In retrospect, Australian Indigenous children have poorer health than non-indigenous children (Lyons & Janca, 2012) and Indigenous infants have been said to be up to four times more likely to die than non-Indigenous infants (Australian Health Ministers’ Advisory Council, 2006). There is an increased incidence of illness in Indigenous children directly related to poor housing, compared with the rest of the Australian population (Dockery et al., 2011 p.10). Physical and mental health implications resulting from inadequate shelter will be discussed in relation to the sub factors of building structure and overcrowding. For the purpose of this paper, the various physical and mental health impacts of housing as shelter will be considered, with specific focus on the health of Australian Indigenous children. Housing of sufficient standard to enable health is a basic human right (United Nations, 2013). Though, there are many other social factors, including socioeconomic status and remoteness, impact on housing can be considered separately as an environmental determinant of health.
Housing as a Determinant of Health for Indigenous Australians
The World Health Organization (2009) defined environmental health as addressing “all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health.” Housing, including the quality of the structure and the services within the structure (sanitation, water supply) and overcrowding can impact on health and although the quality of housing in Australia has improved dramatically over the last 200 years the same level of improvement in housing quality has not been seen in Australian Indigenous communities, especially communities in remote areas (Australian Indigenous HealthInfoNet, 2008).
The Australian Bureau of Statistics [ABS] (2009) identified that in 2008 65% of Indigenous people were living in rented accommodation with one third of Indigenous children living in housing that required more bedrooms. Up to one third of housing accommodated by Indigenous people had major structural problems (including major cracks, plumbing problems and termites) and 13% of households lacked basic facilities (food storage facilities, ability to wash and waste removal) (ABS, 2009). This data showed that for Indigenous children, housing is a significant determinant of health. The impacts on health can be direct physical impacts, such as the spread of diseases or indirect impacts on mental health from overcrowding and functioning of the community (Australian Indigenous HealthInfoNet, 2008).
Impacts of Housing on Physical Health of Australian Indigenous Children
There are “exceptionally high rates” (Bailie, Stevens, McDonald, Brewster & Guthridge, 2010, p. 1) of childhood diseases in remote Australian Aboriginal communities and are correlated with the onset of chronic disease in adults (Bailie et al., 2010). Research shows links between housing and child development (Dockery, Kendall, Li, Mahendran & Ong, 2011) specifically with respect to housing disrepair, overcrowding, allergens and toxicants. Bailie et al. (2010) described several factors linking housing conditions to childhood illness in Indigenous Australian children. Essential components of housing structure such as warmth, safe building materials, adequate plumbing and water supply are relatively lacking in Indigenous communities compared to other sectors of Australian society (Bailie et al. 2010). Increased incidence of disease exists in remote Indigenous populations including skin infections, parasitic infestations, respiratory, eye and chronic middle ear infections (for example suppurative otitis media), diarrhoeal diseases, meningococcal infection and rheumatic fever (Menzies School of Health Research, 2000). These diseases disproportionately impact on Indigenous children and are due to inadequate sanitation, overcrowding, insulation and building repair (Bailie, 2007).
It is generally accepted that the most important advance in health and medicine in about 150 years has been the introduction of reliable clean water and sewage disposal (Rao, Prasad, Adshead & Tissera, 2007 p.1111). Human exposure to poor housing conditions includes risks associated with lack of safe drinking water, ineffective waste disposal, disease transmitted via vectors as well as inadequate food storage (Arku, Luginaah, Mkandawire, Baiden & Aseidu, 2011). Therefore, housing environments lacking these basic facilities, may pose significant health risks to Australian Indigenous children. Physical health impacts associated with poor sanitation include diarrhoeal diseases, E coli, giardia and hepatitis (Australian Indigenous HealthInfoNet, 2008).
Inadequate waste disposal could increase the risk of injury from contact with rubbish (e.g. broken glass), fire risk, and increase risk of infestation from vermin and other disease carriers (Australian Indigenous HealthInfoNet, 2008). Inadequate waste disposal can also impact on the quality of bore water which many Indigenous communities use as their source of drinking water (Australian Indigenous HealthInfoNet, 2008), further increasing the potential for spread of disease.
Overcrowding leads to more frequent physical contact between members of the household increasing the risk of cross infection (McDonald, Bailie, Brewster, & Morris, 2008). “A higher proportion of Aboriginal and Torres Strait Islanders live in overcrowded conditions than other Australians” (Madden & Trewin, 2005, p. 38). In summary about 34% of Indigenous households “were living in overcrowded conditions” (Madden & Trewin, 2005, p. 39). The health risks of overcrowded dwellings arise due to increased demands on bathroom, washing facilities and sewerage systems particularly septic tanks. Increased demand on, or absence of these basic facilities has been linked to the spread of childhood diseases (Dockery et al., 2011). These impacts on health can include the spread of meningitis, respiratory illnesses and skin infections (Australian Indigenous HealthInfoNet, 2008).
Overcrowding not only includes the number of people who reside in the home, but also includes visitors who could also reside in the home for periods of time creating temporary overcrowding, increasing the health risks to the people in the home (Australian Indigenous HealthInfoNet, 2008).
Insulation and thermal comfort
Ormandy and Ezratty 2012 (p. 116) described thermal comfort as being “inextricably linked to health”. An inadequate energy supply in Indigenous housing may result in threats to health such as “ food poisoning, spread of infections, slips and fall injuries, fire injuries (from candles or oil lamps) and carbon monoxide poisoning (from inappropriate heat sources)” (Ormandy & Ezratty, 2012, p. 116). Inability to improve the physical structure of the home means often homes are more expensive to heat leading to a cycle of “fuel poverty” (Howden-Chapman, Viggers, Chapman, O’Sullivan, Barnard & Lloyd, 2012, p. 134). Cold and damp conditions have the potential to cause or worsen respiratory health problems (Gibson, Petticrew, Bambra, Sowden, Wright & Whitehead, 2011). Bailie et al. (2010) linked temperature control in houses with illnesses such as asthma, bronchiectasis, otitis media, skin infections gastroenteritis and diarrhea.