Housing and Health


The relationship of housing with health is well established. This is obvious from the town planning and building regulations which determine various physical aspects of urban and architectural design all over the world. Architects and planners take these regulations for granted, apply them mechanically and never really think of the health issues that have determined their form and content. Similarly, I am sure, most doctors seldom relate the health of their patients to design aspects of the houses they occupy and the nature of settlements they live in. However, a greater awareness among architects and planners on health issues and among doctors on the physical environment is necessary. This is because for the first time in human history millions of men and women live and work together creating immense environmental problems that effect both their physical being and their mental attitudes. In countries like ours, where the change from rural settlements to larger urban centres has been very sudden, and the technical and financial resources and the political organisation to tackle it are not available, this understanding is all the more necessary.

In this paper I will not deal with all aspects of housing that effect health. The relationship between light, ventilation and health is fairly well understood and does not need any elaboration. Similarly the relationship between water, health and housing has been stressed in a big way over the last ten years. That too can be left out. I will confine myself therefore in relating housing with places of work; with access to land; sanitation, density, materials of construction and cooking fuel.

Housing and Work

Housing is related to production. It comes up, or it put up, where work is available or transport to the place of work exists. Attempts of housing people elsewhere fail miserably. In Karachi, like in many Third World cities, people live far away from their places of work. Where an effective transport system is not available, this movement to work is a source of great mental and physical stress. In Karachi, the working class population lives in Landhi and Korangi in East Karachi. However, they work in SITE, well west of Karachi city. It takes a person 2 hours to cover this distance to work.  He has to wait for a bus. Travel in a bus. Change a bus in the city centre where he is surrounded by disorganisation, noise, congestion and pollution and then make the same journey back home.

Studies have determined that these persons seldom have time for their families and children. They leave home at 6 in the morning and get back at 8 in the evening. They are tired when they get to work, and much more tired when they return home.

In addition to the physical and mental stress that people undergo as a result, travel is a costly affair and in Karachi, people belonging to the 30th percentile and below, normally spend 20 percent of their income on travelling to their places of work. To avoid this expense a large number of persons prefer to live in bachelor’s deras near their place of work and go home only for the weekend. This arrangement adversely effects, not only their relationship with their family but also the relationship of various family members among themselves.

Another factor in the design of housing is the manner in which neighbourhoods and cities are planned. The absence of segregation of vehicular and pedestrian traffic leads to a difficulty of movement and a great sense of insecurity, especially among older people. It especially effects the growth of children who cannot have secure areas for playing and are forced by their parents to stay at home so as to be safe from traffic hazards.

Land and Housing

To build a house one has to own land. However, in most Third World countries legal access or tenure security to land is denied to the lower‑income groups. This is because the cost of land as developed by the state, or the formal sector, is far too high for the poor to afford. In addition, the procedures required to acquire it are far too complicated and long for lower‑income groups to relate to. Even if they do manage to acquire a plot, then credit and technical assistance for house construction is not available. Thus, the needs of lower‑income groups are met by the informal sector middlemen, or dallals, who sell them illegally acquired, unserviced land. However, the price of this land is affordable by the poor although no security of tenure is guaranteed. For the people who settle here, the first few years of life on this land are full of uncertainity. Since there is no de‑jure ownership, the threat of eviction is always there.  To avoid that possibility the police has to be apeased, the middle‑ men retained as protectors against harassment by government agencies, and high prices paid for getting an erratic supply of water through bowzers. This period of intense insecurity only comes to an end when this squatter settlement is large enough to seek a sense of security in numbers. Here one should mention that squatter settlements in Pakistan grow at a rate of 7.3 percent per year as opposed to an annual growth rate of 1.5 percent for state or formal sector planned areas. Again, 22 percent of the total urban population in Pakistan lives in squatter colonies today. If this growth rate continues, then by the year 2000, this figure will increase to more than 50 percent. In addition, the government has decided to regularise only those squatter areas which were established before March 23, 1985. All others will be treated as encroachment. The issue of tenure security, especially in the initial years, is a source of great mental stress for the residents of these colonies and forms the basis of their exploitation by various mafias that operate in our city.

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