The "inverse housing law" and respiratory health

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...

Social-biological transitions: how does the social become biological?

“…The distribution of income and wealth affects health via the MIHL, the proportion of life spent below MIHL and, possibly of particular importance, the proportion of the period from conception to late adolescence and the proportion of life after retirement spent below MIHL. The quality of the housing stock affects health via its ability to protect inhabitants against the prevailing climate of their region (Blane, Bartley & Mitchell, 2000;Mitchell, Blane & Bartley, 2002), via exposure to indoor pollutants, nitrogen dioxide, carbon monoxide and allergens associated with asthma (Laquatra, Maxwell & Pierce, 2005) and via crowding's influence on the dose and sequence of infections. In addition, it interacts with income to determine fuel poverty risk, while its proximity to industry and main roads determines air pollution exposure, with its risk of sub-optimal lung development during childhood and adolescence (Gauderman et al, 2004) and chronic lung disease at older ages (Schikowski et al, 2005).…”

Health inequalities

“…In a contribution on life‐course influences on health at older ages, Bartley and Blane (2009) develop the themes of clustering and accumulation to address the issue of how the social becomes biological. They cite their own work on the ‘inverse housing law’ to show that residence in poor‐quality housing in a region with severe climate is associated with both reduced lung function (Blane et al . 2000) and elevated diastolic and systolic blood pressure (Mitchell et al .…”

“…In a contribution on life-course influences on health at older ages, Bartley and Blane (2009) develop the themes of clustering and accumulation to address the issue of how the social becomes biological. They cite their own work on the 'inverse housing law' to show that residence in poor-quality housing in a region with severe climate is associated with both reduced lung function (Blane et al 2000) and elevated diastolic and systolic blood pressure (Mitchell et al 2002). The 'inverse housing law', they maintain, particularly affects older people since they (a) often lack the means to renovate their homes against the local climate, and (b) are more vulnerable to air pollution because of age-related respiratory and cardiovascular decline.…”

Effect of social factors on winter hospital admission for respiratory disease: a case–control study of older people in the UK

“…Several observational studies show that indoor temperature might be an important contributory factor in respiratory morbidity and mortality during winter, [29][30][31][32] but there is no other individual-level study assessing its effect on respiratory admissions. The power in the final analysis of this study was not sufficient to test this appropriately; also the method for determining heating levels was crude.…”