Housing
Secular trends in improvement of housing conditions have been regarded as a major factor behind advances in population health. Research has shown the positive impact on health outcomes of interventions focused on improving conditions of existing housing. In SOPHIE, we adopted a broader vision of access to housing as a social good and one of the largest monthly costs for many EU citizens, putting the lens on the issues of fuel poverty and tenure instability.
Main findings
In Europe, housing conditions related to fuel poverty are unevenly distributed and affect health
One of the important aspects of housing related to health, mainly during the economic recession, has been the presence of and increase in fuel poverty, defined as having difficulties keeping a house at a comfortable temperature and meeting its energy needs at an affordable cost. Major reviews have compiled abundant evidence on the association between fuel poverty -and related temperature and dampness-related discomfort- and cardiovascular and respiratory diseases, depression, and anxiety. Moreover, a significant percentage of elevated winter mortality may be related to fuel poverty (2).
In all countries, poor housing conditions related to fuel poverty were associated with poor health, even after adjustments for material deprivation were made. These conditions are worse and the EWDI is higher in transition countries and in southern European countries mainly due to the poor quality of the housing stock, rises in fuel prices, and low levels of expenditure on housing items, particularly on instruments such as housing or fuel benefits (3). Compared to estimations for previous years, the EWDI has worsened in countries most affected by the global financial crisis such as Greece and Spain (3).
(1). Novoa AM, Bosch J, Díaz F, et al. Impact of the crisis on the relationship between housing and health. Policies for good practice to reduce inequalities in health related to housing conditions. Gac Sanit. 2014; 28 Suppl 1:44-50.
(2). Camprubí L, Malmusi D, Mehdipanah R, et al. Façade insulation retrofitting policy implementation process and its effects on health equity determinants: a realist review. Energy Policy, 2016; Apr; 91:304
(3). Bosch J, Palència L, Malmusi D, et al. Impact of fuel poverty upon self-reported health status among low-income population in Europe. Forthcoming.
Housing insulation for fuel-poor households can improve health
Façade insulation in social housing and cold-related mortality in Barcelona.
The objective of this study was to evaluate the impact on the association between cold outdoor temperatures and mortality of the energy efficiency façade retrofitting of 310 poorly insulated social housing blocks in the city of Barcelona between 1986 and 2012. The design of the study was a time stratified case cross-over analysis. The impacts of the interventions were different for men and women. Although women living in a non-insulated block had a higher risk of death when exposed to extremely cold temperatures on the same day of death and the day before, these associations were not present in cases of women living in an insulated block. Associations were stronger in women aged 70-79 with no education. In men, insulation increased the risks of death 14-16 days after an extremely cold temperature day. While façade retrofitting has significantly reduced the risk of cold-related mortality in women, possible negative impacts on men should be studied (4).
(2). Camprubí L, Malmusi D, Mehdipanah R, et al. Façade insulation retrofitting policy implementation process and its effects on health equity determinants: a realist review. Energy Policy, 2016; Apr; 91:304
(4). Peralta A, Camprubí L, Borrell C, et al. Impact of three decades of energy efficiency interventions in public housing buildings on cold-related mortality in the city of Barcelona: a case-crossover analysis. Forthcoming. PPT.
Access to secure and adequate housing can improve health
Foreclosures and health: people affected by mortgage in Catalonia.
Since the start of the economic recession, Spain has had very high rates of foreclosures and evictions. Given this situation, organised civil society has produced the Platform for People Affected by Mortgages (PAH in Spanish), one of the most important movements in this area. A self-administered online questionnaire was completed by 905 adults belonging to PAH and living in Catalonia. We found an extremely high prevalence of poor mental health among PAH participants (87%), much higher than the general population of Catalonia (13% in the last health survey). Poor mental health was already significantly higher in the period of non-payment compared with those who were current on payment, while self-rated health status was poorer in later steps of the process such as post-eviction (7).
(5). Novoa AM, Ward J, Malmusi D, et al. How substandard dwellings and housing affordability problems are associated with poor health in a vulnerable population during the economic recession of the late 2000s. Int J Equity Health. 2015 Nov 4;14(1):120. doi: 10.1186/s12939-015-0238-z.
(6). Amat J, Malmusi D, Novoa AM, et al. Changes in housing and health in a vulnerable population Càritas Barcelona, 2015.
(7). Vásquez H, Rodríguez-Sanz M, Palència L, et al. Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages Journal of Urban Health. 2016 March, 3. doi:10.1007/s11524-016-0030-4
Policy implications
Public policies that tackle housing instability and their consequences are urgently needed in Southern European countries.
Policies on housing energy efficiency can reduce the health consequences of fuel poverty, but need to be free to users, target the most affected groups and be adapted to their needs.
Research team
Research on housing was part of Work Package 4 (Built environment and housing policies in the local context), which has been led by Giuseppe Costa and Elena Gelormino, Università di Torino.
Other the partners were Agència de Salut Pública de Barcelona, Càritas Diocesana de Barcelona and Universitat Pompeu Fabra.
