Saturday, 1 February 2014

Healthy homes and social justice


The ‘third world’ begins and ends at home

The international work of charities like Habitat for Humanity certainly puts the UK’s experiences into perspective; it also serves to remind that the struggle to secure healthy homes is no simple technocratic pursuit. Like it or not, there’s an essential element of social justice too

By Mark Cantrell

From Housing magazine. September 2013

Photo (Above): Bishkek, Kyrgyzstan. Bermet, 9, with her brother Alybek, 3, outside their dilapidated home in Bishkek. ©Habitat for Humanity/ Daniar Ashymov

THEY say that travel broadens the mind; certainly it can provide a fresh perspective on matters a little closer to home. That’s apt, given the well-established link between health and housing, because even a cursory tour of efforts internationally, serves to remind us that good housing can’t be extricated from aspects of social justice.

The concept is there in the woodwork of a mould-ridden flat unfit for human habitation; it shivers in a cold home wracked by fuel poverty and poor insulation; it suffers the degradation of over-crowding; it frets over security of tenure and the impact of the bedroom tax; it ponders the uncertainties of increasingly unaffordable housing; it’s there in the world’s shanties and the slums, in London’s ‘beds in the sheds’, and the general mess that is the UK’s housing crisis.

It really is enough to make you ill, thinking about all that. Bad housing is detrimental to health; it diminishes life chances and helps to perpetuate poverty. In fact, social justice is built into the very fabric. The other thing about bad housing – it knows no international boundaries.


In that sense, the ‘third world’ begins at home and transcends the artificial division between ‘developing’ and ‘developed’ nations. The conditions vary widely across the globe, being more acute in some countries than others, but the need for a secure, decent home is universal; as is the struggle to achieve it. And what begins – at face value – as a straightforward effort to deliver a healthy home, can very quickly become cross-fertilised by that wider social justice arena.

Maybe that’s reading a lot into it, but it’s certainly what springs to mind when considering the work of Habitat for Humanity. The organisation works in over 70 countries around the world, “helping people to escape from poverty and disease through building safe, decent homes” as it describes itself. As a charity, it doesn’t do politics, of course, but to achieve its aim of securing decent housing, it is often called upon to help communities achieve wider aims of social justice.

In Bolivia and Brazil, for instance, the charity is running land rights projects to help people – especially women – who have been sold land illegally, a situation that has left them struggling to gain access to clean water and sanitation.

“These families are living in what would be classed as an informal settlement and they’d been sold land illegally. They didn’t know it’s illegal and the original landowners are asking for more money, they’re threatening the women, and if you’re a single-headed family, a single woman, then that’s a very precarious situation to be in,” said Lisa Stead, the charity’s assistant programmes manager.

“We’re fighting for their rights – their land rights – and we’re working with them to actually register their land and make it a state governed area. That will require the government to invest in infrastructure and other services. So, sometimes you have to start before the house. You have to start with the security of tenure.”

Security of tenure is a big issue for women in African nations too, she added, a problem exacerbated by the AIDS epidemic. “If the male in the family dies, then land can be grabbed by other members of the family, so that leaves the wife and the children out on the streets,” said Stead. “What we are doing there is not only providing them with housing, but ensuring they learn about inheritance and their land rights to give them some security, not only for them, but for the children, by putting the land and the house in their name. There is a lot of equality [issues] in the projects that we do in Latin America and in Africa.”

Here in the UK, Habitat for Humanity is perhaps best known for its ‘sweat equity’ projects, such as in Liverpool, where it works to provide affordable housing for families by involving them in the build. They literally invest their physical labour in the home; this is a common strand to the charity’s activities, but a current scheme in Cambodia is unusual in that it is a “giveaway project”. To put it bluntly, the recipients of the scheme needed the break; they were for the most part in no fit state to offer even a little of that ‘sweat equity’.

The families involved not only endured the problems of ill health – at least one family member has HIV/AIDS – but the local community also shunned them. Many were living in slums that had grown up around a rubbish site on the outskirts of the capital, Phnom Penh, where they eked out a living scavenging and selling recycled refuse; others lived in 4x5metre rooms where they struggled to meet the expensive (relatively speaking) rents. On top of that they had to pay extra to access inadequate water and sanitation.

(C) Habitat For Humanity
Inevitably, this was taking its toll on their already precarious health; other family members suffered too, mentally and physically, while the children often missed out on school in order to look after the sick adults. They were, as Stead put it, “the poorest of the poor”.

Habitat for Humanity has worked with some 500 ‘home partners’, as the charity calls the people it has helped, in partnership with the Elton John AIDS Foundation, which helped fund the scheme in recognition of the link between housing and health.

Healthcare partners provide support for managing HIV/AIDS such as the provision of anti-retroviral therapy (ART). The intervention has seen the fortunes of the families concerned turned round, from outcasts to accepted members of the community.

“They’ve now got access to clean water, they’ve got access to sanitation, we gave them health and hygiene training, and they’re not living under a leaking roof or in bad environments, which they were around the garbage tip. It’s helped their physical health, but also mentally – it’s given them hope,” said Stead.

“Because their health has improved, they are able to work, they are able to invest in decent food, and also invest in livelihood generation, building up a business, but the most important thing everybody was telling us was the future of their children. Now they have all this, they are able to send their children to school.”

By and large, it’s the children that suffer the most as a result of poor housing, whether directly by its impact on their health, or indirectly through its impact on their education. And this aspect really is a global problem, including those youngsters growing up in damp and mouldy homes in ‘first world’ England, of which many remain. There are many ways that a home can impact on our health.

Key risks according to the World Health Organisation (WHO) include respiratory and cardiovascular diseases from indoor air pollution; illness and deaths from temperature extremes; communicable diseases spread because of poor living conditions; and risks of home injuries. In 2010, the organisation estimated that nearly two million people in developing countries die from indoor air pollution caused by the burning of biomass and coal in leaky and inefficient household stoves.

Habitat for Humanity estimates that over 10,000 children die every day the world over from diseases and illnesses caused by bad housing. Many of these problems can be prevented by making improvements to everyday living conditions – housing key among them.

Take Nepal, where one volunteer with the charity described the poor living conditions he encountered during a visit last year: “The family will cook on an open fire in the house often with no chimney, so respiratory problems are common,” said GP Paul Goozee. “Clean water is difficult, especially if you live downstream of human habitation, or even if there is animal contamination. Basic hygiene of clean water and good sanitation is a huge basic need. Infant mortality is high because of this. Life expectancy is lower than in the UK and the basic living conditions I’m sure are a major reason for this.”

How about Romania, where charity worker Mihaela Apetri described overcrowding in the city of Comăneşti’s apartment buildings: “In one apartment with two rooms we found four families with a total of around 13 people. Another lived in a one-roomed apartment where there was mould and it was very cold. The family had a little girl who was two or three years old. She was always coughing and had different respiratory diseases. After she moved into a new [Habitat for Humanity] home these problems disappeared.”

A decent home is a healthy home. When you stop to think about it, that’s actually a profound call for social justice, because the home is the hearth of a life worth living – no matter where you live.

“The thing that always strikes me when I travel – and I travel a lot for the organisation – is that people are the same everywhere. We have a different culture, a different climate, but people worldwide want the same thing for their families,” said Stead.

“We all want a safe, decent place for our families to live and thrive in. We aspire to that future for our children. I don’t think it matters what country you live in, that is a really important and fundamental message.”


CAMBODIA (October 2012): Homepartner Mern Oeun, 43, who was forced to work away from home as a garbage collector in order to earn enough to support her children. She said, "“My future house means being able to start a business at home and not collect garbage any more” (c) Habitat for Humanity

World view

  • HIV continues to be a major global public health issue, having claimed more than 25 million lives over the past three decades
  • There were approximately 34 million people living with HIV in 2011
  • Sub-Saharan Africa is the most affected region, with nearly one in every 20 adults living with HIV. Of all people living with HIV, 69% are living in this region
In 2011, more than 8 million people living with HIV were receiving anti-retroviral therapy (ART) in low- and middle-income countries. Another 7 million people need to be enrolled in treatment to meet the target of providing ART to 15 million people by 2015 More generally, one quarter of the global “disease burden” is due to environmental factors that could be changed. For instance:
  •  Living conditions are estimated to cause four million deaths among children aged 0-14 each year
  • Indoor air pollution caused by inefficient cookers, poor ventilation or local pollutants leads to 3.6 million premature deaths each year
  • Chagas disease infects 7-8 million people worldwide each year. The World Health Organisation (WHO) is making improvements to homes to prevent the spread of the disease, as the insect carrying the disease lives in poorly constructed mud walls
  • There is a high occurrence of allergic and respiratory diseases associated with poor housing conditions
(Source: WHO, ECEHH, Habitat for Humanity)

This article first appeared in the September edition of Housing magazine. It was subsequently republished on the Housing Excellence website, 6 January 2014.

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