People living in substandard and social housing estates present a higher risk of mortality than those living in conventional (non-subsidised) houses, concluded a study in the Instituto de Saúde Pública da Universidade do Porto (ISPUP), published in the prestigious journal American Journal of Public Health.
Moreover, living in these types of housing is more determinant of mortality than well-established risk factors such as hypertension, physical inactivity, or obesity, also showed the investigation.
According to Ana Isabel Ribeiro, first author of the study, coordinated by the researcher Henrique Barros, “in Oporto, the housing has always been a recurrent and structural problem, firstly with the question of the “ilhas”, fustigated by tuberculosis, cholera and bubonic pest epidemics, in the XIX and XX centuries, and later with the degradation and marginality of many social neighbourhoods. The house is one of the places where we spend more time, therefore the biophysical and social exposures that occur may have a determinant effect on our health.
For that reason, “we wanted to understand if, in Oporto, nowadays, people who live in the so-called “ilhas” and in state-subsided housing (social housing and affordable houses) have more disease burden and, consequently, higher levels of mortality”, refers.
2485 inhabitants of the city of Oporto were analysed
To study the association between the type of housing and mortality, the researchers used data from 2485 adult individuals from the city, who integrate the EPIPorto cohort – a longitudinal ISPUP study that accompanies, since 1999 until today, the health of these participants.
By georeferencing their addresses, the researchers were able to understand the distribution of individuals across the various types of housing: “ilhas” (substandard workers’ housing that emerged in the end of the XIX century, with the industrialisation and rural exodus), social housing (high-rise constructions, also known as “bairros sociais”, destinated to the poorest population), affordable housing (buildings at affordable prices, normally attributed to lower middle class families) and conventional housing, non-subsidised.
The researchers had also access to sociodemographic, behavioural, and clinical characteristics of the participants, through data from the various cohort evaluations, over 20 years of follow-up (from 1999 to 2019).
And it was possible to understand that…
Of the 2485 residents in the city of Oporto who participated in the study, 75,1% (the vast majority) lives in conventional housing, 15,9% lives in social housing, 4,8% in “ilhas” and 4,3% in affordable houses.
On the whole, the individuals who live in “ilhas”, social housing and affordable housing present lower levels of education and more undifferentiated professions. On another domain, the inhabitants of the “bairros socias” and the “ilhas” are also those who consume more alcohol and present higher levels of obesity, sedentarism and hypertension.
Mortality risk is superior in “ilhas” and social housing dwellers
The highest number of deaths occurred among the inhabitants of the “ilhas” (28,3%), affordable housing dwellers (21,7%) and among people living in social housing (21,3%). Only 14,6% of the participants who lived in conventional houses died over the time period analysed.
It was also observed that those who live in “ilhas” and social housing present a risk of death 46% higher than the inhabitants of the conventional housing. “And this is true, regardless of factors such as the profession and education of the individuals, what means that people with exactly the same age, sex, education and profession present a different risk of mortality, depending on the type of housing and neighbourhood in which they live”, highlights the researcher.
In particular, the risk of premature death (before the 70 years of age) is superior in the inhabitants of the “ilhas”, which also have 2,4 times more probability of dying of cardiovascular diseases than people who live in conventional housing.
Another result that stood out from the study was the realisation that living in a somewhat rundown housing context is more determinant for the mortality than well-established risk factors, such as the hypertension, low educational level, the physical inactivity, the excessive alcohol consumption, being manual worker, and being obese.
How can these results be explained?
According to Ana Isabel Ribeiro, this data can be explained, on one hand, “by the physical environment inside and outside the housing”. Although this aspect was not specifically analysed in the study, “we know that the “ilhas” and the social housing have harshest indoor environments, characterized by higher levels of air pollution, presence of fungus and humidity, and higher exposure to extreme temperatures (cold or hot)”. These biophysical exposures are linked to a greater risk of disease and mortality.
On the other hand, there is equally a chance that there is a greater psychological stress level among the social housing and “ilhas” dwellers. “The psychological stress, caused by the social stigma, by the exclusion and ghettoization, affects both physical and mental health, what could mean a greater death risk”, refers.
The relevance of the study
For the ISPUP researcher, this article is of particular importance, because of various factors.
“By demonstrating that housing is a fundamental determinant for population health, we conclude that is essential to have a good housing policy in Portugal”, says. “Given that the individuals who live in “ilhas” and social housing have higher mortality levels than those who live in conventional housing, it would be crucial to improve the physical and social environment of these housing estates and ensure their continuous monitoring”.
It is worth highlighting that, at a time when Portugal faces a housing crisis, characterized by the increase in the value of real estate, by the high cost of rents and by the lack of public investment in this sector, the article comes to put in evidence the role of housing as an important determinant of populational health.
The investigation entitled Affordable, Social, and Substandard Housing and Mortality:The EPIPorto Cohort Study, 1999–2019 , was deleveloped in the scope of the ISPUP’s Unidade de Investigação em Epidemiologia (EPIUnit).