Future Directions in Housing and Public Health: Findings From Europe With Broader Implications for Planners

Abstract Problem: Chronic diseases such as asthma are rising at alarming rates in the United States and worldwide. Housing environments play an important, underappreciated role in these trends. Purpose: In this article, we document the magnitude of the association between housing conditions and asthma and related respiratory symptoms, present examples of new systems for addressing adverse effects of housing on health, and discuss how planners might require or encourage such innovations. Methods: We use logistic regressions based on household survey data from seven European cities to show the magnitude of the association between housing conditions and noise annoyance and the exacerbation of asthma and related respiratory symptoms. To support our argument that new housing intervention systems show great promise for alleviating current housing-related health challenges, we offer several different examples of green building criteria that incorporate health measures. Results and conclusions: After taking into consideration individual-level characteristics, we found that respondents across a range of cities who were strongly annoyed by general neighborhood noise had twice the odds of a doctor-diagnosed asthma attack or related respiratory symptom than those not at all annoyed. Those strongly annoyed by traffic noise had 68% higher odds. Drainage problems at the housing unit were associated with 54% higher odds of experiencing respiratory symptoms, building structural problems with 27% higher odds, and a leaky roof with 35% higher odds. We identify healthy housing development, construction, and housing rehabilitation systems as promising initiatives for addressing the web of associations between housing and health. We suggest that funds such as Community Development Block Grants or housing trusts could subsidize such efforts, and various existing planning processes could incorporate health requirements or scoring criteria. Takeaway for practice: There is compelling evidence that housing conditions are associated with poor health. Planners should inform themselves about these and identify opportunities to incorporate health considerations into planning that affects housing. Research support: None. Keywords: housinghealthbuilt environmenthealthy communitiesgreen communities Notes *p < .05 **p < .01 a. The LARES measure of household socioeconomic status is a composite indicator, here grouped into five categories ranging from the 20% of the population with the lowest socioeconomic status (band 1) to the 20% of the population with the highest socioeconomic status (band 5). *p < .05 **p < . 01 1. A housing cost burden means that housing costs are more than 30% of household income. 2. Because of our interest in urban asthma, we exclude one small city, Ferreira, Portugal, which is more rural than urban, and all households classified by the inspector as "rural" in the other urban areas. 3. The score was produced as a composite indicator of SES, as there were a substantial number of households for whom no information was available on household income. As expected, for those households with complete data, the SES score displays a fairly high correlation with household income (r = 0.5).