Elsevier

Public Health

Volume 123, Issue 2, February 2009, Pages 174-181
Public Health

Original research
Housing quality and ill health in a disadvantaged urban community

https://doi.org/10.1016/j.puhe.2008.11.002Get rights and content

Summary

Objectives

This study examined the association between housing quality and chronic illness among household members in the little investigated, underserved urban communities in Hay el Sellom, one of the largest informal settlements on the outskirts of Beirut, Lebanon.

Study design

A population-based cross-sectional survey.

Methods

Face-to-face interviews were conducted to obtain the required information on 3881 individuals of all age groups in 788 households. Housing quality was measured using infrastructure and services, and housing conditions. Ill health was measured by the reporting of chronic illnesses. A multivariate regression model using the Generalized Estimation was used to analyse the association between ill health and housing quality, controlling for other covariates.

Results

Fifty percent of studied households reported chronic illnesses. Approximately two-thirds of individuals lived in households with more than four problems relating to housing conditions. The results of the study showed a significant positive association between housing conditions and chronic illness.

Conclusion

These findings highlight the need for immediate action as they suggest that health in poor urban communities could be improved with better planning of housing needs.

Introduction

Urbanization has spread rapidly over the past century, creating major changes in several aspects of human life such as economics, education, housing and public health.1, 2, 3, 4, 5, 6, 7 In developing countries, a sizable proportion of this urbanization has happened in informal settlements, where low-income dwellers have, since the 1960s, secured shelter in violation of urban regulations and sometimes property rights, and where the quality of housing and services is often markedly below state-sanctioned standards. While the physical and living conditions in these neighbourhoods were expected to improve gradually through the self-help efforts of their dwellers,8 there is widespread evidence that physical consolidation only occurred in particular contexts; in many cases, living conditions have actually deteriorated.9, 10

Given the environmental challenges associated with urbanization, and building on the assumption that healthier shelter and environmental infrastructure can improve health factors in low-income settlements, health researchers have turned their attention to densely populated cities in both the developed and developing world where they seek to understand and address the rising health challenges.1, 5, 11, 12 A number of studies have assessed the direct relationship between ill health and inadequate urban housing quality, namely factors relating to infrastructure and services, housing conditions and overcrowding.13, 14, 15, 16, 17, 18 Access to basic infrastructure and services includes items such as adequate water and sanitation, reliable electricity supply, and proper disposal of solid wastes.13, 19 The lack of safe drinking water and the inadequate collection/disposal of solid wastes have contributed to public health outbreaks.2, 20 Inadequate housing conditions, including the presence of humidity, pest infestation, the absence of a main source of heating and inadequate lighting, have been associated with negative health effects.16, 21, 22, 23 Crowded, cramped conditions are also linked with acute respiratory infections, poor mental health among children, and household burns and accidents.24, 25, 26 Some of these factors, such as crowding, depend on social and cultural perceptions of the household, as well as the characteristics of residential units (i.e. individual units or a high-rise unit).27 Other factors, such as outdoor air pollutants, insecure tenure and poverty, have been linked with urban housing quality.7, 11, 13, 18, 19, 28

Seeking to contribute to this debate, this study investigated the relationship between chronic health problems and the quality of housing in the little investigated context of Beirut's informal settlements. To the authors' knowledge, this is the first study to use population-based data to investigate the association between housing conditions and ill health in this neighbourhood. Indeed, high rates of urbanization (estimated at 90% by the 2004 World Development Report)29 and rising poverty rates in Lebanon suggest that the health challenges described elsewhere are also likely to manifest themselves here. This is especially the case in the capital city Beirut, where an estimated one-third of Lebanon's population lives, many of them in the informal settlements that have developed since the 1950s in the peripheries of the city. These neighbourhoods resulted from rapid and poorly controlled urbanization (triggered by urban policy, economic forces and forced displacements caused by the various military conflicts in Lebanon) and the absence of adequate housing and social policies in the country. Among these neighbourhoods, Hay el Sellom1 (Fig. 1) is the largest informal settlement in Lebanon.30 The neighbourhood extends over an estimated area of 850,000 m2 and houses approximately 100,000 people, although the number fluctuates with the influx of foreign migrant workers.231

The first urbanization of Hay el Sellom dates back to the 1950s, when rural migrants arriving in the city found this agricultural land relatively affordable, and bought illegally subdivided lots on which they built their houses incrementally. At the time, Hay el Sellom was a natural extension of the urbanization process that was transforming the neighbouring villages of Beirut into its suburbs.32 These newcomers were attracted by employment opportunities in the capital city, the (then) newly inaugurated international airport, and the factories of Choueifat, a national industrial hub located nearby.31 Similar to other Third World countries, urbanization in this neighbourhood was organized in violation of publicly sanctioned urban and building codes. Lots were smaller than legally sanctioned areas, and buildings were developed without proper permits and often with disregard to urban regulations. Furthermore, as of 1975, with the outbreak of the Lebanese civil strife, violations of property rights began to proliferate in the neighbourhood. In the early 1980s, the arrival of large groups of people displaced by the 1982 Israeli invasion led to the occupation of the banks of Ghadeer River.31, 33 Since the river collects both industrial and domestic wastes throughout Choueifat Valley before it reaches Hay el Sellom, living conditions for those occupying its banks are particularly dramatic. Houses are less consolidated physically and many of them still use temporary materials such as metal sheets.31 Furthermore, the continued influx of internal migrants into Hay el Sellom during the years of civil war encouraged the vertical densification of housing units, which developed into six- or seven-storey buildings.30, 31 Since many of these buildings were originally designed as one- or two-storey houses and do not have the proper structural foundations to carry such high buildings, there are concerns about the physical safety of the structures.

The characteristics of this neighbourhood make Hay el Sellom an interesting case study to explore the relationship between urbanization and ill health. Existing research about this and other informal settlements in Lebanon generally relates to land and housing,31 and makes no reference to health. This study focused on urban housing conditions in Hay el Sellom and examined the association between urban housing quality and ill health among household members in this poor, underserved area on the outskirts of Beirut. By highlighting some of the most important environmentally related health problems in this neighbourhood, the study hopes to determine the main elements for investigation in other informal settlements in Lebanon.

Section snippets

Design and data collection

The data used in this analysis were collected as an integral part of the housing quality component of the Urban Health Study, carried out by the Faculty of Health Sciences at the American University of Beirut in 2002. A cross-sectional survey in Hay el Sellom was based on a two-stage probability sample of 788 households with 3881 members of all age groups. Since the study was concerned with the health effects of this informal urbanization, the sample was taken in the neighbourhoods surrounding

Sociodemographics and health profile

The age distribution of household members indicated a relatively young population with a mean age of 23 years and a gender ratio of 1 (Table 1). Residents of Hay El Sellom were predominantly Lebanese (96%), single (62%) and had never been displaced (68%), indicating that the earlier migrants to the neighbourhood remained in this area. Only 40% of those aged ≥15 years were in the labour force. The majority of households were nuclear (86%) and headed by a male (89%). On average, there were five

Discussion

Hay el Sellom, an area with village-like characteristics within an olive grove, shifted within the span of 50 years to become an integral part of the suburbs of Beirut. This study is one of few to describe and evaluate the urban housing conditions that exist in this community. In addition, this research linked the reporting of chronic illnesses with the poor housing quality in this underserved suburban area that evolved rapidly following the urban growth in the country.

Conclusion

This study is the first to explore the association between housing quality and ill health in Hay el Sellom using community-based data. Hay el Sellom is an example of an underserved community that grew on the fringes of Beirut as a result of rapid urbanization. The poor conditions in its household dwellings are associated with poor health among the residents. The existing literature indicates general health improvements with improved housing conditions.47, 48, 49, 50, 51, 52, 53, 54 The results

Acknowledgements

The authors wish to thank all the subjects who participated in the study.

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