The Communist age is now history. But all across Eastern Europe and the former Soviet Union, more than 170 million people continue to live in the soulless, decaying housing complexes that are among the most enduring legacies from that time. These concrete mazes, relics of an era when architecture was at the service of ideology, never matched the state's promises.

The increased demand for urban housing in the late sixties, seventies, and early eighties, was largely attributable to the increasing industrialisation of city economies and the planned reduction in the rural workforce. In their haste to accommodate the influx of workers, Communist regimes began to construct vast estates of largely identical high rise flats, the majority of which were made from prefabricated concrete slabs and panels. While it is possible to discuss the aesthetic pitfalls of such designs and their effects on the social and psychological health of the communities, it is clear that now, some 30 years on from their construction, we must begin to tackle the problems of their physical integrity and safety.

The economic liberalisation and the process of repatriation of property from state to the individual that has followed the collapse of the Iron Curtain, have combined to compound the problems created by poor construction standards. Today, there is very little money within the region, neither public nor private, for investment in the housing sector. Little or no preventative maintenance is carried out and repairs tend to be done on an emergency basis only. This combination of factors, coupled to the extreme climatic conditions, which have a heavy impact on the building materials, means that there is a rising crisis in urban housing in this part of Europe, and that action and more importantly investment will be needed quickly.

This pending crisis manifests itself through a number of different issues. Environmentally, it is now well known that the countries of the former Soviet Union and Warsaw pact, are among the most energy inefficient in the world. Economic inefficiency in many countries results from relatively high energy consumption, distorted energy prices, uncompetitive markets, and regulatory bodies that are not independent. At the Environment for Europe conference in Aarhus in 1998, it was recognised that energy efficiency can be improved by up to 30% over the next two to three years, reducing the cost of fuel for the consumer and decreasing green house gas emissions by four to six billion tones per year. It was also concluded that between 15–20% of energy is lost during use in Central and Eastern Europe compared with just a few per cent in the West. While there is still much to be achieved in terms of ensuring effective and efficient energy generation and usage by industry, the profligate use of energy within the domestic context also presents a major challenge. The now creaking and decrepit district heating systems, once the envy of the West, have been shown to be hugely inefficient and difficult to control. Furthermore the housing stock itself is largely un-insulated, and thermally porous. The sheer scale and the numbers of dwellings involved make this a significant, yet largely hidden, environmental problem.

In physical terms the relations between housing and health is not and never will be an exact science. The inter-relation between housing and physical and mental health is complex, and is invariably affected by extraneous variables, such as social class, poverty, state of nutrition and occupation or unemployment. Research studies have usually been unable to separate or explain the status of these various components. However, the absence of definitive measurements does not denote the absence of a relation between housing and health, it just means that a relation cannot always be proved. This has not stopped the WHO and others from suggesting parameters for healthy housing that reflect considerable knowledge, experience and some intuition of what constitutes healthy housing. However, these parameters can only be generalised as it is recognised that particular groups within the community often have different health and housing needs. It is partly for these reasons that healthy housing issues can be best tackled when it is part of a wider and integrated public health and housing policy.

For the countries of Central and Eastern Europe, the predominance of poorly built and shoddily maintained high rise dwellings within the housing stock, undoubtedly contributes to the already significant health burden. Many studies have shown that high rise housing is unsuitable for family occupancy on health grounds—that is, increased incidence of respiratory infections in young children, and mental disorders caused by social isolation and depression in their mothers. Children have more accidents in high rise accommodation than in traditional low rise housing. Facilities for children to play are restricted, which can affect child development and social interaction. Elderly and disabled people become more confined to the home and can thus become isolated. The air quality and climate indoors, particularly thermal comfort may be poor. Noise levels are often higher and may cause stress.

Of course all of these health hazards pale into insignificance when consideration is given to the physical integrity of the panel flats. Already reports of falling panels and balconies have been recorded, and roofs regularly leak prematurely. The panels are welded together by metal joints, and they are beginning to corrode. That coupled to temperature fluctuations of around 50°C, which are common in Central and Eastern Europe (−10°C winter to +40°C summer), means the buildings constantly expand and contract. Research is undecided and debated, but one estimate considers that such joints will fail after 30 to 40 contractions. But the truth is that one day, and soon, the joints will come loose.

For now it is enough to raise the issue as a significant one, and one that because of the current legal and economic conditions in Central and Eastern Europe, will only get worse unless action is taken urgently. WHO/Euro has a clear competence to work on this issue, and could raise it as a topic for discussion within the European Environment and Health Committee (EEHC), perhaps even leading to consideration at the next Ministerial Conference in 2004.

Socially, eastern European system built, high rise developments, tend to have a different profile than in the west. In Germany, France, Scandinavia, the UK and elsewhere in the EU, the building of huge high rise estates led to the formation of urban ghettos, plagued by high crime and decay. This has not happened yet across most of Eastern Europe. In Western countries where centrally planned suburbs often began as welfare projects for low income families, panel block housing in the East was more egalitarian. A specific feature of these settlements in the East is that they are composed of middle class, well educated people. This is the biggest difference between these areas in the West and East. However, as the estates physically decline, and a new richer middle class emerges, wealthier families will start to move away, beginning the cycle of decline. The lack of social infrastructure such as schools, a range of shops, recreation facilities, etc, within the estates, will also present social and health related problems. It will also serve to increase and perpetuate greater car ownership and use.

Economically, the scale of the problem is hard to imagine, and very few researchers have hazarded a guess at the growing bill that confronts the countries in transition. One estimate suggests that the cost of re-fitting and repairing Eastern Europe's panel apartments to ensure their continued viability is less than that of building new housing. This makes it a far better alternative than knocking them down. But there is still a substantial investment required, which could run to billions of dollars.

Furthermore, the fall of Communism across the region has added a whole host of other problems that similar estates in the West do not have to face: among them, property restitution, privatisation, and the paucity of the general economy. One of the common features of the early transition years, was a sudden rush to de-centralise and generally off load responsibility from central to local governments and individuals. This was done throughout government, often with little thought for the resources required to make the system operate. The administration and maintenance of State housing schemes was a significant drain on the public purse and an easy and obvious choice for early reform. As a result huge batches of state own flats were given to sitting tenants at peppercorn rates or sold off well below market values. As an instant solution it worked on two levels, it off loaded a heavy administrative and economic burden, and at the same time, it answered many of the restitution issues. However, it was a solution that invested deeply in hidden costs. The interest of this policy is now maturing, and Eastern European governments and International Agencies must begin to develop adequate legal and economic tools to deal the consequences.

In many situations, people in private housing can barely find sufficient capital to carry out emergency repairs to their own apartments, and as there is rarely a legal instrument to deal with condominium issues, repairs to common parts become protracted impossibilities. Little or no preventative maintenance is being carried out in multi-owner blocks right across the region.

Real estate markets are only just beginning to be sustainabily active in the most advanced of the central European countries. Elsewhere, financial institutions and mortgage lenders do not have the confidence, neither in the general economy nor in the properties that need the investment. Given the current physical condition of the housing stock in eastern Europe, it is clear that only a small percentage can afford wait for the national economic performance to reach a position where the housing sector becomes self sustaining. For the rest, additional and urgent financial instruments and assistance will be needed.

All of this has major political implications. Failure to tackle this impending housing crisis will result in serious social and political upheaval, particularly as the accession process gains pace and we move to a more expanded political notion of Europe.

The inability to provide secure, comfortable, affordable housing within Central and Eastern Europe will create social pressures and political uncertainty. If the free market is unable to solve the problems of Communist era housing policy, political resentment and uncertainty will result. The botched failures to deliver meaningful change and the general impatience associated with market reforms has already seen political fluctuations. If it cannot provide an adequate roof over the population's head, then voters will naturally hanker for the old times. As political security is one of the key planks upon which European expansion must be built, such a scenario would place the whole project in jeopardy.

Furthermore, if housing reforms fail, and the stock continues to deteriorate, it is inevitable that the freedom of individual movement that EU membership allows, will be fully used, placing immigration pressures on western EU countries.

These political ramifications may sound dramatic and exaggerated, however, when the scale of the problem is considered again, (it is estimated that some 34 million people live in vulnerable dwellings in Central Europe alone) that the possibilities for major social and demographic turmoil becomes apparent.

What has set out above has often been described by other commentators as a social “time bomb”. For the future health of the people of Europe, for the strength of National European economies, and for the social and political security of a wider European region, it is time we turned our collective attention to finding the policies, strategies and resources to “defuse” this impending crisis.