Regional Conference on Public Health in South East Asia in the 21st century, Calcutta, 22-24 November 1999

Abstract

Study objective-To investigate whether there is a mismatch within Britain between climate severity and housing quality ("inverse housing law") and whether this mismatch is associated with respiratory health. Design, setting and participants-Cross sectional observational study. Britain (Scotland, Wales and England). The 3023 male and 3694 female Health and Lifestyle Survey participants with valid data available on all relevant items. Main results-Geographical mapping shows a mismatch between climate severity and housing quality. Individual level analysis shows that lung function is associated with climate and housing, and their interaction, independently of cigarette smoking status. The physical quality of the housing seems to be most important to respiratory health in areas with harsh climate. Conclusions-Interpretation must be cautious because cross sectional data have been used to investigate processes that are longitudinal and, possibly, selective. Nevertheless, there does seem to be an "inverse housing law", such that some of the worst quality housing is found in areas with severe climate; and, on the balance of probabilities, this inverse housing law aVects respiratory health. (J Epidemiol Community Health 2000;54:745-749) Nearly 30 years ago Tudor Hart's article on the "inverse care law" 1 described a mismatch between the need for medical care services and their provision. The Acheson Report 2 recently has re-focused attention on health inequalities and the appropriate policy responses. Reasoning by analogy with the inverse care law suggests there may be other mismatches, between need and provision, which have implications for health and inequalities in health. Housing, in its role as a protector against climate, is one possibility.There is a literature on housing and health [3][4][5][6][7][8][9][10][11][12][13][14] that is surprisingly modest in comparison with, for example, the literature on occupation and health. Evidence of a causal relation is inconsistent; best documented is the eVect of residential damp and mould on respiratory disease, especially in childhood. There is also a literature on climate and health 15-23 that documents a relation between cold ambient temperatures and cardiorespiratory physiology and mortality; a relation that has been implicated in Britain's "north-south health divide".24-26 So far, however, there do not appear to have been any studies of the relation between all three of the factors that would be involved in an inverse housing law; namely, climate, housing and health.This paper aims to investigate this gap in the literature. It seeks to answer two questions. Firstly, within Britain is there a mismatch between severity of climate and quality of housing, such that harsh climate is not matched by better constructed housing? Secondly, is any such mismatch associated with diVerences in respiratory health? A climatehousing mismatch that is associated with diVerences in respiratory health will be taken as evidence of an inverse housing law. MethodsThe climate data in...

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