Housing, stress, and physical well-being: evidence from Thailand

The proposition that poor housing and congested living conditions have a detrimental impact on health has been promulgated for at least 150 years. At a minimum, two major causal mechanisms are thought to be involved in the relationship between crowding and physical health. First, high levels of household crowding can produce stress that leads to illness. Second, through shared physical proximity, household congestion contributes to the spread of communicable disease. The outcomes can be exacerbated by poor quality housing. A significant body of research, conducted primarily in affluent countries, has documented the detrimental effects of housing conditions on a variety of illnesses, including various contagious diseases. Poor housing has even been linked to high infant and adult mortality rates. The view that poor housing conditions and household crowding inevitably leads to poor health is challenged, however, by several observers, who question the role played by both crowding and housing quality. Most existing research has been conducted in affluent countries. Little is known, however, about the nature of these relationships within the context of less developed countries, where health status and housing quality are generally much poorer and where levels of household crowding are generally higher. Determination of the effects, if any, of housing quality--including household crowding--on physical health in developing countries is particularly important given the rapid growth of their urban populations and the difficulty of increasing the physical infrastructure fast enough to keep pace with this growth. This paper reports on an investigation of the impact of housing conditions and household crowding in the context of one developing country, Thailand. Using data from a representative sample of households in Bangkok (N = 2017), our results provide reason for some skepticism regarding the influence on housing on health, at least in its objective dimensions. While the skepticism of some is based on a reading of the evidence in Western countries, we likewise find that, in Bangkok, objective indicators of housing quality and household crowding are little related to health. We do find, however, that subjective aspects of housing and of crowding, especially housing satisfaction and a felt lack of privacy, have detrimental effects on health. Furthermore, psychological distress is shown to have a potent influence on the physical health of Bangkokians. Our analyses suggest that all three factors have independent effects on health outcomes bearing on both men and women.