"Our Home Is a Muddy Structure": Perceptions of Housing and Health Risks Among Older Adults in Contrasting Neighborhoods in Ghana.

Aging occurs in a variety of social and physical environmental settings that affect health. However, despite their rapidly growing populations, public health research in sub-Saharan Africa has yet to address the role of residential environments in the health and well-being of older adults. In this study, we utilized an ethnographic research methodology to explore barriers and facilitators to health among older adults residing in two contrasting neighborhoods in Accra, Ghana. Our specific objective was to identify patterns of health risks among older adults in the two neighborhoods. Data were collected through qualitative interviews with a purposive sample of health workers ( = 5), community leaders ( = 2), and older adults residing in a slum and non-slum neighborhood ( = 30). Our thematic data analysis revealed that, despite different underlying drivers, health barriers across the slum and non-slum were largely similar. The harmful effects of these health barriers - poor built environments, housing precariousness, unsanitary living conditions, defective public services, and social incivilities - were mitigated by several facilitators to health, including affordable housing and social supports in the slum and better housing and appealing doors in the non-slum. Our study contributes to a more nuanced understanding of the ways in which aging and urban environments intersect to influence population health in resource poor settings. In particular, rather than the commonly referenced dichotomy of poor and non-poor settlements in discourses of neighborhood health, our findings point to convergence of health vulnerabilities that are broadly linked to urban poverty and governmental neglect of the elderly.