Housing and Health

Housing and Sanitation

In planned areas piped water and an underground sewerage system is installed by the government. The residents pay a development charge for it. In squatter areas, or katchi abadis, no such provision is made, and where it has been provided, people do not pay for it as it is far too expensive for them to afford. So residents are forced to develop their own systems for excreta and wastewater disposal.

The bucket latrine, where the scavenger throws out the contents of the bucket into the lane, and the soak pit which overflows once a regular piped water supply is guaranteed, are the two main systems used in low‑income areas. Both the systems result in severe environmental problems and create immense health hazards. In addition, where a sewerage system does not exist, and drainage of waste water poses a problem, water-logging sets in, endangering the resident’s houses due to rising damp and creating a new set of health problems.

The political relationship between the katchi abadis and the municipal agencies, is to say the least an unequal one. The squatter areas are not regularised, they do not pay property or conservancy charges, and they are constantly lobbying for assistance of one kind or another. As a result of this unequal relationship, garbage is not lifted from the lanes and clogs up the natural drainage systems which in turn results in flooding of large low‑income areas during the rains. In addition, infra‑structure established by the civic agencies in the squatter or slum areas, is of substandard design and quality, reflecting the manner in which the state agencies view the poor. Instead of helping to eleviate conditions this substandard work actually worsens them.

This state of affairs results not only in various deceases such as typhus, dingo, malaria etc., but also in mental stress and bad social relationships between residents. They also pose problems for children in their games and prevent the lane from being used as a meeting place for adults. These constraints limit social interaction. These results have been brought out very clearly by a comparative study made by the Orangi Pilot Project (OPP) of lanes with sewerage systems and those without sewerage systems. The study also shows that the price of property went up in the lanes that acquired a sewerage system and proposals of marriage for girls living in such lanes increased. The quality of houses also improved with a sewerage system as the security factor increased with a collective investment.

Density

The issue of density is an important aspect of housing that has a very close relationship with health. It is normally held that for a reasonably healthy environment there should not be a density of more than 300 persons per acre and/or 50 square feet of built up area per person. However, in certain low‑income areas of our cities, where land is expensive and plots small, this density is as high as 1200 persons per acre and the average number of persons living in one room in Pakistan is as high as 3.5. This figure has increased by 4 decimal points between 1960 and 1980, which shows that health conditions are not improving in our country. In the more affluent areas of our cities densities are as low as 60 persons per acre and the number of persons per room is 0.48. High densities result in unhygienic conditions, lack of privacy and claustrophobia. The noise factor that is generated by densities larger than 300 per acre also have a  adverse effect on the nerves of residents living in these areas. Large densities very often mean high‑rise buildings. Sociological studies of such buildings have revealed that they are a major cause of stress for the residents. Crime in high‑rise complexes is much higher than where individual houses exist, and so is depression among residents. Social interaction is minimal, for the whole concept of being cooped up in an apartment block helps in developing a desire to withdraw from society. Children who grow up in high‑ rise buildings face special problems. They lack initiative as compared to those who grow up in individual houses and hence develop more slowly. In addition to these factors high‑rise housing is more expensive to maintain and requires a joint effort by residents.

Materials of Construction

Surfaces that are non‑pourus, do not contain organic materials or mix, are easy to wash, wipe and clean. These surfaces are cement concrete, lime plaster, brick and tin and asbestos sheeting. Apart from being easy to clean they are free from microbes and bacteria and require little time and effort for maintenance and repair.

Pourus surfaces such as mud, wattle, mat, and earth‑straw plaster are impossible to clean and wash. In addition, the crevices and organic materials in them are the breeding ground for animals bacteria and insects which effect health adversely. It is sometimes not possible for the poor, especially in the rural areas, to build the entire house in non‑organic materials. Usually the mahman khana or the masters room is built with these materials. However, it would be better that instead of these rooms the internal surfaces of the kitchen, latrines and bathrooms were finished properly. This would go a long way, not only in making life easier for the woman of the house, but also of improving health conditions.

Cooking Fuel

This then brings me to the last issue I wish to touch upon. That is cooking fuel. 79 percent of the homes in rural areas and 48 percent in urban areas in Pakistan use some form of timber for cooking. The stoves used by them do not conserve energy and hence consume unnecessarily large quantities of timber. In addition, the smoke that is generated effects the respiratory system of the residents and their eyes. Economy unfortunately demands that timber continues to be used. However, there is no reason why stoves that are more efficient and which remove the smoke from the homes are not promoted and marketed.

Conclusion

With an improvement in the physical environment health conditions are bound to improve. For this to happen people must live near to their places of work or have a comfortable and reliable system of transport. Planning must segregate vehicular and pedestrian traffic. The poor must have access to land at a price that they can afford or if the cost of services, especially sanitation is high,  then they must have the option of acquiring them incrementally over a period of time. Densities must be reasonable and except where absolutely necessary high‑rise buildings must be discouraged. For all this awareness raising is necessary among people so that they understand the problems associated with high densities.  Local bodies must try to have their regulations understood before trying to have them implemented. Their role must change from that of a policeman to one of an advisor. Special care must be given to the finish of bathrooms, latrines and kitchens so that they are easy to maintain and operate.

If these become our priorities in the housing sector rather than the development of site and service schemes, we will be helping enormously in improving physical health and removing mental stress.