Global health: housing for a healthier future

Overcrowding, overuse and broken hardware are all housing concerns that impact the health of residents. In Australia, this is especially felt by the Indigenous community, and "particularly those that are reliant on public housing or forms of assisted housing, the situation is often fairly grim," says Associate Professor Tess Lea. 

Housing hardware refers to amenities needed for householders to practice healthy living behaviours such as washing themselves, their clothing and cooking items, as well as safe effluent disposal and food storage.

"Poor housing exacerbates health issues. It creates the ideal conditions for the transfer of communicable diseases, or for impeding the management of individual conditions. Otitis media, intermittent hearing loss and respiratory infections are all made more acute with overcrowding and poor hygiene, conditions which directly relate to the function of housing hardware," Associate Professor Lea says.

Housing for Health incubator

Associate Professor Tess Lea's Housing for Health incubator was established to ask why the remedies for addressing poor housing within Indigenous communities are still not routinely implemented. The incubator works with Healthabitat, a not-for-profit who pioneered the Housing for Health (HFH) intervention - a methodology for testing and fixing health hardware.

"By testing, fixing, and upgrading ‘health hardware’ – defined as facilities needed to transact healthy living practices, such as taps, showers, pipes, wiring, power points, effluent disposal – the HFH intervention increases the habitability of existing housing. Based on a comprehensive analysis of epidemiological and infectious diseases data, the program targets a list of nine ‘Healthy Living Practices’ and prioritizes items for fixing based on their proximate health impacts."

The HFH intervention focuses on maintaining the householder's health. Phase one is labelled Survey Fix One, which constitutes local teams reviewing and fixing the functions of over 200 household items. Once all immediate dangers are addressed, the HFH intervention looks at the top-ranked Health Living Practices: washing people, washing clothes/bedding and removing waste/water safely. The second phase, labelled Survey Fix Two, involves capital upgrades on electrical, plumbing and structural issues. A survey is then conducted to measure the improvement of health hardware.

The HFH intervention has been applied to over 9,000 Indigenous households in Australia and also piloted overseas. "Much has been learned about how to do this test-and-fix work economically, with maximal local involvement and with measurable health gains. As a result of tagging surveys to fix work over three decades, Healthabitat has assembled the largest database on housing hardware faults in Australia, thus establishing the leading causes of house decay."

Contrary to public perceptions, the main causes for housing decay in Indigenous households is not caused by tenants:

• 73% is due to lack of routine maintenance
• 19% is due to maintenance required caused by poor initial construction
• 8% is caused by damage, vandalism, misuse or overuse by tenants

"People vacate houses that do not have functioning health hardware and join households which do, resulting in overcrowding. Thus, addressing repair and maintenance issues within existing houses has three dividends: it helps householders to manage the drivers of overcrowding; it strengthens the longevity of existing housing stock; and it measurably improves health."

The Incubator was involved in launching the 2018 WHO Housing and health guidelines - "we are now looking into ways to increase their scope to take in infectious disease control inside households," Associate Professor Tess Lea says.

"Our impacts to date include opening new projects for Healthabitat in the Northern Territory, securing a grant for an Indigenous artist (Miriam Charlie) to pursue her photographic documentation of poor housing in Borroloola, and convening key researchers to attend to issues of water contamination in the MacArthur region."

What needs to be done

"I would like world leaders to take on the issue of corroding legacy infrastructure, the importance of mandating repair and maintenance, of treating infrastructure and hardware as a form of health commons, and to pursue householder health, not just clinical health." 

"There is more attention paid to hospital-acquired infection than to housing-acquired infection. This is disproportionate and the wrong way around, especially as population growth and climate change add to existing neglect."