Intended for healthcare professionals


Cities and global health: fragmented housing policies increase health risks for vulnerable people

BMJ 2022; 379 doi: (Published 01 November 2022) Cite this as: BMJ 2022;379:e069671
  1. Yvonne G Doyle, medical director for public health1,
  2. Bethlehem D Solomon, doctoral candidate2 ,
  3. George Owusu, professor3
  1. 1NHS England, London, UK
  2. 2School of Public Health, Imperial College London, London, UK
  3. 3Institute of Statistical, Social and Economic Research, School of Social Sciences, University of Ghana, Accra, Ghana
  4. Correspondence to: B D Solomon

Yvonne Doyle, Bethlehem Solomon, and George Owusu call for more innovative approaches to healthy housing in cities to improve health inequalities

The association of housing with health was recorded scientifically over 170 years ago, and housing remains a wider determinant of health globally.1 In urban settings where about 54% of the world’s population now live,2 poor housing conditions influence physical health and psychosocial wellbeing through indoor temperature; air and noise pollution; risk of injury, stress, and infection; and the external and internal environment of homes.345 The cost of housing also affects health67 as it determines what residual income remains for other needs such as food, transportation, and medical services.8 Reviews have identified that experiencing foreclosure9 and lack of housing stability1011 are associated with worse physical and mental health.

Globally, environmental risk factors can contribute more than a third of the preventable disease burden in children.12 In parts of Africa, lack of facilities for simple exercise have contributed to a recent and disproportionately increased incidence of obesity in women.13Also, recent studies indicate growing incidence of obesity among children and young people in African cities because of the absence of play spaces.14 In India and parts of east Asia and sub-Saharan Africa, inadequate combustion of charcoal in badly ventilated indoor environments increases risk of respiratory disease among people who spend much time indoors.15 Furthermore, lack of public services in the poorest districts not only causes immediate health threats but delays detection of risk factors for disease with adverse consequences.16

Housing as a pointer to urban health and equity

Poor housing conditions are a known mechanism through which social and environmental inequality translates into health inequality.117 The confluence of accelerating climate degradation and the SARS-CoV-2 pandemic has identified commonalities to both …

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