THE PTI administration has promised to build five million houses for the less fortunate as part of its plan to improve affordability and expand access to affordable housing. The Naya Pakistan Housing Scheme is working its way through its first phase right now. Irrespective of the scale of the PTI’s ambition, there is an urgent need to have a robust debate with a view to improving housing plans that are in sync with public health goals.
Housing is recognised as one of the key social determinants of health and has remained a chief concern of public health policies. Rudolf Virchow, the father of modern social medicine in Germany, was one of the early physicians to discover a link between poorly maintained, crowded housing and infectious diseases. Virchow pursued his health goals through active participation in politics. His path was followed by another medical doctor Salvador Allende of Chile who went on to become president of the country only to be overthrown in the 1973 military coup.
Marxist sociologist Friedrich Engels also concluded that poor housing and the slum-like conditions in which Britain’s workers lived bred many illnesses. His influential work, The Housing Question, was one of the early works on housing policy.
These path-breaking insights and findings have been reinforced by a growing body of research on the health and housing link. Recent literature has shown a number of ways in which housing can affect health outcomes.
Housing can affect health outcomes in a number of ways.
First, many studies have concluded that those with unstable homes and housing situation are prone to higher morbidity in terms of physical and mental health issues as well as increased mortality. The chronically homeless not only experience a drop in their psychological well-being, they are also unable to properly manage their chronic health conditions.
Residential instability among youth is linked to early pregnancies, early drug use and mental health issues. In the UK, homelessness is a growing public health issue permeating the political agenda in recent years. In particular, the British Labour Party has put issues of homelessness, social housing and health firmly on the political agenda. In contrast, homelessness in Pakistan remains a little researched area despite the scale of the problem — with its associated healthcare costs.
Second, the quality and safety of homes is tightly bound up with health impacts. Substandard housing conditions such as water leaks, poor ventilation, and dampness have been shown to be associated with poor health outcomes such as asthma. Exposure to high and low temperatures can have adverse effects on health. For example, well-heated homes are key to maintaining the health of the elderly as cold and freezing homes are linked to mortality. The Naya Pakistan Housing Scheme needs to take into account the safety and quality of the constructed houses; poorly constructed and unsafe houses trigger unforeseen health accidents such as falls.
Third, the affordability of housing options is tied up with health outcomes. Affordability should be at the heart of housing and public health policies. Most tenants spend a substantial part of their income on the rent which, in turn, affects the household spending on essentials including health, education and food. The latter are linked to adverse health and nutritional outcomes.
As the cost of rent continues to rise with inflation, as is the case in most Pakistani cities, there is always ever-increasing pressure on the family finances. Also, people living in rented accommodation tend to spend more on rent in order to live in those areas where better schools and hospitals are available. This again leads to high rents squeezing the family budget further. The rent-triggered adverse health impacts can be mitigated by rent-control policies. Berlin has rent-control policies in place which serves as a huge draw for people of classes and makes Berlin a healthy and livable city.
Fourth, well-planned neighbourhoods are also crucial to the general health of the community. Studies have shown that good neighbourhoods boasting good transportation and shopping areas stocked with nutritious and healthy foods have a positive impact on the health of the community.
Healthy neighbourhoods are also known to provide green spaces and safe spaces for exercise and children’s activities. Even shopping centres tend to provide walk- and cycle-friendly environments to promote a healthy lifestyle.
The Naya Pakistan Housing Scheme needs to factor health-promoting neighbourhoods early into its plans to improve public health outcomes through well-planned living localities.
The writer, a public health consultant, is the author of Patient Pakistan: Reforming and Fixing Healthcare for all in the 21st Century.
Published in Dawn, December 4th, 2019