Housing and Health
'Healthy housing' - Experts call for international guidelines
International guidance on "healthy housing" should be developed to help prevent a wide range of diseases and unintentional injuries that can be effectively addressed through better housing. This was a key message emerging from an international consultation of 40 experts from 18 countries hosted by WHO in Geneva 13-15 October, 2010.
The scientific evidence on the many links between housing and health has grown substantially in recent decades. This evidence can be used to guide "primary preventive" measures related to housing construction, renovation, use and maintenance, which can promote better overall health, said Dr Maria Neira, Director of WHO's Department of Public Health and Environment, which is overseeing the initiative.
"Housing improvements are accelerating for many reasons – to conserve energy in the face of climate change, address needs of a rapidly urbanizing global population, prevention of homelessness and slum growth, and other factors," the participants said in a closing statement.
"There is a clear need and opportunity for governments and others to promote health in the course of making investments in housing. International guidance on healthy housing – targeting construction experts, architects and engineers as well as housing agencies and local authorities – would enable action that is scientifically-based, and protects and advances public health.
Examples of key housing-related health risks include: respiratory and cardiovascular diseases from indoor air pollution; illness and deaths from temperature extremes; communicable diseases spread because of poor living conditions, and risks of home injuries. WHO estimates that nearly 2 million people in developing countries die from indoor air pollution caused by the burning of biomass and coal in leaky and inefficient household stoves.
Inadequate ventilation is also associated with a higher risk of airborne infectious disease transmission, including tuberculosis, as well as the 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.
During the course of the meeting, experts from both developing and developed countries assessed evidence about such risks, as well as needs and priorities in the context of guideline development.
"This is an economic sector where major opportunities exist to promote primary prevention of diseases along with more resilient and energy-efficient housing," participants said.
"Most of the world's population growth over the next 20 years will occur in low and middle income cities; nearly 40 percent of urban growth today is in unhealthy slum housing. Additionally, many countries have initiated programmes to modify their existing housing stock to make homes more energy efficient and more resilient in the face of climate change."
Global guidance can help identify healthy choices in construction, rehabilitation, building and urban design, and ventilation measures.
Construction workers also require protection from occupational health and safety hazards. And finally, home occupants need to know how to use their homes in a healthy manner, for instance, ventilating appropriately, particularly when homes are made more weather tight to save energy.
The guidelines would be global in nature. They respond to requests from a number of member states as well as to recommendations by ministers of health and environment in diverse WHO regions.
For example, Ministers at the Fifth European Ministerial Conference on Environment and Health, 10-12 March, 2010, agreed to step up actions related to unsafe homes and neighbourhoods, particularly environmental health risks affecting children. They also called for an increased focus on non-communicable diseases through policies in urban planning, health equity and environmental justice in housing.
Interest in healthy housing is also high in other regions. 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 sanitation…and 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.
Experts at the October meeting in Geneva represented countries from all WHO regions, as well as international agencies such as UN-HABITAT, the United Nations Environment Programme (UNEP), International Labour Organization (ILO) and the United Nations Economic Commission for Europe (UNECE). The group drew up a "road map" for moving ahead on the development of guidelines, based on a systematic review of available evidence on measures that explicitly protect and advance the public health.
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.
As a next step in the process, the expert housing group will identify a set of "key questions" that could be then explored through such systematic review. Findings would then be peer reviewed, formulated as guidance, and then subject to examination by WHO's Guidelines Review Committee.
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Experts participating in the international consultation:
The societies and bodies represented at the meeting included the following:
Ministry of Health, Brazil; National Engineering Research Center for Human Settlements, China; National Institute of Hygiene, Cuba; National Institute for Health and Welfare, Finland; Ministry of Health, France; WHO Collaborating Centre for Housing and Health Stuttgart, Germany; The Energy and Resources Institute, India Habitat Centre, India; Medical Department Kyoto University, Japan; Faculty of Architecture and Design, Jordan University of Science and Technology, Jordan; Centre for Sustainable Cities and He Kainga Oranga/Housing and Health Research Programme, New Zealand; Medical Research Council, South Africa; Ministry of Health, Portugal; London School of Hygiene & Tropical Medicine, UK; WHO Collaborating Centre for Housing Standards and Health, Institute of Health of the University of Warwick, UK; Abu Dhabi Urban Planning Council, United Arab Emirates; Environmental Protection Agency, USA; National Center for Healthy Housing, USA; National Institute of Environmental Health Sciences, USA; International Council for Building; International Labour Organization (ILO); United Nations Economic Commission for Europe (UNECE); United Nations Environment Programme (UNEP); UN-HABITAT.