Housing And Health – The Problem Of Investigating A Cause-Effect Relationship

Housing in England circa 1960. Does poor housing cause poor health? Researchers dig in on this question.

Do housing conditions cause health conditions? In individual cases, the answer has proven (after many meetings with coroners) to be yes. There is Awaab Ishak, who died from exposure to mould in his home. Also Ella Kissi-Debrah, who died from exposure to vehicle emissions that blanketed her neighbourhood.

At the population level, after years of painstaking quantitative research, health outcomes have been linked to four specific aspects of housing:

• how much a home costs
• where a home is located
• home safety and quality and
• the likelihood of losing your home.

The research establishes an association between these aspects of housing and health, but not a direct cause and affect relationship.

It turns out that asking about cause is barking up the wrong tree. It’s not possible to establish a cause and effect relationship using quantitative research. As the article below explains, the accepted statistical methods for investigating a causal relationship depend on specific conditions being present. In the United States, the required specific conditions are not present often enough to decide whether a causal relationship exists.

A big part of the issue is the way that housing is distributed across neighbourhoods. The extent of housing segregation means it is impossible to make the comparisons necessary to undertake quantitative research about cause. To make comparisons, you need neighbourhoods where Black people and white people have the same characteristics (income, education, wealth). There are not enough neighbourhoods in the U.S. where the same characteristics occur for both races.

Although the cause road is closed, the authors discuss other research methods that are useful in changing the health outcomes of specific groups of people who show up consistently with higher levels of illness and premature death. Qualitative research, which uses interviews and focus groups to gather data, is given as one example.

This article is based on research in the United States. The discussion about when and why research to establish a causal relationship isn’t always possible or useful will be helpful to readers in other jurisdictions. Read more at Health Affairs: Residential Segregation And Health: History, Harms, And Next Steps