Tackling health inequalities through action on housing

1. Tackling health inequalities through action on housing

2. Outline • The problem: Global determinants of “dwellers” health • Opportunities for action • Ongoing and planned WHO activities • Focus on the WHO Housing and Health Guidelines • Outlook

3. 1. The problem

4. Population growth World population by 2050: 9.7 billion Data: United Nations Department of Economic and Social Affairs, Population Division

5. Urban development 60 million additional urban residents per year worldwide Data: UN-Habitat

6. Slums and informal settlements One in three urban dwellers lives in slums or informal settlements

7. Indoor air pollution 4.3 million people a year die from the exposure to household air pollution Data: WHO, Global Health Observatory

8. Indoor air pollution 15% of new childhood asthma in Europe attributed to indoor dampness Data: WHO, Global Health Observatory

9. Crowding In Europe, household crowding is associated with more than 3,500 deaths from tuberculosis per year

10. Home injuries 110,000 people die every year in Europe as a result of an injury at home or during leisure activities & 32 million require hospital admission

11. Lead Lead: caused worldwide 853,000 deaths in 2013

12. Obesity and lifestyles 39% of adults worldwide were overweight in 2014 – that is more than 1.9 billion 3.2 million deaths/yr due to physical inactivity Data: WHO, Global Health Observatory

13. From 1990-2015, access to piped water on the premises declined from 43% to 33% in African cities, while other regions’ cities recorded improvements in piped water access Source: JMP 2015.

14. 2. Opportunities for action through addressing healthy housing

15. Housing: ideal platform for health promotion

16. Vehicles & home energy - one-third of global CO2 emissions

17. The Burden of Disease of Housing

18. Pathways of housingrelatedhealthinequalities Source: Conceptual framework of the CSDH

19. 3. WHO’s response – ongoing activities

20. Health co-benefits of climate change mitigation - Housing sector and other work

21. WHO Housing and Health Guidelines Focus on a sector as opposed to a specific health risk, intervention, activity or policy Enabling health to inform housing, energy, community development, urban development policies New evidence-based recommendations and bringing together existing WHO guidance on housing Setting norms and standards

22. Development • WHO decides to produce guidelines • Guideline Development Group (GDG) assembled • Funding sought from countries • Key questions formulated • Systematic reviews commissioned • Evidence assessed • Formulation of recommendations • External review process • Guideline Review Committee approves guidelines

23. WHO Housing and Health Guidelines (forthcoming) New recommendations Summaries of existing WHO guidelines Water quality Outdoor air quality Indoor air quality, related to indoor fuel & other pollutants, dampness, mould & radon Neighbourhood noise Asbestos Lead • Inadequate living space (crowding) • Low indoor temperatures • High indoor temperatures • Injury hazards in home • Accessibility of housing for people with functional impairments • Proximity of housing to walking & cycling infrastructure

24. Crowding Overcrowding as a key determinant of ill-health Integrated policy approach by appropriate rehousing and other support Ensuring housing is not only available, but also appropriate and affordable Use of adequate measures of overcrowding by national regulations Social welfare system to ensure that loss of jobs or other income shock does not entail moving into a dwelling with inadequate space

25. Thermal comfort – minimum and maximum temperatures Complying to minimal and maximal indoor temperatures Mandating insulation and efficient heating in all housing, paying close attention to the effectiveness of enforcement measures Mandating insulation and efficient heating in all housing, paying close attention to the effectiveness of enforcement measures Thermal insulation to reduces conductive heat loss through the building’s walls and ceiling Thermal insulation and weatherisation to reduce heat loss by sealing unwanted air and improving building envelope. Subsidies and tax incentives for the installation of insulation and efficient heating; measures to encourage energy affordability through subsidising energy costs

26. Home injuries Smoke and carbon monoxide alarmas outside sleeping areas. Window guards installed for each operable window more than two meters above ground level. Window guards installed for each operable window more than two meters above ground level. Guards installed for all operable fireplaces, fuel burning stoves and other hot surfaces. Barriers at the top and floor of each set of stairs occupied by families with young children Guards installed for all operable fireplaces, fuel burning stoves and other hot surfaces.

27. Housing accessibility Proportion of housing stock should be accessible to people with functional impairments. Mandatory vs compulsory modification programmes. Window guards installed for each operable window more than two meters above ground level. 22 times more cost-efficient to build housing that includes key accessibility features than to retrofit. Accessible housing should consider other factors related to healthy housing (social cohesion etc.). Guards installed for all operable fireplaces, fuel burning stoves and other hot surfaces.

28. Proximity of housing to cycling and walking infrastructure Equitable provision of safe walking and cycling infrastructure to connect homes to other destinations. Preferences and needs of people are key when building infrastructure. Window guards installed for each operable window more than two meters above ground level. Individual characteristics remain important to physical activity behaviour in relation to the built environment. High benefit of social and affordable housing initiatives going along with infrastructure development. Guards installed for all operable fireplaces, fuel burning stoves and other hot surfaces.

29. Planned guidelines’ implementation tools • An Implementation Guide(s) of the Housing and Health Guidelines • Healthy housing label/ check list • Collection of interventions, model legislations and regulation • Capacity-building and information tools • Guidance on how to apply the guidelines to slums / informal housing

30. Improving Living Conditions: Health Equity and Socioeconomic Impacts of Slum Upgrading

31. Urban Health Initiative –housing in the wider urban health agenda • Provide evidence on health benefits of sector policies: to be used by population groups, administration • Strengthen capacity for Health Impact Assessment of policy alternatives • Strengthen capacity to estimate costs of inaction in other sectors for health of the local population and local health systems • Tracking Urban Policies implementation and their consequences for health risks and gains • Strengthen capacity of Primary Care System to advise patients and communities about local determinants of health

32. 4. Outlook

33. Developing a common vision for social cohesion and health equity Embrace the improvement of health and wellbeing of all citizens as part of the core business of cities.

34. The SDGs - A turning point for intersectoral action for health

36. Thank you Dr Nathalie Röbbel Technical Officer Department of Public Health, Environmental and Social Determinants of Health Tel.: +41 22 791 21 08 Email: roebbeln@who.int