Housing and Health: Here We Go Again

Parking and Public Health

PURPOSE OF REVIEW

Parking is a ubiquitous feature of the built environment, but its implications for public health are under-examined. This narrative review synthesizes literature to describe pathways through which parking may affect population health.

RECENT FINDINGS

We begin by contextualizing the issue, outlining key terminology, the sheer scale of land dedicated to parking, and the historical factors that led to this dominant land use. Next, we delineate four pathways linking parking with public health: 1) Promoting driving and car dependency, affecting air pollution, greenhouse-gas emissions, physical activity, traffic-related injuries and fatalities, and accessibility; 2) Creating impervious surfaces, with consequences for urban heat, flooding, water pollution, and green space; 3) Affecting housing affordability and associated health outcomes of this social determinant; and 4) Design, construction, and maintenance, the health impacts of which include on-street parking's positive and negative impacts on safety for all roadway users, air-quality effects of parking's construction and maintenance, and the potential for green parking lots to mitigate some health consequences of impervious surfaces. While evidence supports each pathway, additional empirical research is needed to evaluate impacts of parking on public-health outcomes. As a dominant feature of the built environment with many health implications, parking warrants attention by public-health research and practice.

Adequate housing as a social determinant of the health of international migrants and locals in Chile between 2013 and 2022

BACKGROUND

Adequate housing is a fundamental right and a social determinant of health. It also represents a historically contentious topic in Latin America. Migratory flows to Chile have become increasingly precarious in the past few years, limiting opportunities for adequate housing, with potential repercussions on the health of international migrants and the general population. This study aims to analyse adequate housing as a social determinant of health among international migrants and locals between 2013 and 2022 in Chile.

METHODS

Observational cross-sectional study based on repeated versions of the nationally representative Socioeconomic Characterization Survey in Chile. Adequate housing indicators adapted from the United Nations Housing Rights Programme guidelines were analyzed with relation to individual health, distinguishing between the local and international migrant populations. Logistic regression models were fitted for housing indicators with migration as the main independent variable and for short-term and long-term healthcare needs in locals and immigrants with housing as the main dependent variables. Models were adjusted for sociodemographic variables and considered the complex sample design.

RESULTS

Descriptive findings indicated higher availability of services and infrastructure among international migrants, and a disadvantage for habitability, location, and affordability by quintiles compared to locals. Logistic regression models, adjusting for demographic variables, revealed significant associations between migration status and overcrowding (OR 6.14, 2022), poor housing materiality (OR 5.65, 2022) and proximity to healthcare centres (OR 1.4, 2022) compared to locals. Experiencing hazardous situations consistently predicted short-term healthcare needs in both migrants (OR = 1.4, 2022) and locals (OR = 2.8, 2022). Overcrowding predicted both long and short-term healthcare needs among locals across the years and long term needs among migrants in 2013 and 2015.

CONCLUSIONS

We found significant inequities in adequate housing between migrant populations and locals in Chile, and some inequities among both populations based on structural socioeconomic deprivation. Experiencing hazardous situations emerged as a social determinant of health among international migrants in 2022, potentially suggesting growing challenges related to social exclusion in urban areas. However, limitations such as exclusion criteria of the survey and sample sizes for data on the migrant population potentially suggest that housing challenges and their impact on health are underestimated.

Leveraging Electronic Health Records to Assess Residential Mobility Among Veterans in the Veterans Health Administration

BACKGROUND

Residential mobility, or a change in residence, can influence health care utilization and outcomes. Health systems can leverage their patients' residential addresses stored in their electronic health records (EHRs) to better understand the relationships among patients' residences, mobility, and health. The Veteran Health Administration (VHA), with a unique nationwide network of health care systems and integrated EHR, holds greater potential for examining these relationships.

METHODS

We conducted a cross-sectional analysis to examine the association of sociodemographics, clinical conditions, and residential mobility. We defined residential mobility by the number of VHA EHR residential addresses identified for each patient in a 1-year period (1/1-12/31/2018), with 2 different addresses indicating one move. We used generalized logistic regression to model the relationship between a priori selected correlates and residential mobility as a multinomial outcome (0, 1, ≥2 moves).

RESULTS

In our sample, 84.4% (n=3,803,475) veterans had no move, 13.0% (n=587,765) had 1 move, and 2.6% (n=117,680) had ≥2 moves. In the multivariable analyses, women had greater odds of moving [aOR=1.11 (95% CI: 1.10,1.12) 1 move; 1.27 (1.25,1.30) ≥2 moves] than men. Veterans with substance use disorders also had greater odds of moving [aOR=1.26 (1.24,1.28) 1 move; 1.77 (1.72,1.81) ≥2 moves].

DISCUSSION

Our study suggests about 16% of veterans seen at VHA had at least 1 residential move in 2018. VHA data can be a resource to examine relationships between place, residential mobility, and health.

Rural/urban differences in receipt of governmental rental assistance: Relationship to health and disability

PURPOSE

Housing is essential to health. Governmental rental assistance is one way to increase access to affordable housing, but little is known about how it varies by rural/urban location. This paper seeks to address that gap by examining rural/urban and within-rural differences in receipt of rental assistance, with particular attention differences by health and disability.

METHODS

We used data from the 2021 National Health Interview Survey (n = 28,254) to conduct bivariate analyses to identify significant differences in receipt of rental assistance by rural/urban location. We then conducted logistic regression analyses to generate odds ratios of receiving rental assistance, adjusting for self-rated health, disability, sociodemographic characteristics, and the US Census region.

FINDINGS

When limiting the sample to those who rent (20.6% of rural residents and 29.6% of urban residents), rural residents were nearly 5 percentage points more likely to receive rental assistance (13.1% vs 8.2%, P<.001). Rural recipients of rental assistance were more likely to have a disability than urban residents (27.9% vs 20.3%, P<.05) and were more likely to report fair/poor health (41.6% vs 31.4%, P<.05).

CONCLUSIONS

Rural residents are less likely to rent their homes, but, among those who rent, they are more likely to receive governmental rental assistance. This may be reflective of the greater need for rental assistance among rural residents, who were in poorer health and of lower socioeconomic status than urban renters. As housing is essential to good health, policy attention must prioritize addressing a persistent and growing need for affordable housing in rural and urban areas alike.

The intersection of health and housing: Analysis of the research portfolios of the National Institutes of Health, Centers for Disease Control and Prevention, and U.S. Department of Housing and Urban Development

BACKGROUND

Housing is a major social determinant of health that affects health status and outcomes across the lifespan.

OBJECTIVES

An interagency portfolio analysis assessed the level of funding invested in "health and housing research" from fiscal years (FY) 2016-2020 across the National Institutes of Health (NIH), the United States Department of Housing and Urban Development (HUD), and the Centers for Disease Control and Prevention (CDC) to characterize the existing health and housing portfolio and identify potential areas for additional research and collaboration.

METHODS/RESULTS

We identified NIH, HUD, and CDC research projects that were relevant to both health and housing and characterized them by housing theme, health topic, population, and study design. We organized the assessment of the individual housing themes by four overarching housing-to-health pathways. From FY 2016-2020, NIH, HUD, and CDC funded 565 health and housing projects combined. The Neighborhood pathway was most common, followed by studies of the Safety and Quality pathway. Studies of the Affordability and Stability pathways were least common. Health topics such as substance use, mental health, and cardiovascular disease were most often studied. Most studies were observational (66%); only a little over one fourth (27%) were intervention studies.

DISCUSSION

This review of the research grant portfolios of three major federal funders of health and housing research in the United States describes the diversity and substantial investment in research at the intersection between housing and health. Analysis of the combined portfolio points to gaps in studies on causal pathways linking housing to health outcomes. The findings highlight the need for research to better understand the causal pathways from housing to health and prevention intervention research, including rigorous evaluation of housing interventions and policies to improve health and well-being.

Housing tenure and disability in the UK: trends and projections 2004-2030

Introduction

Housing is a major influence on health. Housing tenure is associated with housing conditions, affordability, and security and is an important dimension of housing. In the UK there have been profound changes in both housing conditions and the distribution of households by tenure over the past century, that is during the lifetimes of the current population.

Methods

We firstly reviewed and summarise changes in housing conditions, housing policy and tenure distribution as they provide a context to possible explanations for health variations by housing tenure, including health related selection into different tenure types. We then use 2015-2021 data from a large nationally representative UK survey to analyse associations between housing tenure and self-reported disability among those aged 40-69 controlling for other socio-demographic factors also associated with health. We additionally examine changes in the association between housing tenure and self-reported disability in the population aged 25 and over in the first two decades of the 21st century and project trends forward to 2030.

Results

Results show that associations between housing tenure and disability by tenure were stronger than for any other indicator of socio-economic position considered with owner-occupiers having the best, and social renters the worst, health. Differences were particularly marked in reported mental health conditions and in economic activity, with 28% of social renters being economically inactive due to health problems, compared with 4% of owner-occupiers. Rates of disability have increased over time, and become increasingly polarised by tenure. By 2020 the age standardised disability rate among tenants of social housing was over twice as high as that for owner occupiers, with projections indicating further increases in both levels, and differentials in, disability by 2030.

Discussion

These results have substantial implications for housing providers, local authorities and for public health.

Impact of meeting housing needs on human health

OBJECTIVE

Aim: To identify the impact of meeting the housing needs on human health, which must be taken into account when developing the health care policy for the country's population.

PATIENTS AND METHODS

Materials and Methods: The system of general scientific and special research methods was used during the research. The materials of the work were: statistical data; standards and recommendations regarding sanitary living conditions; court case-law; reports in mass media; scientific sources; regulatory legal acts of Ukraine.

CONCLUSION

Conclusions: Sanitary and hygienic conditions of living in housing provide for the formation of a human life environment, where there is no harmful effect of its factors on human health and there are opportunities to ensure normal and to restore impaired body functions. Each person is responsible for maintaining own sanitary and hygienic living conditions in the housing. Sanitary and hygienic living conditions of a person must be considered through the principle of reasonableness and safety of public health.

The house is a machine for everything: the role of the built environment in group homes during the COVID-19 pandemic

OBJECTIVES

Individuals living in group homes during the COVID-19 pandemic faced unique challenges and health risks related to living in shared spaces. This study aimed to assess the experiences of living and working in a group home during the pandemic and to explore the role of the built environment.

STUDY DESIGN AND METHODS

We conducted longitudinal working groups with group home residents with intellectual and developmental disabilities and serious mental illness, group home staff, and families/caregivers of residents from December 2020 through December 2022. Common themes highlighting ways in which group home residents, staff, and caregivers perceived the built environment to impact living in a group home during the COVID-19 pandemic were identified.

RESULTS

Resonant themes centered around increased risk of COVID-19 infection, ad hoc spatial adaptations for infection control, space-related challenges due to isolation and quarantine requirements, and limited access to public spaces.

CONCLUSION

Group home residents and staff experienced multiple health and wellness challenges during the COVID-19 pandemic related to their surrounding built environment. Mechanisms to engage group home residents in modifications of their built environment may improve the effectiveness of infection control policies while acknowledging individual autonomy.

Mathematical Model of the Spread of Hantavirus Infection

A mathematical epidemiological model incorporating the mobility of rodents and human groups among zones of less or major contact between them is presented. The hantavirus infection dynamics is expressed using a model type SEIR (Susceptible-Exposed-Infectious-Removed), which incorporates the displacement of the rodent and the human, between the urban and rural sector, the latter being subdivided in populated and non-populated. The results show the impact that rodent or human displacement may have on the propagation of hantavirus infection. Human mobility is more significant than rodents in increasing the number of hantavirus infection cases. The results found may be used as a reference by the health authorities to develop more specific campaigns on the territorial dynamics of the rodent, attend to the mobility of humans in these territories, mainly agricultural and forestry workers, and strengthen control-prevention actions in the community, to prevent future outbreaks that are fatal.

Linking the Urban Environment and Health: An Innovative Methodology for Measuring Individual-Level Environmental Exposures

Environmental exposures (EE) are increasingly recognised as important determinants of health and well-being. Understanding the influences of EE on health is critical for effective policymaking, but better-quality spatial data is needed. This article outlines the theoretical and technical foundations used for the construction of individual-level environmental exposure measurements for the population of a northern English city, Bradford. The work supports 'Connected Bradford', an entire population database linking health, education, social care, environmental and other local government data over a period of forty years. We argue that our current understanding of environmental effects on health outcomes is limited both by methodological shortcomings in the quantification of the environment and by a lack of consistency in the measurement of built environment features. To address these shortcomings, we measure the environmental exposure for a series of different domains including air quality, greenspace and greenness, public transport, walkability, traffic, buildings and the built form, street centrality, land-use intensity, and food environments as well as indoor dwelling qualities. We utilise general practitioners' historical patient information to identify the precise geolocation and duration of a person's residence. We model a person's local neighbourhood, and the probable routes to key urban functions aggregated across the city. We outline the specific geospatial procedure used to quantify the environmental exposure for each domain and use the example of exposure to fast-food outlets to illustrate the methodological challenges in the creation of city and nationwide environmental exposure databases. The proposed EE measures will enable critical research into the relationship and causal links between the built environment and health, informing planning and policy-making.

Do the Determinants of Mental Wellbeing Vary by Housing Tenure Status? Secondary Analysis of a 2017 Cross-Sectional Residents Survey in Cornwall, South West England

Housing is a social determinant of health, comprising multiple interrelated attributes; the current study was developed to examine whether differences in mental wellbeing across housing tenure types might relate to individual, living, or neighbourhood circumstances. To achieve this aim, an exploratory cross-sectional analysis was conducted using secondary data from a county-wide resident survey undertaken by Cornwall Council in 2017. The survey included questions about individual, living, or neighbourhood circumstances, as well as mental wellbeing (Short Warwick-Edinburgh Mental Wellbeing Scale). A random sample of 30,152 households in Cornwall were sent the survey, from whom 11,247 valid responses were received (38% response), but only 4085 (13.5%) provided complete data for this study. Stratified stepwise models were estimated to generate hypotheses about inequalities in mental wellbeing related to housing tenure. Health, life satisfaction, and social connectedness were found to be universal determinants of mental wellbeing, whereas issues related to living circumstances (quality of housing, fuel poverty) were only found to be related to wellbeing among residents of privately owned and rented properties. Sense of safety and belonging (neighbourhood circumstances) were also found to be related to wellbeing, which together suggests that whole system place-based home and people/community-centred approaches are needed to reduce inequalities.

Effect of Housing Quality on the Mental Health of University Students during the COVID-19 Lockdown

COVID-19 outbreak imposed rapid and severe public policies that consistently impacted the lifestyle habits and mental health of the general population. Despite vaccination, lockdown restrictions are still considered as potential measures to contrast COVID-19 variants spread in several countries. Recent studies have highlighted the impacts of lockdowns on the population's mental health; however, the role of the indoor housing environment where people spent most of their time has rarely been considered. Data from 8177 undergraduate and graduate students were collected in a large, cross-sectional, web-based survey, submitted to a university in Northern Italy during the first lockdown period from 1 April to 1 May 2020. Logistic regression analysis showed significant associations between moderate and severe depression symptomatology (PHQ-9 scores ≥ 15), and houses with both poor indoor quality and small dimensions (OR = 4.132), either medium dimensions (OR = 3.249) or big dimensions (OR = 3.522). It was also found that, regardless of housing size, poor indoor quality is significantly associated with moderate-severe depressive symptomatology. Further studies are encouraged to explore the long-term impact of built environment parameter modifications on mental health, and therefore support housing and public health policies.

Healthy Dwelling: Design of Biophilic Interior Environments Fostering Self-Care Practices for People Living with Migraines, Chronic Pain, and Depression

The benefits of biophilic interior design have been recognized by healthcare facilities, but residential environments receive relatively less attention with respect to improving the health of people living with chronic diseases. Recent “stay-at-home” restrictions due to the COVID-19 pandemic further emphasized the importance of creating interior spaces that directly and indirectly support physical and mental health. In this viewpoint article, we discuss opportunities for combining biophilic interventions with interior design, fostering disease-specific self-care. We provide examples of designing residential spaces integrating biophilic interventions, light therapy, relaxation opportunities, mindfulness meditation, listening to music, physical activities, aromatherapy, and quality sleep. These modalities can provide the clinical benefits of reducing migraine headaches and chronic pain, as well as improving depressive symptoms. The disease-specific interior environment can be incorporated into residential homes, workplaces, assisted-living residences, hospitals and hospital at home programs. This work aims to promote a cross-disciplinary dialogue towards combining biophilic design and advances in lifestyle medicine to create therapeutic interior environments and to improve healthcare outcomes.