from "David Hulchanski" <[log in to unmask]>
Source: British Medical Journal, Feb 12, 2000 p453.
Title: Home Sweet Home? The Impact of Poor Housing on
Health.(Review)
Author of book review: Sarah Nettleton.
[Sarah Nettleton is senior lecturer in social policy, Department of Social
Policy and Social Work, University of York]
Full Text
____________________
Home Sweet Home? The Impact of Poor Housing on Health
by Alex Marsh, David Gordon, Christina Pantazis, Pauline Heslop
Policy Press, 16.99 [pounds sterling], pp 90 ISBN 1 86 134 176 8
Rating: ***
"The impact of multiple housing deprivation would appear to be
the same order of magnitude as addressing the issue of smoking and the risk to
health posed by multiple housing deprivation seems to be, on average, greater
than that posed by excessive alcohol consumption." Furthermore, "housing
history matters," as adults who are currently living in good housing
circumstances are more likely to be ill if they experienced adverse housing
conditions earlier in life. These represent some of the key findings of this
study, which are particularly important within the context of the current health
policy. They reinforce the need for health and welfare polices to focus on
structural as well as behavioural determinants of health, and so lend weight to
those initiatives outlined in Saving Lives and other recent official
documents. They also reinforce the fact that the housing circumstances of
children are of paramount importance. Housing deprivation was found to be a
highly significant explanatory variable in relation to health, even after
controlling for a range of other factors that included standard of living and
genetic, social, and behavioural indices.
[Graphic omitted]These general conclusions are based on an
extremely thorough study which comprises a secondary analysis of the national
child development survey (NCDS), a longitudinal study that involved collecting
data on all children born in Great Britain between 3 and 9 March in 1958,
1965, 1969, 1974, 1981, and 1991. One of the great merits of this type of
analysis, as opposed to cross sectional studies, is that it allows
investigators to ascertain the extent to which factors have long term effects.
It has allowed the authors of this book to explore the proposition associated
with life course theories-that there could be an accumulation of risks
associated with housing deprivation throughout the course of life. No strong
evidence was found to support this thesis, but this may well be because of the
effect of other related factors which have variable and interactive impacts
over time.
A range of indicators were used to measure health status, including those
associated with infectious illnesses, respiratory conditions, and overall ill
health. More importantly, however, the authors attempted to develop a reliable
housing deprivation index. This task proved to be especially challenging, and,
although no ideal index was constructed, their contribution to this task is
substantial. Herein lies one of the main achievements of this study. Housing
deprivation, like poverty, is a relative concept, and those working in this
subject must take this into account in their analysis. For example, the authors
point to the need in contemporary societies to measure not just the lack of
physical amenities but also subjective factors such as satisfaction with
dwelling or residential area. This is, of course, more than just a
methodological point: policies, too, must address both the material and
psychosocial aspects of housing deprivation if they are to improve health and
reduce health inequalities.
Reviews are rated on a 4 star scale (4=excellent)
The BMJ Bookshop will endeavour to obtain any books reviewed
here. To order contact the BMJ Bookshop, BMA House, Tavistock Square, London
WC1H 9JR.
Tel: 020 7383 6244, Fax: 020 7383 6455
Visit our Web Sites for information and reports from all of our Quality of Life
Projects!
http://www.utoronto.ca/qol http://www.utoronto.ca/seniors
******************************************************************
Where a great proportion of the people are suffered to languish
in helpless misery,
That country must be ill-policed and wretchedly governed:
A decent provision for the poor is the true test of civilization.
-- Dr. Samuel Johnson, 1770
******************************************************************
Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8
voice: (416) 978-7567
fax: (416) 978-2087
e-mail: [log in to unmask]
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