hartig

Journal of Social Issues, Vol. 59, No. 3, 2003, pp. 455--473

Introduction: The Residential Context of Health

Terry Hartig∗Uppsala University

Roderick J. LawrenceUniversity of Geneva

Our understanding of the relationship between housing and health will improvewith closer attention to the characteristics of residents, their activities in relationto their housing, and social ecological factors that set the boundaries for thoseactivities. To highlight these aspects of the subject area, we propose recharacter-izing the housing and health field as one of inquiry into the residential context ofhealth. In introducing this issue of the journal, we first elaborate on this proposalin conceptual and practical terms. We then overview the individual articles, eachof which helps us develop a more nuanced view of the subject area. Finally, wecomment on two themes running through multiple articles—stress and coping, andsocial ecological influences on residence.

Housing should provide shelter, and, by definition, shelter should reduceour exposure to harmful environmental conditions and our vulnerability to other

∗Correspondence concerning this article should be addressed to Terry Hartig, Institute forHousing and Urban Research, Uppsala University, Box 785, S-80129 Gavle, Sweden [e-mail:[email protected]].

This issue consists of papers presented at a workshop on “The residential context of health,”held during the European Network for Housing Research (ENHR) conference in Gavle, Sweden, June26−30, 2000. The workshop was the inaugural event of the ENHR Working Group on Housing andHealth and was cosponsored by the Environmental Design Research Association and the InternationalAssociation for People-Environment Studies. We gratefully acknowledge the financial support for theworkshop provided by the Swedish Building Research Council, the Swedish Council for Researchin the Humanities and Social Sciences, and the Swedish Council for Social Research. We thank thecontributing authors for their cooperation and hard work, and we thank the other workshop participantsand the reviewers for their constructive comments. We also thank Irene Hanson Frieze for helping usto bring these articles together in a form suited to the readers of this journal. Finally, we dedicate thisissue to the memory of Lyn Harrison, who was a Senior Lecturer in Health Policy at the University ofBristol. Lyn died of cancer on March 6, 2001. She brought warmth, humor, enthusiasm, and constructivecriticisms to the workshop.

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C© 2003 The Society for the Psychological Study of Social Issues

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people. It follows that a persistent lack of housing will ordinarily have negativeimplications for health. In rich countries as in poor countries, homelessness trans-lates into health problems among adults (e.g., Hwang, 2001; Matte & Jacobs,2000), children (e.g., Waldron, Tobin, & McQuaid, 2001), and newborns (e.g.,Stein, Lu, & Gelberg, 2000). Consequently, many view homelessness as an im-portant public health challenge (Breakey, 1997) and its eradication an importantgoal (cf. Shinn & Weitzman, 1990; United Nations, 1996).

The relevance of housing for health, however, goes far beyond simply havingor not having housing. To begin with, housing varies in how well it shelters itsoccupants and in the degree to which it presents risks to them. Motivated by suchconcerns, research has for many years sought to estimate associations betweenphysical features of housing and diverse health outcomes (for reviews, see, e.g.,Burridge & Ormandy, 1993; Fuller-Thomson, Hulchanski, & Hwang, 2000; Kasl,1977). However, when confronted with weak research designs, problems in mea-surement, flawed strategies for statistical analysis, and inconsistent results, review-ers have emphasized that much of the evidence does not support firm conclusions.

The challenges in drawing conclusions about relations between housing fea-tures and health indicators multiply when we ask about the psychological andsocial processes that may mediate those relations and the personal and environ-mental factors that may moderate them. Interpreting health in relation to housingbecomes still more complicated when we draw in yet other matters such as con-straints on access to satisfactory housing arrangements due to poor health, themodification of housing for reasons related to health, and the provision of domi-ciliary health care. However, if we do not attend to what people do in, around,to, and for their housing; the psychological and social processes involved therein;or the factors that condition their activities in relation to their housing, then werisk further difficulties in drawing conclusions about the relevance of housing forhealth and in developing policies and interventions.

The present issue provides a broad and yet in many ways nuanced view of theresearch area conventionally referred to as housing and health. In introducing theissue here, we first elaborate on the relationship between housing and health. Wedo so in two ways, one more conceptually oriented and the other more practicallyoriented. First, toward a more accurate characterization of the research area, wework from a distinction between “housing” and “residence” to the notion of a res-idential context of health. Second, toward developing a coherent view of means toserve health through the residential context, we comment on the utility and struc-ture of a taxonomy of tried and potential practical measures. In these elaborations,we assume a view of health as a condition of physical, psychological, and socialwell-being subject to multiple influences on multiple levels.

In the subsequent two sections we overview the articles in this issue and wehighlight some major themes that run through them. In examining some of theintricacies of the relations between housing and health, the articles identify and

The Residential Context of Health 457

address various limitations of earlier work on housing and health. They also presentconcepts, methods, and findings that will help in clarifying problems for study,developing and testing theories, and designing practical measures.

Elaborations on Health in Relation to Housing

Housing, Residence, and the Residential Context of Health

Definitions of “housing” refer to shelter or lodging, in the singular or as a col-lection, and to the act of providing shelter or lodging. In contrast, while “residence”ordinarily refers to the place, especially the housing, where a person or householdresides, it also carries other meanings. Residence also refers to the fact of residing ina place, to the act of residing in a place, and to the time during which a person residesin a place (e.g., Flexner et al., 1987; Merriam-Webster’s Collegiate Dictionary,1983; Oxford English Dictionary Online, 2002). Although used in distinct ways,these four common meanings of residence indicate inseparable aspects; we canview residence as an integrated whole that involves people, place, activity, and time.

Consider what the different aspects of residence, taken together, imply forresearch guided by simple causal models in which housing characteristics directlydetermine health outcomes. Putative causes—structural features, characteristics ofthe indoor environment, and so forth—help constitute but one aspect of residence atthe level of the housing unit. Describing any one of them as a determinant of healthinvolves assuming that a person does in fact reside there, a necessary condition forexposure. That assumption of itself does not differ from the assumption implicitin references to housing effects on health, namely, the health in question is thatof a person housed. But explicit reference to the act of residing makes a crucialdifference. The person uses the housing as a residence, as manifest in distinctiveactivities, cognitions, and emotions that recur, continue, or develop over the periodof residence. The acts of residence go far beyond a person simply placing himselfor herself within the housing, thereby allowing for exposure to a possible causeof ill health. In addition, they shape the conditions for exposure and provide thevehicle for the mediating processes implied by simple causal models.

Alone or together, different people act within and upon their housing in dif-ferent ways, with more or less ease, for varying purposes, with varying frequency,for varying amounts of time (e.g., Robinson & Godbey, 1997). To exemplify howthis might affect the association between a housing feature and a negative healthoutcome, we can mention two cases in which residents create harmful ambientconditions as they fulfill domestic roles and perform habitual behaviors (i.e., foodpreparation, smoking). First, women in poor countries suffer more from respira-tory illnesses when they spend much of the day cooking over smoky fires fueled bywood or animal dung (e.g., Smith, 2000). Second, children whose parents smokein the home have an increased risk of developing asthma (e.g., Redd, 2002). In


both cases, the strength of an association between respiratory illness and housingquality (in terms of ventilation and indoor air quality) depends on activities per-formed in the residence, identified respectively through reference to the resident’sdomestic role and the status of a parent as a smoker or nonsmoker.

These two cases involve physical features of the housing and the physicalby-products of mundane acts of residence performed indoors by different peo-ple. Other acts of residence have prominent psychological and social functions,concomitants, and consequences. Such acts carry other processes through whichhealth may become linked to housing. People may express their identities throughthe size, style, and quality of their housing, the furnishings inside it, the display ofphotographs and mementos, and so forth. In doing so, they represent themselves toothers as well as to themselves (e.g., Cooper Marcus, 1995). People may use theirhousing to control interactions with people outside of the household, and to shieldfrom outside view some of the activities that they perform alone or with otherhousehold members. Housing thus aids in regulating privacy (see Altman, 1975;Lawrence, 1987). While performing day-to-day chores, spending time with others,traveling to and from housing, seeking better housing, or struggling to hold ontothe housing they have, people commonly attribute emotional and social meaningsto their housing. In attributing meanings such as control, refuge, connectedness,continuity, and security to their housing, residents create a sense of “home” (e.g.,Despres, 1991; Dovey, 1985; Lawrence, 1987; Tognoli, 1987). In performing suchacts of residence, people use or enhance their housing as a resource for meetingthe adaptational demands of everyday life. Conversely, increased psychologicaland social vulnerability may follow from an impaired ability to perform such acts.

In that residence is not necessarily confined to a particular housing unit, butrefers as well to “place,” the term invites us to examine the situation of hous-ing within its surroundings. Seen in this way, the fact of residence encompasseslocational attributes of the housing and physical and social attributes of its sur-roundings. Acts of residence may thus reflect influences of the surroundings. Forexample, socially and aesthetically pleasing surroundings may draw residents out-doors (cf. Kuo, Sullivan, Coley, & Brunson, 1998), thereby reducing the time theyspend in their housing while at the same time possibly strengthening their sense ofattachment to it, even if it has poor physical quality (cf. Fried, 1963). Conversely,heavy car traffic in the neighborhood may reduce residents’ reliance on their hous-ing as an aid to emotion regulation, leading them to spend more of their leisuretime away from the residence (Fuhrer, Kaiser, & Hartig, 1993). For people withmobility constraints, heavy car traffic in the neighborhood may hinder neighbor-ing and increase a sense of isolation within the residence (cf. Appleyard, 1981).As this last example suggests, how the surroundings figure in processes throughwhich health becomes associated with housing will depend to some extent on thecharacteristics, roles, and habits of the resident(s) as well as the nature of the healthindicator in question.


We have so far characterized residence and distinguished it from housing byconsidering the meanings of the words as commonly used. We can also distinguishresidence in another way, drawing on the material evidence that stands around us.Consider the diversity of housing forms that have appeared around the world overthe millennia. That diversity speaks of the many ways that people have foundto combine available technology, materials, and housing sites in building sheltersuited to the local climatic conditions and environmental hazards. That diversityin housing forms also tells us about the ways in which different kinds of people indifferent times and cultures have organized and conducted their social, economic,ritual, family, leisure, consumptive, and hygienic activities in and around theirhousing (e.g., Lawrence, 1987; Mazumdar & Mazumdar, 1997; Rapoport, 1969).Housing as a material entity, then, prompts questions not only about how well theoccupants are sheltered from environmental exposures and hazards, but also abouttheir personal characteristics, their numbers, what they do in and around theirhousing, with whom, why they do it there and not elsewhere, what their housingmeans to them, and so on.

In sum, the concept of residence more explicitly places the resident(s), fact(or facts) of residence, acts of residence, and period of residence together in aframework with housing than does the term “housing” alone. Furthermore, theconcept of residence as we have articulated it here more explicitly includes theimmediate surroundings of the housing, and so the boundary between them, in-clusive of their respective psychological and social as well as physical aspects.Accordingly, we see value in recharacterizing the field of research as inquiry intothe residential context of health. With the notion of a residential context of healthwe encompass three sets of variables relevant to the health of individuals, in ad-dition to physical housing variables. The first set includes variables that reflecton the biological, psychological, and social processes that join health with thehousing and its surroundings within the course of a person’s residential activities(Lawrence, 2002). The second set includes the characteristics of the individualresident, coresidents, the household, and the immediate social and physical sur-roundings that modify those processes. Finally, in the spirit of Lewin’s (1951)psychological ecology, we include indicators of the factors that shape the bound-aries for residents’ actions within, around, or (as with efforts to change residence)directed at their housing (e.g., racial discrimination, economic change, housing pol-icy). Social, economic, technological, or otherwise, these factors operate above thehousehold level and beyond the immediate influence and awareness of individualresidents.

Before closing this discussion of residence and the residential context ofhealth, we should note how the problem area we have just sketched overlapswith two other fields of inquiry. First, how people assign meaning and becomeemotionally attached to their housing figures in studies of “home” and “dwelling”by phenomenologists, anthropologists, environmental psychologists, and others


(e.g., chapters in the volume edited by Altman & Werner, 1985; also Kaiser &Fuhrer, 1996; Lawrence, 1987). Like “residence,” both “home” and “dwelling”can encompass not only the housing unit and people acting within it, but also thesurroundings of the housing. Although we acknowledge the relevance of studies ofhome and dwelling and the potential for substituting terms, we refer to residencehere to mark our concern for phenomena related to health that those terms maynot cover. Those phenomena include health risks and benefits of out-of-awarenessfeatures of the housing unit and its surroundings, physical aspects of housing-based activities that might affect health without mediation by psychological orsocial processes, and the operation of extra-individual factors on the boundariesfor residential activities.

Second, research on the residential context of health overlaps with researchon health and place, which takes interest in, among other things, “variation in therates of illness across places” and “variation in illness across people as a functionof the places in which they live” (Catalano & Pickett, 2000, p. 65). Three factsseem salient to us in this regard. First, the fact of residence ordinarily provides thelink between individuals and places defined without specific reference to housing(e.g., census tracts). Second, housing commonly has a physically, psychologically,and socially permeable boundary with its surroundings. For example, air qualitywithin buildings will vary with outdoor air quality (e.g., Chaloulakou & Mavroidis,2002), just as air quality in an area can decline as the cumulative result of residen-tial activities, as when residents use wood fires for heating or cooking (e.g., Smith,2002). Third, in line with the function of housing as shelter, some features of hous-ing only gain relevance for health in relation to exterior conditions. For example,windows designed to provide protection from noise may yield little health benefitin areas with little automobile or aircraft traffic. These facts imply the value, andperhaps necessity, of exchange between the two research areas. Rather than takethat exchange further, here we simply want to note a feature of research on theresidential context of health that distinguishes it from research on health and place:a central and abiding concern for housing.

Toward a Coherent View of Health Measures Directed at the Residential Context

In sketching the field of interest, we have worked with a conception of healthfounded on three basic assumptions. First, health has psychological and social aswell as physical aspects. Second, we should define health in positive terms, notmerely as the absence of symptoms of disease and infirmity (cf. World HealthOrganization, 1946). Third, as with many forms of illness, health has multiple de-terminants, including characteristics of the person (e.g., genetics, locus of control,sense of coherence), his or her behaviors (e.g., diet, exercise, sleep), and featuresof the sociophysical environment, considered on multiple levels (e.g., housing


quality, presence of hazards, social support, distribution of income in the society;e.g., Lawrence, 1993; Lawrence, 2002; Stokols, 1992).

Such a conception of health has gained acceptance over the past decades inpart because of historical successes with public health measures directed at the res-idential context. In particular, systems for the delivery of clean water and removalof sewage have had a tremendous impact on morbidity and mortality from infec-tious disease, even when implemented without accurate knowledge of the diseasesin question (Catalano, 1979; Rosen, 1958/1993). In modern times, such sanitarymeasures have contributed to a major shift in the health challenges of Westernsocieties. The leading causes of premature adult death are now noncommunicablediseases with multiple causes that may operate over long periods (Beaglehole &Bonita, 1997) rather than infectious diseases due to specific exposures.

This epidemiologic transition implies a reduced potential for further loweringthe incidence of specific illnesses through interventions that target disease vectorsin the residential environment. However, this does not in turn imply that the resi-dential context has diminished importance for the pursuit of health goals. Given itscentrality to people in their daily lives, the residential environment can continueto provide an effective locus for a variety of measures that serve health. Sanitarymeasures still have preventive value; we will still need them to hold down theincidence of those diseases they address. Sources of morbidity and mortality thatassumed greater salience with the epidemiologic transition also may present tar-gets for actions directed at the residential context. Further, a conception of healththat specifies physical, mental, and social well-being encourages us to considermeasures that can increase the adaptive and life-enhancing resources available topeople in their residential environment (e.g., Bistrup, 1991; Stokols, 1992).

Taxonomic efforts can help us achieve a coherent view of present and poten-tial measures that serve health through action directed at the residential context.A taxonomy could yield practical benefits, notably in the coordination of mea-sures. Governmental authorities at different levels (e.g., municipal, county, state,national, international) have put into place or lent political if not economic sup-port to policies and programs that serve to prevent illness and promote healththrough actions within or directed at the residential context. These measures re-flect varying degrees of cooperation among authorities at different levels and withdifferent responsibilities. They also reflect varying degrees of cooperation amonginterested parties, such as governmental authorities, professional groups, researchinstitutions, and nongovernmental organizations. The measures themselves con-cern widely differing aspects of the residential context, including but not limitedto distinct physical features of housing (e.g., ventilation, electrical wiring, plumb-ing, materials, staircases), the location of housing in relation to landscape fea-tures (e.g., shorelines, earthquake fault zones, flood plains) and other land uses(e.g., industrial sites, public parks), the operations of facilities that impact on resi-dences (e.g., as with airports and major transportation corridors), supports for social


contact and crime prevention (e.g., surveillance), and access to housing (e.g., aswith low-interest loans, public housing, and the sweat-equity approach of Habitatfor Humanity). Clearly, then, we can identify many measures to include in a tax-onomy, with widely varying character not only in terms of the relevant feature ofhousing but also of the health variables targeted and the biological, psychological,and/or social processes assumed to be involved (see, e.g., subject index entriesrelated to health and public health in van Vliet, 1998).

Although a detailed taxonomy is far beyond the scope of this introduction, wecan at least offer some preliminary ideas on how to structure one. In making thesesuggestions, we start from the conceptions of health and its residential context thatwe presented above. Following the example of Catalano and Pickett (2000), wewould base a taxonomy on a series of questions that begins with the health target ofinterest. Here, however, it seems necessary to first ask whether the measure is meantto prevent or mitigate ill health or to promote sound health, and to then ask whetherthe health target has a primarily physical, psychological, or social character. Athird question would then concern that aspect of the residential context in whichthe measure operates. This involves not only the housing and its surroundings,but also sometimes less tangible issues of access. Finally, we see a potential fordistinguishing the measures on the basis of whether they have some physicalexpression (e.g., in the design or construction of the housing) or exist only as someform of policy or regulation.

Consider some examples of where we might come by working through thesequestions. To prevent respiratory illness through the physical housing, we havehousing standards that prescribe minimum requirements for ventilation and build-ing materials (Burridge & Ormandy, 1993). To promote physical and perhapspsychological health through physical measures directed at the surroundings, wehave planning measures that prescribe desirable conditions in residential neighbor-hoods with respect to, for example, air pollution, noise, and proximity of outdoorrecreation facilities to the housing (Barton & Tsourou, 2000). To mitigate theill effects of physical disability, there are a variety of design measures that canease movement within the house and otherwise improve access to functions (e.g.,Preiser & Ostroff, 2001). Programs for low-interest loans may promote psycho-logical and social health for some people of low income by making it easier forthem to access home ownership.

The utility of such a taxonomy for the coordination of measures and for schol-arly inquiry would increase with the provision of the following supplementary in-formation: evidence of effectiveness in terms of the health target, the governmentalauthorities or actors responsible for implementing the measure in the given country(e.g., municipal housing authority), and the presumed or known process (biologi-cal, psychological, social) through which the measure has its effect. Conceivably,we can place some measures in more than one of the cells of the taxonomy, as theymay operate through multiple processes to affect different types of health targets.


In the case of an empty cell in the taxonomy, we can ask whether it represents aproven dead end or a potential for some new measure. In cases where the processpresumed by a measure does not take residential activities into account, we seeroom for inquiry on the validity of that assumption.

Like our conceptual characterization, this discussion of practical measuresspeaks to the broad scope of the residential context of health and the multi-disciplinary character of inquiry into its workings. As exemplified in this issue,environmental psychologists, geographers, sociologists, design professionals, epi-demiologists, and others have joined in elaborating causal models and discussingways to serve health through actions directed at the residential context. The ar-ticles we will now summarize illustrate the range of topics encompassed by thefield.

Organization and Contents of the Issue

We have organized the articles in this issue into four groups according to adefining feature or important shared concerns. Admittedly, we could have usedother groupings. Certainly, some important themes run through articles that wehave separated here into different groups. After reviewing the articles group bygroup in this section, we will comment on two of these themes.

Expanding the Scope of Outcomes and Processes: Mental Healthin Relation to Housing

Although a quick review of the extant literature reveals a heavy emphasison compromised physical health due to housing, some researchers have also con-sidered relations between aspects of residence and poor mental health. Evans,Wells, and Moch (this issue) review studies about the relations between housingcharacteristics and a variety of manifestations of poor mental health, such as de-pression and alienation among adults and behavioral problems among children.They focus on three housing variables: housing type, the floor level in multistorybuildings, and general physical housing quality. In the process, they indicate re-current methodological problems in housing–health research, such as difficultieswith the measurement of housing quality and the self-selection of less healthy peo-ple into lower quality housing. Also, they raise questions about the psychologicalmechanisms at work in relations between housing and mental health. They con-solidate these points in outlining a theoretical framework that includes moderatingvariables and psychosocial mediating processes. Important variables that mightamplify or attenuate the impacts of housing on mental health include gender, age,and neighborhood characteristics such as socioeconomic status. The mediatingprocesses that they discuss involve identity and self-esteem, security, social sup-port, control, and parenting. Although they can identify various methodological


and conceptual shortcomings in many of the studies they review, they do judgethe research sufficient to support the conclusion that housing does matter forpsychological health, particularly for low-income families with young children.They also raise a warning flag regarding residence in high-rise, multifamily hous-ing by families with preschool-age children.

Owning Versus Renting—Health and Housing Tenure

The next two articles call attention to the character of the relationship be-tween residents and housing as implied by the form of housing tenure. In botharticles, the authors consider the health implications of owning versus renting, inthe process raising issues of control, coping, and stress. Both articles contributehelpful insights on the extant literature on housing tenure as a predictor of healthoutcomes; however, the material used and the insights provided in the two articlesdiffer in important ways.

In their article, Smith, Easterlow, Munro, and Turner (this issue) look at someof the ways in which change in housing tenure and change in health status gotogether. Their examination fits with an effort to reconcile two perspectives onthe housing–health relationship, one that emphasizes the effects of housing onhealth and another that emphasizes self-selection of unhealthy people into poorhousing. Their integration of the perspectives builds on the concept of health cap-ital. Constituted within a network of health resources, health capital is a “storeof resilience” that may be enhanced or diminished, thus shaping a person’s sus-ceptibility to ill health and resilience from disease. In considering housing as afeature of this health resources network, the authors call attention to the possi-bility that as a person’s health changes, the health resource value of that person’shousing may also change. Through qualitative analysis of interviews with En-glish and Scottish people with health problems, they identify difficulties that arisewhen changing health requires extra efforts to hold onto or obtain housing thathas a positive health resource value in relation to current health. Smith and col-leagues also illustrate some of the ways in which change in social welfare policyand practices within the housing market might operate on the health resourcevalue of a person’s housing or on a person’s ability to maintain or achieve a par-ticular form of housing tenure, such as owner occupation. In the process, theychallenge the notion of home ownership as an unalloyed good, a notion oftenimplicit in work that has uncovered an association between housing tenure andhealth.

In the next article, Hiscock, Macintyre, Kearns, and Ellaway (this issue) startfrom reports that people who own their homes do tend to show better healthand live longer than private renters or people who rent their housing through asubsidized housing program. In longitudinal as well as cross-sectional studiescarried out in several European countries, home ownership appears salutary in


comparison to renting with respect to outcomes as diverse as mortality, doctorvisits, suicide, and cancers. Hiscock and colleagues group explanations for thisgeneral finding under two perspectives. From an epidemiological perspective,housing tenure stands as a useful proxy for socioeconomic, demographic, andpsychological characteristics of individuals and households. From a housing per-spective, tenure represents the characteristics of the housing and the surroundingarea, and perhaps the various meanings that owning versus renting one’s housingholds for an occupant. Analyzing survey data from a large sample of Scottishadults, the authors found that the home owners in their sample reported betterphysical and mental health than the social renters. They also uncovered bivariateassociations between housing tenure and a range of demographic, socioeconomic,psychological, and housing variables. Finally, they used multivariate analyses toaddress the issue of which of the variables studied would help more in under-standing the relationship between housing tenure and their health measures. Age,income, and self-esteem appeared most potent in this regard. Area conditionsdid more to account for relations between tenure and health across the healthmeasures than did housing conditions; however, housing conditions and the pro-tection meaning of home helped account for variation in anxiety and depression,respectively.

Residence, Poverty, and Health

Interest in the association between housing tenure and health commonly startsfrom a concern for socioeconomic status (SES) inequalities and health. In the nexttwo articles, SES inequalities as expressed through housing opportunities come intothe forefront. Both articles bear on how people of few economic means struggle tosecure good housing; however, they focus on quite different strategies for securinghousing.

In opening her article, Ahrentzen (this issue) paints a bleak backdrop: de-clining availability of low-income apartments, an increasing number of house-holds spending more than 50% of income on rent, and popular media reports ofhouseholds “doubling up” or sharing housing, purportedly with negative healthconsequences. Against this backdrop, she asks whether existing evidence actuallyshows that homesharing has deleterious consequences. Questioning the media in-terpretations of crowding research behind the belief in adverse effects, Ahrentzenseeks “a more productive line of discussion” (p. 548). She sketches some of thereasons why people homeshare, and in doing so, she debunks a view of doublingup as a desperate last measure to avoid homelessness. The subsequent speculativereview considers four categories of health-related consequences of homesharing:physical (asthma, nutrition, self-reported health, injury from domestic violence),psychological (distress, stigmatization), social (relationships, parenting), and eco-nomic (ability to pay rent, better quality housing, exchange of services between


housemates). Continuing, she examines the social and physical environmentalconditions that may support or undermine residents’ health in shared housingarrangements. Entering here are issues of control, territoriality, privacy, and themanagement of social relations; conflict versus communality in expectations,goals, and practices; and space and spatial layout in the housing unit. Concluding,she reminds us to view issues of physical housing quality in light of poor house-holds’ concerns about affordability, neighborhood quality, and safety, and to askwhether and when homesharing constitutes adaptive coping.

Saegert and Evans (this issue) focus on how residence becomes an expres-sion of SES, commonly in conjunction with racial or ethnic status. They introducethe concept of housing niche, an ecological metaphor that captures the sense ofselective processes at work in shaping—and perpetuating—group-environmentconstellations. They elaborate their housing niche model by first describing theeconomic and social sorting mechanisms that operate on multiple levels to joinparticular groups of people with particular types of residences. These they con-sider not only in terms of housing quality, but also in terms of neighborhood andcommunity characteristics, including racial composition, social integration, andthe availability of social capital. In a second step, they consider how those sortedinto niches of disadvantage can come to show worse health. In this they iden-tify various pathways (harmful exposures, the psychosocial dynamics of racism,lack of environmental amenities, low perceived control), and they emphasize thecumulation of risks on multiple levels. Finally, they look at what residence in apoverty niche means for the accumulation of those resources important for thesuccess of children later in life, and so offer an explanation for how poor resi-dential options and poor health together become perpetuated across generations.Turning to the public policy implications of their model, they identify the so-cial and economic processes that shape housing niches as fundamental causes ofill health, and they use the case of the Moving to Opportunities program in theUnited States to illustrate how institutions can yield health benefits by helpinghouseholds overcome housing segregation and move out of areas of concentratedpoverty.

Residential Activities, Stress, and Health

The last two articles focus more specifically on what people do in their homes,when, where, and with whom. Both articles consider the residence as a setting foractivities that involve particular people in particular roles. Also, the two articlesshare a practical concern for health and other impacts on household members ifactivities now typically situated outside the residence transfer into it as a result ofpolitical, technological, economic, and other developments in the society. Focusingon health care and paid work, respectively, as examples of activities transferringback to the home, the two articles illustrate how change in the society can shape


relations between residence and health via effects on activities, responsibilities,and workload.

Michelson and Tepperman (this issue) present a detailed picture of unpaidhealth care in the home. Change in health care policies in Canada and other coun-tries has resulted in the transfer of some health care activities back to the home.As a household assumes the burden of caregiving, several problems may arise,including an excessive total workload for the (usually female) caregiver, conflictsbetween the caregiver’s work and family responsibilities, and adverse impacts onher (or his) mental and physical health. The authors advocate the application oftime-use methods for studying such problems, as they enable investigators not onlyto determine who delivers care, when, where, and for how long, but also to isolategroups for study on the basis of the time spent giving care to an adult during agiven day. Michelson and Tepperman demonstrate the utility of time-use methodswith data from a large Canadian population survey, with which they documentgender and age characteristics of care receivers and caregivers, the relationshipbetween them, the caregivers’ paid employment outside the home, the amount anddistribution of time given over to caregiving, and so forth. Also, they describebehavioral and subjective aspects of adult caregiving, such as the similarity be-tween caregivers and noncaregivers in self-reported happiness and life satisfactiondespite the caregivers’ greater self-reported stress and time pressure. Finally, theymention possible changes in housing needs related to caregiving at home, andthe limitations of available time-use data sets for addressing questions about theconsequences of changing health care policies.

In their article, Hartig, Johansson, and Kylin (this issue) consider how resi-dence relates to health through stress, coping, and restoration. They start from asocial ecological model grounded on three assumptions: that people cycle throughstress and restoration processes; that stress–restoration cycles are regulated byactivity cycles (which incorporate multiple settings and so movements across set-tings); and that social, economic, technological and other factors above the levelof households influence their activity cycles and the settings within them. Theyview the residence as a crucial setting in this social ecology of stress and restora-tion. This owes to the residential location’s significance for stressor exposures,the concentration of coping resources in the residence, the status of the residenceas a primary setting for restoration, and the spatial and temporal location of theresidence relative to the other major settings organized in activity cycles. In thislast regard, they note that households ordinarily have more possibilities for ex-ercising control in locating the residence relative to other settings than they doin locating those other settings at convenient distances from the home. Hartiget al. go on to consider what developments in information and communicationstechnologies mean for the distribution of women’s and men’s work across resi-dential and other settings. In particular, by teleworking from home, people mayseek to reduce stress they attribute to commuting, but they may undermine the


home’s restorative functions by blurring the boundary between work and nonworklife.

Closing Comments on Housing Policy and Health

In each of the preceding articles the authors comment on possible practicalimplications of their work, touching variously on environmental design, urbanplanning, housing policy, other areas of social welfare policy, and the organizationof working life. These diverse commentaries provide the point of departure for aconcluding commentary by Catalano and Kessell (this issue). After noting the valueof the reported research for understanding relations between residence and health,as well as for interventions based on the improved understanding, they assertthat “none of the recommended actions, whenever implemented, will eliminatethe contribution of housing to the positive association between socioeconomicstatus and health” (p. 638). Their assertion reflects an appreciation of constraintsthat taxpayers impose on their elected officials. Although Catalano and Kessellexpect gradual improvement in the average quality of housing available to manypopulations, and with it improvement in the health of those populations, they do notexpect the quality of housing to become uniform. Rather, they suggest, we shouldexpect substantial variation around a gradually rising level of average housingquality. Assuming, then, that we will continue to find people with more economicmeans either locating into housing of increasingly better quality or upgradingtheir existing housing, they argue that a standard of policy relevance for researchon housing and health should not be whether it helps eliminate differences inhealth between rich and poor, but whether it “helps us sustain or accelerate theimprovement in health enjoyed across the income strata over at least the lastcentury” (p. 647).

Major Themes

Of the themes that run through several articles in this issue, we want to em-phasize two in particular: stress and coping, and social ecological influences onresidence. Both of these themes bear on our characterization of the residential con-text of health. With stress and coping, we refer to processes that join health withhousing and its surroundings within residential activities. With social ecologicalinfluences on residence, we refer to the factors shaping the boundaries for thoseactivities.

Stress and Coping

Stress is commonly defined as a process of responding to an imbalance be-tween demands and resources available for meeting those demands (e.g., Appley


& Trumbull, 1986). Coping has been defined as “cognitive and behavioral effortsto reduce or eliminate stressful conditions and associated emotional distress”(Holahan, Moos, & Schaefer, 1996, p. 24). Most of the articles here refer to stressand/or coping in some way. We cannot give an exhaustive account here, but in thefollowing we do give some examples of the ways in which different articles bringdemands, resources, and coping efforts into the picture.

Several of the articles refer to stressors faced in the residential environment,such as hassles due to poor housing quality (Evans et al.); persistent demands con-nected to domestic roles, as with the extra burden of unpaid work and responsibilityborne by those who care for another adult in the home (Michelson & Tepperman);exposure to ambient stressors and daily hassles due to the location of the housing(Hartig et al.); and the problems of holding onto or securing adequate housingin the face of poor health and/or limited economic means (Ahrentzen; Saegert &Evans; Smith et al.).

To counter demands faced inside and outside of the residence, people fre-quently draw on coping resources connected with residence. Several of the articlesidentify resources that people invest or access in their housing. With their healthcapital formulation, Smith and colleagues make a distinctive statement in thisregard, treating housing as an element in a network of health resources. In con-sidering how home ownership may confer a health advantage, Smith et al. andHiscock et al. observe that rental housing and owner occupation may differ notonly in terms of the material resources they comprise, but also in terms of psycho-logical coping resources, as in emotional well-being and self-esteem. Similarly,Evans et al. discuss how poor housing quality may rob or deprive a person of self-esteem. Evans et al. also discuss how housing features may affect possibilities fordeveloping supportive social contacts with neighbors. As a setting for individuals’interactions with family members and friends as well as neighbors, the residenceis a key point of access for social coping resources, as noted by Hartig et al.

The articles by Ahrentzen and Michelson and Tepperman focus on how peopleuse and provide social support in the residence as they cope with difficult circum-stances, as in providing health care to a loved one or doubling up householdsto achieve a better standard of housing. The adaptive solutions that they discussreflect on possibilities for the exercise of control and therefore on instrumentalcoping through the use of housing. Control concepts also enter in other articles, asa characteristic of the person and/or as an environmental affordance. Hiscock etal. discuss how the perception that one’s life chances are under one’s own control(i.e., mastery) relates to both health and home ownership. Evans et al. point to theutility of housing in controlling social interactions. Hartig et al. refer to controlexpectations in the home and how violations of those expectations may increasethe potency of a stressor.

Finally, we note that restoration is another component of the stress equation,a necessary and recurrent phase in adaptation. Hartig et al. take up this point, and


comment on the special status commonly assigned to the residence as a setting forrestoration, whether for sleep or for leisure activities.

Social Ecological Influences

Social, political, and economic factors that shape the boundaries for residentialactivities come into the discussion in several of the articles. One major concerninvolves residence as an aspect of the link between socioeconomic status andhealth. With their ecological housing niche model, Saegert and Evans focus onissues of poverty and race in discussing the “structural and policy determinantsthat establish the context within which people perceive choices related to residenceand evaluate the threats and opportunities in their residential environment” (p. 570).In this, they take particular interest in the operation of housing markets.

Other articles refer to changes in policy of one kind or another that havea bearing on access to suitable housing by people of limited economic means.Ahrentzen’s analysis of “doubling up” starts from a change in U.S. welfare policythat has made it more difficult for poor households to cover their housing costs in atime of declining construction of low-income housing. Also, Smith et al. illustratesome of the ways in which social welfare policy and housing market practicescan operate on the health resource value of a person’s housing or on a person’sability to maintain or achieve a particular form of housing tenure, such as owneroccupation.

The article by Michelson and Tepperman looks at the impacts of changes inhealth policy rather than housing or other forms of welfare policy. Their studyillustrates how policy change that deinstitutionalizes long-term care can relocatecare functions into the home, and it details some implications of such a change forresidential activities. Similarly, the article by Hartig et al. looks at how technolog-ical innovations have made it possible for some people to perform some of theirpaid work inside the home, thereby reconfiguring the spatial and temporal distri-bution of demands and restoration opportunities across the settings of everydaylife.

Finally, the articles discuss policy measures that might provide a more sup-portive context for residential activities that may have some bearing on health.The possibilities raised are the focus of Catalano and Kessell’s discussion in thefinal article, which provides, also, a sense of the limitations of policy approachesin addressing relations between housing and health.

Concluding Comments

Taken together, the articles in this issue make a unique contribution to theliterature on housing and health. They give insights into the scope and complexity of


housing–residence–health relations, thereby illustrating why we think the researcharea warrants recharacterization as inquiry into the residential context of health.Also, they provide behavioral and social scientists with additional tools to usein studying relations between housing and health, and they suggest avenues forintervention not visible from a perspective focused on physical environmentalpredictors and physical health outcomes. They capture some of the internationalvariation and similarities not only in residence–health challenges but also in theirlarger social context. Also, the articles indicate that residence–health issues relateto a range of other social issues, such as stigmatization, environmental justice, theprotection of privacy, and health care delivery. Thus, this issue gives an impressionnot only of the intellectual challenges faced in the area, but also of the area’s greatpractical importance and promise.

References

Altman, I. (1975). The environment and social behavior. Monterey, CA: Brooks/Cole.Altman, I., & Werner, C. (Eds.). (1985). Home environments. New York: Plenum.Appley, M. H., & Trumbull, R. (1986). The dynamics of stress: Physiological, psychological and social

perspectives. New York: Plenum.Appleyard, D. (1981). Livable streets. Berkeley, CA: University of California Press.Barton, H., & Tsourou, C. (2000). Healthy urban planning. London: E & FN Spon.Beaglehole, R., & Bonita, R. (1997). Public health at the crossroads. Cambridge, MA: Cambridge

University Press.Bistrup, M. L. (1991). Housing and community environments: How they support health. Copenhagen,

Denmark: National Board of Health.Breakey, W. R. (1997). It’s time for the public health community to declare war on homelessness.

American Journal of Public Health, 87, 153–155.Burridge, R., & Ormandy, D. (Eds.). (1993). Unhealthy housing: Research, remedy and reform. London:

E & FN Spon.Catalano, R. (1979). Health, behavior and the community: An ecological perspective. New York:

Pergamon Press.Catalano, R., & Pickett, K. E. (2000). A taxonomy of research concerned with place and health. In G.

L. Albrecht, R. Fitzpatrick, & S. C. Scrimshaw (Eds.), Handbook of social studies in healthand medicine (pp. 64–83). London: SAGE Publications.

Chaloulakou, A., & Mavroidis, I. (2002). Comparison of indoor and outdoor concentrations of COat a public school: Evaluation of an indoor air quality model. Atmospheric Environment, 36,1769–1781.

Cooper Marcus, C. (1995). House as a mirror of self: Exploring the deeper meaning of home. Berkeley,CA: Conari.

Despres, C. (1991). The meaning of home: Literature review and directions for future researchand theoretical development. Journal of Architectural and Planning Research, 8, 96–115.

Dovey, K. (1985). Home and homelessness. In I. Altman & C. Werner (Eds.), Home environments(pp. 33–64). New York: Plenum.

Flexner, S. B. et al. (1987). The Random House dictionary of the English language (2nd ed., unabridged).New York: Random House.

Fried, M. (1963). Grieving for a lost home. In L. J. Duhl (Ed.), The urban condition (pp. 151–171).New York: Basic Books.

Fuhrer, U., Kaiser, F. G., & Hartig, T. (1993). Place attachment and mobility during leisure time.Journal of Environmental Psychology, 13, 309–321.


Fuller-Thomson, E., Hulchanski. D., & Hwang, S. W. (2000). The health–housing relationship: Whatdo we know? Reviews on Environmental Health, 15, 109–134.

Holahan, C. J., Moos, R. H., & Schaefer, J. A. (1996). Coping, stress resistance, and growth: Con-ceptualizing adaptive functioning. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping:Theory, research, and applications (pp. 24–43). New York: Wiley.

Hwang, S. W. (2001). Homelessness and health. Canadian Medical Association Journal, 164, 229–233.Kaiser, F. G., & Fuhrer, U. (1996). Dwelling: Speaking of an unnoticed universal language. New Ideas

in Psychology, 14, 225–236.Kasl, S. V. (1977). The effects of the residential environment on health and behavior: A review. In L. E.

Hinkle & W. C. Loring (Eds.), The effect of the man-made environment on health and behavior(pp. 65–127). Atlanta, GA: Centers for Disease Control.

Kuo, F. E., Sullivan, W. C., Coley, R. L., & Brunson, L. (1998). Fertile grounds for community:Inner-city neighborhood common spaces. American Journal of Community Psychology, 26,823–851.

Lawrence, R. J. (1987). Housing, dwellings, and homes. New York: Wiley.Lawrence, R. J. (1993). An ecological blueprint for healthy housing. In R. Burridge & D. Ormandy

(Eds.), Unhealthy housing: Research, remedy and reform (pp. 338–360). London: E & FNSpon.

Lawrence, R. J. (2002). Healthy residential environments. In R. Bechtel & A. Churchman (Eds.),Handbook of environmental psychology (pp. 394–412). New York: Wiley.

Lewin, K. (1951). Field theory in social science. New York: Harper & Row.Matte, T. D., & Jacobs, D. E. (2000). Housing and health: Current issues and implications for research

and programs. Journal of Urban Health, 77, 7–25.Mazumdar, S., & Mazumdar, S. (1997). Religious traditions and domestic architecture: A comparative

analysis of Zoroastrian and Islamic houses in Iran. Journal of Architectural and PlanningResearch, 14, 181–208.

Merriam-Webster’s collegiate dictionary (9th ed.). (1983). Springfield, MA: Merriam-Webster.Oxford English Dictionary Online. (2002). Retrieved May 16, 2003, from http://www.oed.com

[Accessed through the Uppsala University Library subscriber link.]Preiser, W. F. E., & Ostroff, E. (Eds.). (2001). Universal design handbook. New York: McGraw-Hill.Rapoport, A. (1969). House form and culture. Englewood Cliffs, NJ: Prentice-Hall.Redd, S. C. (2002). Asthma in the United States: Burden and current theories. Environmental Health

Perspectives, 110(Suppl. 4), 557–560.Robinson, J. P., & Godbey, G. (1997). Time for life: The surprising ways Americans use their time.

University Park, PA: Pennsylvania State University Press.Rosen, G. (1993). A history of public health (Expanded ed.). New York: MD Publications. Baltimore,

MD: Johns Hopkins University Press. (Original work published 1958)Shinn, M., & Weitzman, B. C. (1990). Research on homelessness: An introduction. Journal of Social

Issues, 46, 1–11.Smith, K. R. (2000). National burden of disease in India from indoor air pollution. Proceedings of the

National Academy of Sciences, 97, 13286–13293.Smith, K. R. (2002). Indoor air pollution in developing countries: Recommendations for research.

Indoor Air, 12(3), 198–207.Stein, J. A., Lu, M. C., & Gelberg, L. (2000). Severity of homelessness and adverse birth outcomes.

Health Psychology, 19, 524–534.Stokols, D. (1992). Establishing and maintaining healthy environments: Toward a social ecology of

health promotion. American Psychologist, 47, 6–22.Tognoli, J. (1987). Residential environments. In D. Stokols & I. Altman (Eds.), Handbook of environ-

mental psychology: Vol. 1 (pp. 655–690). New York: Wiley.United Nations. (1996). Istanbul declaration on human settlements. Retrieved May 16, 2003, from

http://www.un-habitat.org/unchs/english/hagenda/ist-dec.htmvan Vliet, W. (Ed.). (1998). The encyclopedia of housing. Thousand Oaks, CA: SAGE.Waldron, A., Tobin, G., & McQuaid, P. (2001). Mental health status of homeless children

and their families. Irish Journal of Psychological Medicine, 18(1), 11–15.World Health Organization. (1946). Constitution. Geneva: Author.


TERRY HARTIG is an Associate Professor of Psychology with the Institute forHousing and Urban Research and the Department of Psychology of UppsalaUniversity. He completed graduate training in social ecology at the Universityof California at Irvine and postdoctoral training in social epidemiology at theUniversity of California at Berkeley. His research focuses on health values of na-ture experience, restorative environments, health in relation to residence, and thesocial ecology of stress and restoration.

RODERICK J. LAWRENCE, B. Arch (Hons), MA, D.Sc, is Professor in theFaculty of Social and Economic Sciences at the University of Geneva, and heworks in the Centre for Human Ecology and Environmental Sciences. In 1994 hewas appointed to the Scientific Advisory Committee of the World Health Organi-zation’s European Centre for Environment and Health. In 1999 he was nominatedChair of the Evaluation Advisory Committee of the World Health Organization’sHealthy Cities Project for the European Region. In 2001 he was nominated to theWHO European Taskforce on Housing and Health.

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