Healthy Home Settings
mould and moisture),
The World Health Organization (WHO)
(Bonnefoy, 2007) defines housing as:
The house or dwelling: the physical
structure, including factors such as mould
growth, quality, design, and noise exposure;
the meaning of "home" as a protective, safe
and intimate refuge where one develops a
sense of identity and attachment; economic,
social and cultural structure established by
the household
The neighborhood: immediate housing
environment, including the quality of urban
design (e.g., public services, playgrounds,
green space, parks, places to socialize)
The community: those living, working and
providing services in the neighborhood. That
is, the quality of the neighborhood and its
relation to social cohesion, sense of trust and
collective efficacy.
HOME:
Home is a site of constancy in the
social and material environment, that
is, a source of control and privacy.
Home is a space for day-to-day
routine and rituals, especially
involving children.
Home is a refuge that provides
freedom from the surveillance of the
contemporary world, thus enhancing
an individual's sense of control over
his/her life.
Home ownership is a rite of passage,
achievement and source of pride,
which forms part of an adult identity.
Risk factors at home that lead to illness
(WHO)
Home injuries unintentional home
injuries are a serious public health
problem. In the years 20022004, in
some countries home injuries were
the leading cause of injury death in
children under 5 years of age. Home
injuries can be reduced through
adequate building design
Indoor Air Quality- has been
identified as a key concern of
environmental health in many
countries and is dependent on the
quality of the building, the materials,
cooking and heating technologies
and user behaviour. Indoor air
quality is therefore determined by
biological (e.g.
chemical and physical factors.
Hazards in the house include
cleaning products, asbestos and other
construction materials and
deteriorating lead based paint.
Pests- in warmer climates,
infestations pose health threats due
to infections and food poisoning.
Risks can be significantly reduced by
adequate housing conditions.
Crowding- a major risk for social
pathologies and mental symptoms,
and increases the risk for infectious
disease transmission. Problems with
lack of space can be modified by
housing design and usability.
Water/sanitation- one of the major
public goods to be provided in or
near the home and the biggest cause
of child mortality as well as the
main requirement for any healthy
home.
Location - selection of residential
sites for urban development based on
an assessment of environmental risks
(flooding, pollution sources etc.) is
crucial to avoid extreme exposures.
Climate protection function - if
adequately built, the home is a
shelter to protect from weather
 extremes such as heat and cold, but
also wind and rain. Therefore,
adaptation in the housing stock is a
key public health issue to mitigate
climate change effects on health.
Inadequate ventilation is also
associated with a higher risk of
airborne infectious disease
transmission, including tuberculosis
accumulation of indoor pollutants
and dampness - which are factors in
the development of allergies and
asthma
Poor housing quality and design
also can exacerbate the health
impacts from exposure to
temperature extremes, which are
occurring more frequently due to
climate change.
Link between poor housing and health
Can have confounders, but studies
consistently show this link
At times when pollution is so bad, docs may
advise people not to go outside, and stay
inside, but if their indoor environment is just
as bad, or contributing to the problem, it
does not help.
Increased length of exposure to poor
housing leads to worsened health
Excess winter mortality 2/2 poor
heating, ventilation, increased
respiratory infection
Mold: respiratory problems, asthma,
allergies, eczema
Indoor pollutants and infestation:
asthma
Overcrowding: increased risk of
infectious disease
Affects mental well-being,
depression
Sress
Unsafe outside, unhealthy inside
Linking Housing to Health
Substandard housing conditions are
intimately linked with three of the leading
pediatric health concerns:
Asthma
Lead poisoning
Household Injuries
Estimated 40% of doctor diagnosed
asthma is due to residential exposure
Poor Indoor Air Quality
-People spend 80% of time indoors
Damp housing :
due to poor construction and
materials, inadequate heat, lack
of ventilation
Ideal conditions for mold
Evidence of link is strongest in
children
House dust mites, cockroaches
Pets
Tobacco smoke
VOCs (volatile organic compounds)- in
cleaning products, paints- ex- formaldehyde
Radon
Cooking and heating equipment
Social Justice
Housing and health: building for the future
5/2003- British medical association
At times when pollution is so bad, docs may
advise people not to go outside, and stay
inside, but if their indoor environment is just
as bad, or contributing to the problem, it
does not help.
Vulnerable populations at most risk
Elderly
Very young
Chronic illness
Greatest exposure to indoor hazards due to
the time they spend inside at home
Shortage of adequate housing
Provision of reasonable standard of
accommodation will have health benefits for
the most disadvantaged in society
Environmental Justice
Linking environmental health and social
justice
Environmental justice is achieved when
everyone, regardless of race, culture, or
income, enjoys the same degree of
protection from environmental and health
hazards and equal access to the decision-
making process to have a healthy
environment in which to live, learn and
work
Housing and Environmental Justice
Health hazards in homes concentrated in
lower-income communities and
communities of color
Disproportionately harm poor and minority
families
Exposures to hazards directly linked to
substandard housing conditions
More likely to live near pollution sources
Typical illness at home
Respiratory diseases related to indoor
air quality
Thermal comfortrelated morbidity and
mortality
Vector borne and zoonotic diseases
Exposure to pests and infestations
Airborne infections
Waterborne diseases
Domestic injuries
Mental health: Noise effects and
morbidity Housing and mental health
Lead poisoning
Studies on house type have suggested that
Health relevance of urban design,
high-rise, multi-dwelling units are
density and the immediate housing
detrimental to psychological wellbeing,
environment. Many of these outcomes
particularly that of mothers with young
refer to formal houses, while there are
children and possibly the children
many people who are living in
themselves (Evans, Wells, & Moch, 2003).
informal houses.
This may be due to social isolation, a lack of
Exposure to dangerous waste,
access to play spaces that promote social
asbestos, insufficient hygiene and
interaction, the stigmatisation of high-rise
sanitation
living, or a combination of these.
Wells and Moch's (2003) review of 27
studies suggests that overall housing quality
is positively correlated with psychological
wellbeing, although issues that may affect
this relationship include identity/self-esteem,
anxiety about structural hazards or a fear of
crime.
Housing and childrens well-being lethargy. Its effects are irreversible and ASK: Have you noticed anything in
include reduced IQs, impaired growth and your home, work, or school that makes your
The physical quality of housing may lead to
neurological development, and behavior asthma worse?
childhood diseases including asthma, lead
problems
poisoning, and respiratory distress, as well Multiple environment:
as accident, injury, or even death. Factors A childs physical health depends on
Home: kitchen, bathroom, basement,
that can lead to such diseases include the characteristics of the home in
bedroom
structural conditions relating to building which he lives (Breysse et al. 2004).
School, daycare, car, boy scouts, girl
quality and maintenance, safety hazards, Paying the bills necessary to
scouts
functional systems (for example, ventilation, maintain a home may leave less
Workplace
smoke alarms heating/cooling, plumbing) or money for food, childrens clothing,
Outdoors
environmental toxins including lead, or medical care. Two good reasons to focus on indoor
asbestos, and neurotoxins. Lead poisoning is the most common
triggers:
cause of environmental disease in People spend up to 90% of their
In individuals who have asthma, exposure to children
small amounts of allergens can result in time indoors
The most common chronic disease in Much easier to control indoor vs.
major breathing problems. Although asthma children is asthma
can resolve itself in childhood, it can reoccur outdoor
in adulthood and lead to abnormal lung Asthma triggers: Asses home triggers
functioning later in life. Chronic exposure to Cockroach
indoor allergens including mold, dust mites, Does the patient:
Flea/ dog lice
mice, rats, and cockroaches is associated Fur/ animal hair keep a pet?
with the initiation and continuation of Mold have signs of pest infestation in any
asthma symptoms. Poor ventilation and part of home?
indoor moisture and dampness sustain mold Assess Environment
have visible mold in any part of
and bacteria which can help set off asthma Identify & control triggers to: home?
attacks smoke or live with a smoker?
Prevent symptoms have a wood-burning stove or
Lead poisoning results from exposure to Prevent hospitalizations & ED visits fireplace?
paint, lead paint dust, and soil found in older Improve quality of life and self- have unvented stoves or heaters?
and poorly maintained homes. Symptoms management skills
include irritability, stomach-ache, poor Reduce medications NEETF Environmental History Form for
appetite, diarrhea, colic, distractibility, and Pediatric Asthma Patient
MOLD
Mold spores are everywhere!
Mold growth in a home can affect your
asthma in three ways:
1. Allergen
2. Mycotoxins (toxic mold) VERY
RARE
3. VOCs can irritate the airways and
worsen asthma symptoms.
Grow everywhere: wood surfaces,
insulation materials, beneath carpets,
inside duct work, bathroom tile etc.
A mold problem is a moisture problem
Solution to Confined, Surface
Contamination
Add more ventilation
Increase air circulation
Avoid dead air spaces
Add a good dehumidifier
Change habits
Clean it up
Smoke & Gases- minimize production
Have the heating system inspected
annually.
Inspect and keep clear the chimney
clean-out opening
Do not use un-vented space heaters
Do not use stoves for heating
Do not use wood burning fireplaces
Use kitchen exhaust fans
Do not let the car idle in the garage
Volatile Organic Compounds (VOCs)
Group of chemicals with similar
properties
Number of common sources in most
homes
Off-gassing from pressed wood and dry
cleaning
Strategies limit use and store properly
Complicated Solutions
Acknowledge that where we
live impacts health
Environment consists of:
Community
Social
Physical
Economic
Housing policy is health policy
Neighborhood improvement policies are
health policies
Global Efforts
The First Interministerial Conference
on Health and Environment in Africa
in Libreville, Gabon in 2008 called
for greater intersectoral cooperation
on access to safe drinking water,
hygiene and sanitationand
inadequate and poorly constructed
road infrastructure, housing and
waste management systems.
A Second Interministerial
Conference on Health and
Environment took place 23-26
November 2010 in Luanda, Angola.
Along with synthesizing new
evidence, healthy housing guidelines
would build upon existing WHO
guidelines and expertise. WHO's
guidelines development process is
anchored around systematic and
transparent review of scientific
evidence.
The Universal Declaration of Human
Rights
Everyone has the right to a standard of
living adequate for the health and Well-
being of himself and of his family, including
food, clothing, housing and medical care.