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We all believe that policies outside the traditional health sector have major impacts on health. But empirically demonstrating such social causation is another matter. Housing is one such example. There is a strong theoretical case for improved housing (eg, insulation, mould reduction) improving health (eg, respiratory and cardiovascular diseases).1 2 In some cases, one can conduct randomised trials. For example, we have previously reported that people randomised to homes that were then insulated had substantial and significant improvements (ie, about 50% reductions and highly statistically significant) on multiple self-reported health measures and visits to general practitioners. On the objective measure of respiratory hospitalisations, we found a rate ratio of 0.53 (95% CI 0.22 to 1.29) for randomised subjects versus controls.3
Demonstrating that actual housing policies impact on health—especially on more objective measures of health—using ‘real-life’ data from observational studies is extremely challenging. Classic epidemiological threats to internal validity abound: people taking up, or offered, the housing intervention may be very different from those not (confounding); …
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