Next Article in Journal
Using the Large Language Model ChatGPT to Support Decisions in Sustainable Transport
Previous Article in Journal
Exploring Synergies Among European Universities, Government, Industry, and Civil Society on Promotion of Green Policies and Just Transition Facets: Empirical Evidence from Six European Countries
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

Sustainable Housing as a Social Determinant of Health and Wellbeing

1
Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
2
Philanthropy Research Collaboration, Auburn, NSW 2144, Australia
Sustainability 2025, 17(16), 7519; https://doi.org/10.3390/su17167519
Submission received: 28 June 2025 / Revised: 15 August 2025 / Accepted: 18 August 2025 / Published: 20 August 2025
(This article belongs to the Special Issue The Built Environment and One Health: Opportunities and Challenges)

Abstract

Sustainable housing is increasingly recognized as a crucial social determinant of health, intersecting environmental sustainability with affordability, safety, and inclusivity to shape population health and equity. This paper reviews the existing literature and presents that integrating sustainable housing into public health frameworks can mitigate health risks, reduce inequities, and promote resilient urban futures. This review paper reframes sustainable housing through a holistic lens, emphasizing its potential to improve health through inclusive design, energy efficiency, green infrastructure, and affordability. Theoretically grounded in the Social Determinants of Health framework, Ecological Systems Theory, Environmental Health Theory, and Life Course Perspective, sustainable housing is shown to influence health outcomes across multiple levels and life stages. Empirical studies further validate these connections, demonstrating improved physical and mental health, particularly among vulnerable populations, when sustainable housing features are implemented. While these benefits span multiple health domains, persistent implementation challenges related to equity, financing, and policy coherence can limit their reach. Equity-centered approaches and cross-sector collaboration are essential to ensure the health benefits of sustainable housing are distributed fairly. Climate-resilient design strategies further underscore the role of housing in protecting communities against growing environmental threats. Furthermore, research priorities are required to strengthen the evidence base, including studies utilizing longitudinal study designs and participatory approaches. The findings of this review call for policy innovations that embed sustainable housing within broader public health and urban development agendas.

1. Introduction

In contemporary public health, the concept of sustainable housing is gaining prominence as both an environmental imperative and a critical social determinant of health [1,2,3]. Sustainable housing encompasses more than energy efficiency or the use of eco-friendly materials; it also involves creating living environments that are safe, affordable, inclusive, and resilient to environmental, social, and economic challenges [2]. As urbanization accelerates and climate change intensifies, the design, location, and quality of housing have emerged as pivotal factors shaping population health and health equity [3,4]. While well established in the literature, recognizing housing as a key social determinant of health means acknowledging that where and how people live can either promote health and wellbeing or reinforce cycles of disadvantage and disease [5,6,7,8].
The World Health Organization (WHO) defines social determinants of health as the conditions in which people are born, grow, live, work, and age [9]. These conditions are largely determined by the distribution of resources, power, and opportunity. Within this framework, housing intersects multiple dimensions of health: it influences exposure to physical hazards (e.g., air pollution, mold, poor insulation), access to essential services (e.g., healthcare, transportation, nutritious food), and psychosocial wellbeing (e.g., safety, social cohesion, stress levels) [5]. Sustainable housing, therefore, extends the traditional health-housing nexus by integrating long-term ecological sustainability with affordability, habitability, and resilience. Importantly, the health benefits of sustainable housing are not evenly distributed [1,2,3]. Low-income and marginalized communities are often excluded from accessing sustainable housing due to systemic barriers such as housing market inequities and underinvestment in public infrastructure [10,11]. In some cases, sustainability initiatives can unintentionally worsen these disparities. Green gentrification, for example, can displace vulnerable residents when environmental upgrades lead to rising property values and living costs [12]. These disparities not only entrench health inequities but also undermine broader sustainability goals. Thus, placing sustainable housing at the center of public health and urban policy requires a shift toward upstream, multisectoral strategies that prioritize equity and resilience across the life course. Integrating sustainability principles into housing policy and practice, when guided by equity-oriented frameworks, will yield co-benefits for health, the environment, and social wellbeing, as supported by interdisciplinary evidence [1,13]. The recognition of sustainable housing as a social determinant of health necessitates the integration of theoretical insights from various traditions. These include the Environmental Health Theory, the Life Course Perspective, and Environmental Justice. Together, these frameworks help us understand the complexity in the wide-ranging and long-term effects of housing on population health and wellbeing. Therefore, this paper positions sustainable housing as a key social determinant of health by projecting how its environmental, social, and economic dimensions intersect to influence population health outcomes. Building on this foundation, this study aims to demonstrate that sustainable housing is not solely about energy efficiency or green design, but fundamentally about enabling equitable, safe, and health-promoting living environments. This framing also allows us to explore actionable strategies that bridge environmental sustainability with social justice.

2. What Is Sustainable Housing?

Sustainable housing, ideally grounded in the Brundtland Report’s definition of sustainable development, represents meeting present needs without compromising the ability of future generations to meet theirs [14]. However, this definition faces widespread challenges due to a lack of practical, consensus-based clarity in policy and implementation. Although true sustainability should encompass environmental, social, and economic dimensions, housing practice and research frequently overemphasize environmental aspects. This imbalance stems from the environmental origins of the sustainability discourse in the 1980s and the relative ease of measuring environmental performance compared to social or economic impacts [15,16]. As a result, many housing policies reduce sustainability to notions of energy efficiency and resource conservation, neglecting broader human and social concerns [17,18,19]. Conversely, the public health literature presents sustainability as inherently human-centered and emphasizes that housing should improve quality of life within environmental limits [1,20,21]. The lack of a unified definition risks fragmented policymaking and allows for trade-offs among sustainability goals, undermining equitable outcomes.
In this manuscript, a synthesized definition of sustainable housing drawn from urban planning, environmental science, and the public health literature was adopted. This definition frames “sustainable housing” as an integrative concept that combines environmental performance with affordability, safety, inclusivity, and health-promoting design, thereby establishing it as a key social determinant of health. This approach bridges public health, urban planning, and environmental science, positioning housing as a multisectoral social determinant of health that requires coordinated action across disciplines. Social sustainability, in this context, is operationalized through indicators such as housing affordability, tenure security, accessibility for marginalized populations, and opportunities for community engagement. It should be acknowledged that the perception and priorities of sustainable housing vary across cultural and geographic contexts, underscoring the need for culturally sensitive frameworks in both policy and implementation. Therefore, reorienting sustainable housing toward people-centered, integrated design is crucial for achieving meaningful, long-term improvements in both environmental and public health domains.

3. Sustainable Housing and Health Equity in Theoretical Context

Understanding sustainable housing as a social determinant of health requires integrating multiple theoretical perspectives that highlight the complex ways housing influences health outcomes within broader social, environmental, and policy contexts. These theoretical constructs collectively underscore that housing is not merely a physical structure but a dynamic environment intertwined with equity, sustainability, and wellbeing. The Social Determinants of Health framework, advocated by the World Health Organization, forms the cornerstone of this understanding [9]. It emphasizes that health is shaped by the conditions in which individuals live, work, and age, with housing playing a pivotal role in mediating exposure to health risks and access to protective factors. Factors such as housing quality, affordability, security, and neighborhood characteristics are determinants that affect risk associated with both acute and chronic diseases, mental wellbeing, and social integration. This framework also directs attention to health inequities by revealing how systemic issues such as poverty, discrimination, and policy neglect lead to uneven access to safe and sustainable housing environments. Complementing this, Ecological Systems Theory offers a layered perspective on how individuals interact with their environments at multiple levels [22]. Originally developed by Bronfenbrenner, this theory situates housing within nested systems, starting from the immediate home environment to broader societal structures including urban planning and governance. Sustainable housing therefore extends beyond physical shelter to wider access to green spaces, transportation, and community resources that collectively support healthy behaviors and social connectedness. Environmental Health Theory provides further support by focusing on the direct impact of physical environments on human health [23,24]. Sustainable housing, in this view, is a means to reduce harmful exposures (e.g., indoor pollutants, extreme temperatures, and toxic building materials) while promoting conditions conducive to health, such as adequate ventilation and thermal comfort [25]. Importantly, this framework also stresses the need for resilience in housing design to mitigate emerging climate risks, ensuring that homes remain safe and supportive under changing environmental conditions. The Life Course Perspective adds a critical temporal dimension, stressing that housing-related exposures and experiences accumulate and interact across an individual’s lifespan [26,27]. Early childhood housing conditions can have lasting effects on respiratory and cognitive development, while housing stability and suitability in adulthood and old age continue to shape health trajectories [28,29]. These findings direct us toward the potential for sustainable housing policies to generate long-term, intergenerational health benefits by ensuring supportive environments at every life stage. Integrating the above constructs with the theories of Equity and Environmental Justice helps explain the uneven distribution of sustainable housing and its health benefits [30,31]. It highlights how marginalized populations, often divided along socioeconomic and racial lines, disproportionately face poor housing conditions and increased exposure to environmental hazards. Addressing these disparities requires policies that not only improve housing quality but also confront systemic barriers and equitably redistribute resources. Sustainable housing initiatives, when guided by equity, can help correct historic injustices and foster inclusive, healthy, and resilient communities by simultaneously addressing housing quality, affordability, environmental impact, and social equity.

Where Housing and Health Theories Intersect

Positioning housing as a determinant of health integrates the Social Determinants of Health framework, Ecological Systems Theory, Environmental Health Theory, and Life Course Perspective to provide a temporally sensitive understanding of how housing influences health. The Social Determinants of Health framework draws attention to structural and systemic factors such as housing quality, affordability, and neighborhood conditions that contribute to health disparities [9]. Ecological Systems Theory positions individuals within nested environmental contexts, from household settings to broader policy environments, highlighting how each layer influences daily behaviors and risk exposure [22]. Environmental Health Theory contributes by emphasizing the direct impacts of housing features such as ventilation, thermal conditions, and indoor pollutants on physical and mental wellbeing [23,24]. In addition, the Life Course Perspective introduces a temporal dimension, illustrating how housing conditions across different life stages accumulate to shape long-term health trajectories [26,27]. In combination, the aforementioned theories underscore that housing is not a static backdrop but a dynamic and cumulative determinant of health. Recognizing these interconnections is essential for developing policies that promote equitable and sustainable housing environments capable of addressing complex health challenges. This holistic view reinforces the idea that health outcomes are influenced by a constellation of environmental and social factors operating simultaneously as shown in Figure 1.

4. Empirical Evidence Linking Sustainable Housing to Health Outcomes

4.1. Methodology for Literature Identification

This synthesis of current evidence linking sustainable housing features to health outcomes was an outcome of a literature search conducted across three electronic databases: PubMed, Scopus, and Google Scholar. The search focused on empirical studies published in English that evaluated the health impacts of sustainable housing design, building interventions, or policy frameworks. Search terms included combinations of “sustainable housing”, “green building”, “health outcomes”, “indoor environmental quality”, “LEED”, “ventilation”, and “low-income housing”, among others. Boolean operators were used to combine terms and filter relevant studies. Titles and abstracts were screened to ensure relevance, and full texts of selected papers were reviewed for empirical findings. Studies included in this synthesis spanned diverse geographical contexts and population groups, with particular emphasis on interventions in low-income or high-risk communities as described below.

4.2. Sustainable Housing and Health Outcomes

Empirical studies across diverse settings consistently demonstrate that sustainable housing features are linked to improved health outcomes, particularly among vulnerable populations. Interventions have incorporated green building standards such as Enterprise Green Communities and Leadership in Energy and Environmental Design (LEED), featuring enhanced ventilation, mold and pest control, and low-VOC (volatile organic compounds) materials. Green building standards have led to significant improvements in general health, asthma symptoms, and reductions in respiratory issues [32,33]. One example is based in South Bronx, New York, which observed LEED-certified housing was associated with reduced asthma symptoms and healthcare use among low-income tenants, supported by tenant education on environmental triggers [34]. Beyond residential settings, poor indoor environmental quality in Malaysian public office buildings was linked to Sick Building Syndrome symptoms, with mechanical ventilation upgrades proving beneficial [35]. Similarly, a study in Mexico using a Healthy-Sustainable Housing Index found that better housing quality, including ventilation, construction materials, flooring, and hygiene and was associated with reduced respiratory symptoms and illness duration in children [36]. The health impact of sustainable housing is summarized in Figure 2.

4.3. Sustainable Housing Interventions

Housing interventions aimed at promoting health and sustainability incorporate a variety of design-, construction-, and policy-based strategies, addressing indoor environmental quality, energy efficiency, community wellbeing, and disease prevention. A recurring theme across studies is the importance of mechanical ventilation systems compliant with ASHRAE 62.2 standards [37] to ensure adequate air exchange and reduce indoor pollutants [32,33]. Low-VOC materials are emphasized to minimize respiratory irritants, advocating for their use in construction [34,38]. Mold and pest control through leak sealing and reduced pesticide use is another critical factor in preventing asthma triggers [33,34]. Sustainable building design and energy efficiency play a central role in these interventions, with green building certifications such as LEED and Enterprise Green Communities serving as key frameworks [33,34]. Innovations such as geothermal HVAC systems, high-performance windows, and smart home automation contribute to energy conservation, with additional features such as green roofs, rainwater harvesting, and greywater reuse to enhance sustainability [38]. Smoke-free policies, both indoors and within designated perimeters around buildings, are widely recommended to reduce secondhand smoke exposure [32,34,35]. Some interventions also implement pet-free policies to mitigate allergens [34]. Beyond individual housing units, neighborhood design significantly influences health and sustainability. Accessible public greenspaces, crime-preventive design, and proximity to amenities highlight the benefits of shared gardens and flexible interior designs in fostering social interaction [38,39]. Water and waste management strategies, such as pneumatic waste collection systems and regular cleaning protocols, improve hygiene [35,36,38]. Water conservation through efficient fixtures and greywater recycling is another key strategy [36,38]. Collectively, these findings highlight the significant health benefits of integrating sustainable housing features, particularly in low-income and high-risk settings. Some examples of sustainable design features and its mechanism impacting health outcomes are outlined in Table 1.

4.4. Geographic and Contextual Variations in Evidence

Contextual differences were thematically understood through the empirical studies included in this synthesis, which can be broadly categorized by geographic region, housing type, and target population. In high-income urban settings such as the United States, studies have largely focused on low-income, multi-unit housing developments, with interventions centered around LEED-certified buildings and tenant education programs, demonstrating improvements in asthma outcomes and overall health [32,34]. In contrast, research from low- and middle-income countries such as Mexico and Malaysia have emphasized individual housing quality elements (e.g., ventilation, flooring, hygiene) and workplace-related exposures, highlighting a need for scalable, cost-effective interventions to address basic environmental health risks [35,36]. Evidence also underscores the importance of geographic and climatic context in shaping the design and implementation of sustainable housing interventions. In rapidly urbanizing regions of East Asia, state power and environmental initiatives in China with green design have been instrumental in promoting energy-efficient construction at scale, responding to dense urban development and severe air pollution challenges [40,41]. In South Asia, India’s Eco-Niwas Samhita building code addresses thermal comfort in hot-humid and composite climates, tailoring sustainability standards to the needs of low-income populations vulnerable to heat-related illnesses [42,43]. These examples reflect how national policies in the Global South adapt sustainable housing to local environmental stressors, population density, and resource constraints. It also highlights the importance of contextualized design rather than relying on one-size-fits-all frameworks derived from high-income settings. Additionally, housing types varied across contexts, ranging from public housing complexes and renovated urban apartment blocks to rural family homes and informal settlements. Across these varied environments, the evidence consistently suggests that vulnerable populations, particularly children, the elderly, and low-income residents experience the most significant health benefits from sustainable housing interventions. Table 2 provides details on some empirical studies that were identified from the literature search.

5. Integrating Sustainable Housing into Public Health Policy

The integration of sustainable housing into public health policy is imperative to address the intersectional challenges of environmental degradation, housing insecurity, and population health disparities. As a key component of the broader Social Determinants of Health (SDH), housing profoundly influences physical, mental, and social wellbeing. Embedding sustainable housing into SDH frameworks ensures that policy interventions address not only environmental sustainability but also social equity, affordability, and long-term health outcomes [44]. Achieving this integration requires robust cross-sectoral collaboration involving housing authorities, public health departments, urban planners, environmental protection agencies, and social service providers [45,46]. These sectors must coordinate to establish strategies that reflect the shared responsibility for human and environmental wellbeing, consistent with SDH principles that emphasize intersectoral action for health equity.
The need for cross-sectoral collaboration is evident in urban centers experiencing high levels of pollution, inadequate housing infrastructure, and poor health outcomes. Collaboration can facilitate shared data systems, joint funding opportunities, and cohesive planning processes that ensure housing developments meet sustainability criteria while supporting public health objectives [45]. For instance, aligning zoning regulations with health-promoting infrastructure such as green spaces, public transport access, and energy-efficient buildings can significantly impact respiratory health, physical activity levels, and overall quality of life. Moreover, several successful policy models exemplify effective integration. The Enterprise Green Communities Criteria provide a comprehensive framework for affordable housing developers, emphasizing sustainable building practices and health outcomes [47]. Similarly, the Leadership in Energy and Environmental Design (LEED) certification, while often associated with commercial buildings, has been adapted to support affordable and sustainable residential housing [48]. Internationally, China’s Green Building Action Plan has served as a key driver for scaling up sustainable construction practices, mandating energy-efficient and health-conscious design in urban development [41]. In India, the Eco-Niwas Samhita building code promotes thermal comfort and energy efficiency in affordable housing for hot-humid climates [42,43]. These examples broaden the global applicability of sustainability frameworks beyond high-income contexts. These models demonstrate that environmentally conscious housing does not need to be cost-prohibitive or limited to affluent populations. When embedded within SDH policy structures, such frameworks can guide equity-focused housing interventions.
Despite some successes in integrating sustainable housing into public health policy, significant barriers hinder widespread implementation. Funding gaps present a primary challenge, particularly for public housing agencies operating under constrained budgets [49,50]. Additionally, political resistance can arise from stakeholders opposing regulatory changes or perceiving sustainable practices as burdensome [49]. A lack of standardized metrics to evaluate health and sustainability outcomes further complicates policy adoption and effectiveness assessments [51,52]. Moreover, the high upfront costs associated with certain policy can inadvertently exclude low-income households, thereby reinforcing green gentrification and exacerbating housing inequities. Critical reflection on such outcomes is vital for designing inclusive policy mechanisms that do not trade off affordability for efficiency. To overcome these barriers, policies must promote interagency collaboration, incentivize sustainable practices through subsidies and tax credits, and develop robust monitoring systems to evaluate long-term impacts. Institutionalizing sustainable housing within public health and SDH frameworks ensures a proactive, integrated, and equity-oriented approach to improving population health and achieving environmental justice. It reaffirms housing as not merely shelter, but a fundamental platform for health and wellbeing.

6. Equity-Centered Approaches to Sustainable Housing

Equity-centered approaches are essential to ensure that sustainable housing benefits all communities, especially low-income and marginalized groups who often face disproportionate housing and health challenges [53,54]. Without intentional design, sustainability initiatives risk exacerbating existing inequalities by pricing out vulnerable residents or prioritizing environmental goals over social equity. Strategies to address this include the development of inclusive zoning policies that mandate a portion of sustainable housing units be affordable to low- and moderate-income households [54,55]. These policies can prevent displacement and promote socioeconomic diversity within green neighborhoods. Rent control mechanisms in green-certified buildings can also help maintain affordability as property values rise due to sustainability upgrades [56,57,58].
Community-led housing projects can serve as another powerful model. When residents are involved in the planning and development process, the resulting housing is more likely to reflect their needs, foster community ownership, and build local capacity [59]. Examples include cooperative housing models and land trusts that embed affordability and sustainability into their governance structures [60]. Moreover, financial tools can also play a crucial role. Subsidies for energy-efficient retrofits in low-income housing, tax incentives for developers incorporating affordable green units, and public–private partnerships that align profit motives with social impact can expand access to sustainable housing [61,62]. For instance, cities such as Portland and New York have piloted incentive programs that reward developers for meeting affordability and green building benchmarks [63,64].
Equity must also be central in resilience planning. Marginalized communities often reside in areas more vulnerable to climate hazards. Sustainable housing initiatives must therefore prioritize these neighborhoods for climate-resilient infrastructure, such as floodproofing, passive cooling systems, and improved air filtration [4]. Policymakers should engage directly with affected communities to understand their unique vulnerabilities and co-create adaptive solutions. By embedding equity into every stage of sustainable housing policy, from planning to implementation, governments can ensure that environmental progress does not come at the expense of social justice. Equity-centered sustainability is not merely an ethical imperative but a necessary condition for holistic and inclusive urban development.

7. Digital Technologies in Sustainable Housing

Digital technologies are increasingly shaping the design, operation, and monitoring of sustainable housing. Smart home systems such as energy-efficient thermostats, occupancy sensors, smart lighting, and ventilation monitoring can enhance environmental sustainability while also supporting health and wellbeing [65]. These systems allow residents to manage energy use more efficiently, maintain indoor air quality, and reduce exposure to allergens and pollutants, which is especially beneficial for individuals with asthma or cardiovascular conditions [66,67,68]. In particular, smart sensors embedded in heating, ventilation, and air conditioning (HVAC) systems have shown promise in maintaining optimal indoor environmental quality. An important example includes the real-time monitoring of temperature, humidity, and air pollutants, which enables proactive responses to health threats such as mold or high particulate matter levels [69]. Additionally, wearable health devices linked to home automation systems can personalize indoor environments for vulnerable residents, such as the elderly or chronically ill, enhancing comfort and reducing health risks [70]. However, the digitalization of housing also raises critical concerns. Digital inequity, where low-income households may lack access to smart technologies or digital literacy can inadvertently widen health disparities. High upfront costs of smart systems, data privacy concerns, and reliance on internet infrastructure may exclude those in underserved communities [71,72]. As such, policy interventions must ensure that smart housing initiatives are inclusive and accessible. Government subsidies for smart retrofits in public housing, open source technology solutions, and digital literacy campaigns are crucial to prevent the deepening of existing inequities.
Real-world implementations further illustrate the potential of digital technologies. In Singapore, the Housing and Development Board (HDB) Smart-Enabled Homes Program equips public housing units with elderly monitoring systems to prevent falls and health crises [73]. This case demonstrates the feasibility of inclusive smart housing when paired with public sector support and community engagement. Integrating digital innovations into sustainable housing must be guided by the dual goals of environmental sustainability and health equity. Smart housing should not only optimize performance but also empower all residents to live healthier, more connected lives.

8. Climate Resilience and Health-Protective Housing Design

Sustainable housing cannot be fully realized without incorporating climate resilience, as climate-related risks are increasingly shaping health outcomes. Housing that fails to withstand extreme weather, pollution, or environmental degradation places already vulnerable populations at heightened risk, exacerbating health inequities [74]. Integrating climate-resilient design features such as passive cooling, flood resistance, and improved air filtration into sustainable housing, can strengthen its role as a protective factor in public health [75,76,77]. This alignment reinforces the central argument that sustainable housing, when holistically designed, functions as a critical social determinant of health by mitigating environmental exposure and enhancing long-term wellbeing. Climate change presents an escalating threat to public health, making climate-resilient housing a critical component of sustainable development [4]. Climate-resilient housing mitigates health risks associated with extreme weather events, including heatwaves, flooding, and air pollution, thereby serving as a frontline defense in protecting vulnerable populations. Design principles that enhance climate resilience include passive cooling systems, high-performance insulation, reflective roofing, and strategic landscaping to reduce urban heat island effects [78]. These features can significantly reduce the incidence of heat-related illnesses, particularly among elderly residents, young children, and individuals with chronic health conditions. Similarly, flood-resistant materials, elevated foundations, and effective drainage systems can minimize the impact of increasingly frequent and severe flooding events [79]. In regions prone to wildfires or air pollution, air-sealed construction and integrated filtration systems enhance indoor air quality and reduce exposure to harmful particulates [80,81]. These innovations not only mitigate immediate health threats but also foster long-term community stability by reducing displacement and property damage.
Case studies from around the globe illustrate effective implementation of health-protective housing. In Bangladesh, low-income coastal communities have adopted stilted homes and cyclone-resistant materials to combat flood risk [82,83]. In Phoenix, Arizona, developers have utilized passive solar designs and shaded outdoor areas to address extreme heat [84]. Post-Hurricane Katrina efforts in New Orleans resulted in the Make It Right Foundation built LEED Platinum-certified homes using elevated designs and eco-friendly materials tailored to withstand future hurricanes [84,85]. To embed climate resilience into mainstream housing policy, governments must revise building codes to incorporate adaptive standards. These codes should mandate energy efficiency, sustainable materials, and design features that respond to local climate risks. Moreover, financial incentives can facilitate compliance, especially in low-income housing developments [63]. Training programs for architects, builders, and city planners must emphasize resilience as a central pillar of health-promoting design. Ultimately, housing must be reframed not just as shelter but as a tool of public health protection in a world undergoing global warming. As climate change accelerates, such design principles will become not just preferable but essential in safeguarding communities and ensuring long-term sustainability [86].

9. Future Directions for Research and Advocacy

The relationship between sustainable housing and public health is complex and multifaceted, necessitating continued research and advocacy. Although progress has been made in identifying the co-benefits of environmentally sound housing, significant gaps remain in our understanding, particularly concerning long-term health outcomes, cost-effectiveness, and the lived experiences of diverse communities. One of the most critical gaps is the lack of longitudinal data examining the sustained health impacts of sustainable housing. While short-term improvements in indoor air quality or thermal comfort are well documented, few studies track residents over extended periods to assess outcomes such as chronic disease incidence, mental health trajectories, or intergenerational health effects [25,87,88]. Future research must prioritize such longitudinal studies, ideally integrating qualitative and quantitative methods to capture both health metrics and lived experiences. Additionally, comprehensive cost–benefit analyses are needed to inform policy decisions and justify public and private investment. These analyses should extend beyond construction costs and consider long-term savings related to reduced healthcare expenditures, increased productivity, and environmental preservation. Policymakers and funders may require this evidence to scale up sustainable housing initiatives.
Research should also focus on community-specific impacts. Marginalized groups including Indigenous populations, immigrants, and residents of informal settlements experience unique housing and health challenges [5]. Culturally tailored research can inform more effective interventions and ensure policies do not inadvertently reinforce existing inequities. Participatory action research, in which community members co-design and co-conduct studies, is particularly valuable for fostering relevance and trust, which can be further fortified with quantitative data [89,90]. This would result in prioritizing interventions that address systemic barriers, such as green gentrification, digital divides, and inequitable access to safe, healthy housing, so that sustainable housing research and policy can directly mitigate health disparities among marginalized populations. Another emerging area is the integration of digital technologies into sustainable housing [91]. Smart sensors, for instance, can monitor indoor air quality, energy consumption, and thermal comfort in real time. Studying the effectiveness of such technologies in improving health outcomes and reducing energy costs offers a promising frontier for innovation. In addition, the use of big data methodologies such as satellite imagery and geolocation tracking can help researchers monitor patterns of residential mobility, environmental exposure, and health service use over time. These data streams can provide granular insights into how housing conditions interact with population health across space and time. Advances in artificial intelligence (AI) and machine learning also provide potential for predicting housing-related health risks and personalizing interventions based on environmental and behavioral patterns [92,93]. However, these innovations also raise critical ethical concerns, particularly regarding privacy, data governance, and consent. Similarly, technologies such as smart home surveillance and continuous environmental monitoring may lead to intrusive data collection without adequate safeguards for residents. Another important challenge remains: digital equity concerns must be addressed to prevent technological interventions from exacerbating social divides [94]. In terms of practical relevance for policymakers and practitioners, future studies must also develop and utilize concrete, standardized indicators for measuring health outcomes associated with sustainable housing. These may include metrics such as frequency of asthma-related emergency visits, prevalence of respiratory symptoms, blood pressure and cardiovascular health markers, levels of stress and sleep disturbance, and validated scales for mental health outcomes such as the Kessler Psychological Distress Scale (K-10), the Patient Health Questionnaire-9 (PHQ-9), or the Generalized Anxiety Disorder-7 (GAD-7). Future studies with such indicators will allow for clearer benchmarking of interventions and facilitate cross-study comparisons that are essential for evidence-based policymaking.
In terms of advocacy, health professionals are uniquely positioned to champion sustainable housing within broader social determinants of health frameworks. Medical associations and public health bodies can issue policy statements, support cross-sectoral initiatives, and educate stakeholders about the health benefits of sustainable housing [95]. Incorporating housing questions into clinical practice through social prescribing or social determinants of health screening tools can also increase awareness and support for policy change. Effective advocacy requires coalitions of stakeholders, including community-based organizations, researchers, developers, and residents. These interdisciplinary groups must articulate a unified vision and leverage collective influence to shape policy agendas [96]. Strategic use of media, storytelling, and data visualization can also enhance public engagement and political will. Furthermore, fostering cross-sector collaboration among public health professionals, urban planners, developers, and policymakers is essential to implement climate-resilient housing solutions that respond effectively to urbanization and environmental challenges. Finally, academic institutions should incorporate sustainability and housing justice into curricula across disciplines, including public health, urban planning, and architecture [96,97]. Training future professionals to understand and address the health implications of housing is essential to building a knowledgeable and committed workforce.

10. Conclusions

This study underscores the critical role of sustainable housing as a fundamental social determinant of health, demonstrating its potential to improve health outcomes, reduce inequities, and enhance climate resilience. By integrating environmental, economic, and social dimensions, sustainable housing not only mitigates exposure to physical hazards but also fosters psychosocial wellbeing and community stability. Empirical evidence highlights tangible benefits, particularly for vulnerable populations, through improved indoor air quality, thermal comfort, and reduced disease burden. However, achieving these benefits requires equity-centered policies, cross-sectoral collaboration, and systemic reforms to overcome financial, political, and structural barriers. Future research should prioritize longitudinal studies, cost–benefit analyses, and participatory approaches to ensure interventions are both effective and inclusive. Furthermore, embedding sustainable housing within public health and urban policy frameworks is essential for advancing health equity, environmental justice, and resilient urban futures in an era of rapid urbanization and climate change.

Funding

This research received no external funding. Open access article processing charges and in-kind logistical support were provided by the Philanthropy Research Collaboration.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study.

Acknowledgments

This research was conducted as part of the Scholarship, Partnerships and Research for Knowledge (SPARK) initiative under the Philanthropy Research Collaboration. I would like to acknowledge all members of Philanthropy Research Collaboration (previously known as Philanthropy Nepal Research Collaboration) for their support and assistance in completing this study.

Conflicts of Interest

The author declares no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
AIArtificial Intelligence
ASHRAEAmerican Society of Heating, Refrigerating and Air-Conditioning Engineers
Bla g1Blattella germanica allergen 1 (cockroach allergen)
CFU/m3Colony Forming Units per cubic meter (measure of fungal/bacterial contamination)
CO2Carbon Dioxide
GAD-7Generalized Anxiety Disorder-7
HDBHousing and Development Board
HSHIHealthy-Sustainable Housing Index
HVACHeating, Ventilation, and Air Conditioning
IAQIndoor Air Quality
K-10Kessler Psychological Distress Scale
LEEDLeadership in Energy and Environmental Design
Mus m1Mus musculus allergen 1 (mouse allergen)
OROdds Ratio
PHQ-9Patient Health Questionnaire-9
pCi/LPicocuries per liter (measure of radon concentration)
ppmParts per million
RHRelative Humidity
SBSSick Building Syndrome
SDHSocial Determinant of Health
VOCVolatile Organic Compounds
WHOWorld Health Organization

References

  1. Prochorskaite, A.; Maliene, V. Health, well-being and sustainable housing. Int. J. Strateg. Prop. Manag. 2013, 17, 44–57. [Google Scholar] [CrossRef]
  2. Wahowiak, L. Healthy, safe housing linked to healthier, longer lives: Housing a social determinant of health. Nation’s Health 2016, 46, 1–19. [Google Scholar]
  3. Schneider-Skalska, G. Healthy housing environment in sustainable design. IOP Conf. Ser. Mater. Sci. Eng. 2019, 471, 092083. [Google Scholar] [CrossRef]
  4. Ruíz, M.A.; Mack-Vergara, Y.L. Resilient and Sustainable Housing Models against Climate Change: A Review. Sustainability 2023, 15, 13544. [Google Scholar] [CrossRef]
  5. Rana, K.; Kent, J.L.; Page, A. Housing inequalities and health outcomes among migrant and refugee populations in high-income countries: A mixed-methods systematic review. BMC Public Health 2025, 25, 1098. [Google Scholar] [CrossRef]
  6. Rana, K.; Page, A.; Kent, J.L.; Arora, A. Pathways Linking Housing Inequalities and Health Outcomes among Migrant and Refugee Populations in High-Income Countries: A Protocol for a Mixed-Methods Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 16627. [Google Scholar] [CrossRef]
  7. Li, A.; Toll, M.; Bentley, R. Health and housing consequences of climate-related disasters: A matched case-control study using population-based longitudinal data in Australia. Lancet Planet. Health 2023, 7, e490–e500. [Google Scholar] [CrossRef]
  8. The, L. Housing: An overlooked social determinant of health. Lancet 2024, 403, 1723. [Google Scholar] [CrossRef]
  9. WHO. Social Determinants of Health. Available online: https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health (accessed on 20 June 2025).
  10. Kotsila, P.; Anguelovski, I.; García-Lamarca, M.; Sekulova, F. Injustice in Urban Sustainability: Ten Core Drivers; Taylor & Francis: Abingdon, UK, 2023. [Google Scholar]
  11. Rauh, V.A.; Landrigan, P.J.; Claudio, L. Housing and health: Intersection of poverty and environmental exposures. Ann. N. Y. Acad. Sci. 2008, 1136, 276–288. [Google Scholar] [CrossRef]
  12. Bockarjova, M.; Botzen, W.; Van Schie, M.; Koetse, M. Property price effects of green interventions in cities: A meta-analysis and implications for gentrification. Environ. Sci. Policy 2020, 112, 293–304. [Google Scholar] [CrossRef]
  13. Kennedy, A.M.; Tsakonas, K.; Berman-Hatch, F.; Conradi, S.; Thaysen, M.; Gillespie, M.A.; Gislason, M.K. Promoting community health and climate justice co-benefits: Insights from a rural and remote island climate planning process. Front. Public Health 2024, 12, 1309186. [Google Scholar] [CrossRef] [PubMed]
  14. Brundtland, G.H. Our Common Future: World Commission on Environment and Development; United Nations: New York, NY, USA, 1987. [Google Scholar]
  15. Carter, K.; Fortune, C. Sustainable development policy perceptions and practice in the UK social housing sector. Constr. Manag. Econ. 2007, 25, 399–408. [Google Scholar] [CrossRef]
  16. Pakir, A.H.K.; Tabassi, A.A.; Ramli, M.; Bakar, A.H.A.; Roufechaei, K.M. Sustainable housing development and leadership: A review. Aust. J. Basic Appl. Sci. 2012, 6, 385–395. [Google Scholar]
  17. Sunikka, M. Fiscal instruments in sustainable housing policies in the EU and the accession countries. Eur. Environ. 2003, 13, 227–239. [Google Scholar] [CrossRef]
  18. Priemus, H. How to make housing sustainable? The Dutch experience. Environ. Plan. B Plan. Des. 2005, 32, 5–19. [Google Scholar] [CrossRef]
  19. Pickvance, C. Choice or coercion: Dilemmas of sustainable social housing. A study of two developments in Kent. Local Environ. 2009, 14, 207–214. [Google Scholar] [CrossRef]
  20. Burinskienė, M.; Rudzkienė, V.; Venckauskaitė, J. Effects of quality of life on the price of real estate in Vilnius city. Int. J. Strateg. Prop. Manag. 2011, 15, 295–311. [Google Scholar] [CrossRef]
  21. Barton, H. Healthy urban planning: The anatomy of a WHO Healthy Cities project. In Incentives, Regulations and Plans; Knaap, G.-J., Haccoû, H.A., Clifton, K.J., Frece, J.W., Eds.; Edward Elgar Publishing: Cheltenham, UK, 2007; Chapter 9; p. 193. [Google Scholar]
  22. Bronfenbrenner, U. Ecological Systems Theory; American Psychological Association: Washington, DC, USA, 2000. [Google Scholar]
  23. Parkes, M.; Panelli, R.; Weinstein, P. Converging paradigms for environmental health theory and practice. Environ. Health Perspect. 2003, 111, 669–675. [Google Scholar] [CrossRef]
  24. Chandrappa, R.; Das, D.B. Environmental Health-Theory and Practice; Springer: Berlin/Heidelberg, Germany, 2021. [Google Scholar]
  25. Rana, K. Towards passive design strategies for improving thermal comfort performance in a naturally ventilated residence. J. Sustain. Archit. Civ. Eng. 2021, 29, 150–174. [Google Scholar] [CrossRef]
  26. Feijten, P.; Mulder, C.H. Life-course experience and housing quality. Hous. Stud. 2005, 20, 571–587. [Google Scholar] [CrossRef]
  27. Robison, J.T.; Moen, P. A life-course perspective on housing expectations and shifts in late midlife. Res. Aging 2000, 22, 499–532. [Google Scholar] [CrossRef]
  28. Weitzman, M.; Baten, A.; Rosenthal, D.G.; Hoshino, R.; Tohn, E.; Jacobs, D.E. Housing and child health. Curr. Probl. Pediatr. Adolesc. Health Care 2013, 43, 187–224. [Google Scholar] [CrossRef]
  29. Howden-Chapman, P.; Bennett, J.; Edwards, R.; Jacobs, D.; Nathan, K.; Ormandy, D. Review of the impact of housing quality on inequalities in health and well-being. Annu. Rev. Public Health 2023, 44, 233–254. [Google Scholar] [CrossRef]
  30. Foy, K.C. Home is where the health is: The convergence of environmental justice, affordable housing, and green building. Pace Environ. Law Rev. 2012, 30, 1. [Google Scholar] [CrossRef]
  31. Chitewere, T. Equity in sustainable communities: Exploring tools for environmental justice and political ecology. Nat. Resour. J. 2010, 50, 315. [Google Scholar]
  32. Breysse, J.; Jacobs, D.E.; Weber, W.; Dixon, S.; Kawecki, C.; Aceti, S.; Lopez, J. Health Outcomes and Green Renovation of Affordable Housing. Public Health Rep. 2011, 126, 64–75. [Google Scholar] [CrossRef] [PubMed]
  33. Jacobs, D.E.; Breysse, J.; Dixon, S.L.; Aceti, S.; Kawecki, C.; James, M.; Wilson, J. Health and housing outcomes from green renovation of low-income housing in Washington, DC. J. Environ. Health 2014, 76, 8–16; quiz 60. [Google Scholar] [PubMed]
  34. Garland, E.; Steenburgh, E.T.; Sanchez, S.H.; Geevarughese, A.; Bluestone, L.; Rothenberg, L.; Rialdi, A.; Foley, M. Impact of LEED-certified affordable housing on asthma in the South Bronx. Prog. Community Health Partnersh. Res. Educ. Action 2013, 7, 29–37. [Google Scholar] [CrossRef]
  35. Norhidayah, A.; Chia-Kuang, L.; Azhar, M.K.; Nurulwahida, S. Indoor Air Quality and Sick Building Syndrome in Three Selected Buildings. Procedia Eng. 2013, 53, 93–98. [Google Scholar] [CrossRef]
  36. Zúñiga-Bello, P.; Schilmann, A.; Félix-Arellano, E.; Gama-Hernández, G.; Alamo-Hernández, U. Healthy-sustainable housing index: A pilot study to link architecture and public health in a semi-urban community in Mexico. Int. J. Environ. Res. Public Health 2019, 16, 295. [Google Scholar] [CrossRef]
  37. ASHRAE 62.2-2019; Ventilation and Acceptable Indoor Air Quality in Residential Buildings. ASHRAE: Atlanta, GA, USA, 2019. Available online: https://www.ashrae.org/file%20library/technical%20resources/standards%20and%20guidelines/standards%20addenda/62_2_2019_h_20220429.pdf (accessed on 20 June 2025).
  38. D’Alessandro, D.; Gola, M.; Appolloni, L.; Dettori, M.; Fara, G.M.; Rebecchi, A.; Settimo, G.; Capolongo, S. COVID-19 and Living space challenge. Well-being and Public Health recommendations for a healthy, safe, and sustainable housing. Acta Biomed. 2020, 91, 61–75. [Google Scholar] [CrossRef]
  39. Prochorskaite, A.; Couch, C.; Malys, N.; Maliene, V. Housing stakeholder preferences for the “Soft” features of sustainable and healthy housing design in the UK. Int. J. Environ. Res. Public Health 2016, 13, 111. [Google Scholar] [CrossRef] [PubMed]
  40. Yu, H.; Wen, B.; Zahidi, I.; Fai, C.M.; Madsen, D.Ø. China’s green building revolution: Path to sustainable urban futures. Results Eng. 2024, 23, 102430. [Google Scholar] [CrossRef]
  41. Zhang, Y.; Kang, J.; Jin, H. A review of green building development in China from the perspective of energy saving. Energies 2018, 11, 334. [Google Scholar] [CrossRef]
  42. Ghosh, A.; Neogi, S. Energy efficiency in buildings and related assessment tools under Indian perspective. In Strategic Management, Decision Theory, and Decision Science: Contributions to Policy Issues; Springer: Berlin/Heidelberg, Germany, 2021; pp. 33–50. [Google Scholar]
  43. Maithel, S.; Rawal, R.; Shukla, Y. Thermal Properties of Indian Masonry Units & Masonry for Eco-Niwas Samhita Implementation. Available online: https://www.researchgate.net/publication/375609528_Thermal_Properties_of_Indian_Masonry_Units_Masonry_for_Eco-Niwas_Samhita_Implementation (accessed on 20 June 2025).
  44. Block, M.; Bokalders, V. The Whole Building Handbook: How to Design Healthy, Efficient and Sustainable Buildings; Routledge: Abingdon, UK, 2010. [Google Scholar]
  45. Marín-González, F.; Moganadas, S.R.; Paredes-Chacín, A.J.; Yeo, S.F.; Subramaniam, S. Sustainable local development: Consolidated framework for cross-sectoral cooperation via a systematic approach. Sustainability 2022, 14, 6601. [Google Scholar] [CrossRef]
  46. Joseph, M.L.; Chaskin, R.J.; Khare, A.T.; Kim, J.-E. The organizational challenges of mixed-income development: Privatizing public housing through cross-sector collaboration. In Transforming Social Housing; Routledge: Abingdon, UK, 2020; pp. 125–147. [Google Scholar]
  47. Bourland, D. Incremental Cost, Measurable Savings: Enterprise Green Communities Criteria; Enterprise Community Partners, Inc.: Columbia, MD, USA, 2009. [Google Scholar]
  48. U.S. Green Building Council. Leadership in Energy and Environmental Design; US Green Building Council: Washington, DC, USA, 2008; Available online: http://www.usgbc.org (accessed on 20 June 2025).
  49. Arman, M.; Zuo, J.; Wilson, L.; Zillante, G.; Pullen, S. Challenges of responding to sustainability with implications for affordable housing. Ecol. Econ. 2009, 68, 3034–3041. [Google Scholar] [CrossRef]
  50. Coscia, C.; Mukerjee, S.; Palmieri, B.L.; Quintanal Rivacoba, C. Enhancing the sustainability of social housing policies through the social impact approach: Innovative perspectives form a “paris affordable housing challenge” project in France. Sustainability 2020, 12, 9903. [Google Scholar] [CrossRef]
  51. Hall, A.; Shoesmith, A.; Doherty, E.; McEvoy, B.; Mettert, K.; Lewis, C.C.; Wolfenden, L.; Yoong, S.; Kingsland, M.; Shelton, R.C.; et al. Evaluation of measures of sustainability and sustainability determinants for use in community, public health, and clinical settings: A systematic review. Implement. Sci. 2022, 17, 81. [Google Scholar] [CrossRef]
  52. Pawson, H.; Milligan, V.; Phibbs, P.; Rowley, S. Assessing management costs and tenant outcomes in social housing: Developing a framework. AHURI Position. Pap. 2014, 160, 1–69. [Google Scholar]
  53. Swope, C.B.; Hernández, D. Housing as a determinant of health equity: A conceptual model. Soc. Sci. Med. 2019, 243, 112571. [Google Scholar] [CrossRef]
  54. Mukhija, V.; Das, A.; Regus, L.; Tsay, S.S. The tradeoffs of inclusionary zoning: What do we know and what do we need to know? Plan. Pract. Res. 2015, 30, 222–235. [Google Scholar] [CrossRef]
  55. Lerman, B.R. Mandatory inclusionary zoning-the answer to the affordable housing problem. BC Environ. Aff. Law Rev. 2006, 33, 383. [Google Scholar]
  56. Jayakody, T.A.C.H.; Vaz, A. Impact of green building certification on the rent of commercial properties: A review. J. Inform. Web Eng. 2023, 2, 8–28. [Google Scholar] [CrossRef]
  57. Jang, D.-C.; Kim, B.; Kim, S.H. The effect of green building certification on potential tenants’ willingness to rent space in a building. J. Clean. Prod. 2018, 194, 645–655. [Google Scholar] [CrossRef]
  58. Devine, A.; Kok, N. Green certification and building performance: Implications for tangibles and intangibles. J. Portf. Manag. 2015, 41, 151–163. [Google Scholar] [CrossRef]
  59. Lachapelle, P. A sense of ownership in community development: Understanding the potential for participation in community planning efforts. Community Dev. 2008, 39, 52–59. [Google Scholar] [CrossRef]
  60. Ehlenz, M.M. Making home more affordable: Community land trusts adopting cooperative ownership models to expand affordable housing: Journal of Community Practice, 2018. In The Affordable Housing Reader; Routledge: Abingdon, UK, 2022; pp. 176–190. [Google Scholar]
  61. Bratt, R.G.; Lew, I. Affordable rental housing development in the for-profit sector: A review of the literature. Cityscape 2016, 18, 229–262. [Google Scholar]
  62. Lento, R.E. The future of affordable housing. J. Afford. Hous. Community Dev. Law 2010, 20, 215. [Google Scholar]
  63. Circo, C.J. Using mandates and incentives to promote sustainable construction and green building projects in the private sector: A call for more state land use policy initiatives. Penn State Law Rev. 2007, 112, 731. [Google Scholar]
  64. Circo, C.J. Should Owners and Developers of Low-Performance Buildings Pay Impact or Mitigation Fees to Finance Green, Building Incentive Programs and Other Sustainable Development Initiative. William Mary Environ. Law Policy Rev. 2009, 34, 55. [Google Scholar]
  65. Patience, C.U.; Apaokueze, T.N. The Impact of Smart Home Technologies on Energy Efficiency, Cost Savings, and Environmental Benefits. J. Energy Eng. Thermodyn. (JEET) 2024, 4, 21–32. [Google Scholar]
  66. Moses, J.C.; Adibi, S.; Angelova, M.; Islam, S.M.S. Smart home technology solutions for cardiovascular diseases: A systematic review. Appl. Syst. Innov. 2022, 5, 51. [Google Scholar] [CrossRef]
  67. Schieweck, A.; Uhde, E.; Salthammer, T.; Salthammer, L.C.; Morawska, L.; Mazaheri, M.; Kumar, P. Smart homes and the control of indoor air quality. Renew. Sustain. Energy Rev. 2018, 94, 705–718. [Google Scholar] [CrossRef]
  68. Alvarez-Perea, A.; Dimov, V.; Popescu, F.D.; Zubeldia, J.M. The applications of eHealth technologies in the management of asthma and allergic diseases. Clin. Transl. Allergy 2021, 11, e12061. [Google Scholar] [CrossRef] [PubMed]
  69. Kumar, P.; Skouloudis, A.N.; Bell, M.; Viana, M.; Carotta, M.C.; Biskos, G.; Morawska, L. Real-time sensors for indoor air monitoring and challenges ahead in deploying them to urban buildings. Sci. Total Environ. 2016, 560, 150–159. [Google Scholar] [CrossRef] [PubMed]
  70. Chan, M.; Estève, D.; Escriba, C.; Campo, E. A review of smart homes—Present state and future challenges. Comput. Methods Programs Biomed. 2008, 91, 55–81. [Google Scholar] [CrossRef]
  71. Powell, A.; Bryne, A.; Dailey, D. The essential Internet: Digital exclusion in low-income American communities. Policy Internet 2010, 2, 161–192. [Google Scholar] [CrossRef]
  72. Servon, L.J.; Nelson, M.K. Community technology centers: Narrowing the digital divide in low-income, urban communities. J. Urban Aff. 2001, 23, 279–290. [Google Scholar] [CrossRef]
  73. Cao, Y.; Erdt, M.; Robert, C.; Naharudin, N.B.; Lee, S.Q.; Theng, Y.L. Decision-making Factors Toward the Adoption of Smart Home Sensors by Older Adults in Singapore: Mixed Methods Study. JMIR Aging 2022, 5, e34239. [Google Scholar] [CrossRef]
  74. Smith, G.S.; Anjum, E.; Francis, C.; Deanes, L.; Acey, C. Climate change, environmental disasters, and health inequities: The underlying role of structural inequalities. Curr. Environ. Health Rep. 2022, 9, 80–89. [Google Scholar] [CrossRef]
  75. Maller, C.J.; Strengers, Y. Housing, heat stress and health in a changing climate: Promoting the adaptive capacity of vulnerable households, a suggested way forward. Health Promot. Int. 2011, 26, 492–498. [Google Scholar] [CrossRef] [PubMed]
  76. Parihar, J.; Birman, S. Heat resilience in urban environments: Strategies for sustainable city climate management. In The Climate-Health-Sustainability Nexus: Understanding the Interconnected Impact on Populations and the Environment; Springer: Berlin/Heidelberg, Germany, 2024; pp. 305–324. [Google Scholar]
  77. Hussain, B.; ur Rehman, A.; Naqvi, S.A.A. Role of Green Building Technologies in Achieving Climate-Resilient Cities. In Designing Healthy Buildings and Communities: Shaping a Climate-Resilient Future; Springer: Berlin/Heidelberg, Germany, 2025; pp. 85–96. [Google Scholar]
  78. Ruhl, J.B. General design principles for resilience and adaptive capacity in legal systems-with applications to climate change adaptation. NCL Rev. 2010, 89, 1373. [Google Scholar]
  79. Proverbs, D.; Lamond, J. Flood resilient construction and adaptation of buildings. In Oxford Research Encyclopedia of Natural Hazard Science; Oxford University Press: Oxford, UK, 2017. [Google Scholar]
  80. Daghistani, F. Conceptual design and performance evaluation of an air-cushion floating purifier (ACFP) for improving air quality in semi-confined spaces. Energy Build. 2023, 300, 113672. [Google Scholar] [CrossRef]
  81. Singer, B.C.; Delp, W.W.; Black, D.R.; Walker, I.S. Measured performance of filtration and ventilation systems for fine and ultrafine particles and ozone in an unoccupied modern California house. Indoor Air 2017, 27, 780–790. [Google Scholar] [CrossRef] [PubMed]
  82. Kashem, S.B. Housing practices and livelihood challenges in the hazard-prone contested spaces of rural Bangladesh. Int. J. Disaster Resil. Built Environ. 2019, 10, 420–434. [Google Scholar] [CrossRef]
  83. Prosun, P. LIFT House: An Amphibious Strategy for Sustainable and Affordable Housing for the Urban Poor in Flood-Prone Bangladesh. Ph.D. Thesis, University of Waterloo, Waterloo, ON, CA, 2011. [Google Scholar]
  84. Unal, M.; Middel, A. Improving thermal comfort in hot-arid Phoenix, Arizona courtyards: Exploring the cooling benefits of ground surface cover and shade. Build. Environ. 2025, 278, 113001. [Google Scholar] [CrossRef]
  85. Darden, E. Make It Right: A Post-Katrina Rebuilding Initiative. Master’s Thesis, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2011. [Google Scholar]
  86. Eriksen, S.; Aldunce, P.; Bahinipati, C.S.; Martins, R.D.A.; Molefe, J.I.; Nhemachena, C.; O’brien, K.; Olorunfemi, F.; Park, J.; Sygna, L. When not every response to climate change is a good one: Identifying principles for sustainable adaptation. Clim. Dev. 2011, 3, 7–20. [Google Scholar] [CrossRef]
  87. Spengler, J.D.; Chen, Q. Indoor air quality factors in designing a healthy building. Annu. Rev. Energy Environ. 2000, 25, 567–600. [Google Scholar] [CrossRef]
  88. Rana, K.; Shrestha, V.; Chimoriya, R. The effect of housing on health and challenges of demographic changes. Glob. J. Sci. Front. Res. 2020, 20, 75–82. [Google Scholar]
  89. Rana, K.; Poudel, P.; Chimoriya, R. Qualitative Methodology in Translational Health Research: Current Practices and Future Directions. Healthcare 2023, 11, 2665. [Google Scholar] [CrossRef]
  90. Rana, K.; Chimoriya, R. A Guide to a Mixed-Methods Approach to Healthcare Research. Encyclopedia 2025, 5, 51. [Google Scholar] [CrossRef]
  91. Ohakawa, T.C.; Adeyemi, A.B.; Okwandu, A.C.; Iwuanyanwu, O.; Ifechukwu, G.-O. Digital Tools and Technologies in Affordable Housing Design: Leveraging AI and Machine Learning for Optimized Outcomes. Int. J. Smart Cities Hous. Technol. 2024, 10, 55–71. [Google Scholar]
  92. Johnson, K.B.; Wei, W.Q.; Weeraratne, D.; Frisse, M.E.; Misulis, K.; Rhee, K.; Zhao, J.; Snowdon, J.L. Precision Medicine, AI, and the Future of Personalized Health Care. Clin. Transl. Sci. 2021, 14, 86–93. [Google Scholar] [CrossRef]
  93. Alowais, S.A.; Alghamdi, S.S.; Alsuhebany, N.; Alqahtani, T.; Alshaya, A.I.; Almohareb, S.N.; Aldairem, A.; Alrashed, M.; Bin Saleh, K.; Badreldin, H.A.; et al. Revolutionizing healthcare: The role of artificial intelligence in clinical practice. BMC Med. Educ. 2023, 23, 689. [Google Scholar] [CrossRef] [PubMed]
  94. Ragnedda, M.; Ruiu, M.L.; Addeo, F. The self-reinforcing effect of digital and social exclusion: The inequality loop. Telemat. Inform. 2022, 72, 101852. [Google Scholar] [CrossRef]
  95. Krieger, J.; Higgins, D.L. Housing and health: Time again for public health action. Am. J. Public Health 2002, 92, 758–768. [Google Scholar] [CrossRef] [PubMed]
  96. Rana, K.; Aitken, S.J.; Chimoriya, R. Interdisciplinary Approaches in Doctoral and Higher Research Education: An Integrative Scoping Review. Educ. Sci. 2025, 15, 72. [Google Scholar] [CrossRef]
  97. Munala, L.; Allen, E.M.; Beall, O.M.; Phi, K.M. Social justice and public health: A framework for curriculum reform. Pedagog. Health Promot. 2023, 9, 288–296. [Google Scholar] [CrossRef]
Figure 1. Positioning sustainable housing in Ecological Systems Theory.
Figure 1. Positioning sustainable housing in Ecological Systems Theory.
Sustainability 17 07519 g001
Figure 2. Health impacts of sustainable housing features.
Figure 2. Health impacts of sustainable housing features.
Sustainability 17 07519 g002
Table 1. Examples of sustainable housing interventions and potential health outcomes.
Table 1. Examples of sustainable housing interventions and potential health outcomes.
Sustainable Design FeatureFunction/MechanismPotential Health Outcomes
Energy-efficient housing (e.g., insulation, passive solar design)Reduces energy demand through better thermal regulation and passive heating/coolingReduced respiratory illness, improved thermal comfort, lowered household energy stress
Use of non-toxic, low-VOC (volatile organic compound) building materialsReplaces harmful chemicals in construction with safer alternativesDecreased exposure to allergens and carcinogens, improved indoor air quality
Green space integration (e.g., gardens, communal parks)Incorporates vegetation and nature into residential designLowered stress levels, improved mental wellbeing, increased physical activity
Active transport infrastructure (e.g., bike paths, walkability)Encourages walking and cycling through design and connectivityReduced obesity risk, cardiovascular benefits, enhanced social cohesion
Affordable, inclusive housing designProvides equitable access to housing, considering income, disability, and agingReduced housing insecurity and associated mental distress, improved social determinants of health
Natural lighting and ventilationEnhances indoor environmental quality through architectural designImproved circadian rhythm and mental health, reduced dependence on artificial lighting
Table 2. Example studies linking sustainable housing or some features of sustainability to health outcomes.
Table 2. Example studies linking sustainable housing or some features of sustainability to health outcomes.
ReferenceSustainable Housing Feature or InterventionHealth
Outcome
Population/SettingStudy Findings
Breysse et al., 2011 [32]
  • Enterprise Green Communities standards (ventilation, mold/pest control, low-VOC materials)
  • Mechanical ventilation (ASHRAE 62.2 compliance)
  • Radon mitigation
  • Energy/water conservation (geothermal HVAC, high-performance windows)
  • Smoke-free policies
General health, asthma,
respiratory conditions,
injuries
Population: Low-income families (49 adults, 30 children; 57% immigrant, median income of $29K)
Setting: Renovated 60-unit affordable housing complex, Minnesota
Study design: Pre-post intervention (baseline recall, 1-year follow-up)
  • Health improvements: Adults reported significant improvements in overall health (34% better vs. 7% worse, p = 0.042), asthma (p = 0.046), and non-asthma respiratory issues (p = 0.030). Children’s non-asthma respiratory problems declined from 33% to 15% (p = 0.025).
  • Housing quality: Fewer reports of dampness (p = 0.083), mold odors (p = 0.020), and pests (p = 0.046) post-mitigation.
  • Energy/indoor air quality (IAQ): 48% energy reduction; CO2 levels (982 ppm) met IAQ guidelines; radon post-mitigation < 2 pCi/L.
  • Policy impact: Demonstration of health benefits by integrating green standards (e.g., ventilation, low-VOC materials) into affordable housing.
D’Alessandro et al., 2020 [38]
  • Green roofs and walls
  • Balconies, terraces, and shared gardens
  • Energy-efficient ventilation systems
  • Smart home automation
  • Low-VOC and antimicrobial building
  • Pneumatic waste collection systems
  • Rainwater harvesting and greywater reuse
  • Flexible interior designs
Mental health (stress,
anxiety and depression); COVID-19 transmission; chronic diseases due to
sedentary lifestyles
during lockdown
Population: Italian residents (16.8 million living in overcrowded housing; 28.8% of population)
Setting: Urban apartments across Italy (average size 88 m2 in Milan, 20.7% of units < 80 m2 for families of 4+)
Study design: Cross-sectional analysis of national housing census data and policy review
  • Over 20% of Italian apartments housing >4 people are under 80 m2, increasing infection risks.
  • In total, 11.4% of Italian homes lack balconies/terraces, worsening mental health during lockdowns.
  • Natural ventilation and proper IAQ reduce viral transmission indoors.
  • SARS-CoV-2 genetic material found in wastewater, requiring better sewage management.
  • Smart home automation improves living conditions but raises concerns about electromagnetic exposure (e.g., 5G).
  • Copper and cardboard surfaces reduce viral persistence compared to plastic/stainless steel.
  • Italy’s outdated housing regulations fail to address modern health and sustainability needs.
Garland et al., 2013 [34]
  • LEED-certified construction (low-toxicity materials)
  • Specialized ventilation systems
  • Smoking prohibition (25 feet from building)
  • Pet-free policy
  • Asthma trigger reduction (e.g., mold/pest control)
Asthma symptoms,
urgent healthcare use
Population: Low-income tenants (adults/children with asthma)
Setting: Melrose Commons V (LEED-certified affordable housing), South Bronx, New York
Study design: Longitudinal (18-month follow-up)
  • Asthma symptoms: Significant reduction in continuous daytime respiratory symptoms and nighttime asthma symptoms post-move.
  • Healthcare use: Fewer urgent visits (including emergency room trips) and reduced school/work absenteeism.
  • Behavioral changes: Improved tenant knowledge of asthma triggers and adoption of hypoallergenic bedding/green cleaning products post-education.
  • Policy impact: Supports LEED standards as a tool to reduce asthma disparities in high-risk urban communities.
Jacobs et al., 2014 [33]
  • Mechanical ventilation (ASHRAE 62.2 compliance)
  • Pest control (sealing leaks, reduced pesticide use)
  • Mold/dampness remediation
  • Energy/water conservation (LEED Gold/Enterprise Green Communities standards)
General health, asthma, mental health, injuries, allergen exposurePopulation: Low-income, primarily African American residents (57 adults, 64 children)
Setting: Renovated housing in Washington, DC
Study design: Pre-post intervention (baseline and 1-year)
  • General health: 8% improvement in adults reporting good/very good/excellent health (p = 0.026).
  • Allergens: Median cockroach (Bla g1) and mouse (Mus m1) allergens significantly reduced post-renovation (sustained at 1 year; p < 0.05).
  • Pests: Cockroach/rodent reports declined by 48% and 52%, respectively (p ≤ 0.003).
  • Housing quality: Dampness/mold issues resolved (p < 0.001); 54% water savings, 16% energy savings.
Norhidayah et al., 2013 [35]
  • Mechanical ventilation systems
  • Smoking prohibition policies
  • Regular cleaning protocols (detergent mopping)
  • Renovating/upgrading ventilation systems (PMA building)
Sick Building
Syndrome (SBS)
symptoms
(ophthalmic,
respiratory,
psychological,
dermal)
Population: Office workers (44 in PPAP, 5 in PKBF, 9 in PMA; mean age, 35–39 years)
Setting: Three public buildings in Malaysia (PPAP, PKBF, PMA; aged 53–100 years)
Study design: Cross-sectional comparative study
  • SBS prevalence: PKBF had highest SBS prevalence (55.55%), followed by PPAP (35.25%) and PMA (20%). No significant association between building type and SBS (p = 0.368).
  • IAQ parameters: All buildings complied with Malaysia’s IAQ standards except air velocity in PKBF. CO2 levels were highest in PKBF (717 ppm), indicating poor ventilation.
  • Symptom patterns: Ophthalmic (itchy eyes, 16–44%) and respiratory (sneezing, 20–33%) symptoms were most common. PKBF’s high fungal counts (206 CFU/m3) correlated with elevated humidity (78.8% RH).
  • Key risk factors: Poor ventilation (low air velocity, high CO2) and contaminant accumulation (fungi) were linked to SBS.
Prochorskaite et al., 2016 [39]
  • Suitable indoor space
  • Private outdoor space
  • Adaptability of housing layouts
  • Compatibility with local heritage
  • Neighborhood social features
  • Accessible public greenspace
  • Attractive views
  • Opportunities for community involvement
  • Crime-preventive design
  • Compact neighborhoods
  • Proximity to amenities
Mental health
symptoms, physical health, social wellbeing, and
general quality
of life
Population: 235 housing stakeholders (123 housing users, 48 housing associations, 34 local authorities, 30 private developers)
Setting: West Midlands and Northwest England, UK
Study design: Cross-sectional study
  • All stakeholder groups ranked suitable indoor space (F1) as the most important feature (mean: 4.47–4.60/5); housing users highly valued private outdoor space (F2; mean: 4.31) and attractive views (F7; mean: 3.73), which were undervalued by providers (F2: 3.53–3.90; F7: 2.82–3.57).
  • Social housing providers prioritized security (F9; mean: 4.15–4.48) and adaptability (F3; mean: 3.56–3.88), more than users did.
  • Private outdoor space (F2) showed the largest disparity in ratings (r = 0.41), with users assigning it much greater importance.
  • Compact neighborhood design (F10) was the lowest-ranked feature by all stakeholder groups (mean: 1.93–2.43).
  • Opportunities for community involvement (F8) were undervalued by users (mean: 2.66) and developers (mean: 2.27).
  • A clear misalignment exists between user preferences (e.g., outdoor space, views) and provider priorities (e.g., adaptability, security).
Zúñiga-Bello et al., 2019 [36]
  • Ventilation, lighting, and laundry habits (Component 1)
  • Construction materials, painted walls, and bathroom type (Component 2)
  • Floor material and hygiene (Component 3)
  • Water supply and mold/dampness control (Component 5)
  • Overall Healthy-Sustainable Housing Index (HSHI)
Respiratory
symptoms and
conditions
Population: School children aged 7–12 years
Setting: Semi-urban community (Alpuyeca, Mexico)
Study design: Cross-sectional pilot study (60 households)
  • Ventilation/lighting: Sufficient-quality housing reduced allergic symptoms (OR = 5.32 lower) and shortened nose irritation duration (4× less).
  • Construction materials: Linked to 2.9× shorter common cold duration and 4.3× shorter upper respiratory infection duration.
  • Flooring: Poor-quality flooring (e.g., earth/wood) correlated with 1.8× longer sneezing episodes.
  • Water supply: Adequate water supply increased sore throat duration (2.7× longer), possibly due to dampness from storage.
  • Overall HSHI: Sufficient-quality housing reduced wheezing and ear pain risk, demonstrating a positive impact of sustainable design on respiratory health.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Rana, K. Sustainable Housing as a Social Determinant of Health and Wellbeing. Sustainability 2025, 17, 7519. https://doi.org/10.3390/su17167519

AMA Style

Rana K. Sustainable Housing as a Social Determinant of Health and Wellbeing. Sustainability. 2025; 17(16):7519. https://doi.org/10.3390/su17167519

Chicago/Turabian Style

Rana, Kritika. 2025. "Sustainable Housing as a Social Determinant of Health and Wellbeing" Sustainability 17, no. 16: 7519. https://doi.org/10.3390/su17167519

APA Style

Rana, K. (2025). Sustainable Housing as a Social Determinant of Health and Wellbeing. Sustainability, 17(16), 7519. https://doi.org/10.3390/su17167519

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop