Environmental burden of disease associated with inadequate housing: a method guide to the quantification of health effects of selected housing risks in the WHO European Region
Overview
In 2003, the WHO published an introduction to the methodology for assessing the environmental burden of disease (EBD) (WHO 2003). This gave the background to, and a description of, the general method developed for quantifying the health impact (whether disease, injury or other health condition) attributable to a particular environmental risk at a population level.
The intention was to provide a means to help prioritize policies and actions directed at preventing or reducing the health impact of environmental risks, a means to identify high-risk groups in the population, and also a means to estimate health gains that interventions can bring. Housing conditions are known to influence health, and there is a growing bank of evidence of the potential harmful effect that unsatisfactory housing can have on the health of occupiers. WHO recognizes that housing comprises four inter-related elements – the house (or dwelling), the home (the social, cultural and economic structure created by the household), the neighbourhood (or immediate housing environment), and the community (the population and services within the neighbourhood). Each of these individual elements has the potential to have a direct or indirect impact on physical, social and mental health, and two or more of them can have an even larger combined impact.
Housing is used by the whole population, but certain groups make greater use of it than others. These groups include young children, the elderly, the unemployed, those who are sick or for other physical or mental health reasons spend a greater proportion of time within the dwelling. The exposure to unsatisfactory housing conditions will be greater for these vulnerable groups than for the rest of the population.
In 2005, the WHO Regional Office for Europe (coordinated by the European Centre for Environment and Health, Bonn Office) organized the first of a series of workshops to examine the possibility of quantifying the negative impact of inadequate housing. The workshops brought together experts on a range of housing related subjects to investigate quantifying that impact using the EBD methodology. Two subsequent workshops were held to develop this approach, and the result was the commissioning of the work behind this report.
This report presents the results from using the EBD methodology to quantify the health impact of risks from particular unsatisfactory housing conditions. It does not cover all potential risks that could be attributed to inadequate housing, but it does demonstrate that this approach can be used effectively. The selection of the particular housing conditions covered by this report was based primarily on whether the relevant data existed and were available. However, limiting the report to those where the data were available would exclude some known high risk conditions (such as low indoor temperatures). Therefore, some chapters use alternative methods to quantify the risk from such conditions. In addition, where there exists EBD assessments of certain environmental risks (such as lead, environmental tobacco smoke, combustion of solid fuels, and radon), rather than duplicate the assessment, the report includes chapters that estimate the proportion of the burden that could be attributed to inadequate housing.
Each chapter in this report has been prepared by internationally recognized experts and subjected to peer review. That said, it is acknowledged that this work represents an important first step. It shows that the EBD methodology can be used to quantify the health impact of housing conditions where the appropriate data are available. And, by using that methodology, it has provided a means to compare the quantifiable health impact of particular risks from housing conditions with the impacts from other environmental risks.