Fuller T D, Edwards J N, Sermsri S, Vorakitphokatorn S
Virginia Polytechnic Institute and State University, Blacksburg 24061.
Soc Sci Med. 1993 Jun;36(11):1417-28. doi: 10.1016/0277-9536(93)90384-g.
The proposition that poor housing and congested living conditions have a detrimental impact on health has been promulgated for at least 150 years. At a minimum, two major causal mechanisms are thought to be involved in the relationship between crowding and physical health. First, high levels of household crowding can produce stress that leads to illness. Second, through shared physical proximity, household congestion contributes to the spread of communicable disease. The outcomes can be exacerbated by poor quality housing. A significant body of research, conducted primarily in affluent countries, has documented the detrimental effects of housing conditions on a variety of illnesses, including various contagious diseases. Poor housing has even been linked to high infant and adult mortality rates. The view that poor housing conditions and household crowding inevitably leads to poor health is challenged, however, by several observers, who question the role played by both crowding and housing quality. Most existing research has been conducted in affluent countries. Little is known, however, about the nature of these relationships within the context of less developed countries, where health status and housing quality are generally much poorer and where levels of household crowding are generally higher. Determination of the effects, if any, of housing quality--including household crowding--on physical health in developing countries is particularly important given the rapid growth of their urban populations and the difficulty of increasing the physical infrastructure fast enough to keep pace with this growth. This paper reports on an investigation of the impact of housing conditions and household crowding in the context of one developing country, Thailand. Using data from a representative sample of households in Bangkok (N = 2017), our results provide reason for some skepticism regarding the influence on housing on health, at least in its objective dimensions. While the skepticism of some is based on a reading of the evidence in Western countries, we likewise find that, in Bangkok, objective indicators of housing quality and household crowding are little related to health. We do find, however, that subjective aspects of housing and of crowding, especially housing satisfaction and a felt lack of privacy, have detrimental effects on health. Furthermore, psychological distress is shown to have a potent influence on the physical health of Bangkokians. Our analyses suggest that all three factors have independent effects on health outcomes bearing on both men and women.
住房条件差和居住环境拥挤对健康有不利影响这一观点已被提出至少150年了。至少有两种主要的因果机制被认为与拥挤和身体健康之间的关系有关。首先，家庭高度拥挤会产生导致疾病的压力。其次，通过身体上的近距离接触，家庭拥挤会导致传染病的传播。住房质量差会使这些后果更加严重。主要在富裕国家进行的大量研究记录了住房条件对包括各种传染病在内的多种疾病的不利影响。住房条件差甚至与婴儿和成人的高死亡率有关。然而，一些观察家对住房条件差和家庭拥挤必然导致健康状况不佳的观点提出了质疑，他们对拥挤和住房质量所起的作用表示怀疑。大多数现有研究是在富裕国家进行的。然而，对于欠发达国家的这种关系的本质我们知之甚少，在这些国家，健康状况和住房质量通常要差得多，家庭拥挤程度通常也更高。鉴于发展中国家城市人口的快速增长以及难以足够快地增加物质基础设施以跟上这种增长，确定住房质量（包括家庭拥挤）对发展中国家身体健康的影响（如果有影响的话）尤为重要。本文报告了对一个发展中国家泰国的住房条件和家庭拥挤影响的调查。利用曼谷家庭的代表性样本（N = 2017）的数据，我们的结果为至少在客观层面上对住房对健康的影响持一些怀疑态度提供了理由。虽然一些人的怀疑是基于对西方国家证据的解读，但我们同样发现，在曼谷，住房质量和家庭拥挤的客观指标与健康几乎没有关系。然而，我们确实发现，住房和拥挤的主观方面，特别是住房满意度和感觉缺乏隐私，对健康有不利影响。此外，心理困扰对曼谷人的身体健康有很大影响。我们的分析表明，这三个因素对男性和女性的健康结果都有独立影响。
