Johannesburg's 'poor housing, good health' paradox: the role of health status assessment, statistical modelling, residential context and migrant status

Ellison, George and De Wet, T (2020) Johannesburg's 'poor housing, good health' paradox: the role of health status assessment, statistical modelling, residential context and migrant status. Public Health, 186 . pp. 257-264. ISSN 0033-3506

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Official URL: https://doi.org/10.1016/j.puhe.2020.04.039

Abstract

The 'poor housing, good health' paradox observed by De Wet et al. (2011) across eight of Johannesburg's poorest Wards (neighbourhoods), was re-examined using: a more generic measure of self-reported health; better-specified adjustment for measured confounders; household data from a range of Wards and income strata across Johannesburg and Gauteng; and adjustment for migrant status. The present study examined the relationship between (formal vs. informal) housing and self-reported health (-limited work and/or social activities) across four subsamples of respondents to the 2013 Quality of Life survey undertaken by the Gauteng City Regional Observatory: n = 1494 from households in the eight Wards examined by De Wet et al. (2011); n = 3059 from households with the lowest income tertile in Johannesburg; n = 8263 from households throughout Johannesburg; and n = 24,727 from households throughout Gauteng Province, irrespective of Ward or income. The relationship between housing and self-reported health in each of these subsamples was examined before and after adjustment for measured confounders identified using a temporally determined causal path diagram in the form of a directed acyclic graph. Following adjustment for measured confounders, 'informal housing' was only associated with 'good' self-reported health in Johannesburg's poorest Wards (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.07, 1.79) and Johannesburg as a whole (OR: 1.15; 95%CI: 1.00, 1.31). These associations were substantially attenuated following adjustment for migrant status (OR: 1.26; 95%CI: 0.97, 1.65; OR: 1.07; 95%CI: 0.93, 1.22, respectively). While the present study found that Johannesburg's 'poor housing, good health' paradox was still evident when using a more generic/subjective (self-reported) measure of health, the apparent paradox appears to reflect, at least in part: the differential aggregation of migrant-headed households in Johannesburg neighbourhoods exhibiting a high concentration of informal housing; and the likely impact of the health-related selection on the health of migrant-headed households. [Abstract copyright: Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.]


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