1. Assessment of housing and health on the basis of European indicators in Hungary T. Málnási, A. Páldy, P. Rudnai ‘József Fodor’ National Centre for Public Health National Institute of Environmental Health

2. Fourth Ministerial Conference, Budapest, 2004 14. a), b), c) paragraphs of Declaration: – The ministers understand that many environmental exposures occurring in the indoor and outdoor environment are linked to inadequate housing conditions, – They are therefore committed to taking action to ensure that health and environmental dimensions are placed at the core of all housing policies and that healthy conditions are ensured and maintained in the existing housing stock. Housing and health 10 recommendations: – assess more carefully the health impact of the ongoing housing programmes and policies in countries – data on housing and health should be made available to policy-makers and the general public

3. Exposure: 1. Crowding 2. Household hygiene 3. Mould / dampness Effect: 1. Mortality due to household accidents / poisonings 2. CO poisoning (mortality, morbidity) Indicators

4. Crowding 1. Objective: – Living floor area/person: WHO EuroIndy – Rate of persons living in crowded homes definition: >1 person / room (Eurostat) a) % of people living in crowded conditions b) ” among people living under poverty threshold 2. Subjective Effects: increase of risk: mental diseases, stress, spread of infectious diseases, accidental injuries, dampness, mould

5. Living floor area per 1 person (m 2 ) in some European countries (WHO EuroIndy)

6. Rate of persons living in crowded homes (> 1 person / room) ( WHO LARES survey, 2003)

7. Household hygiene % of population living without suitable household hygienic circumstances: a) without piped water in the home b) without toilet with running water inside the home c) without bathing facilities

8. Water and sanitation indicators acc. to settlement size, Hungary Census – Hungarian Central Statistical Office

9. Rate of homes with piped drinking water Rate of homes with flush toilets

10. Rate of homes with running cold water Rate of homes without running water and toilet in the home

11. Mould a)Rate of persons living in homes with mould problems b)Rate of homes with mould problems Possible health effects: – Irritation of eyes and respiratory tract – Frequency of infections of respiratory tract – Frequency of chronic respiratory symptoms and diseases: bronchitis, allergy, asthma

12. Rate of homes with mould problems WHO LARES survey, 2003

13. Rate of persons living in homes with mould problems and rate of homes with mould problems WHO LARES survey, 2003

14. Rate of homes with mould problems according to Hungarian surveys among schoolchildren grade 3-4 1996-2002

15. OR of chronic bronchitis symptoms among 8-10 year old children and its association with mould in the flats adjusted for age and sex odds ratio CESAR 6 cities 3 cities 6 counties Heves county

16. OR of asthmatic symptoms among 8-10 year old children and its association with mould in the flats adjusted for age and sex odds ratio CESAR 12 cities 6 cities 3 cities 6 counties Heves county

17. Number of hospital admissions due to acute CO intoxication (ICD-10: T58) in Hungary 1997-2002

18. Number of deaths due to acute CO intoxication (ICD-10: T58) in Hungary, 1996-2003

19. Domestic accidents, poisoning in children Annual mortality rate due to the external causes: domestic accidents and poisoning in children under 5 years of age (ICD-10: W00.0 – Y34.0) ICD fourth digit: place of occurrence 0: home (flat, house) and the immediate environment (e.g. garden, garage, swimming pool)

20. Mortality due to external causes of death in < 5 years old children in some European countries (ICD-10: W00–Y34) (WHO EuroIndy)

21. Tasks for the future, possibilities of intervention Education, information: – general population: prevention of injuries, accidents at home, mould prevention – designers – decision makers Legislation: maintenance of heating equipment (CO) – regulation for new buildings (design, construction) – (enforcement of) legislation and subsidies for existing dwellings Rehabilitation campaigns: e.g. rehabilitation of flats with unhealthy conditions (insulation, heating etc.)