The WHO « Housing and Health policy »

1. The WHO « Housing and Health policy » Xavier Bonnefoy / Matthias Braubach WHO-European Centre for Environment and Health, Bonn Office

2. Structure • Housing and health – the challenging trends • The WHO approach to housing and health • Priority work areas • WHO activities on housing and health

3. The emerging problems (1) Life expectancy has risen from 50 years to 80 in less than a century, while the exchange rate of the housing stock is at ca. 1% per year

4. Housing stock for Germany, 2050 Still to be built Already existing in 2005

5. The emerging problems (2) The number of people with physical limitations living in their own dwelling increases every year

6. European Disability Forum 2002:% of population being limited in their daily activities due to handicaps (based on Eurostat) Strongly limited – 4% Partially limited – 9% Not limited – 87% Accessible housing “A specific comment is to be made in the case of housing. Our research highlights the high level of inaccessibility of housing for many disabled people, which is close to 66%. The lack of accessibility is not only due to architectonical barriers; financial barriers in housing are quite important, in particular because of the extra costs of adapting inaccessible dwellings.” ...and for the popula-tion above 65 years: Data provided by: European Disability Forum / Eurostat

7. The emerging problems (3) The world is facing a new energy crisis, and Europe is not well-prepared for supporting the most underprivileged (private households account for ca. 50% of energy consumption)

8. Excess winter deaths UK Mortality (all causes) in relation to the lowest point in summer => BLUE LINE: for coldest dwellings => RED LINE: for hottest dwellings Data provided by: Dr Wilkinson et al. (2001)

9. The emerging problems (4) In Europe, relevant regulations for construction work, maintenance of the housing stock, and rehabilitation programs are mostly out of influence of ministries of health

10. Legal responsibility Ministry of Housing / Construction Ministry of Social Affairs Building guidelines Housing conditions Health effects Impact assessments Law enforcement Ministry of Health Ministry of Environment Ministry of Consumer Protection

11. The emerging problems (5) Poverty and inequalities are increasingly affecting the housing market – social segregation is rising while the public and social housing stock is reduced or privatized

12. Poverty and housing (data for 2000) Source: Eurostat

13. The emerging problems (6) Home safety issues are an underestimated section of unintentional injuries and are mostly relevant for vulnerable groups such as children and elderly

14. Unintentional injuries by causes (*) among which 300 road accidents EU-15 (2004): 130.000 fatalities (54% home and leisure) Killer No. 1 for age group 1-45 years More than 10% of all health care costs Data provided by: Min. of Health France / UK Slide prepared by: Prof Ormandy / WHO

15. The emerging problems (7) Urban patterns and residential environments are often car-dependent and provide little opportunities for children to play or for outdoor physical exercise

16. Obesity and housing environments Obesity is a normal response to an abnormal environment Data / Pictures provided by: Prof Moreno / CDC, USA / WHO ECEH Bonn

17. A new approach to housing and health Housing and health... • is more than „sanitation, crowding and indoor air quality“ • needs a much wider definition • is not only a responsibility of the health or housing ministry • must integrate societal changes

18. …I urge individuals, businesses, and local and national governments to take up the urban environmental challenge…let us create « green cities » where people can raise their children and pursue their dreams in a well planned, clean and healthy environment. Kofi Annan, 05 June 2005

19. Immediate environment Neighbourhood Dwelling Family The WHO approach (1) Housing is...

20. The WHO approach (2) Sectoral and focused studies are needed, but often not sufficient: • Potential associations may be overlooked • The relative importance of selected housing factors - among other factors - is not clear • The effect of multiple exposure (cocktail effect) cannot be identified • The interaction between dwelling and resident is often underestimated • Social and mental factors / outcomes often neglected

21. The WHO approach (3) Effective work on housing and health needs to consider: • The realistic experience of housing • The relevance of a holistic approach bringing together all housing areas and domains • Work on cross-cutting issues dealing with more than one aspect is to be prioritised • Hard data and soft data is both needed to reflect the impact of housing on health

22. Priority work areas Working areas touching or merging a variety of housing aspects (technical, economic, archi-tectural, material, user-related...) are e.g.: • Noise exposure / home as place to sleep • Energy efficiency / thermal comfort • Indoor air quality, tightness, air exchange • Architecture and design in relation to home safety and accessibility • Residential environment and leisure / transport options • Etc.

23. Some priority work areas for CEE • Maintenance of the housing stock • Access to (social) housing • Energy efficiency measures of the housing stock (considering air quality issues) • Residential environment / social stability • Safety of housing to avoid home accidents

24. The political response of WHO Budapest ministerial declaration (Art. 14c) • We call for initiatives and programmes aimed at providing national and local authorities all over the region with guidance for integrating health and environment concerns into housing policies. Children Environment and Health Action Plan for Europe Priority 1: access to adequate sanitation Priority 2: promoting safe, secure and supportive human settlements to avoid accidents / injuries Priority 3:ensure an environment with clean air Vilnius housing and health symposium – final declaration • We affirm that a decent home for all citizens is to be a priority target for all national and local governments

25. The technical response of WHO • WHO Large Analysis and Review of European housing and health Status (LARES survey) • Housing and Health indicator set for the European Environmental Health Information System • Urban pests and health • Legal framework of housing and health • Child accident prevention • Night noise guidelines • Housing and Health Action Plan (Portugal) • Environmental Burden of Disease for housing • Longitudinal study on housing interventions • Information brochures on housing-related topics

26. Thank you! Further information at www.euro.who.int/housing