Housing as a social determinant of health and wellbeing: developing an empirically-informed realist theoretical framework

Abstract

Background: The role of housing as a social determinant of health is well-established, but the causal pathways are poorly understood beyond the direct effects of physical housing defects. For low-income, vulnerable households there are particular challenges in creating a sense of home in a new tenancy which may have substantial effects on health and wellbeing. This study examines the role of these less tangible aspects of the housing experience for tenants in the social and private rented sectors in west central Scotland. Methods: The paper analyses quantitative data from a mixed methods, longitudinal study of tenants from three housing organisations, collected across the first year of their tenancy. The paper postulates causal hypotheses on the basis of staff interviews and then uses a Realist Research approach to test and refine these into a theoretical framework for the connections between tenants' broader experience of housing and their health and wellbeing. Results: Housing service provision, tenants' experience of property quality and aspects of neighbourhood are all demonstrated to be significantly correlated with measures of of health and wellbeing. Analysis of contextual factors provides additional detail within the theoretical framework, offering a basis for further empirical work. Conclusions: The findings provide an empirically-informed realist theoretical framework for causal pathways connecting less tangible aspects of the housing experience to health and wellbeing. Applying this within housing policy and practice would facilitate a focus on housing as a public health intervention, with potential for significant impacts on the lives of low-income and vulnerable tenants. The framework also offers a basis for further research to refine our understanding of housing as a social determinant of health.

Associations between Objective and Subjective Housing Status with Individual Mental Health in Guangzhou, China

“…Drawing upon previous literature [38][39][40], objective housing status included housing tenure, living space, housing conditions, and housing stability. Subjective housing status mainly included housing satisfaction.…”

COVID-19 and Diabetes: Unintended Medical, Financial and Societal Consequences

“…Recent evidence has shown that adults who live alone are less likely to engage in healthy behaviors than their counterparts who live with others [31]. These findings highlight the importance of housing structure as a social determinant of health and its causal relationship to health outcomes [32]. To date, scant data is available regarding diabetes management adherence, a study from India showed that only 30 percent of patients taking oral anti-diabetic medication and insulin were checking their blood sugar levels regularly during the lockdown [33].…”

Incorporating Social Determinants of Health into Modelling of COVID-19 and other Infectious Diseases: A Baseline Socio-economic Compartmental Model

“…Conditions of housing encompass issues such as overcrowding and sub-standard buildings, lack of access to safe drinking water and other utilities, ineffective waste disposal, poor quality sanitation infrastructure and inadequate provision of affordable and quality housing stock. The SDH literature has illustrated a clear relationship between housing and deleterious social health outcomes ( Krieger and Higgens 2002 ; Rolfe et al 2020 , Kang et al 2020 ). This is a global issue, but it is one that particularly impacts the estimated 1-1.6 billion people who live in slums and informal housing, a figure that represents around one-quarter of the world’s urban population ( Habitat for Humanity 2020 ).…”

“…Our choice of SDs draws upon key factors that have been highlighted in the SDH literature ( Rolfe et al 2020 ; Braveman and Gottlieb 2014 ; Solar and Irwin 2010 ) but should be understood as merely illustrative of our broader argument. We recognise that a different range of SDs could be utilised, and also that social determinants of health are significantly co-constituted and mutually-reinforce one another (see the discussion of Solar and Irwin 2010 , pp.…”