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Mary E. Northridge, PhD, MPH, Editor-in-Chief and Elliott D. Sclar, PhD, Director

Urban Planning Program, Columbia University

Urban planning and population health share an important intellectual premise—namely, that context counts. Accordingly, both professions view the quantity and quality of housing as crucial concerns. As James Krieger and Donna Higgins document in their comprehensive Public Health Matters piece, interest in housing as a determinant of health has fluctuated over the last 2 centuries in response to "infectious disease outbreaks (e.g., cholera in New York City in the 1830s), social unrest and class conflict, industrialist interest in maintaining a healthier workforce, and economic downturns leading to crises in housing availability and quality."^(p758) These concerns are all too contemporary for the swelling numbers of urban poor throughout the world, who live in cramped, precarious conditions, often without electricity, running water, or title to the land they occupy. Spurred in recent decades by civil wars, natural disasters, and plummeting agricultural prices, Latin America has become the most urbanized region of the world, with 75% of the population living in sprawling slums on the outskirts of cities (Gonzalez D. Central America's Cities Grow Bigger, and Poorer. New York Times 2002 Mar 17;A: 3).

The crisis in safe and affordable housing is also rampant in the United States, where homelessness has risen 13% over the past year. The situation is especially acute in the Northeast, where rents are among the highest in the nation. Barbara Ehrenreich, in her first-hand account, "Nickel and Dimed: On (Not) Getting By in America" (New York: Metropolitan Books, 2001), cites housing as the principal source of disruption in the lives of full-time workers earning poverty-level wages:

There are no secret economies that nourish the poor. If you can’t put up the 2 months' rent you need to secure an apartment, you end up paying through the nose for a room by the week. If you have only a room, with a hot plate at best, you can’t save by cooking up huge lentil stews that can be frozen for the week ahead. You eat fast food or the hot dogs and Styrofoam cups of soap that can be microwaved in a convenience store. If you have no money for health insurance—and the Hearthside's [a fictitious name for the restaurant in Florida where she worked as a waitress] niggardly plan kicks in only after 3 months—you go without routine care or prescription drugs and end up paying the price.^(p27)

Several authors in this month's issue propose mechanisms for addressing the affordable housing crisis and its profound effects on the public's health. Michael Greenberg considers whether or not housing should be built on contaminated urban sites known as brownfields (page 703). Lance Freeman makes the case for a societal obligation to meet the housing needs of everyone, including the most disadvantaged, and describes the policy orientation necessary to achieve this objective (page 709). Bret Thiele argues that the right to adequate housing can be traced to the Universal Declaration of Human Rights, unanimously adopted by the world community in 1948, which may prove valuable as a tool to promote healthful housing and living conditions (page 712).

In New York City alone, about 29 400 homeless people, including 12 500 children, spend their nights in shelters or hot-plate hotel rooms (Powell M. Homeless Problem Deepens. Boston Globe 2001 Dec 30;A: 19). Discrimination in the siting of housing against people of color, the poor, and the disabled contributes to egregious disparities in health among population groups. Broad societal support is needed to solve the current housing crisis. In pursuit of this goal, public health and planning professionals can help hammer home the connections between the basic human need for proper shelter and overall well-being. In the final analysis, while safe and affordable housing alone cannot ensure sound population health, it is undoubtedly a necessary condition.

Related articles in AJPH:

Should Housing Be Built on Former Brownfield Sites?

Michael Greenberg
AJPH 2002 92: 703-705. [Extract] [Full Text]  

America's Affordable Housing Crisis: A Contract Unfulfilled

Lance Freeman
AJPH 2002 92: 709-712. [Abstract] [Full Text]  

The Human Right to Adequate Housing: A Tool for Promoting and Protecting Individual and Community Health

Bret Thiele
AJPH 2002 92: 712-715. [Abstract] [Full Text]  

This article has been cited by other articles:

				M. E. Northridge, G. N. Stover, J. E. Rosenthal, and D. Sherard Environmental Equity and Health: Understanding Complexity and Moving Forward Am J Public Health, February 1, 2003; 93(2): 209 - 214. [Abstract] [Full Text] [PDF]

				M. E. Northridge and E. Sclar A Joint Urban Planning and Public Health Framework: Contributions to Health Impact Assessment Am J Public Health, January 1, 2003; 93(1): 118 - 121. [Abstract] [Full Text] [PDF]

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