It is too simplistic to see housing as merely a physical dwelling in which one resides. The World Health Organization (WHO) (Bonnefoy, 2007) defines housing as being based on four interlinked levels, with an array of possible health effects in each:
- the physical structure, including factors such as mould growth, quality, design, and noise exposure;
- the meaning of “home” as a protective, safe and intimate refuge where one develops a sense of identity and attachment;
- the immediate housing environment, including the quality of urban design (e.g., public services, playgrounds, green space, parks, places to socialise); and
- the community, that is, the quality of the neighbourhood and its relation to social cohesion, sense of trust and collective efficacy.
Shaw (2004) categorises these levels in a model that indicates how housing affects health, through direct and indirect, hard and soft ways (see Figure 1). This paper mainly concentrates on the direct, “soft” ways in which housing can influence health, that is, the effects of poor housing; insecurity and debt; and housing as a component of general wellbeing, ontological security3 and social status perception. Each of these issues is addressed in the following sections.
Figure 1: Direct and indirect (hard and soft) ways in which housing can affect health
Reproduced with permission from Shaw (2004)
Poor quality housing/housing conditions
In his review of the relationship between the built environment and mental health, Evans (2003) notes that house type (e.g., high-rise), floor level, and housing quality (e.g., structural problems) have all been linked to mental health. Studies on house type have suggested that high-rise, multi-dwelling units are detrimental to psychological wellbeing, particularly that of mothers with young children and possibly the children themselves (Evans, Wells, & Moch, 2003). This may be due to social isolation, a lack of access to play spaces that promote social interaction, the stigmatisation of high-rise living, or a combination of these. Evans, Wells and Moch’s (2003) review of 27 studies suggests that overall housing quality4 is positively correlated with psychological wellbeing, although issues that may affect this relationship include identity/self-esteem, anxiety about structural hazards or a fear of crime.
Evans (2003) provides some explanations for the possible link between issues with housing quality and mental health, including insecurity/tenure concerns, difficulties with repairs and landlords, frequent relocations, less controllable social interactions, and stigma associated with poor housing. There is some evidence to suggest that when people move to better quality housing, mental health can improve (AHURI, 2005; Evans, Wells, Chan, & Saltzman, 2000; Wells & Harris, 2007), with Evans, Wells, Chan, & Saltzman (2000) finding that the degree of improvement in housing predicted the level of change in psychological distress.
One large-scale, cross-sectional, European housing and health study by the World Health Organization has indicated a relationship between depression/anxiety and living in a dwelling that: has insufficient protection against external aggressions, e.g., cold, draughts, noise; has little space for solitude or freedom; lacks light and/or an external view; does not facilitate socialisation; and is prone to vandalism. Low socioeconomic status, fear of losing dwelling, an inability to move due to financial constraints, and a bad image of the neighbourhood also contributed to anxiety and depression (Bonnefoy et al., 2004).