This summary is based on self-reported data collected by EUROSTAT on the proportion of households with problems of damp (1, 2). It also contains information on the environment and health context, the policy relevance and context, and an assessment of the situation in the WHO European Region.

Key message

In European countries, exposure to damp in the home varies greatly, ranging between 4% and 40%. In some countries for which data is available over a wider time span, the prevalence of damp homes has slightly increased, but in general there is rather a trend towards exposure reduction.

Differences between countries may be due to a combination of factors including climate characteristics, socioeconomic status, housing characteristics, culture and lifestyle and the existence and effectiveness of related policies (e.g. on ventilation or thermal insulation). Children are particularly susceptible to the health effects of damp, which include respiratory disorders such as irritation of the respiratory tract, allergies and exacerbation of asthma.

Figures

Presentation of data

Fig. 1 shows the proportion of the population in selected European countries living in homes with self-reported problems of damp for 1995, 2001 and 2006. 1995 and 2001 data are based on the EUROSTAT ECHP survey (voluntary survey for the EU 15 between 1995 and 2001), while data for 2006 are based on the ongoing EUROSTAT SILC survey (mandatory for all EU member states with voluntary participation of Norway and Iceland).

Fig. 2 shows the impact of tenure on the perception of damp, based on data from selected European countries for 1997 (ECHP data). More people living in rented accommodation reported problems of damp than home owners. This difference has been found in many surveys of damp and may (to an extent not yet quantified) relate to the responsibility for interventions rather than the real exposure. Data for 2006 will be added as soon as available from SILC.

Fig. 1. Proportion of the total population living in homes with self-reported problems of damp, 1995–2006

1995, 2001: ECHP; 2006: SILC

Source: EUROSTAT ECHP (European Community Household Panel) (1) and EUROSTAT SILC (Statistics on Income and Living Conditions) (2). Date of extraction: 30 September 2008.

Fig. 2. Self-reported problems of damp in the home by housing tenure, 1997

Source: EUROSTAT ECHP (1)

Download Excel sheet with data of the figures

Rationale

This indicator provides an estimate of the proportion of households exposed to damp. The data are not child-specific, and as they are based on household’s reports of such problems, they serve only as an indication of the scale of the problem. International comparisons are difficult and the main message can be derived from trends in national data rather than variations between countries. Exposure to damp in the home is an important risk factor for a number of illnesses, particularly respiratory illnesses; and an indication for the risk of mould growth which may trigger serious health effects as well..

Health and environment context

Dampness and thermal/humidity conditions are of particular concern in European countries with temperate and damp climates. The number of people, activities such as cooking, laundering and bathing, the use of certain fuels for heating and cooking, the indoor temperature and especially the degree of ventilation all affect the amount of water vapour in indoor air. Water leakage due to structural damage may contribute to damp as well.

Damp inside the home induces the growth of moulds, dust mites and various microbial agents and, at the correct temperature, may initiate chemical reactions leading to the release of chemicals from building materials and furnishings. Mould and damp are important risk factors for a variety of illnesses, particularly those of the respiratory and immune systems. Generally, there are four kinds of health problems: allergic illness, irritation of the respiratory tract, infection and toxicological effects. For people that are sensitive to moulds, symptoms such as nasal irritation or congestion, dry or productive cough, wheezing, skin rashes or burning, watery or reddened eyes may occur. Sufferers of severe allergies to moulds may have more serious reactions, such as hay-fever-like symptoms or shortness of breath. Moulds can also trigger asthma attacks in persons with asthma. Individuals with chronic illnesses or those with immune deficiencies are more likely to develop infections from certain moulds.

WHO has concluded that the strongest evidence exists for the association of damp with cough, wheeze and asthma (3). Children, who tend to spend more time than adults in their homes and whose immune systems are still developing, are at increased risk of developing respiratory disorders when living in damp, mouldy housing. The prevalence of asthma, cough and wheezing among children living in homes with problems of damp or mould is 1.4–2.2 times higher than among children living in drier housing conditions (3). According to the currently available evidence, 13% of childhood asthma in the developed countries could be attributable to dampness (4).

Other illnesses associated with exposure to indoor damp include bronchial obstruction, bronchitis, persistent allergic rhinitis and eczema (5-8).

It has been suggested that damp is associated with mental health problems and other types of illness. Depression and the presence of general symptoms such as fatigue, headache, dizziness and difficulty concentrating have been linked to damp, mouldy living conditions (9).

This exposure indicator is closely connected with other housing quality indicators and their effects. Damp is often associated with poor housing and social conditions, poor indoor air quality and inadequate housing hygiene, which includes factors such as overcrowding, low air exchange rate, low indoor temperature and poor insulation. All these factors influence health status.

Reduction of mould and damp in housing can be achieved by a policy framework describing the components and implementation of national plans, and through strengthening the requirements for building standards. Financial incentives and supporting instruments are necessary for the implementation of effective interventions such as the rehabilitation of housing stock.

WHO Guidelines on damp and mould have been suggested, providing both an ovverview of potential health risks of dampo and mould, and a set of recommendations on prevention and mitigation (10).

Policy relevance and context

In 2004, the Fourth Ministerial Conference on Environment and Health adopted the Children’s Health and Environment Action Plan for Europe (CEHAPE), which includes four regional priority goals to reduce the burden of environment-related diseases in children. One of the goals (RPG III) aims at preventing and reducing respiratory diseases due to outdoor and indoor air pollution, thus contributing to a reduction in the frequency of asthmatic attacks and ensuring that children can live in an environment with clean air (11).

Several initiatives, action programmes and declarations within the framework of the United Nations Human Settlements Programme (UN-HABITAT) coordinate international bodies in their efforts to reach the United Nations’ Millennium Declaration. This is achieved by promoting human development as the key to sustaining social and economic progress in all countries.

In January 2006, the EU Stability Pact for South Eastern Europe implemented a cooperation agreement with UN-HABITAT to improve social housing and urban development across the Region (12). This agreement will contribute to economic growth and help countries in the Region achieve essential reforms.

In European countries the problems with damp housing have been addressed partly by technical building codes (usually only applicable to new buildings) and partly by hygiene requirements aiming to ensure that conditions are not hazardous to life, although these frequently fail to include a requirement for protection against excessive humidity.

In addition, many European countries have public health services that carry out health inspections of dwellings according to specific guidelines. In general, existing policies aim to ensure habitable and healthy housing conditions but do not include specific health promotion objectives. Portugal, with one of the higher rates of damp housing according to EUROSTAT, has developed a project on housing and health action plans as a national follow-up to the Fourth Ministerial Conference on Environment and Health (13). This project will enable all the municipalities to develop their own plans, based on a national action plan document. Finland, one of the countries with the lowest exposure to damp housing, addresses dampness in its Land Use and Building Act (132/1999), section 13: Building Codes D2 Indoor Climate and Ventilation of Buildings (2003) (14). The United Kingdom has recently developed a Housing Health and Safety Rating System in which residential buildings are evaluated on the basis of their risk to health, with damp and mould being one of the major issues addressed (15).

The differences between countries may, to some extent, be due to the existence and implementation of policies for preventing damp in homes. The responsibility for avoiding or reducing damp is largely left to the individual or household. With free housing markets, households that are vulnerable due to socioeconomic status are likely to be at risk, as they will be restricted to low-quality housing and be likely to suffer from greater problems.

An additional risk factor for damp and mould has emerged in recent years with the trend towards energy efficiency in the housing stock, leading to more tight houses and - especially in rehabilitated buildings - the reduction of air exchange rates which may result in increased indoor pollution and dampness problems.

Assessment

The assessment of national data is difficult as country data is available for different time periods. For the old EU members (EU 15), the indicator shows a trend towards a decreasing exposure to damp in most of the countries with data, but this does vary strongly between countries and for some countries, the prevalence did increase in 2006. For the new EU members (and Norway / Iceland), data has only been collected by SILC so no trend can be given. However, the data for 2006 show that the eastern European members of the EU have on average much higher number of damp homes than the old members.

Children are more susceptible than adults to exposure to indoor air pollution, including moulds and bacteria which are increased by excessive damp (16,17). Good evidence to support this is available from a number of studies in Finland, Germany, Italy and Sweden which have focused on asthma and allergic symptoms among small children and their parents (18–20).

The lack of binding policies on housing standards, combined with the large number of organizations and authorities responsible for housing policy, make the rehabilitation of housing stock a challenge. In this context, international forums should support the development and implementation of national intersectoral policies on specific action aimed at improving the housing stock. In non-EU countries there is a need for standardized procedures to collect these data.

Metadata

Name: Homes with problems of damp

Definiton: Data on the exposure of the population to damp in the home

Code: RPG3_Hous_Ex2

Data source

EUROSTAT ECHP database, specifically the variable on housing problems with damp (1); and EUROSTAT SILC database, variable HH040 on damp problems in housing (2).

Description of data

Data on exposure to damp in the home were routinely collected through EUROSTAT by the ECHP from 1995 until 2001 (EU countries participated voluntarily). Since 2004, new data are available based on the new framework regulation EU Statistics on Income and Living Conditions (EU-SILC), which is mandatory for all EU countries and provides data in a similar format (percentage of population living in damp housing). For comparison reasons, the years 1995, 2001 and 2006 have been selected.

Method for indicator calculation

Original data provided by EUROSTAT.

Geographical coverage

For ECHP data: voluntary participation of countries belonging to the EU before May 2004. For SILC data: all EU countries (with Romania and Bulgaria starting data collection in 2007) and Norway / Iceland.

Period of coverage

For ECHP data: 1994–2001.

For SILC data: 2004 and continuing.

Frequency of update

Annual, although access to the data may be delayed.

Data quality

Weaknesses: both the ECHP and EU-SILC data rely on subjective assessments made by residents and are not, therefore, scientifically accurate. No direct link to health effects can be made and only EU countries are included. Finally, international comparisons may suffer from many influencing factors and therefore be limited. Although the SILC survey tool was developed using ECHP question formats, there may stil be some method-related data variations for individual countries so comparison of ECHP and SILC data may have restrictions.

Strengths: the data are collected according to consistent methodology, will be available for all EU countries (plus Norway / Iceland) on an annual basis and will provide a good indication of national trends.

For more information on meta data and calculation of this indicator, please refer to the methodology .

References

1. Europe in figures – EUROSTAT yearbook 2006–07. 4. Living conditions and welfare. EUROSTAT - The Statistical Office of the European Communities, 2007 (http://www.euro.who.int/air/activities/20070716_1, accessed 12 March 2007).
2. Survey on Income and Living Conditions (SILC) Questionnaire Manual 2008. (http://www.cso.ie/eusilc/documents/Copy%20of%20silc_manual_2008.pdf , accessed 20 October 2008).
3. Report on the WHO technical meeting on quantifying disease from inadequate housing. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/Housing/20060519_2, accessed 12 March 2007).
4. WHO second technical meeting on quantifying disease from inadequate housing. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who.int/Document/HOH/EBD_report.pdf, accessed 15 March 2007).
5. Brunekreef B. et al. Associations between questionnaire reports of home “dampness” and childhood respiratory symptoms. The Science of the Total Environment, 1992, 127:79–89. Cited in Bornehag CG et al. Dampness in Buildings and Health, Nordic interdisciplinary Review of the Scientific Evidence on Associations between Exposure to “Dampness” in Buildings and Health Effects (NORDDAMP). Indoor Air, 2001, 11:72–86.
6. Jaakkola JJK, Hwang Bing-Fang, Jaakkola N. Home dampness and molds, parental atopy, and asthma in childhood: a six-year population-based cohort study. Environmental health perspectives, 2005, 113:357-361.
7. Bornehag CG et al. 'Dampness' at home and its association with airway, nose, and skin symptoms among 10 851 preschool children in Sweden: a cross-sectional study. Indoor air, 2005, 15(Suppl 10):S48-55.
8. WHO European Centre for Environment and Health. The LARES project (Large Analysis and Review of European housing and health Status). Preliminary overview. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/Housing/activities/20020711_1, accessed 13 March 2007).
9. Shenassa ED, Daskalakis C, Liebhaber A, Braubach M, Brown M.: Dampness and mold in the home and depression: An examination of possible pathways. American Journal of Public Health, 2007, 97(10):1893-1899
10. WHO Report on Development of WHO guidelines for indoor air quality: dampness and mould. report on a working group meeting, Bonn, Germany, 17-18 October 2007. (http://www.euro.who.int/air/activities/20070510_2, accessed 20 October 2008)
11. Children’s Environment and Health Action Plan for Europe. Fourth Ministerial Conference on Environment and Health, Budapest, 23–25 June 2004 (EUR/04/5046267/7) (http://www.euro.who.int/document/e83338.pdf, accessed 2 March 2007).
12. UN-HABITAT signs new social housing improvement programme for southeast Europe. Nairobi, United Nations Human Settlements Programme, 2006 (http://www.unhabitat.org/content.asp?cid=1483&catid=5&typeid=6&subMenuId=0, accessed 15 March 2007).
13. Declaration. Fourth Ministerial Conference on Environment and Health, Budapest, 23–25 June 2004 (EUR/04/5046267/6) (http://www.euro.who.int/document/e83335.pdf, accessed 16 March 2007).
14. Land Use and Building Act (132/1999), section 13: Building Codes D2 Indoor Climate and Ventilation of Buildings (2003) (http://www.ymparisto.fi/download.asp?contentid=33667&lan=EN, accessed 13 March 2007).
15. Housing Health and Safety Rating System. London, Communities and Local Government, 2007 (http://www.communities.gov.uk/index.asp?id=1152820, accessed 13 March 2007).
16. Flynn et al. Indoor air pollutants affecting child health. Schaumburg, IL, American College of Medical Toxicology. 2000 (http://www.acmt.net/content/resources/monographs/IndoorAirPolution.pdf.
17. de Garbino JP, ed. Children’s health and the environment. Geneva, World Health Organization, 2004 (http://libdoc.who.int/publications/2005/9241562927_eng.pdf, accessed 12 March 2007).
18. Wickman M et al. Strategies for preventing wheezing and asthma in small children. Allergy, 2003, 58:742–747.
19. Simoni M et al. Mould/dampness exposure at home is associated with respiratory disorders in Italian children and adolescents: the SIDRIA-2 Study. Occupational and environmental medicine, 2005, 62:616–622.
20. German Environmental Survey 2003/06 (GerES IV) for Children. Dessau, Umweltbundesamt, 2006 (http://www.umweltbundesamt.de/survey-e/us03/uprog.htm, accessed 12 March 2007).

WHO European Centre for Environment and Health. Prevalence of asthma and allergies in children. Copenhagen, WHO Regional Office for Europe (ENHIS-2 fact sheet No. 3.1).

EU Stability Pact for South Eastern Europe [web site]. Brussels, Special Coordinator of the Stability Pact for South Eastern Europe, 2007 (http://www.stabilitypact.org/, accessed 13 March 2007).

For this indicator, a feasibility study has been carried out: HIA for children living in homes with mould and dampness

Authors: Alexandra Cucu, Senior Lecturer, University of Medicine and Pharmacology “Carol Davila”, Bucharest, Romania; Matthias Braubach, WHO European Centre for Environment and Health, Bonn, Germany.

First update: Matthias Braubach, WHO European Centre for Environment and Health, Bonn, Germany