The impact of housing improvement and socio-environmental factors on common childhood illnesses: a cohort study in Indigenous Australian communities

Abstract

BackgroundImprovements in health are an important expected outcome of many housing infrastructure programs. The authors aimed to determine if improvement in the notoriously poor housing infrastructure in Australian Indigenous communities results in reduction in common childhood illness and to identify important mediating factors in this relationship.MethodsThe authors conducted a prospective cohort study of 418 children aged 7 years or younger in 10 Australian Indigenous communities, which benefited most substantially from government-funded housing programs over 2004–2005. Data on functional and hygienic state of houses, reports of common childhood illness and on socio-economic conditions were collected through inspection of household infrastructure and interviews with children's carers and householders.ResultsAfter adjustment for a range of potential confounding variables, the analysis showed no consistent reduction in carers' reporting of common childhood illnesses in association with improvements in household infrastructure, either for specific illnesses or for these illnesses in general. While there was strong association between improvement in household infrastructure and improvement of hygienic condition of the house, there were only marginal improvements in crowding.ConclusionsHigh levels of household crowding and poor social, economic and environmental conditions in many Australian Indigenous communities appear to place major constraints on the potential for building programs to impact on the occurrence of common childhood illness. These findings reinforce the need for building programs to be supported by a range of social, behavioural and community-wide environmental interventions in order for the potential health gains of improved housing to be more fully realised.

Trachoma elimination in remote Indigenous Northern Territory communities: baseline health-promotion study

“…Yet, improved housing infrastructure alone has been found to have limited health benefits, in that it does not significantly reduce crowding or improve the general community environment or health-related behaviours (Bailie et al 2012).…”

“…Further, housing improvements alone without education and behaviour change will not be sufficient to reduce trachoma (Bailie et al 2012). To compound matters, in some remote Indigenous communities there is an observed tolerance for children to have ocular or nasal discharge, and the concept that dirty faces spread infection does not appear to be recognised .…”

“…Lack of facial cleanliness is implicated in trachoma transmission (Lynch et al 1994;West et al 1995;Bailey and Lietman 2001;Schémann et al 2002;Ejere et al 2004;Khandekar et al 2006;Ngondi et al 2008;Bailie et al 2012) and this is the key to its control:…”

Lung disease in indigenous children

“…61 However, in some indigenous settings housing upgrades were insufficient to improve health outcomes in children. 62 Also, whether the lung microbiome differs (and/or influence disease manifestation) among indigenous and non-indigenous children within the same setting is unknown.…”

Reducing recurrence of bacterial skin infections in Aboriginal children in rural communities: new ways of thinking, new ways of working

“…These factors are interwoven and cannot be considered in isolation. More effective management of bacterial skin infections in Aboriginal children will need to incorporate factors beyond housing, such as poor social, economic and environmental conditions that appear to be directly associated with skin infections (Bailie et al 2012).…”