Child health and the housing environment

We propose and test an internationally-comparable country-level index of the adequacy of the housing environment for protecting children from ill-health. The housing environment for protection (HEP) index combines seven easily-monitored indicators of housing conditions related to communications, density of occupants, toilet and handwashing facilities, the use of finished construction materials, and cooking facilities. In calibrating and validating the HEP index, the paper uses infant mortality, the incidence of child illnesses and child stunting. We calculate the HEP index for the 41 developing countries with complete recent data from the Demographic and Health Surveys. We find that only 8% of households fully comply with all our identified housing conditions, though there is considerable variation across countries, with full compliance varying from virtually zero to almost 60% of households. A poor HEP is found to be associated with significantly worse health outcomes among children. This finding is robust to adding controls for likely confounders such as income and poverty. Our results suggest that reducing the incidence of ill-health among children is in part achieved by reducing income poverty, but also depends crucially on how much income gains tend to directly improve housing conditions.