Assessment of housing and health on thebasis of European indicators in Hungary

T. Málnási, A. Páldy, P. Rudnai

‘József Fodor’ National Centre for Public Health National Institute of Environmental Health

Fourth Ministerial Conference, Budapest, 2004

14. a), b), c) paragraphs of Declaration:

– The ministers understand that many environmental exposures occurring in the indoor and outdoor environment are linked to inadequate housing conditions,

– They are therefore committed to taking action to ensure that health and environmental dimensions are placed at the core of all housing policies and that healthy conditions are ensured and maintained in the existing housing stock.

Housing and health 10 recommendations:

– assess more carefully the health impact of the ongoing housingprogrammes and policies in countries

– data on housing and health should be made available to policy-makers and the general public

Exposure:

1. Crowding

2. Household hygiene

3. Mould / dampness

Effect:

1. Mortality due to household accidents / poisonings

2. CO poisoning (mortality, morbidity)

Indicators

Crowding

1. Objective:

– Living floor area/person: WHO EuroIndy

– Rate of persons living in crowded homes definition: >1 person / room (Eurostat)

a) % of people living in crowded conditions

b) ” among people living under poverty threshold

2. Subjective

Effects:increase of risk: mental diseases, stress, spread of infectious diseases, accidental injuries, dampness, mould

Living floor area per 1 person (m2) in some European countries

(WHO EuroIndy)

15

20

25

30

35

40

45

1996 1997 1998 1999 2000 2001

m2

Bulgaria Germany Hungary Lithuania Spain

Rate of persons living in crowded homes (> 1 person / room)(WHO LARES survey, 2003)

0

5

10

15

20

25

30

35

40

45

50

Angers Bonn Bratislava Budapest Ferreira Forli Geneva Vilnius

%

total surveyed population among persons indicated financial problems

Household hygiene

% of population living without suitable household hygienic circumstances:

a) without piped water in the home

b) without toilet with running water inside the home

c) without bathing facilities

Water and sanitation indicators acc. to settlement size, Hungary Census – Hungarian Central Statistical Office

0%

20%

40%

60%

80%

100%

Flats with pipedwater

Flats with flushtoilet

Flats connectedto sewage

system

Flats with homesewage

Flats withsemicomfort

Flats withoutcomfort

Temporaryaccommodation

<1000

1000-2999

3000-9999

10000-49999

>50000

Rate of homes with piped drinking water

Rate of homeswith flush toilets

Rate of homes with running cold water

Rate of homes without running water and toilet in the home

Mould

a) Rate of persons living in homes with mould problems

b) Rate of homes with mould problems

Possible health effects:

– Irritation of eyes and respiratory tract

– Frequency of infections of respiratory tract

– Frequency of chronic respiratory symptoms and diseases: bronchitis, allergy, asthma

Rate of homes with mould problems WHO LARES survey, 2003

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Angers Bonn Bratislava Budapest Ferreira Forli Geneva Vilnius

contaminated area < 0,1 m2 contaminated area >= 0,1 m2

Rate of persons living in homes with mould problems and rate of homes with mould problems

WHO LARES survey, 2003

0%

10%

20%

30%

40%

50%

60%

70%

Angers Bonn Bratislava Budapest Ferreira Forli Geneva Vilnius

dwellings affected persons affected

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Dorog

Tata

Cegléd

Tata

bány

aEge

rAjka Baja

Békés

csab

a

Gyula

Kazinc

barc

ika

Kecsk

emét

Misk

olc ÓzdPáp

a

Sajósz

entp

éter

Százh

alom

batta

Tisza

újvár

os

Hódm

ezőv

ásár

hely

Sajósz

entp

éter

Salgót

arján

Szeks

zárd

Szere

ncs

Zalaeg

ersz

egGyő

r

Siófok

Veszp

rém

Gyöng

yös

Solym

ár

Budap

est-R

ákos

palot

a

Budap

est-P

este

rzsé

bet

Somog

y meg

ye

Nógrá

d m

egye

Győr-M

oson

-Sop

ron

meg

ye

Hajdú-

Bihar m

egye

Bács-

Kiskun

meg

ye

Szabo

lcs-S

zatm

ár-B

ereg

meg

ye

Csong

rád

meg

ye

Heves

meg

ye

Rate of homes with mould problems according to Hungarian surveys among schoolchildren grade 3-4

1996-2002

OR of chronic bronchitis symptoms among 8-10 year old children and its association with mould in the flats adjusted

for age and sex

1,46 1,44

1,83 1,83

2,12

0

0,5

1

1,5

2

2,5

3

CESAR 6 város 3 város 6 megye Heves m.

Es

ély

há

ny

ad

os

(O

R)

od

ds

ra

tio

CESAR 6 cities 3 cities 6 counties Heves county

OR of asthmatic symptoms among 8-10 year old children and its association with mould in the flats adjusted for age and sex

1,44 1,46 1,49

1,92

1,37

1,92

0

0,5

1

1,5

2

2,5

3

CESAR 12 város 6 város 3 város 6 megye Heves m.

Es

ély

há

ny

ad

os

(O

R)

od

ds

ra

tio

CESAR 12 cities 6 cities 3 cities 6 counties Heves county

Number of hospital admissions due to acuteCO intoxication (ICD-10: T58) in Hungary

1997-2002

0

50

100

150

200

250

1997 1998 1999 2000 2001 2002

ho

spit

al a

dm

issi

on

s

male female total

Number of deaths due to acute CO intoxication (ICD-10: T58) in Hungary, 1996-2003

0

20

40

60

80

100

120

140

1996 1997 1998 1999 2000 2001 2002 2003

nu

mb

er o

f d

eath

s

male female total

Domestic accidents, poisoning in children

Annual mortality rate due to the external causes: domestic accidents and poisoning in children under 5 years of age(ICD-10: W00.0 – Y34.0)

ICD fourth digit: place of occurrence0: home (flat, house) and the immediate environment (e.g. garden, garage, swimming pool)

Mortality due to external causes of death in < 5 years old children in some European countries (ICD-10: W00–Y34)

(WHO EuroIndy)

0

5

10

15

20

25

30

1996 1997 1998 1999 2000 2001

nu

mb

er o

f d

eath

s /

100.

000

Bulgaria Czech Rep. Finland Hungary Lithuania Spain

Tasks for the future, possibilities of intervention

Education, information:– general population: prevention of injuries, accidents at

home, mould prevention– designers – decision makers

Legislation: maintenance of heating equipment (CO) – regulation for new buildings (design, construction)– (enforcement of) legislation and subsidies for

existing dwellings

Rehabilitation campaigns:e.g. rehabilitation of flats with unhealthy conditions

(insulation, heating etc.)