Housing and health: an overview

Living environment, and especially dwellings, affect directly and indirectly health in several ways end represent one of the key social determinants of health. The relationship between health and housing has long been recognized and, in the last decades, researchers developed several conceptual models to put in relation the numerous housing factors able to impact on inhabitants' health. For some authors, factors linked to housing and neighborhood conditions that influence health, can be grouped into four broad categories: first considers the health impacts of not having a stable home (residential instability); second, the financial burdens resulting from high-cost housing (affordability); third, the health impacts of conditions inside the home (the housing' safety and quality); lastly, the health impacts of neighborhoods, including both the environmental and social characteristics of where people live (neighborhood). It is evident that the theme of "housing and health" nowadays needs to be assessed with a multidisciplinary approach, because of the complexity and wideness of its components. Moreover it is today clear that to guarantee good health standards it is indispensable to direct political and administrative choices to improve the overall conditions of the neighborhood and of the buildings, and, At the same time, to dispose of a clear and updated regulatory system, since key factor to ensure Public Health protection and social justice.

A project to identify the best practices and health performance objectives for building construction and renovation

The 2014-2018 National Prevention Plan (NPP), in order to promote a correct relationship between health and the environment, indicated, among the central objectives, the definition of guidelines to promote the building hygiene codes in an eco-compatible way, but also to develop specific skills on the subject of confined environments and residential construction in the operators of the Regional Health Services. The CCM2015 Project has therefore set itself the goal of taking stock of the best health practices available today in terms of sustainability and eco-compatibility in the buildings' construction and renovation actions. All this in order to define updated health performance targets to be made available to the competent Authorities, to adapt the current legislation at national, regional and local level, and finally to define the contents of a continuing education (training courses) capable to support operators in risk assessment related to the built environment and in the definition of effective preventive measures.

Towards an update of the Italian Ministerial Decree July 5th, 1975

In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach

BACKGROUND

World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues.

METHODS

The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects.

RESULTS

The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc.

CONCLUSION

The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

A proposal of hygienic and sanitary standards for the new Building Code in Italy

The traditional emphasis of Public Health on the type and quality of housing today merges with other wider determinants of health such as: the neighbourhood, the community and the "place" where a home is located, but also the policies that make access to a healthy home within everyone's reach. At the neighbourhood scale, context-related aspects heavily influence the internal quality and real usability of the buildings themselves, with particular reference to factors such as the quality of the site, the relationship between the building and the context, the presence and quality of the greenery and open spaces surrounding the building, as well as all measures that make it possible to reduce the building's impact on the environment, to protect it against environmental pollution, and to manage the building in an integrated manner for maintenance purposes. Creating healthy living environments means referring to the different dimensions mentioned above, and this not only requires the attention of Public Health operators, but also implies an integration of vision and objectives among various professional skills and competences that puts health at the center of all policies. This proposal, which starts from the analysis of existing local hygiene regulations and scientific literature, aims to take stock of a number of areas considered fundamental for the assessment of building hygiene aspects, with particular reference to the eco-sustainability of buildings and adaptation to climate change. The aspects identified can be considered as a starting point for the preparation of integrated building and hygiene regulations based on documented effective practices for the protection of Public Health.

Hygienic and sanitary standards of housing in Europe: a comparative analysis of nine countries

In recent years, growing interest was devoted to housing conditions from both scientific community and public health, so they are now considered among the main environmental and social health determinants of health of the population. Aim of the study is to analyze and compare the current regulations regarding housing sanitary requirements in different Countries of the EU (Sweden, United Kingdom, Denmark, the Netherlands, France, Germany, Portugal, Spain) with the contents of the Italian Health Ministerial Decree 5th July 1975. From the websites of the official channels of the various countries the regulations have been downloaded. For the comparison, only the aspects of BCs concerning the scale of the building were examined; the comparison concerned all the requirements of the Health Ministerial Decree of 5.07.1975 and some other parameters (e.g. indoor chemical pollution, ionizing radiation, non-ionizing radiation) not provided for in the Ministerial Decree, treated in the other standards regulations, and relevant for the indoor well-being of the occupants. The authors observe a wide variability in the contents and in the formulation of the hygienic-sanitary requirements among the different Building Codes, above all as regards the dimensional data and some fundamental themes (e.g. heating systems, mechanical ventilation) whose treatment is often not it is updated with respect to the technological-scientific innovation consolidated over the past few years. A diverse approach among European Countries is also observed: from a market-oriented logic (e.g. UK), to a prescriptive one (Italy), to a functionality-oriented (the Netherlands). The comparative analysis we carried out made it possible to identify convergences and divergences in the standards analysed for the different European countries. As far as the Italian legislation on the usability of residential premises, finally, considering the health, social, environmental and economic trends, many standards contained in the MD 5th July 1975 should be reviewed and updated.

Housing spaces in Europe: a comparative analysis of standards in nine European Countries

Introduction

In recent years, Public Health devoted a growing interest to housing conditions. In particular, housing dimensions and functional characteristics are relevant, mainly considering population ageing and disability. Aim of the study is to compare housing standards of some European countries to analyse their ability to satisfy new population needs.

Methodology

The dwellings dimensional standards of 9 European countries (Sweden, UK, Denmark, The Netherlands, France, Germany, Portugal, Spain and Italy) are compared. From the websites of the official channels of the various countries the regulations have been downloaded. The standards have been compared.

Results

A wide variability in the dimensions of room among the standards is observed (e.g. single room: from 9 sqm in Italy, to 7 sqm in France, to the absence of any limit in UK, Germany - Hesse and Denmark). Italian and French regulations define housing dimension considering the room use (eg. bed or living room) and the number of people. The Swedish regulation provides performance requirements and functional indications but does not specify the minimum dimensions of habitable rooms. The rooms' minimum height varies between the standards. In Italy and Portugal, the minimum height of the ceiling is intended to be 2.70 m, while in the other nations the minimum heights vary from 2.60 m in the Netherlands to no limit in UK.

Conclusions

A diverse approach among European Countries is observed: from a market-oriented logic (e.g., UK), in which minimum dimensions are not defined, to a prescriptive one (Italy), to a functionality-oriented (the Netherlands). The regulations of some Countries are health-oriented especially for most fragile social classes, since, defining larger dimensional standard, they reduce the risk of overcrowding, indoor air pollution and mental distress. However, considering the health, social, environmental and economic trends, many of these standards should be revised.

Key messages

Optimal housing standards promote the health and well-being of occupants. Healthy housing, healthy people.

How to foster cities resilient to the COVID-19 pandemic through Urban Health strategies

Background

The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make the systems and local capacities resilient to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities?

Methods

According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing.

Results

Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities.

Conclusions

The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments.

Key messages

The strategies described in this paper are at the basis of a social and infrastructural rethinking of the city, careful to the Welfare and Public Health needs.

The physical distancing imposed, may have amplified population's social and health inequalities.

Changes in walkability in three urban neighborhoods of the city of Rome: a comparison 2009-2019

Introduction

Scientific evidence stresses that more walkable neighborhoods are linked to increased physical activity. Walking Suitability Index of the territory (T-WSI) is an easy method, already validated, to evaluate the walkability on the basis of direct observation. Aim of the study is to compare the walkability indices obtained in three urban neighborhoods of the city of Rome in 2009 and 2019, to evaluate whether the urban redevelopment interventions, performed in the decade, do really promote walkability.

Methods

An audit, through T-WSI, is carried out for each street of a neighborhood. T-WSI audit evaluates 12 indicators subdivided into 4 categories: practicability, safety, urbanity, pleasurableness. The weighted analysis of these indicators gives an overall score of the actual usability of the neighborhood. In this study, 2 different trained surveyors, evaluated T-WSI in three neighborhoods of Rome (San Saba, Sacco Pastore and Tufello-Val Melaina), which differ in socio-economic conditions. Average scores have been compared using t-student.

Results

A considerable improvement was observed in the Sacco Pastore neighborhood final weighted scores (T-WSI scores: from 53.6 in 2009 to 68.3 in 2019, with an increase of 14.7% (p < 0.005). All categories improved, although Safety (T-WSI scores: from 35.0 to 59.3; increase of 24.3% - p < 0.005) and Pleasurableness (T-WSI scores: from 48.5 to 61.4; increase of 12.9% - p < 0.005) show the greatest improvements. It is mainly due to redevelopment works carried out in the neighborhood in the last 10 years, mainly aimed to increase citizen's perceived safety (e.g. signs, crossing protection devices, traffic lights, greenery management) and to remove architectural barriers.

Conclusions

The results show T-WSI is a useful tool in order to measure the effectiveness of the interventions already realized at local level, but it could also contribute to making decisions to develop regeneration projects for degraded areas of the cities.

Key messages

Physical Activity must become a priority and part of a daily routine. Healthy cities, healthy people.

Hygienic Requirements of Urban Living Environment in the Russian Federation and in Italy: a comparison

AIM

Urban planning tries to contain and regulate the uncontrolled growth of cities, encouraging their sustainable development at environmental, social and health levels. In the present work, the authors compare the regulatory frameworks of the Russian Federation and of Italy, with particular attention paid to the urban aspects of living spaces.

METHODS

Considering the extant normative production in the two countries, the authors examine national legislation for Italy and federal legislation for Russia, mainly taking into account the following aspects: urban planning tools and environmental and sanitary protection of living spaces.

RESULTS

Hygienic-sanitary requirements regarding living environment in Russia are essentially expressed by two regulatory systems (SNiP and SanPiN), while in Italy they are regulated by the D.M. 07/05/1975. The main principles of urban planning in Russia are expressed by federal standards, while in Italy they are incorporated in the Municipal General Plan (PRG) and in the various local regulations, where all the superordinate regulations are summarized. Finally, aspects related to environmental quality in both countries are governed by various specific laws (federal and state); a complex system of rules that take into account potential impacts on health and the environment.

CONCLUSIONS

The authors reckon that clear and updated regulatory tools should be developed, especially in Italy that lags behind, regarding the building and urban hygiene, relying on the most recent acquisitions of international scientific literature in order to guarantee the highest standards in Public Health safeguard.

Public health and urban planning: a powerful alliance to be enhanced in Italy

Urban planning has played and still plays a key role in improving urban health and indoor health. The authors sketch out the historical evolution of the relationships between Public Health and urban planning, in particular to what happened in Italy during the past 150 years. The authors suggest some lines for further research, but also describe some interventions that could obtain practical results in terms of health gains for the population.

Health inequalities and inadequate housing: the case of exceptions to hygienic requirements for dwellings in Italy

In the past decades, Italian hygienic requirements for dwellings have been modified by multiple derogations. Aim of the present work is to analyse the derogations introduced at a national, regional, and local level. The most important derogations were related to the habitable use of semi-basements and garrets, and building restoration. The paper also describes the regulations regarding indemnity for infringement of building abuses. The authors underline the need for more uniformity and clarity in the determination of health standards of dwellings, as well as for a simplification of the existing legislation.

The Walking Suitability Index of the Territory (T-WSI): a new tool to evaluate urban neighborhood walkability

AIM

To design an easy method to evaluate the walkability of an urban neighborhood, in order to support Public Administrations in the decision making related to urban health policy and local development.

METHODS

The tool, called the Walking Suitability Index of the territory (T-WSI), has been further developed by our team. T-WSI is applied to each street of an environmental area. It includes 12 indicators subdivided into 4 categories: practicability, safety, urbanity, pleasurableness. Data collected in each street are inserted in an algoritm to perform weighted sums and to aggregate the indicators and the categories, up to compute the final index. To validate T-WSI an experimental study was carried out in two environmental areas of Rome: "San Saba" and "Sacco Pastore".

RESULTS

The average index is: 58.6 for the neighborhood "San Saba" and for 55.1 for "Sacco Pastore. Both results detected gaps in the design for pedestrian use of public spaces. Among the analysed categories, Safety showed the worst results in both neighborhoods, mainly for the lack of "protection from vehicle speed".

CONCLUSIONS

The developed tool is easy to use, inexpensive, sensible and reproducible, offering a good basis for urban health policy decisions. The relevance of the tool stands on the survey methodology, based on the direct and objective observation of the context.