The COVID-19 pandemic has hit the poor the hardest and further exposed the gaping inequalities in access to health care, food, and housing.
The government has been enforcing lockdowns and curfews with little thought to mitigating the impact on the most vulnerable.
Shacks no bigger than a bus waiting shed accommodate several families whose members sleep side by side on wooden or cement floors. In the slums where people are packed like sardines, there is no such thing as social distancing, much less isolation and quarantine.
Crowded households are often exposed to housing risks. People with low incomes are forced to live in unhealthy dwellings with inadequate space and facilities for their needs.
Crowding also increases exposure to risk factors associated with home injury, domestic violence, and other social tensions.
The effects of crowding are the hazards associated with inadequate space within the dwelling for living, sleeping, and household activities. Epidemiological studies have shown a positive association between crowding and respiratory diseases spread by transmission of infectious pathogens through air by droplet infection.
Crowding increases the risks of volatile infections (measles, rubella, rhinoviruses, influenza), droplet-transmitted (coughing, sneezing) infections such as tuberculosis, pertussis, diphtheria, viral meningitis, and colonization of endogenous pathogens producing pneumonia and bronchopneumonia.
Enteric diseases also are more frequent in overcrowded housing. This can be partly explained by the increased opportunity for cross-infection through person-to-person contact and by indirect contact with poor sanitary conditions often associated with overcrowding.
Crowding increases vulnerability to possible infections by increasing the frequency, duration, and mode of contact between people and infectious agents. The sharing of beds by family members increases the transmission of airborne infections, and risks are exacerbated by the large variety of respiratory infections typically found in public places and the limited acquired immunity of the population to respiratory diseases.
Overcrowding also promotes disturbances in mental health by creating confusion, noise, and lack of privacy, which may lead to depression, feelings of annoyance, and interpersonal conflicts. Overcrowding, lack of privacy, and lack of housing facilities often create a situation where violence may erupt when some triggering factor operates. Overcrowding may also increase promiscuity and incestuous relationships, which can add further tension and stress within the family.
While residential density standards can be enforced for new housing development plans, the problems of overcrowding cannot be overcome by planning controls alone. Problems of enforcing densities in overcrowded cities are inextricably linked with the available supply of suitable housing and the demand for accommodation. When demand outstrips supply, high residential densities and crowding inevitably result.
Our space norms and crowding conditions are reflections of socioeconomic status. Policymakers often deal with the effects of overcrowding without addressing the underlying causes—poverty, rapid population growth, and uncontrolled urbanization. A multi-year comprehensive planning strategy must therefore address these issues by improving rural conditions, employment opportunities, and fiscal support measures aimed at reducing poverty, redirecting urbanization, and slowing down population growth.
The long-term strategy must also include the adoption of a set of basic principles for healthy housing that should inform the development of policies, standards, and regulations.
These strategies should address:
- Physiological needs (e.g., for ventilation, illumination, sunlight, space, protection against excessive noise);
- Psychological needs (for privacy, adequate space, cleanliness, peace of mind, normal family and household activity);
- Protection against contagion (from disease, vermin, sewage, contaminated water, overcrowding); and
- Protection against accidents (from falls, fire, burns, gas, electric shock, building collapse).
An integrated approach, in which reductions in crowding are supported by appropriate rehousing that takes these considerations about unintended effects into account, is fundamental to health and equity. Reductions in crowding will be most effective when combined with policies that support employment and improve household incomes to increase the affordability of homes with sufficient space.