Band 19, Heft 3-4

This study investigates gender differences in housing, socioeconomic status, and self-reported health status. The analysis focuses on the social and economic dimensions of housing, such as demand, control, material aspects (affordability, type of dwelling) and meaningful aspects (pride in dwelling, home as a refuge) of everyday life in the domestic environment. A random sample, crosssectional telephone survey was administered in the city of Vancouver, Canada in June 1999 (n = 650). Survey items included measures of material and meaningful dimensions of housing, housing satisfaction, and standard measures of socioeconomic status and social support. The main outcome measure was self-reported health (excellent/very good/good vs. fair/poor). A three-stage analysis provides an overall picture of the sample characteristics for male and female respondents, detects significant relations between individual and housing characteristics and self-rated health status, and investigates male-female differences in the factors associated with fair/poor self-rated health. In multivariate analyses, a small number of socioeconomic dimensions of housing were associated with self-rated health status for women. For men, only one attribute of housing was associated with self-rated health: crowding was positively related to poor health, contradicting expectations and the findings for women. The self-reported strain of housework was unrelated to self-rated health for men, bot strongly related to poor health for women. For men and women, satisfaction with social activities increased the likelihood of reporting better health. Future research should focus on the health effects of geodered differences in domestic and paid work, and on home and family roles and the interaction among gender, household crowding, and health.

Young children spend more than 90% of their time in the household environment-a likely place of exposure to hazardous substances. In the developing world, childhood diarrheal disease and acute lower respiratory infections represent a large portion of the global burden of disease and are strongly related to housing conditions. In the developed world, allergies and asthma are also strongly linked to housing conditions. Therefore, intervention to improve housing is essential to improve and maintain children's health. This paper will review several factors that have been shown to mediate housing and health relations, including psychosocial, environmental, socioeconomic, behavior-cultural, and physiological factors, and will provide examples of intervention to improve child health, with housing as a focus. Environmental contaminants found in the household include biological (for example, vector-borne diseases, dustmites, mold, water and sanitation-related), chemical (for example, lead, volatile organic compounds, asbestos) or physical (for example, radon, electric and magnetic fields). Socioeconomic factors include bousehold income, the ability to obtain adequate and appropriate housing, and the ability to implement ongoing preventative maintenance. Housing tenure has been used as a proxy for socioeconomic status and shown some relation with health outcome. Socioeconomic factors can be relevant to the ability of households to create social networks that affect bealth. Psychosocial factors, including stress and depression, can also be related to housing type or design. Behavioral-cultural factors include practices that might influence exposure to chemical, biological, or radiation hazards like time-activity patterns, including gender relations and household decision-making patterns. Physiological factors include genetics or the nutritional and immune status of household members, which can influence the extent to which other housing factors like biological or chemical contaminants adversely affect children. Examples of intersectoral interventions and strategies to improve child health globally, with housing and health as a focus, include integrated pest-management programs to control vector-borne diseases like malaria and Chagas disease and energyefficiency programs to improve thermal comfort and to reduce the presence of allergens like mold and dustmites. Other interventions include housing and health policy, regulation and standard setting, education, training, and participation.

The goal of this paper is to compile recent data on the housing and health in old age, with special emphasis on geropsychological and gerontological studies. The authors first introduce their understanding of both housing and health. Second, theoretical models that are important to understand better the relation between housing- and health-related outcomes are incorporated into an analytic scheme. Third, data on objective and subjective aspects of housing in old age in relation to healthrelated outcomes are presented. Among the objective functional housing aspects are healthrelevant micro-environmental indicators like housing hazards and amenities, retrofitting and assistive devices, as well as meso- and macroenvironmental indicators like housing type, neighborhood conditions, or urban-rural differences. Relocation is a classic field in environmental gerontology in which drastic environmental change has been linked to health outcomes. Among subjective housing aspects are residential satisfaction, housing-related control beliefs, and meaning of home. Direct health-related outcomes, such as physical and mental diseases and functional limitations, as well as indirect health-related outcomes like satisfaction or well-being receive attention. We conclude with a discussion addressing the environment and health dynamics of aging in the future.

Injuries and deaths from home accidents are a major public health problem. This paper describes how data on housing characteristics were matched with dwelling-related mortality and injuries data. As no single database provided sufficient accurate data on housing and occupiers, this task involved identifying data-sets to create and validate a Housing and Population Database, which was matched with various data-sets on injuries and fatalities that are associated with the home. Taking account of both frequency of accidents and severity of outcomes, analyses of the matched data showed the true rank order of type of home accidents. Also investigated was whether one age group was more vulnerable to a particular type of accident and the relation between different types of accidents and the age and type of dwelling. A literature review was carried out to look at the relation between the design and condition of dwelling features and accidents and between human behavior and accidents. The results showed that little work has been done in most areas on the different degrees of the contribution made by human behavior and building conditions. Even though more focused research would be useful, preventative actions could reduce the scale oft he problem.

The self-reported prevalence of asthma in the United States increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase was most marked in children from birth to 14 years of age; and growing evidence indicates that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environmental risk factors, especially in homes and schools. Such factors include moisture and mold growth, pest infestation, dust mites, the building envelope, heating systems, inadequate Ventilation, nitrogen dioxide, and environmental tobacco smoke. The Healthy Public Housing Initiative (HPHI) is a Boston-based communitycentered research and intervention project designed to engage Boston Housing Authority residents in a collaborative process to improve respiratory health, quality of life, building conditions, and building maintenance in public housing. This article summarizes the significant research findings from four pilot studies in housing developments that laid the foundation for the larger HPHI asthma-related environmental intervention study. The research design for the pilot projects is informed by principles of community-collaborative research. The strengths of this model of research for our work are also discussed.

Environmental tobacco smoke (ETS) can be a major constituent of air pollution in indoor environments, including the home. Regulation on smoking in the workplace and public places has made the home the dominant unregulated source of ETS, with important potential impacts on children. Between 40% and 60% of cbildren in the United Kingdom are exposed to ETS in the home. Many experimental and human and studies have investigated the adverse health effects of ETS. Substantial evidence shows that in adults ETS is associated with increased risk of chronic respiratory illness, including lung cancer, nasal cancer, and cardiovascular disease. In children, ETS increases the risk of sudden infant death syndrome, middle ear disease, lower respiratory tract illness, prevalence of wheeze and cough, and exacerbates asthma. Although banning smoking in the home would be the optimal reduction strategy, several barrier and ventilation methods can be effective. Nevertheless, such methods are not always practical or acceptable, particularly when social pressures contribute to a lack of support for ETS control in the home. Smoking cessation interventions have bad limited success. Research is needed to explore the barriers to adopting ETS risk-reducing behaviors.

Over the past half-century, Thailand's health profile has been undergoiog an epidemiologic transition in association with various fundamental societal changes, shifting from one with a predominant burden of communicable disease to one in which noncommunicable diseases and accidents now predominate. The primary question is why have the disease rates in the Thai population changed? Answering this question requires an examination of the underlying transitions in social and contextual factors. This paper explores, using published data, how housing conditions, as one set of environmental health risks, have undergone transition in recent years and how this change maps on the health-transition process. A combination of economic development, urbanization, modernization, and increased health literacy resulted in a range of health-protecting changes in housing design and materials. Pre-eminent among such changes are improvements in household sanitation and in equipment, ventilation, and fuel pertaining to indoor cooking and heating. In tropical countries like Thailand, gains have been made in mosquito-proofing houses and in minimizing open pools of water to combat the risks of malaria, dengue fever, and other mosquito-borne infections. Meanwhile, the growth in shantytown and slum housing around the urban fringe, often in precarious environmental settings, introduced a negative dimension to the evolving profile of housing-related health risks, whereas the urban sprawl of modern residences creates health risks that are due to traffic crashes and the lack of walking in daily transport.

Since the outset of the 201 h century, growing urbanization and its contingent waxing populations in Latin America, including Brazil, have come to have alarming effects on the conditions of life, especially in the areas of housing and healthcare for such populations. In this paper, we present data describing and qualifying the process of urbanization and its consequences for Latin American countries and certain Brazilian cities. Arguments are presented about the effects of the urbanization process and the development of low-income human settlements (slums known as favelas and squatting in tenement housing) on health conditions, diseases, and the death rate. The first part of the paper is based on secondary and quantitative data about urbanization, housing, and health in Brazilian and other Latin American cities. Governmental and nongovernmental data are used to structure the problematic landscape of the Latin American region. In the second part of the paper, we focus on a case study of a Brazilian coast city that has registered an intense population growth. This study demonstrates that urban policy (housing, environmental, sanitation, and urban transportation) requires an integration of health and environmental public policy and demonstrates the importance of the role of popular participation in urban public policy-making, and the potential importance of the Bertiioga Healthy City Project from the perspective of a better integration of actions, policies, and programs.

Lead is a toxic heavy metal that has been used extensively in modern society, causing widespread environmental contamination even in isolated parts of the world. Irrefutable evidence associates lead at different exposure levels with a wide spectrum of health and social effects, including mild intellectual impairment, hyperactivity, shortened concentration span, poor school performance, violent/aggressive behavior, and hearing loss. Lead has an impact on virtually all organ systems, including the heart, brain, liver, kidneys, and circulatory system, resulting in coma and death in severe cases. In recent years, a consensus was reached regarding the absence of a threshold for the key health effects associated with lead exposure and the permanent and irreversible nature of many health and social consequences of lead exposure. The public health problem of environmental lead exposure has been widely investigated in developed countries like the United States of America, where actions taken have led to significant reductions in children's blood lead concentrations. In contrast, there is a relative dearth of information and action regarding lead poisoning in developing countries, particularly in African countries, despite evidence of widespread and excessive childhood lead exposure. In this paper, we will review the information from available published papers, the 'grey Literature', and unpublished reports to give an overview of lead exposure in South African children over the past two decades, with particular emphasis on sources of exposure in the home environment.

Building a sustainable and inclusive future for Wales is at the heart of the constitution of the National Assembly for Wales, which means forging a crosscutting approach to social policy. Improving health is a strategic priority within this agenda, and homelessness and housing appear to be at the center of the Assembly Government's vision of developing sustainable and cohesive communities and promoting social inclusion. This article considers the links between homelessness and mental and physical ill health and the importance of combating homelessness and poor housing within the health agenda in Wales. The article cites the links between homelessness and health identified in the United Kingdom and in international research and highlights the growth in homelessness witnessed during the late 1990s and beginning of the 21"1 Century. The paper considers the significant increase of homelessness and assesses whether, in reality, sufficient practical measures are being taken to combat homelessness as a means of tackling ill health in Wales. The authors conclude that although Wales is making progress toward an integrated approach to health and well-being and that the need to tackle broader health determinants has gained recognition, investment in effectively tackling homelessness and exclusion is needed. Integrating the broader housing, homelessness, and health agendas could contribute to health gains in Wales.

Geographic patterns of poor health and mortality risk are found in most countries. Important health effects at the neighborhood level are mortality, general health, illness and disabilities, mental health, and healthcare utilization. Awareness of the influence of social class on health has been growing during the last decades. Studies show that individuals with lower socioeconomic status (SES) have a shorter life expectancy than do their 'well-off' counterparts. Yet SES-related health inequalities cannot be fully explained by individual characteristics, and environmental qualities should be taken into account. Many aspects of local areas that might be related to health or access to opportunities to live healthily are systematically poorer in socially disadvantaged areas. Such factors have the potential to explain health differences between deprived and prosperous neighborhoods. Investigating health differences at the neighborhood level implies conceptual as well as methodological issues pertaining to selection, accumulation, multiple level measurement, objective features versus perceptions, and time dynamic aspects. This article reviews such issues and evaluates several exemplary theoretical approaches from the fields of public health and environmental health in their ability to overcome such problems.