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 inv olved in the relationship between crowding and physical health. First. high levels of household crowding can produce stress that leads to il lness. Second, through shared physical proximity, household congestion contributes to the spread of communicable disease. The outcomes can b e exacerbated by poor quality housing. A significant body of research, conducted primarily in affluent countries, has documented the detrime ntal effects of housing conditions on a variety of illnesses, includin g various contagious diseases. Poor housing has even been linked to hi gh infant and adult mortality rates. The view that poor housing condit ions and household crowding inevitably leads to poor health is challen ged, however, by several observers, who question the role played by bo th crowding and housing quality. Most existing research has been condu cted 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 an d where levels of household crowding are generally higher. Determinati on of the effects, if any, of housing quality-including household crow ding-on physical health in developing countries is particularly import ant given the rapid growth of their urban populations and the difficul ty 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 de veloping 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 r eading of the evidence in Western countries, we likewise find that, in Bangkok, objective indicators of housing quality and household crowdi ng are little related to health. We do find, however, that subjective aspects of housing and of crowding, especially housing satisfaction an d a felt lack of privacy, have detrimental effects on health. Furtherm ore, psychological distress is shown to have a potent influence on the physical health of Bangkokians. Our analyses suggest that all three f actors have independent effects on health outcomes bearing on both men and women.