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Housing quality is essential for population health and broader well-being. The World Health Organization housing and health guidelines highlight interventions that protect occupants from cold and hot temperatures, injuries, and other hazards. The COVID-19 pandemic has emphasized the importance of ventilation standards. Housing standards are unevenly developed, implemented, and monitored globally, despite robust research demonstrating that retrofitting existing houses and constructing high-quality new ones can reduce respiratory, cardiovascular, and infectious diseases. Indigenous peoples, ethnic minorities, and people with low incomes face cumulative disadvantages that are exacerbated by poor-quality housing. These can be partially ameliorated by community-based programs to improve housing quality, particularly for children and older people, who are hospitalized more often for housing-related illnesses. There is renewed interest among policy makers and researchers in the health and well-being of people in public and subsidized housing, who are disproportionately disadvantaged by avoidable housing-related diseases and injuries. Improving the overall quality of new and existing housing and neighborhoods has multiple cobenefits, including reducing carbon emissions. Expected final online publication date for the

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.

Over five million households in France are estimated to be in fuel poverty and so possibly exposed to low indoor temperatures. Such exposure is a threat to health. Besides the individual’s suffering, negative health outcomes, ranging from mild respiratory conditions to death, create demands on the health sector and costs to society. The health costs associated with energy inefficient dwellings have been calculated in England using a method based on the Housing Health & Safety Rating System (HHSRS); a health-based risk assessment system, adopted in 2006 as the prescribed statutory method for appraising housing conditions in England and Wales. The aim of this study was to use the English approach to estimate the health costs attributable to energy inefficient dwellings and energy vulnerability in France, and to analyse the cost benefits of thermal upgrades. This article details the methodology used to match the English and French housing energy efficiency assessment to provide the foundation necessary for t...

High on the political and social agenda are the levels of domestic energy use, of carbon emissions, and of fuel poverty. Strategies to reduce these levels should ensure that the health and well-being of residents are protected and improved. Thermal discomfort in housing ranges from being uncomfortable to serious health impacts. Avoiding thermal discomfort maintains well-being and protects the health of, in particular, the most susceptible members of the population. This position paper defines thermal discomfort, examines how it can be measured, and looks at the health impacts of low and high temperatures. Factors that increase susceptibility to low and to high temperatures, both human and building related, are identified and discussed. This paper shows that there are similarities between some of these factors, and that tackling these together will provide protection for those most at risk from exposure to high and low temperatures. Strategies aimed at reducing susceptibility to both excess heat and excess...

In New Zealand, as in many other countries, housing in the private-rental sector is in worse condition than in the owner-occupier housing sector. New Zealand residential buildings have no inspection regime after original construction signoff. Laws and regulations mandating standards for existing residential housing are outdated and spread over a range of instruments. Policies to improve standards in existing housing have been notoriously difficult to implement. In this methods paper, we describe the development and implementation of a rental Warrant of Fitness (WoF) intended to address these problems. Dwellings must pass each of 29 criteria for habitability, insulation, heating, ventilation, safety, amenities, and basic structural soundness to reach the WoF minimum standard. The WoF's development was based on two decades of research on the impact of housing quality on health and wellbeing, and strongly influenced by the UK Housing Health and Safety Rating System and US federal government housing standards. Criteria were field-tested across a range of dwelling types and sizes, cities, and climate zones. The implementation stage of our WoF research consists of a non-random controlled quasi-experimental study in which we work with two city-level local government councils to implement the rental WoF, recruiting adjoining council areas as controls, and measuring changes in health, economic, and social outcomes.

BACKGROUND: Child poverty rates are compared throughout Europe to monitor how countries are caring for their children. Child poverty reduction measures need to consider the importance of safe living environments for all children. In this study we investigate how European country-level economic disparity and housing conditions relate to one another, and whether they differentially correlate with child injury mortality. METHODS: We used an ecological, cross-sectional study design of 26 European countries of which 20 high-income and 6 upper-middle-income. Compositional characteristics of the home and its surroundings were extracted from the 2006 European Union Income Social Inclusion and Living Conditions Database (n = 203 000). Mortality data of children aged 1-14 years were derived from the World Health Organization Mortality Database. The main outcome measure was age standardized cause-specific injury mortality rates analysed by income inequality and housing and neighbourhood conditions. RESULTS: Nine measures of housing and neighbourhood conditions highly differentiating European households at country level were clustered into three dimensions, labelled respectively housing, neighbourhood and economic household strain. Income inequality significantly and positively correlated with housing strain (r = 0.62, P = 0.001) and household economic strain (r = 0.42, P = 0.009) but not significantly with neighbourhood strain (r = 0.34, P = 0.087). Child injury mortality rates correlated strongly with both country-level income inequality and housing strain, with very small age-specific differences. CONCLUSIONS: In the European context housing, neighbourhood and household economic strains worsened with increasing levels of income inequality. Child injury mortality rates are strongly and positively associated with both income inequality and housing strain, suggesting that housing material conditions could play a role in the association between income inequality and child health. Language: en

There are many references to the WHO guidance on thermal comfort in housing, but not to the original source material. Based on archive material, this paper gives the evidential basis for the WHO guidance. It then reports on evidence that some groups may be more susceptible to high or low indoor temperatures than others. It examines different methods for measuring thermal comfort, such as air temperature measurement, assessing residents' perception, and predicting satisfaction. Resident's perception was used effectively in the WHO LARES project, showing that self-reported poor health was significantly associated with poor thermal comfort.\ud \ud Tools to inform strategies directed at dealing with cold homes and fuel poverty are considered, including Energy Performance Certificates, Fuel Poverty Indicators, and the English Housing Health and Safety Rating System. Conclusions from a WHO Workshop on Housing, Energy and Thermal Comfort are also summarised.\ud \ud The WHO view of thermal comfort, which is driven by protecting health from both high and low indoor temperatures, should be recognised in energy efficiency, fuel poverty and climate change strategies. While this is a major challenge, it could provide both health gains for individuals, and economic benefits for society.

Children will spend a considerable amount of time at home, and so housing will have an impact on their health and development. There is now a growing bank of evidence on the negative affects associated with unhealthy housing situations. This review looks at some of the most serious threats and the related effects on child health. In particular it looks at crowding, frequent moves, housing insecurity, cold homes (and fuel poverty), dampness and mould growth, and fall hazards. For each of these the causes of the problem are discussed before reviewing the related health outcomes. Finally, it is suggested that the housing and health sectors should co-operate, and that actions to improve unsatisfactory housing conditions should be seen as interventions for the benefits of patients.

Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect safety and injury outcomes, such as falls, fire-related injuries, burns, drowning, carbon monoxide poisoning, heat-related deaths, and noise-related harm, associated with structural housing deficiencies. Structural deficiencies were defined as those deficiencies for which a builder, landlord, or home-owner would take responsibility (ie, design, construction, installation, repair, monitoring). Three of the 17 interventions reviewed had sufficient evidence for implementation: installed, working smoke alarms; 4-sided isolation pool fencing; and preset safe hot water temperature. Five interventions needed more field evaluation, 8 needed formative research, and 1 was found to be ineffective. This evidence review shows that housing improvements are likely to help reduce burns and scalds, drowning in pools, and fire-related deaths and injuries. Language: en

After ten years of development, the English government adopted the Housing Health and Safety Rating System (HHSRS) as the prescribed method for assessing housing conditions. Prior to 2006, the assessment was based on the condition of the building and the presence of necessary facilities. Being ‘building focussed’, the basis of the severity of the condition was the extent and cost of any remedial works considered necessary to make the dwelling ‘fit for human habitation’. The HHSRS shifts the focus to the potential threat to health and safety from any defects and deficiencies. The assessment takes account of the likelihood of a hazardous occurrence, and the probable severity of harm that could result from such an occurrence. This approach acknowledges that defects that would be relatively inexpensive to deal with can pose a serious threat to health and/or safety. Work on the development of the HHSRS included matching data on housing conditions with data on health outcomes. The analyses of the matched database provided information on, among other factors, the range and severity of harm outcomes associated with particular hazards. As the health data used was that available from hospitals and general practitioners, it meant that the health outcomes were those serious enough for the victim to seek medical attention. It has now been realised that it is possible to compare the one-off cost of works to remove or reduce housing hazards with the estimated annual saving to the health service. Using this approach, it has been estimated that poor housing in England is costing the health service around £600 million a year. This cost to the health service is estimated to be around 40% of the total cost of poor housing to society.

This paper reviews two legislative approaches intended to control housing conditions in the rented sector - the landlords' contractual obligations, and the powers of local authorities. The authors argue that the landlords' covenants are almost totally ineffective, and that it now rests on local authorities to protect the health and safety of tenants. Breaches of the implied covenants that houses should be fit and in repair will provide tenants with a legal action against their landlords. However, the tenant's standing is now so weak that these covenants fail to provide protection. The Housing Act 2004 introduced a regulatory framework based upon assessing the risks to the health and safety - the Housing Health and Safety Rating System (HHSRS) - giving local authorities tools to ensure that housing is as safe and health as possible. The history of the regulation of housing conditions also reveals important insights into the nature of private and public regulation.

Background The adverse health and environmental\ud effects of poor housing quality are well established. A\ud central requirement for evidence-based policies and\ud programmes to improve housing standards is a valid,\ud reliable and practical way of measuring housing quality\ud that is supported by policy agencies, the housing sector,\ud researchers and the public.\ud Methods This paper provides guidance on the\ud development of housing quality-assessment tools that\ud link practical measures of housing conditions to their\ud effects on health, safety and sustainability, with\ud particular reference to tools developed in New Zealand\ud and England.\ud Results The authors describe how information on\ud housing quality can support individuals, agencies and the\ud private sector to make worthwhile improvements to the\ud health, safety and sustainability of housing. The\ud information gathered and the resultant tools developed\ud should be guided by the multiple purposes and end users\ud of this information. Other important issues outlined\ud include deciding on the scope, detailed content, practical\ud administration issues and how the information will be\ud analysed and summarised for its intended end users.\ud There are likely to be considerable benefits from\ud increased international collaboration and standardisation\ud of approaches to measuring housing hazards. At the\ud same time, these assessment approaches need to\ud consider local factors such as climate, geography,\ud culture, predominating building practices, important\ud housing-related health issues and existing building\ud codes.\ud Conclusions An effective housing quality-assessment\ud tool has a central role in supporting improvements to\ud housing. The issues discussed in this paper are designed\ud to motivate and assist the development of such tools.

In this cross-disciplinary research David Ormandy and expert contributors explain the nature and development of the World Health Organization's study of housing across Europe. In-depth analysis provides new evidence of links between the health of inhabitants and their housing conditions, with focus on critical topics such as: indoor air pollution the effect of cold homes and dampness noise effects domestic accidents. With practical examples of survey tools, the attention given to methodological approaches makes this text an important resource for policy professionals as well as housing, planning and public health academics.

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 datasets to create and validate a Housing and Population Database, which was matched with various datasets 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 of the problem.

Deaths and injuries from home accidents are a major, but under-rated, public health problem and certainly an under-rated housing problem. A method is proposed, which takes account of both the frequency of accidents and the severity of outcomes which, it is suggested, will give a truer picture of the rank order of accidents. The paper discusses factors contributing to home accidents - human behaviour and dwelling design and condition. It discusses work in the UK to assess the relationship between home accidents and housing conditions and analyses of the LARES database both of which suggest links between dwelling condition and accidental home injuries.

Background The authors recently undertook a study for the World Health Organization estimating the European burden of injuries that can be attributed to remediable structural hazards in the home. Such estimates are essential for motivating injury prevention efforts as they quantify potential health gains, in terms of injuries prevented, via specific environmental interventions. Methods We combined exposure estimates from existing surveys and scenarios with estimates of the exposure-risk relationship obtained from a structured review of the literature on injury in the home and housing conditions. The resulting attributable fractions were applied to burden of injury data for the WHO European Region. Results This analysis estimated that two specific hazards, lack of window guards at second level and higher, and lack of domestic smoke detectors resulted in an estimated 7,500 deaths and 200,000 disability adjusted life years (DALYs) per year. In estimating the environmental burden of injury associated with housing, important deficiencies in injury surveillance data and related limitations in studies of injury risk attributable to the home environment were apparent. The ability to attribute proportions of the home injury burden to features of the home were correspondingly limited, leading to probable severe underestimates of the burden. Conclusions The burden of injury from modifiable home injury exposures is substantial. Estimating this burden in a comprehensive and accurate manner requires improvements to the scope of injury surveillance data and the evidence base regarding the effectiveness of interventions.