111n2 focus rpp

A 92 VOLUME 111 | NUMBER 2 | February 2003 • Environmental Health Perspectives

Mar

k H

enle

y/Pa

nos

Environews Focus

The problem of inadequate or nonexistent housinghas reached crisis proportions globally. The world population passed 6.1billion in 2001 and is expected to reach 7.9–10.9 billion by 2050, accord-ing to the United Nations (UN) Population Fund. This sheer volumealone exerts enormous pressure to improve existing housing and createnew homes. As the global population grows, rural areas around the world

Environmental Health Perspectives • VOLUME 111 | NUMBER 2 | February 2003 A 93

Focus | Give Me Shelter

are emptying and megacities springing up, usually as unregulated districtscircling an older, more organized core. According to the Washington,D.C.–based advocacy group Population Action International, as of 1996(the latest figures available), approximately 52% of the total housing inCaracas, Venezuela, consisted of squatter settlements; in Dar es Salaam,Tanzania, the figure was 49%, and in Karachi, Pakistan, 40%.

Housing affects healthin many different ways.Deficient housing cancompromise the mostbasic needs of water, sani-tation, and safe foodpreparation and storage,allowing the rapid spreadof communicable andfoodborne diseases. Otherproblems, such as poortemperature and humidityregulation, can lead to res-piratory disease. Over-crowding brings bothphysical and psychologicaldangers. And living innonresidential settingssuch as factory groundsoften exposes people totoxic chemicals that cancause both acute and chronic health effects.

A Multifactorial EpidemicThe UN Human Settlements Programme(UN-HABITAT) estimates that 600 millionurban residents and 1 billion rural dwellersin developing countries live in overcrowdedhousing with poor water quality, lack of san-itation, and no garbage collection. Peoplelive in old buses, shipping containers, card-board boxes, and aluminum shacks, andunder staircases and plastic sheeting, amongother forms of inadequate housing. In boththe developed and developing worlds,industrial sites have become attractive settle-ments for displaced populations, partlybecause settlers can sometimes appropriate

building materials and tap into water andelectricity systems.

Inadequate housing can be considereda multifactorial epidemic—rapid urban-ization, economic restructuring, naturaldisasters, and political events such asregime changes and wars all have con-tributed to the crisis. In China, where theeconomy is modernizing rapidly, increasingurbanization in the next few decades willcreate a need for more than 200 millionnew housing units, almost twice the totalnumber of existing housing units in theUnited States, says John Spengler, a pro-fessor of environmental health at theHarvard School of Public Health.According to A Report on Worst Case

Housing Needs in 1999: New OpportunityAmid Continuing Challenges, published inJanuary 2001 by the U.S. Department ofHousing and Urban Development(HUD), more than 5 million Americanfamilies live in housing that is substan-dard, yet barely affordable.

A 2000 report by the SpecialRapporteur to the UN Commission onHuman Rights, The Realization ofEconomic, Social and Cultural Rights, notedthat regional housing crises are increasinglybeing triggered by forced evictions stem-ming from ethnic cleansing and civil wars.For example, as many as 1.5 million peoplemay have been displaced in southeastTurkey during a civil conflict from 1984 to1999 between the government and theKurdish Workers’ Party, according toDisplaced and Disregarded: Turkey’s FailingVillage Return Program, an October 2002report published by the nonprofit HumanRights Watch. This report also says manyvillagers are still waiting in cities for thechance to reclaim their lands. In the city ofVan, one refugee reported his family livingin stables, 13 to a room, with 100 peoplesharing one water tap and one toilet.

Consequences of the CrisisNot surprisingly, such conditions of over-crowding have fostered physical healthproblems such as typhoid fever and bronchi-tis, as well as post-traumatic stress disorderand depression, according to the HumanRights Watch report. In developing coun-tries, overcrowding and poor ventilationcan encourage the growth of disease vectorssuch as mosquitoes, parasites, bacteria, andviruses. Noise and sheer physical safety,including vulnerability to violent crime,contribute to anxiety and depression inboth developed and developing countries.


Top:

Arn

old

Gre

enw

ell/E

HP;

Bot

tom

: Bo

rje T

obia

sson

/Pan

os


Taking simplicity to the edge. Sometimes squatting, whether on thefringe of a megacity or in the heart of a forest, is the best—or only—hous-ing option available.

A global dilemma. The lack of adequate housing is a problem with no geographical bound-aries. Regional factors contributing to homelessness vary, but even affluent nations have beenunable to escape the epidemic.


Some of the worst environmental healthproblems associated with housing, especiallyin developing countries, are unsafe watersupplies, lead exposure, and poor indoor airquality (along with related dust and mois-ture problems).

Unsafe water. The developing worldsuffers 98% of the deaths resulting fromunsafe water, sanitation, and hygienefacilities, according to the World HealthOrganization’s (WHO) World HealthReport 2002. The report identifies infec-tious diarrhea as the largest single contrib-utor to ill health associated with water,sanitation, and hygiene inadequacies. Insome countries schistosomiasis, trachoma,and other parasitic diseases arise fromcontaminated water systems. Schisto-somiasis is caused by a blood fluke andcauses fever, diarrhea, and enlargement ofthe liver and spleen. Trachoma is causedby a Chlamydia parasite and causesinflamed eyelids, corneal abrasion, andeventually blindness. According to theWHO, 6 million people worldwide areblind due to trachoma, and more than

150 million are threatened with blindnessbecause of trachoma infection.

Drinking water can also be contaminat-ed with naturally occurring chemicals. Forexample, in the Gaza Strip section of thePalestinian Occupied Territories, thealready-scarce drinking water supply hasbecome increasingly salty as rapid popula-tion increase and overuse deplete theregional aquifer, allowing seawater tointrude. According to Anna Bellisari, anassistant professor of anthropology atWright State University in Dayton, Ohio,many Gaza physicians believe the excesssalt is responsible for the area’s high inci-dence of liver and kidney diseases. Chronicingestion of salt can predispose people tohypertension, edema, and neurologicalproblems, as well.

Drinking water is also the most commonpathway for arsenic exposure. According tothe WHO’s Arsenic Fact Sheet No. 210, inBangladesh, the United States, Australia,and a number of other countries, arsenichas been detected at levels above the 0.01milligram per liter (mg/L) denoted by the

WHO as the “realistic limit to measure-ment”—that is, a limit imposed by therestrictions of the measurement technologyrather than by a known health effectthreshold. The fact sheet estimates that28–35 million people worldwide areexposed to arsenic concentrations above0.05 mg/L. The U.S. EnvironmentalProtection Agency (EPA) estimates that 13million Americans use drinking water witharsenic concentrations above 0.01 mg/L.Acute arsenic poisoning symptoms includevomiting, abdominal pain, and diarrhea,while chronic exposure leads to skin pig-mentation and cancer of the lung, skin,bladder, and kidney.

Lead exposure. Lead paint is still usedin much of the developing world, as is lead-ed gasoline. According to the World HealthReport 2002, 120 million people worldwidehave blood lead levels between 5 and 10micrograms per deciliter (µg/dL), with40% of the world’s children having bloodlead levels above 5 µg/dL. For children,blood lead levels above 10 µg/dL are con-sidered elevated by the Centers for Disease

Cris

pin

Hug

hes/

Pano

sFocus | Give Me Shelter

Bleak prognosis. Overcrowding, poor indoor air quality from the use of biofuels, and lack of clean water and sanitation—all apparent in this slumin Nairobi, Kenya—are only a few of the many housing-related deficiencies that can lead to serious health problems.

Control and Prevention (CDC). In theUnited States, lead exposure is one of themost prominent and most studied healthrisks associated with housing.

In the United States, lead was removedfrom paint in 1978 (and from gasoline in1986). However, paint is still the most com-mon pathway for U.S. children’s exposure.In addition to ingestion of paint chips anddust tracked into the home, exposure canalso occur by drinking water carriedthrough lead pipes and by ingesting orinhaling material used in hobbies such asstained glass–making.

According to HUD, 24 million U.S.housing units still have lead-based painthazards, exposing 5.6 million children toenough lead to interfere with their devel-opment. Lead poisoning can reduce IQand cause learning and attention disabili-ties. In high doses it can causekidney damage, anemia, anddeath. Although the currentCDC threshold for health anddevelopmental effects is 10µg/dL, a study by BruceLanphear of the Children’sHospital Medical Center inCincinnati, Ohio, published inthe November/December 2000issue of Public Health Reports,suggested that there are cognitiveeffects below 5 µg/dL.

Low-income and ethnic pop-ulations continue to bear a dis-proportionate burden of leadexposure in developed countries.For example, the EnvironmentalHealth Coalition of San Diego,California, an environmental jus-tice advocacy group, determinedthat 81% of the children in San DiegoCounty with elevated blood lead levels areLatino. The most recent nationwide esti-mates from the CDC show that whereas4.4% of all U.S. children have blood leadlevels above 10 µg/dL, 16% of low-incomechildren living in old housing and 22% ofblack children living in old housing haveblood lead levels above 10 µg/dL.

Indoor air quality. The burning of solidfuels such as dung, wood, and coal, which areused by nearly half the world’s population,exposes people who use them to particu-lates, nitrogen and sulfur compounds, andbenzene. The resulting poor indoor airquality is associated with respiratory infec-tion, chronic obstructive pulmonary dis-ease, respiratory tract cancers, tuberculosis,cataracts, and asthma. According to theWorld Health Report 2002, indoor air pollu-tion is estimated to cause 36% of all lowerrespiratory infections and 22% of chronicobstructive pulmonary disease in the world.

In the United Kingdom, a 1999 reportby Diana Wilkinson of the Scottish OfficeHousing Research Branch titled PoorHousing and Ill Health: A Summary ofResearch Evidence states that even thoughmuch of the research is fragmented andinconclusive, a strong relationshipbetween defective housing and health isevident. Wilkinson cited several studiesshowing strong associations betweendampness and headaches, sore throats, andrespiratory problems including asthma,especially among children. Radon, dustmites, environmental tobacco smoke, car-bon monoxide, and fungal growth werethe next-highest risks.

Asthma. Asthma is increasing at analarming rate in the United States and dis-proportionately affects blacks. According tothe Children’s Environmental Health

Network, a Washington, D.C.–based non-profit group, between 1980 and 1993 deathrates for asthma were consistently highestamong blacks aged 14–24 years. Asthmasensitizers and triggers found indoorsinclude dust mites; cockroach, pet, androdent allergens; molds; fine dust; tire frag-ments; and chemical air pollution such asenvironmental tobacco smoke, wood smoke,and volatile organic compounds from build-ing materials. Many of these sensitizers arepresent in higher concentrations in low-income housing, but according to the mostrecent (October 2001) draft of the HUDreport Healthy Homes Issues: Asthma, “resi-dence in an urban area has been implicatedas an important risk factor for all children.”

Building materials. An emergingsource of housing-related health problemsis building materials commonly used innew housing, which can influence respira-tory health. Composite wood panels suchas particleboard are vulnerable to moisture

damage that can encourage mold growth.Dan Morris of Healthy BuildingsIncorporated, a private consulting firm inSeattle, compares these materials withwood: “When solid wood stays wet forextended periods, many cellulose-digestingmolds will start growing on the surface.Only a few of these will [penetrate] intothe core of the wood, and then very slow-ly,” he says. “Particleboard and orientedstrand board provide pathways and foodfor fungi through the entire thickness ofthe material very quickly.” Mold is knownto be an allergen and a lung irritant, par-ticularly for people with asthma, but thescientific evidence for health risks frommycotoxins released by molds is still incon-clusive, says Tim Takaro, an acting assistantprofessor of medicine and environmentalhealth at the University of Washington.

According to the EPA, theresin glue used in some particle-board, plywood paneling, andfiberboard also releases form-aldehyde, a volatile organiccompound that above concen-trations of 0.1 part per millioncan cause watery and burningeyes, nausea, coughing, skinrash, and severe allergic reac-tions, among other symptoms.More seriously, it can impairlung function at high enoughdoses. The EPA classifies it as aprobable human carcinogen.

Chris Leffel, senior vicepresident of the CompositePanel Association, which repre-sents manufacturers of materialsused in cabinetry, shelving,millwork, and furniture, says,

“The composite panel industry continuesto educate architects and designers onproper installation techniques for interiorproducts made with composite wood [tominimize mold growth].” Leffel also notesthat industry efforts have successfullyreduced formaldehyde emissions by over80% in the last 20 years, and that emis-sions from finished products made withtoday’s composite panels fall below 0.1 partper million. But Morris maintains that,although formaldehyde emissions aremuch lower now in products made in theUnited States due to HUD requirements,the North American Free Trade Agreementand the World Trade Organization allowthe import of products with no emissionstandards.

Home, Toxic Home?Probably no place on earth illustrates theenvironmental health challenges of inade-quate housing better than Porto Romano,


Vale

rie J

. Br

own


A special population at risk. Sights such as this, of children playingamong hazardous waste—in this case, among piles of toxic chemicals inPorto Romano, Albania—are common around the world.


Albania. Located on the Adriatic coast nearDurrës, which is Albania’s major port andsecond-largest city, Porto Romano is acommunity of an estimated 6,000–10,000people, half of whom live amid the rustingskeletons of a former factory that made thepesticide lindane and chromium-6, whichis used in tanning leather.

The Porto Romano factory was closedin 1990, but people settled on the site afterthe collapse of Albania’s communist systemin 1991 triggered massive migrations fromcountryside to city. The 1999 war inneighboring Kosovo also brought an esti-mated 450,000 Kosovar refugees intoAlbania. Porto Romano, as unoccupiedland with building materials to appropriateand still-functioning water and electricitysupplies, was an inviting prospect for poor,displaced migrants.

About 400 tons of chemicals remain onthe 750-acre site, with another 20,000 tonsof hazardous waste lying in an open dumpand leaching into the groundwater and thebay. The air in Porto Romano is bitter withthe smell of lindane, and children, carthorses, cats, and dogs roam among moundsof neon-yellow chromium-6.

Lindane has been linked to breast cancerand endocrine disruption, according to thePesticide Action Network North America,and is classified by the EPA as a possiblehuman carcinogen. Large doses can causeseizures and blood disor-ders, and ingesting ortouching small amountsof lindane can causeheadaches, nausea, diz-ziness, tremors, and mus-cular weakness, accordingto the U.S. Agency forToxic Substances andDisease Registry. As apersistent organic pollu-tant, it has been bannedfor commercial and agri-cultural uses in Europesince 2001.

Chromium-6 is themost toxic of the chro-mium compounds, ac-cording to the Agencyfor Toxic Substancesand Disease Registry[see “Reflections onHexavalent Chromium:Health Hazards of anIndustrial Heavyweight,”EHP 108:A402–A407(2000)]. Breathing highconcentrations can causenasal irritation, ulcers,and holes in the septum.Long-term exposure is

associated with lung cancer. Ingestinglarge amounts can cause stomach upset,convulsions, kidney and liver damage,and death.

In 2001 the UN EnvironmentProgramme assessed the site, declared it adisaster area, and urged the Albanianauthorities to close it and relocate its resi-dents. But Albania’s new national and localgovernments have had shaky authority, lit-tle money, and overwhelming challenges.No official action has been taken except thebuilding of a wall across the access road,which was soon torn down by residents.

People continue to settle at PortoRomano. Most residents know about thecontamination, and many have exposuresymptoms, especially nausea and abdomi-nal cramps. They say their cows’ milk andtheir vegetables taste strange. In July 2002,The New York Times reported that milkfrom one resident’s cow contained 100times the European safety limit for lindane.

Thousands of miles away, the Mon-golian capital of Ulaanbaatar also faces ahousing crisis of fairly recent origin. Sincecommunism collapsed in Mongolia about adecade ago, thousands of nomads and ruraldwellers have flocked to Ulaanbaatar. Athird of the Mongolian population nowlives there.

The influx of new people has resultedin the rise of ger districts circling the

developed city center. (A ger, also knownas a yurt, is a round felt tent used bynomadic herders in Mongolia.) The gerdistricts have no potable water or sewerinfrastructure, according to MarlowRamsay, development manager for JCSInternational. JCS International, analliance of Christian groups working inMongolia, is operating a joint project inthe city with Habitat for Humanity tobuild homes using traditional Mongolianand Russian building techniques com-bined with Western methods (such asmore efficient stove design) and materials(such as Styrofoam insulation).

Most heating and cooking in Mongoliais done with coal or wood, resulting inlarge amounts of particulate matter bothindoors and outdoors. “On cold winternights the smoke is overpowering through-out the city,” says Ramsay. “Respiratoryproblems are common. The smoke, inaddition to the cold, extremely dry air,makes this a serious problem. Chroniccough is a way of life for many peoplethrough the winter season.” Tuberculosisalso is common, Ramsay adds.

Water in Ulaanbaatar comes from twosources: wells and natural springs. TheMongolian government trucks water fromseveral deep wells to distribution stations inthe ger districts, where it is sold for a fewcents a liter. But people have to hand-carry

Nin

a Be

rman

/Aur

ora


Home at what price? Abandoned industrial sites such as Porto Romano are attractive to settlers because they offer build-ings and utilities for the taking. Unfortunately, they also offer the health risks associated with contaminated soil and water.

water from the stations to their homes intheir own containers, and often the stationsare far enough away that some people takewater from nearby ditches instead.

The WHO recently determined that18 of Ulaanbaatar’s 29 natural springs arenow contaminated. New residents arebuilding homes and latrines uphill of thespring outflows; they also dip their person-al containers into the water, thus spreadingany disease-causing agents they may be car-rying to the common supply. Diarrhealdiseases are a leading cause of death amongyoung Mongolians, according to the WorldBank’s 2002 report, Mongolia EnvironmentMonitor.

But Ulaanbaatar now faces a brighterfuture than settlements such as PortoRomano. According to Reijo Salmela, aWHO medical officer in Mongolia, theWHO is working with the Mongolian gov-ernment to determine the extent to whichindoor air pollution affects health and toimprove the efficiency of, and reduce pollu-tion from, the ger stoves. In addition toimproving indoor air quality, the JCSInternational/Habitat project helps gerdwellers maintain consistent indoor temper-atures to help protect the old and veryyoung from exposure and immune systemstress—temperatures can fall to 0°C in anunheated ger, according to Ramsay. Betterstoves will also reduce burn injuries in chil-dren, Ramsay adds: the traditional stoveshave no safety devices, and manyMongolian children carry burn scars. TheWHO has also begun a project to collectdata on the usage and geography of theUlaanbaatar springs, build fountains andother safe outflow points, and place warningsigns at contaminated springs in coopera-tion with local authorities.

What Else Is Being Done?The idea that housing conditions stronglyinfluence health status is not new. Thegreat public health and housing move-ments of the 19th and early 20th centuriesdramatically reduced infectious diseasessuch as cholera and tuberculosis by improv-ing urban water, sanitation, ventilation,and overcrowding, while also improvinghousing quality.

But in later decades the housing andhealth communities went in differentdirections as rapid and dramatic medicaladvances tended to obscure the relationshipbetween adequate housing and publichealth, says David Jacobs, director ofHUD’s Office of Healthy Homes and LeadHazard Control. Jacobs believes that as thehealth effects of lead exposure becameclearer and mitigation actions were takenin the latter half of the 20th century, both

housing and health professionals came torecognize once again that the solution tothe public health problem of childhoodlead poisoning, as well as certain other dis-eases and injuries, lay in remedying haz-ardous housing conditions. “We have comefull circle,” he says. “Good public healthmeans decent, affordable housing.”

In the 20th century, housing as a keypolicy issue gathered momentum interna-tionally at the 1976 UN Conference onHuman Settlements (Habitat I), saysRoderick Lawrence, a professor at theUniversity of Geneva’s Centre for HumanEcology and Environmental Sciences. “Themain idea was that housing and sheltershould be a human right . . . because itshould not only provide protection fromharsh or severe environmental conditionsbut also access to clean water and sanita-tion,” he says. The UN has included theright to safe, healthy housing in a numberof international declarations, such as theUniversal Declaration of Human Rights(1948), the International Covenant onEconomic, Social and Cultural Rights(1966), and the International Covenant onCivil and Political Rights (1976). In 1993,UN-HABITAT adopted its first-ever reso-lution specifically on housing rights.

The WHO European Office forEnvironment and Health organized a semi-nar in 2001 that established the EuropeanTask Force on Housing and Health. Thetask force will advise the WHO on designand development of a European survey onhousing and health. The survey will address

physical, social, and institutional condi-tions affecting health at the levels of house,neighborhood, and community, accordingto task force member David Ormandy, aprincipal research fellow at the Universityof Warwick Law School in Coventry,England. The WHO has drawn up a set of“health principles of housing,” whichinclude protection from communicable dis-eases and protection from injury, poison-ing, and chronic disease. Both the UN andnongovernmental organizations (NGOs)such as the Geneva, Switzerland–basedCentre on Housing Rights and Evictionshave pressed for a binding internationalagreement to make housing a basic rightthat can be enforced under internationallaw, although this has been resisted by somecountries, including the United States.

Within the United States, HUDformed its Healthy Homes Initiative(HHI) in the late 1990s. The HHI contin-ues previously existing HUD programs tomitigate lead paint hazards and serves as anumbrella to coordinate mitigation of manydifferent housing-related health threats tochildren and families. In October 2002,President Bush awarded nearly $95 millionin HHI-funded grants to cities, counties,and states to increase the removal of lead-based paint hazards from housing and tosupport research and pilot programs aimedat mitigating asthma risks and other house-hold dangers. Jacobs says the HHI focuseson housing interventions that will havemultiple benefits, such as adding mechani-cal ventilation—replacing windows to



The lucky ones? Wars and regime changes such as the fall of communism leave millionsaround the world uprooted and homeless. Some, including these street children in theMongolian capital of Ulaanbaatar, manage to find shelter. Others aren’t so fortunate. M

ark

Hen

ley/

Pano

s


affect ventilation, temperature, andhumidity—which in turn will improveoverall respiratory health, energy conserva-tion, and housing quality.

One such HHI-funded research projectwas a recent study by Takaro and JamesKrieger, a project leader with the healthorganization Public Health—Seattle &King County. Takaro and Krieger foundthat community outreach to low-incomehomes, including the provision of vacuumcleaners, information about mitigatingasthma triggers, and several health workervisits over the course of a year, reducedmorbidity from asthma. The outreachresulted in fewer urgent care visits andsymptom days (defined as days withcough, wheeze, or chest tightness; limitedactivity; shortness of breath; nights wak-ened by symptoms; or 24-hour periodswith any symptoms). Takaro and Kriegerare currently conducting a HUD-fundedstudy to determine if home remediation,such as preventing water damage andremoving moldy materials, will providefurther benefits beyond those seen in theintervention study.

Many organizations are working onmaking housing materials more sustain-able, but less clear is how many are intenton making sustainable housing methodsand materials that are also healthful. Forexample, organic insulation materials suchas straw, flax, and other cellulose-basedproducts are much more susceptible tomold and moisture problems than moreconventional insulation. The Danish

Building Research Institute and DanishWorking Environment Council havebegun a project to assess the health conse-quences of organic building materials.

Many NGOs are active in housing andhealth issues ranging from asthma andlead paint mitigation to meeting desperatebasic needs in refugee and squatter settle-ments. For example, JCS Internationalworks exclusively in Mongolia, andHabitat for Humanity has projects in allU.S. states and 83 other countries.Environmental Health Watch inCleveland, Ohio, features a “HealthyHouse” website (http://www.ehw.org/Healthy_House/HH_home.htm) thatguides visitors through a range of environ-mental health risks, their health effects,and mitigation steps. San Diego’sEnvironmental Health Coalition hastrained promotoras—people who inspecthomes and educate their neighbors aboutreducing home lead exposures—in threearea communities.

Heading for HomeClearly, the health of the world’s popula-tion would be well served by significantimprovements in housing for all people,from the homeless in Indonesia to upscalenew home buyers on the American coasts.Making relatively simple changes in basichousing, such as providing safe drinkingwater, reducing humidity, and improvingventilation, could save billions of lives andmedical care dollars over the comingdecades.

Frustratingly, despite a great deal ofactivity by governments, internationalagencies, and NGOs, the housing andhealth crisis is expanding rather thandiminishing. “The number of people with-out permanent housing or living in inade-quate housing appears to have increasedduring the era of contemporary globaliza-tion, even though the legal framework ofthe right to housing has improved duringthe same period,” says Lawrence. He attrib-utes the continuing problem to, amongother factors, a decline in the per capitainvestment in basic urban services globallyand an increase in urban poverty amongwomen. Regarding the latter, the SpecialRapporteur to the UN Commission onHuman Rights noted that women “bearthe primary responsibility for sustainingand maintaining homes,” so that their eco-nomic status directly affects the quality offamily housing. Moreover, women havelimited rights to land tenure and homeownership in many developing countries.Yet, according to UN-HABITAT, half of allhouseholds in Africa and Latin America areheaded by women. Lawrence also points toother factors: Between 1990 and 1999, hesays, more than 186 million people losttheir homes to natural or anthropogenicdisasters; of the latter, armed conflict leftabout 100 million people homeless, andabout 164,000 people lost their homes as aresult of industrial accidents and accompa-nying chemical releases.

Despite the many efforts of interna-tional policy groups and NGOs, housingand health issues may get worse before theyget better, as economies globalize and pop-ulations shift on a large scale. It seems themore things change, the more they stay thesame, at least in times of major socialupheaval. Consider the words of a 19th-century observer of British housing duringthe first flowering of the IndustrialRevolution: “These towns have been builtby small speculators with no interest foranything except immediate profit. . . . Inone place we saw a whole street followingthe course of a ditch, in order to have deep-er cellars without the cost of excavations.The streets are unpaved, with a dunghill ora pond in the middle; the houses are builtback to back without ventilation ordrainage.”

Yet these words may be too pes-simistic—as the connection betweenhousing and health is re-established andmore research is completed, effectiveimprovements in housing can be appliedin ways that result in large health benefitsat relatively low cost.

Valerie J. Brown


111n2 focus rpp

Documents