Review

Health and home

HOME SWEET HOME? The impact of poor housing on health
A Marsh, D Gordon, C Pantazis, P Heslop
The Policy Press, 1999, £16.99

The 1998 Acheson report was the first official recognition that an individual’s health is not dependent solely on his or her lifestyle but also upon the impact of multiple agencies, nearly all of which are outside the control of the individual and most of which are not overtly health-oriented.

But this acknowledgement of the global determinants of health, along with the government’s stated aim of improving the nation’s health in parallel with regenerating the environment, still requires hard causal evidence so that limited resources can be targeted at the areas which will provide greatest benefit.

Housing is recognised as one of the key environmental influences upon health, and considerable work has been done attempting to document its impact, although most of it has been poor quality, limited research on a local scale.

The research presented in this book makes a very important contribution to the overall debate on housing and health as it uses robust evidence gathered at a national level. It uses new analyses of existing data to explore the impact of poor housing on health. The source data is taken from material collected as part of the National Child Development Study (NCDS), set up to monitor all 17,415 babies born in Great Britain in the week beginning 3 March 1958. This cohort has been surveyed a further five times since, in 1965, 1969, 1974, 1981 and 1991.

While the original study, with its initial focus on perinatal mortality, collected detailed health data, other information on the social, educational and physical development of the cohort as children, and their employment and life histories as adults, has also been recorded.

Using this rich longitudinal data set, the authors set out to examine three research topics: the link between overcrowding and respiratory and infectious disease; if, and when, housing deprivation impacts upon overall health; and the link between housing and health in the context of the range of other possible influences upon health.

Where some analyses would have been limited by the availability of data, such as that relating to income, the authors have endeavoured to identify alternative proxy material.

The contribution these research findings make to the housing and health debate cannot be emphasised too strongly, even acknowledging their limitations. The research demonstrates that, after controlling for other factors, housing plays a significant role in health outcomes and that deprivation earlier in life can have an impact on future health.

The report and its findings should be essential reading for all those working in the arena of housing and health and, if we are to benefit from it, the key message must be that housing concerns have to be an integral and explicit part of health policy.