Housing and health in Dhaka city’s urban informal settlements: developing the health socio-environmental housing index

Abstract

Housing has been studied as an important social determinant of health for its influence in an individual’s physical and mental well-being. With the growing population in Dhaka city, many families are being forced to live in urban informal settlements in search of cheap and available housing. Characterized by inadequate basic services, informal settlements are a public health issue of concern as it increases the likelihood of individuals experiencing adverse health outcomes. A cross-sectional study was conducted across Dakshinkhan and Shyampur Informal settlements. With a systematic sampling approach 316 households were surveyed which resulted in health status information for 1219 individuals. Household information was collected for 16 dimensions of housing quality, and individual health information was collected for respiratory conditions, infectious diseases, and mental health disorders (only for female respondents above the age of 18, n=316). A composite index was created using principal component analysis and scores were normalized (0= inadequate housing, 1= adequate housing) to assess housing quality through the Healthy Socio-Environmental Housing Index (HSEH). Multiple logistic regressions were used to assess the association between the HSEH index and health. Findings suggest a significant association between housing and health status, with improving housing quality associated with better health outcomes. Multiple logistic regression resulted in significant relationship for (i)respiratory conditions (OR:0.16, CI: 0.07-0.37), (ii)infectious diseases (OR:0.18, CI: 0.05-0.55) and (iii)mental health disorders (OR: 0.28. CI: 0.07-1.10) with housing quality. Inadequacies in housing quality increase the likelihood for negative health outcomes, highlighting the importance of housing as a public health concern. For Dhaka city to equitably serve its residents, it needs to take immediate action to improve the standard of housing across the city through policy and interventions. The HSEH is useful in these policy discussions as an appropriate means of monitoring and evaluation, especially to recognize areas of priority by degree of inadequate quality across different informal settlements in the city.