摘要：Objectives. The World Health Organization’s Regional Office for Europe has undertaken a large study to evaluate housing and health in 7 European cities. Methods. Survey tools were used to obtain information about housing and living conditions, health perception, and health status from a representative sample of the population in each city. Results. In Forli, Italy, the first city studied, preliminary findings indicate some important potential links between housing and health. Conclusions. These findings, when combined with those from the remaining European cities, will likely generate concrete recommendations for the allocation of resources to programs that can improve housing and health. Environmental living conditions, including housing conditions, are among the primary determinants of an individual’s health and have attracted the interest of public health scientists since ancient times. 1– 3 There is a substantial body of evidence on the health impacts of specific substances found in the housing environment, 4– 6 including asbestos, radon, lead, molds, and volatile organic chemicals (VOCs). 7– 12 Housing conditions such as air pollution levels and condensation may contribute to seasonal fluctuations in cardiovascular and respiratory mortality. 13, 14 The home is where accidents frequently occur. In the European Union, more than half of the 20 million home and leisure-related accidents that occur each year take place in or around the home. 15 There is less documentation about the relationships among housing conditions, lifestyles, and health. Recent research has focused on specific individual risk factors and housing elements, 4 whereas the link between housing and psychosocial and mental health issues has been relatively neglected. 16 Few reports exist about the “global” housing conditions of the European population. 17 In both the western and eastern parts of the European Region of the World Health Organization, social, political, and economic changes have affected housing environments and their impacts on health. For example, the quality of outdoor air and drinking water has improved in many big cities, but noise has worsened all over the continent. 18– 20 In Western Europe, many countries are undergoing fast decentralization, and local authorities have been given more responsibility for housing as a result. Many countries have a large stock of 25- to 30-year-old housing from the postwar reconstruction era that is now showing signs of age. New lifestyles, including a heavy reliance on automobiles, are emerging, and a large proportion of the European population lives in cities lacking the infrastructure required by these lifestyles. The new political and economic situations that have emerged in Central and Eastern Europe since the fall of the Berlin Wall have created dramatically new housing situations. The percentage of homeowners has increased to more than 95% in some countries. 21 An emerging affluent middle class and a large population living close to or below the poverty level have led to a new stratification of cities. An unprecedented energy crisis, a near-total absence of regulation for condominium management, and the absence of a tradition for maintaining private and commonly shared properties—which were previously maintained by a state organization—have led to (1) a new distribution of housing conditions (e.g., an increased number of bad houses and an emerging new stock of high-luxury houses), (2) an accelerated deterioration of the housing stock, and (3) dramatic changes in the urban landscape. 22, 23 Aware of these trends, the World Health Organization’s (WHO) Regional Office for Europe embarked on a study to review and, when needed, enlarge the body of evidence regarding the relationship between housing conditions and health. An informal working group was convened to discuss the health effects that could be influenced by housing conditions and to identify any confounding factors that could mask these effects during a study. 24 This group provided recommendations on which factors in a housing complex should be surveyed. The group also recommended how those factors should be measured to draw conclusions about possible cause–effect relationships. A symposium took place in Bonn, Germany, to validate the study. 25 Our study started with a pilot project during the winter of 2000 in selected neighborhoods in Schwedt-Oder, Germany; Vilnius, Lithuania; and Bratislava, Slovakia, containing dwellings made of pre-fabricated blocks. The pilot project focused on a housing type that was deemed likely to provide the most inadequate housing conditions. It identified major gaps in the survey tools that were developed for analyzing both housing conditions and health conditions of the inhabitants. The project helped local authorities throughout Europe to identify the qualitative housing needs of their citizens. The results of the pilot project informed the development of the current study.
