How and where you live can drastically affect your health, future prospects, and general wellbeing.

Last month, Public Health England came under scrutiny for a tweet that read, “Healthcare is only accountable for 20% of your health. The rest is down to the choices we make. Namely, smoking, diet, exercise, and alcohol.”

Many took issue with the vernacular used, namely that health is a “choice” for people. In fact, chance has a large amount of say in a person’s health.

Take housing.

It is proven that poor living conditions can have adverse effects on the people living in them, affecting everything from mental health to school or job performance, to physical health. Of course, measuring the effects of substandard housing on a person’s health can be difficult as many variables can co-occur.

But research in Hong Kong, the United States and the UK all demonstrate different aspects of this issue, and prove that despite the regulatory and other differences in each country, this is a persistent problem across the globe.

Hong Kong

With a population density of 6,300 people per square kilometer, Hong Kong is one of the most densely populated areas in the world. A 2018 study published in the International Journal of Environmental Research and Public Health explored the health repercussions of community conditions in Hong Kong.

“With decades of urbanization,” reads the study, “housing and community problems have become important social determinants of health that require increasing attention worldwide. Knowledge regarding the link between health and these problems can provide crucial evidence for building healthy communities.”

The study analyzed participants on seven factors: chronic disease, sleep problems, self-reported health status, anxiety, and depression measured by the Depression Anxiety Stress Scales, and physical and mental health composite scores.

The study found that the middle- to low-income groups were more sensitive to temperature extremes, perhaps due to general substandard ventilation and insulation practices. It also found that those lower-income people who reported sensitivity to this indicator were more likely to have chronic diseases, while the rest of the population did not report the same findings.

Additionally, it seems that the group of middle- to low-income individuals studied had a higher threshold for when they would report a problem. Essentially, while higher-income people see problems all around their environments, the lower-income bracket either didn’t notice the problems, or didn’t see the point in reporting it.

The United States

Many studies of this nature have occurred in the United States, the most significant of which may be the Gautreaux Project. In 1966, a class action lawsuit by activist Dorothy Gautreaux against the Chicago Housing Authority (CHA) resulted in an experiment set up by the courts to see how low-income families were affected by their public housing living conditions.

Gautreaux’s case argued that the CHA was putting African-American families at a disadvantage by assigning them to public housing complexes in more disrepair than their white counterparts. The courts set up the Gautreaux project by randomizing all of the families given Section 8 Housing Vouchers and assigning them to housing projects throughout the city, varied in surrounding affluence.

By 1998, over 7,000 families had participated in this experiment, and a number of indicators were analyzed, showing that the families placed in lower-income urban settings were more likely to have lower-performing children, remain on welfare, and have lower high school graduation rates than their suburban counterparts. This experiment has been cited as definitive proof that housing has an effect on wellbeing, no matter race or economic standing.

Housing in the US is also subject to a number of toxins that can affect physical health. Lead paint, asbestos shingles and insulation, and mold are all dangerous substances that US regulations can’t seem to address.

Chief among these issues is the problem of asbestos, which causes a rare and mostly fatal form of cancer called mesothelioma. Regulations around this mineral have recently been relaxed by the current administration, which could result in the carcinogenic material being allowed back into production.

The United Kingdom

In 2016, a study by the National Health Service Confederation (NHSC) examined the effect of housing on mental health in the UK. Mental illness is often cited as a reason why someone may end up in substandard housing in the first place, and the stigma surrounding the mental health of homeless people is quite strong.

The study found that children living in temporary and poor housing for over a year are three times more likely than their stably housed counterparts to have mental health problems. The study also indicated that women’s mental states are more affected by poor living conditions than men’s are.

However, this issue may bring up the question of which came first: the mental illness or the substandard housing? The NHS study seems to indicate that both can come first; it found that 33% of people reported housing conditions causing stress or depression in their family.

Closing Thoughts

In Hong Kong it was proven that substandard housing affects physical health. In the United States, the Gautreaux project proved that randomly assigning people to better or worse situations had a profound impact on overall health. In the UK, the NHSC proved that mental health is also subject to the effects of poor regulations in housing.

These clear indicators, from cross cultural studies, definitively show that there is a worldwide substandard housing problem, and that it adversely affects people’s health in tangible ways.

Redefining the way we view “health” is an important step towards ensuring that negative systemic impacts on health are minimized, and advantages of good public services infrastructure are maximized.

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This piece was contributed by Mesothelioma.com.