. She is also Deputy Director of the National Health and Medical Research Council’s recently established Centre for Research Excellence in Healthy Housing.