Journal of Urban Health

, Volume 77, Issue 1, pp 7–25 | Cite as

Housing and health—Current issues and implications for research and programs

  • Thomas D. Matte
  • David E. Jacobs
Special Feature: Urban Home Environment and Health Reviews and Commentaries


This article provides an overview of the ways in which the home environment can affect human health, describes how specific health hazards in housing are related, and considers implications of these concerns for research and programs to address the health-housing connection. The widespread availability of decent housing has contributed greatly to improvements in health status in developed countries through, for example, provision of safe drinking water, proper sewage disposal, and protection from the elements. However, a lack of decent housing and homelessness among a significant number of Americans remains a significant public health concern. In addition, a number of specific health hazards can be found even in housing that is in good condition and provides all basic amenities. Specific health hazards related to housing include unintentional injuries, exposure to lead, exposure to allergens that may cause or worsen asthma, moisture and fungi (mold), rodent and insect pests, pesticide residues, and indoor air pollution. A number of these specific hazards share underlying causes, such as excess moisture, and all may be influenced by factors in the community environment or by occupant behaviors. We make recommendations for developing programs and research efforts that address multiple housing problems in an integrated way, rather than categorically, and for closer collaboration between housing and public health programs.

Key words

Housing Environmental Exposures Public Health Social Factors 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    The Doc4Kids Project. Not safe at home: How America's housing crisis threatens the health of its children. Boston Medical Center and Children's Hospital, Boston, MA, February 1998. Available at: Accessed October 29, 1999.Google Scholar
  2. 2.
    Lowry S: An introduction to housing and health.BMJ. 1989;299:1261–1262.PubMedGoogle Scholar
  3. 3.
    Kasl SV. Quality of the residential environment, health, and well-being.Bull NY Acad Med. 1990;66:479–490.Google Scholar
  4. 4.
    World Health Organization.Health Principals of Housing. Geneva: World Health Organization; 1989.Google Scholar
  5. 5.
    APHA Program Area Committee on Housing and Health, 1968. Basic health principles of housing and its environment.Am J Public Health. 1969;59:841–851.Google Scholar
  6. 6.
    Bureau of Census.American Housing Survey for the United States in 1995, Current Housing Reports H150/95RV. Washington, DC: US Department of Commerce; 1997. Available at: Accessed October 29, 1999.Google Scholar
  7. 7.
    Smith SJ. Health status and the housing system.Soc Sci Med. 1990;31:753–762.PubMedGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: control of infectious diseases.MMWR Morb Mortal Wkly Rep. 1999;48:621–629.Google Scholar
  9. 9.
    Link B, Susser E, Steve A, Phelan J, Moore R, Struening E. Lifetime and five-year prevalence of homelessness in the United States.Am J Public Health. 1994;84:1907–1912.PubMedGoogle Scholar
  10. 10.
    Lowry S. Health and homelessness.BMJ. 1990;300:32–34.PubMedGoogle Scholar
  11. 11.
    Efron D, Sewell JR, Horn M, Jewell F. Children in homeless families in Melbourne: health status and use of health services.Med J Aust. 1996;165(11–12):630–633.PubMedGoogle Scholar
  12. 12.
    Weinreb L, Goldberg R, Bassuk E, Perloff J. Determinants of health and service use patterns in homeless and low-income housed children.Pediatrics. 1998;102:554–562.CrossRefPubMedGoogle Scholar
  13. 13.
    Bassuk EL, Weinreb LF, Buckner JC, Browne A, Salomon A, Bassuk SS. The characteristics and needs of sheltered homeless and low-income housed mothers.JAMA. 1996;276:640–646.CrossRefPubMedGoogle Scholar
  14. 14.
    National Safety Council.Accident Facts—1998 Edition. Itasca, IL: National Safety Council; 1998.Google Scholar
  15. 15.
    Lowry S. Accidents at home.Br Med J. 1990;300:104–106.Google Scholar
  16. 16.
    Centers for Disease Control and Prevention. Deaths resulting from residential fires and the prevalence of smoke alarms—United States, 1991–1995.MMWR Morb Mortal Wkly Rep. 1998;47:803–806.Google Scholar
  17. 17.
    Marshall SW, Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts JD. Fatal residential fires: who dies and who survives?JAMA. 1998;279(20):1633–1637.CrossRefPubMedGoogle Scholar
  18. 18.
    Sharp GB, Carter MA. Prevalence of smoke detectors and safe tap water temperatures among welfare recipients in Memphis, Tennessee.J Community Health. 1992;17:351–365.CrossRefPubMedGoogle Scholar
  19. 19.
    Mallonee S, Istre GR, Rosenberg M et al. Surveillance and prevention of residential-fire injuries.N Engl J Med. 1996;335(1):27–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Schwarz DF, Grisso JA, Miles C, Homes JH, Sutton RL. An injury prevention program in an urban African-American community.Am J Public Health. 1993;83:675–680.PubMedGoogle Scholar
  21. 21.
    Roberts I, Kramer MS, Suissa S. Does home visiting prevent childhood injury? A systematic review of randomized controlled trials.BMJ. 1996;312:29–33.PubMedGoogle Scholar
  22. 22.
    Pirkle JL, Brody DJ, Gunter EW et al. The decline in blood lead levels in the United States—the National Health and Nutrition Examination Surveys.JAMA. 1994;272:284–291.CrossRefPubMedGoogle Scholar
  23. 23.
    Centers for Disease Control and Prevention. Blood lead levels—United States, 1991–1994.MMWR Morb Mortal Wkly Rep. 1997;46:141–146.Google Scholar
  24. 24.
    Centers for Disease Control and Prevention. Preventing lead poisoning in young children. Atlanta, GA: Center for Disease Control and Prevention.Google Scholar
  25. 25.
    US Department of Housing and Urban Development.Comprehensive and Workable Plan for the Abatement of Lead-Based Paint in Privately Owned Housing, Report to Congress. Washington, DC: Office of Policy Development and Research; 1990.Google Scholar
  26. 26.
    US Environmental Protection Agency.Distribution of Soil Lead in the Nations' Housing Stock. Washington, DC: Office of Pollution Prevention and Toxics; 1996. Report no. EPA 747-R-96-003.Google Scholar
  27. 27.
    Bornschein RL, Succop P, Kraft KM, Clark CS, Peace B, Hammond PB. Exterior surface dust lead, interior house dust lead and childhood lead exposure in an urban environment. In Hemphill DD, ed.Trace Substances in Environmental Health, 20. Proceedings of University of Missouri's 20th Annual Conference, June 1986. Columbia, MO: University of Missouri; 1987:322–332.Google Scholar
  28. 28.
    Lanphear BP, Roghmann KJ. Pathways of lead exposure in urban children.Environ Res. 1997;74(1):67–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Lanphear BP, Weitzman M, Winter NL et al. Lead-contaminated house dust and urban children's blood lead levels.Am J Public Health. 1996;86:1416–1421.PubMedGoogle Scholar
  30. 30.
    Lanphear BP, Matte TD, Rogers J et al. The contribution of lead-contaminated house dust and residential soil to children's blood lead levels.Environ Res. 1998;79:51–68.CrossRefPubMedGoogle Scholar
  31. 31.
    US Department of Housing and Urban Development.Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing. Washington, DC: HUD, 1995.Google Scholar
  32. 32.
    Pirkle JL, Kaufmann RB, Brody DJ, Hickman T, Gunter EW, Paschal DC. Exposure of the US population to lead, 1991–1994.Environ Health Perspect. 1998;106:745–750.PubMedGoogle Scholar
  33. 33.
    Farfel MR, Chisholm JJ, Rohde CA. The longer-term effectiveness of residential lead paint abatement.Environ Res. 1994;66:217–221.CrossRefPubMedGoogle Scholar
  34. 34.
    Environmental Protection Agency.Lead-Based Paint Abatement and Repair and Maintenance Study in Baltimore: Findings Based on Two Years of Follow-Up. Washington, DC: EPA; 1997. EPA no. 747-R-97-005.Google Scholar
  35. 35.
    National Center for Lead-Safe Housing.Evaluation of the HUD Lead-Based Paint Hazard Control Grant Program. Fifth Interim Report. Columbia, MD: National Center for Lead-Safe Housing; February 1998.Google Scholar
  36. 36.
    Staes C, Matte T, Copley CG, Flanders D, Binder S. Retrospective study of the impact of lead-based paint hazard remediation on children's blood lead levels, St. Louis.Am J Epidemiol. 1994;139:1016–1026.PubMedGoogle Scholar
  37. 37.
    Farfel MR, Chisolm JJ. Health and environmental outcomes of traditional and modified practices for abatement of residential lead-based paint.Am J Public Health. 1990;80:1240–1245.PubMedGoogle Scholar
  38. 38.
    Amitai Y, Graef JW, Brown MJ et al. Hazards of “deleading” homes of children with lead poisoning.Am J Disabl Child. 1987;141:758–760.Google Scholar
  39. 39.
    Swindell SL, Charney E, Brown MJ, Delaney J. Home abatement and blood lead changes in children with class III lead poisoning.Clin Pediatr. 1994;33:536–541.Google Scholar
  40. 40.
    Ashengrau A, Beiser A, Bellinger D, Copenhafer D, Weitzman M. Residential lead-based-paint hazard remediation and soil lead abatement: their impact among children with mildly elevated blood lead levels.Am J Public Health. 1997;87:1698–1702.Google Scholar
  41. 41.
    Rhoads GG, Ettinger AS, Weisel CP et al. The effect of dust lead control on blood lead in toddlers: a randomized trial.Pediatrics. 1999;103(3):551–555.CrossRefPubMedGoogle Scholar
  42. 42.
    Weitzman M, Ashengrau A, Bellinger D, Jones R, Hamlin JS, Beiser A. Lead-contaminated soil abatement and urban children's blood lead.JAMA. 1993;269:1647–1654.CrossRefPubMedGoogle Scholar
  43. 43.
    Farrell KP, Brophy MC, Chisholm JJ Jr, Rohde CA, Strauss WJ. Soil lead abatement and children's blood lead levels in an urban setting.Am J Public Health. 1998;88:1837–1839.PubMedGoogle Scholar
  44. 44.
    Environmental Protection Agency.Urban Soil Lead Abatement Demonstration Project. Volume 4: Cincinnati Report. Washington, DC: EPA; 1993. Report no. EPA 600/AP93/001d.Google Scholar
  45. 45.
    Mannino DM, Homa DM, Pertowski CA et al. Surveillance for asthma—United States, 1960–1995.MMWR Morb Mortal Wkly Rep CDC Surveill Summ. 1998 Apr 24;47(1):1–27.Google Scholar
  46. 46.
    Platts-Mills TAE, Vervloet D, Thomas WR, Aalberse RC, Chapman MD. Indoor allergens and asthma: report of the third international workshop.Am J Allergy Clin Immunol. 1997;100:S2-S24.Google Scholar
  47. 47.
    Rosenstreich DL, Eggleston P, Kattan M et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.N Engl J Med. 1997;336:1356–1363.CrossRefPubMedGoogle Scholar
  48. 48.
    Bierman CW. Environmental control of asthma.Immunol Allergy Clin North Am. 1996;16:753–764.CrossRefGoogle Scholar
  49. 49.
    Platts-Mills TA. The role of allergens in allergic airway disease.J Allergy Clin Immunol. 1998;101:S364-S366.PubMedGoogle Scholar
  50. 50.
    Murray AB, Ferguson AC. Dust-free bedrooms in the treatment of asthmatic children with house dust or house dust mite allergy. A controlled trial.Pediatrics. 1983;71:418–422.PubMedGoogle Scholar
  51. 51.
    Gergen PJ, Mortimer KM, Eggleston PA et al. Results of the National Cooperative Inner-City Asthma study (NCICAS) environmental intervention to reduce cockroach allergen exposure in inner-city homes.J Allergy Clin Immunol. 1999;103:501–506.CrossRefPubMedGoogle Scholar
  52. 52.
    Verhoeff AP, Burge HA. Health risk assessment of fungi in home environments.Ann Allergy Asthma Immunol. 1997;78:544–556.PubMedGoogle Scholar
  53. 53.
    Nikulin M, Reijuka K, Jarvis BB, Veijalainen P, Hintikka EL. Effects of intranasal exposure to spores orStachybotrys atra in mice.Fund Appl Toxicol. 1997;35:182–188.CrossRefGoogle Scholar
  54. 54.
    American Academy of Pediatrics Committee on Environmental Health. Toxic effects of indoor molds.Pediatrics. 1998;101:712–714.Google Scholar
  55. 55.
    Montana E, Etzel RA, Horgan TE, Dearborn DG. Environmental risk factors associated with pediatric idiopathic pulmonary hemorrhage and hemosiderosis in a Cleveland community.Pediatrics [serial on-line]. 1997;99(1). Available at:http://www.pediatrics. org/cgi/content/full/99/1/e5.url. Accessed October 29, 1999.
  56. 56.
    Sudakin DL. Toxigenic fungi in a water-damaged building: an intervention study.Am J Ind Med. 1998;34:183–190.PubMedGoogle Scholar
  57. 57.
    Brunekreef B, Dockery DW, Speizer FE et al. Home dampness and respiratory morbidity in children.Am Rev Respir Dis. 1989;140:1363–1367.PubMedGoogle Scholar
  58. 58.
    Wickman J, Nordvall SL, Pershagen G et al. House dust mite sensitization in children and residential characteristics in a temperate region.J Allergy Clin Immunol. 1991;88:89–95.CrossRefPubMedGoogle Scholar
  59. 59.
    Verhoff AP, van Strien RT, Van Wijnen JH, Brunekreef B. Damp housing and childhood respiratory symptoms: the role of sensitization to dust mites and molds.Am J Epidemiol. 1995;141:103–110.Google Scholar
  60. 60.
    Rosenstreich DL, Eggleston P, Kattan M et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.N Engl J Med. 1997;336:1356–1363.CrossRefPubMedGoogle Scholar
  61. 61.
    Rao CY, Burge HA, Chang JCS. Review of quantitative standards and guidelines for fungi in indoor air.J Air Waste Manag Assoc. 1996;46:899–908.PubMedGoogle Scholar
  62. 62.
    Centers for Disease Control and Prevention. Rat-bite fever—New Mexico, 1996.MMWR Morb Mortal Wkly Rep. 1998;113:89–91.Google Scholar
  63. 63.
    Vinetz JM, Glass GE, Flexner CE, Mueller P, Kaslow DC. Sporadic urban leptospirosis.Ann Intern Med. 1996;125:794–798.PubMedGoogle Scholar
  64. 64.
    Smith RP Jr, Rand PW, Lacombe EH, et al. Norway rats as reservoir hosts for Lyme disease spirochetes on Monhegan Island, Maine.J Infect Dis. 1993;168:687–691.PubMedGoogle Scholar
  65. 65.
    Coombe N, Marr JS. Rat bites support need for in-home control: an epidemiologic study of rat bites in New York City, 1974–1978.J Environ Health. 1980;42:321–326.PubMedGoogle Scholar
  66. 66.
    Cloarec A, Rivault C, Fontaine F, Le Guyader A. Cockroaches as carriers of bacteria in multi-family dwellings.Epidemiol Infect. 1992;109:483–490.PubMedGoogle Scholar
  67. 67.
    Fotedar R, Nayar E, Samantray JC et al. Cockroaches as vectors of pathogenic bacteria.J Commun Dis 1989;21:318–322.PubMedGoogle Scholar
  68. 68.
    Landrigan PJ, Claudio L, Markowitz SB et al. Pesticides and inner-city children: exposures, risks, and prevention.Environ Health Perspect. 1999;107:431–437.PubMedGoogle Scholar
  69. 69.
    Gurunathan S, Robson M, Freeman N et al. Accumulation of chlorpyrifos on residential surfaces and toys accessible to children.Environ Health Perspect. 1998;106:9–16.PubMedGoogle Scholar
  70. 70.
    Davis DL, Ahmed AK. Exposures from indoor spraying of chlorpyrifos pose greater health risks to children than currently estimated.Environ Health Perspect. 1998;106:299–301.PubMedGoogle Scholar
  71. 71.
    Chanda SM, Pope CN. Neurochemical and neurobehavioral effects of repeated gestational exposure to chlorpyrifos in maternal and developing rats.Pharmacol Biochem Behav. 1996;53:771–776.CrossRefPubMedGoogle Scholar
  72. 72.
    Huss K, Rand C, Butz AM et al. Home environmental risk factors in urban minority children.Ann Allergy. 1994;72:173–177.PubMedGoogle Scholar
  73. 73.
    Samet JM, Spengler JD. Indoor air pollution. In Rom WN, ed.Environmental and Occupational Medicine. 2nd ed, Boston: Little Brown and Company; 1992.Google Scholar
  74. 74.
    Centers for Disease Control and Prevention. Unintentional carbon monoxide poisonings in residential settings—Connecticut, November 1993–March 1994.MMWR Morb Mortal Wkly Rep. 1995;44:765–767.Google Scholar
  75. 75.
    American Thoracic Society. Achieving healthy indoor air. Report of the ATS Workshop: Sante Fe, New Mexico, November 16–19, 1995.Am J Respir Crit Care Med. 1997;156:S33-S64.Google Scholar
  76. 76.
    National Academy of Sciences. Biological effects of ionizing radiation (BEIR) VI report: the health effects of exposure to indoor radon. Executive summary. Available at: Accessed October 29, 1999.Google Scholar
  77. 77.
    Centers for Disease Control and Prevention. Radon testing of households with a residential smoker—United States, 1993–1994.MMWR Morb Mortal Wkly Rep. 1999;48:683–686.Google Scholar
  78. 78.
    Morrison Hershfeld Limited.Moldy Houses: Why They Are and Why We Care, Report to Canada Mortgage and Housing. Ottowa, Ontario, Canada: Morrison Hershfield Limited; 1995.Google Scholar
  79. 79.
    Roscoe RJ, Gittleman JL, Deddens JA, Petersen MR, Halperin WE. Blood lead levels among children of lead-exposed workers: a meta-analysis.Am J Ind Med. 1999;36:475–481.CrossRefPubMedGoogle Scholar
  80. 80.
    US Department of Housing and Urban Development, Office of Lead Hazard Control. The Healthy Homes Initiative: a preliminary plan. April 1999. Available at: Accessed October 29, 1999.Google Scholar
  81. 81.
    US Department of Housing and Urban Development. Community Development Block Grant (CDBG) Entitlement Communities Program. Available at: Accessed October 18, 1999.Google Scholar
  82. 82.
    US Department of Housing and Urban Development. HUD's Budget. Available at: Accessed October 29, 1999.Google Scholar
  83. 83.
    Lead-Based Paint Hazard Reduction and Financing Task Force.Putting the Pieces Together: Controlling Lead Hazards in the Nation's Housing. Washington, DC: US Department of Housing and Urban Development; 1995. Publication no. HUD-1547-LBP.Google Scholar
  84. 84.
    Gulson BL, Gray B, Mahaffey KR et al. Comparison of the rates of exchange of lead in the blood of newly born infants and their mothers with lead from their current environment.J Lab Clin Med. 1999;133:171–178.PubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2000

Authors and Affiliations

  • Thomas D. Matte
    • 1
    • 2
  • David E. Jacobs
    • 3
  1. 1.Center for Urban Epidemiologic Studies (CUES)New York Academy of MedicineNew YorkUSA
  2. 2.Centers for Disease Control and PreventionNational Center for Environmental HealthUSA
  3. 3.Office of Lead Hazard ControlUS Department of Housing and Urban DevelopmentUSA

Personalised recommendations