The hidden ways our housing could be making us sick

From air and water pollution to a chronic lack of footpaths, decisions we make about how and where to build houses have a long-term impact on health

Good housing policy also means good transport policy, good planning policy, good economic policy and good social policy.

But in the drive for an ever increasing supply of new housing we have overlooked a key part of the discussion: good housing policy is also good health policy. Where and how we live matters for our wellbeing. In the drive to increase housing supply that has been forgotten.

We saw this illustrated during Covid when people were suddenly confined to home. A longitudinal study in Australia demonstrated how apartment design made residents more vulnerable to the impacts of repeated lockdowns. Across the world those living in apartments discovered a new appreciation of their balconies, however small they were. Natural light, plants and acoustics were more important than ever.

Unfortunately before the pandemic, on foot of industry lobbying, the Department of Housing abolished the requirement for balconies in apartments built to rent developments despite being a negligible construction cost. As many people would discover during Covid access to alternative outdoor amenity space is no substitute when you can’t go out for health, mobility or other reasons.


Older people are increasingly being nudged to sell their houses and move into an apartment – just at the time in life when financial concerns become less important and things like having a pet and gardening take centre stage. But you can’t have plants on balconies that don’t exist or are so lightweight they can’t take the weight of a freshly watered flower pot. You can’t have pets in buildings that don’t allow them. Small things are important and bring happiness.

Another area where housing and health intersect concerns pollution. Air pollution affects people from the womb to old age yet most people are unaware of the implications for their health. In 2020 for the first time a UK coroner ruled that a nine-year-old girl’s death was the result of air pollution, making her the first person in the UK to have that listed as her cause of death. Ella Adoo-Kissi-Debrah lived near a busy road in south London. Her inquest found that “air pollution made a material contribution” to her death, the coroner concluding there is “no safe level of particulate matter in the air”.

Most people correctly associate particulate matter with emissions from vehicle engines. But particulate matter doesn’t just come from engines, it also comes from vehicle tyres and the road material itself.

Road noise is a further critical health issue (the noise is caused by tyres on the road surface, not the engines), second only to that of air pollution. It is linked to a range of health problems, including high blood pressure, sleep deprivation, strokes, stress and anxiety. Yet despite the health implications of air pollution and noise we still facilitate housing development alongside large and busy roads.

Transport, housing, infrastructure and health outcomes are intricately related, yet governance of transport in Ireland is a multi-agency mess

Then there is the question of exercise. We know it is critical to our health and that travelling short journeys by car adds to our emissions. So why do councils still allow housing to be built on roads with no footpaths? Ireland has the fourth highest rate of pedestrian fatalities in the EU.

Meanwhile, people living in housing built after 2001 are more likely to drive and travel further than those living in older housing. New housing areas beyond Dublin’s M50 have virtually no public transport and are almost totally car-dependent. There is a gender inequality here too, as women typically do the bulk of household trips for domestic and caregiving reasons.

Yet stamp duty figures show that it is increasingly further out from urban centres where new housing is being bought. New apartment supply is up over 400 per cent in Dublin since 2017, but these are almost all for rent and too small for families. In the same period first-time purchasers of new homes are down over 70 per cent in Dublin city but up 212 per cent in the mid-east region. Recent CSO figures show new house completions up 17 per cent year-on-year in the midlands, evidencing the creep of car-based development.

Cue yet more pollution, road noise and connected health issues in a country that has the fourth highest rate of asthma in the EU, including 10 per cent of all children, and some 200,000 people diagnosed with chronic obstructive pulmonary disease. Air pollution is also likely to increase the risk of developing dementia.

And then there’s water pollution. Take the almost 500,000 septic tanks in Ireland. Nearly half of the 1,143 septic tanks inspected in 2022 failed, with 20 per cent being deemed a risk to human health or the environment. Half the septic tanks that have failed inspections outstanding more than two years involve “sewage surfacing in gardens and/or discharging illegally to ditches/streams”, according to the EPA. Local authority enforcement of failed septic tank inspections is inconsistent. Clare, Waterford, Offaly and Monaghan failed to complete their inspection targets in 2022; Galway City Council was allocated just one inspection, which it failed to do.

Clean water is also problematic, especially in the Greater Dublin Area (GDA), where homes and businesses are currently at serious risk of having no water. Water demand runs at an average of 588 million litres per day out of a maximum capacity of 620 million litres (about 95 per cent). In 2022 over 16,000 new houses were completed in the GDA, adding about 6 million litres demand per day. At the same time the Government’s Housing for All policy proposes some 300,000 new houses by 2030 – which is an extra demand of some 150 million litres per day on the national water system, over half of which is likely to fall on the GDA.

Transport, housing, infrastructure and health outcomes are intricately related, yet governance of transport in Ireland is a multi-agency mess, with 70 bodies involved nationally and locally. Housing is mostly left to the market and built wherever developers have land. Water infrastructure takes decades. And health doesn’t seem to get a look-in at a macro level. Multiple state policies are at odds with each other, such as climate change and housing. Planning policy, while trying to promote urban density, has instead promoted sprawl. Small, expensive apartments for rent don’t suit what households want.

Our housing should not make us sick. Although the specific issues have changed huge health challenges still exist, and public health’s role in the quality of housing structure and location is as important as ever.

  • Dr Lorcan Sirr is a senior lecturer in housing at the Technological University Dublin