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This paper explores how housing modifies the temperature–mortality relationship in the Eastern and Western Cape provinces of South Africa. We estimate dose–response relationships for residents living in each of the five common types of South African housing by combining linear-threshold models for Cape Town with concurrent data on the city's housing composition and expert estimates of how well different types of housing protect against heat and cold. We then apply temperature data to determine provincial-level dose–response relationships, relative risks, attributable fractions and mortality burdens for heat and cold under seven housing scenarios – three past, three future and a scenario of maximum protection. We find that future mortality burdens would be lower under a policy scenario that prioritizes the replacement of informal housing compared to one that prioritizes the replacement of traditional dwellings. In a maximum protection scenario, where everyone lived in houses characteristic of the wealthy, temperature-related mortality could be reduced by over 50% (approximately 5000 deaths annually) in the two provinces combined. These results have relevance to current housing policy but also reinforce the importance of the built environment in mitigating adverse effects of future climate change. [Copyright &y& Elsevier]

Previous estimates of childhood lead poisoning prevention benefits have quantified the present value of some health benefits, but not the costs of lead paint hazard control or the benefits associated with housing and energy markets. Because older housing with lead paint constitutes the main exposure source today in the US, we quantify health benefits, costs, market value benefits, energy savings, and net economic benefits of lead-safe window replacement (which includes paint stabilization and other measures). The benefit per resident child from improved lifetime earnings alone is $21,195 in pre-1940 housing and $8685 in 1940–59 housing (in 2005 dollars). Annual energy savings are $130–486 per housing unit, with or without young resident children, with an associated increase in housing market value of $5900–14,300 per housing unit, depending on home size and number of windows replaced. Net benefits are $4490–5,629 for each housing unit built before 1940, and $491–1629 for each unit built from 1940–1959, depending on home size and number of windows replaced. Lead-safe window replacement in all pre-1960 US housing would yield net benefits of at least $67 billion, which does not include many other benefits. These other benefits, which are shown in this paper, include avoided Attention Deficit Hyperactivity Disorder, other medical costs of childhood lead exposure, avoided special education, and reduced crime and juvenile delinquency in later life. In addition, such a window replacement effort would reduce peak demand for electricity, carbon emissions from power plants, and associated long-term costs of climate change. [Copyright &y& Elsevier]

Abstract: While the general link between substandard housing and poor health has received increased attention recently, there are currently no widely accepted standardized protocols to assess and remediate multiple housing-related health hazards. This paper compares several protocols that assess housing health hazards, including the Hazard Assessment and Reduction Program, the American Healthy Homes Survey, the Public Housing Assessment System, the Housing Quality Standards, the American Housing Survey, the Community Environmental Health Resource Center protocol, and the National Energy Audit Tool. The comparison shows considerable variability across the protocols, particularly in the collection of environmental samples or measurements. This may be due in part to differing end uses, as well as the fact that the intersection of housing and health issues is not clearly in the domain of either profession. Housing professionals typically focus on durability and affordability, while environmental health professionals are frequently focused on specific disease or injury vectors, not on place-based interventions. Validation studies at both the national and the international level are needed to determine how well both the hazard assessment and the resulting interventions predict health outcome. Standardizing and validating such protocols can help move beyond the existing limited categorical approaches and will help improve both substandard housing quality and public health. [Copyright &y& Elsevier]