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EDITORIALS: Hilary Thomson and Mark Petticrew Housing and health BMJ 2007; 334: 434-435 [Full text]

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Environmental improvement

Christopher M. Buttery   (3 March 2007)

Environmental improvement 3 March 2007
Christopher M. Buttery, Clinical Professor of Public Health Virginia Commonmwealth University Send response to journal: Re: Environmental improvement	I enjoyed this article and was happy to see this important public health topic in a general medical journal. Most of us in public health have been concerned about housing for more than 50 years. In the early 1950s the American Public Health Association published a set of model housing standards. In 1968 when health director in Portsmouth, Virginia the Mayor and city manager asked me to develop a progam to improve housing standards for the underserved low income population in the city. We selected and improved on a model developed in the late 1950s in Ypsilanti, Michigan. We required that on turnover of any rental property that all public utilities be disconnected and the unit ( house/apartment) remain vacant until the landlord/owner had brought the unit into compliance with the state building code. This meant that the housing unit had to have refrigeration for food, safe heating and cooling, intact windows, sanitary waste disposal and clean potable water in addition to being rendered lead paint free. Unfortunately many communities still do not have such occupancy codes. Within 3 years of starting the project we noted improved health of those attending our public health clinics. The housing stock went from 40% dilapidated to 95%+ in compliance. As with many other important public health programs we believe we did more with environmental improvement than any amount of medical intervention could have accomplished. Competing interests: None declared