Overpopulation and COVID-19 | Investigator’s opinion

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The COVID-19 pandemic hits the poor hardest and further exposes yawning inequalities in access to health care, food and housing. The government has imposed closures and curfews without giving much thought to mitigating the impact on the most vulnerable. Cabins no larger than a bus waiting shed accommodate several families whose members sleep side by side on wooden or cement floors. In the slums where people are crowded like sardines, there is no social distancing, let alone isolation and quarantine.

Overcrowded households are often exposed to housing risks. Low-income people are forced to live in substandard housing with inadequate space and facilities for their needs. Overcrowding also increases exposure to risk factors associated with injuries in the home, domestic violence and other social stresses.

The effects of overcrowding are the dangers associated with not having enough space in the home for living, sleeping and household activities. Epidemiological studies have shown a positive association between overcrowding and respiratory diseases spread by transmission of infectious pathogens through the air through droplet infection. Overcrowding increases the risk of volatile infections (measles, rubella, rhinovirus, influenza), droplet-borne infections (coughing, sneezing) such as tuberculosis, whooping cough, diphtheria, viral meningitis and colonization of agents endogenous pathogens producing pneumonia and bronchopneumonia.

Enteric disease is also more common in crowded housing. This may be explained in part by the increased risk of cross-infection through person-to-person contact and indirect contact with poor sanitary conditions often associated with overcrowding. Overcrowding increases vulnerability to possible infections by increasing the frequency, duration and mode of contact between people and infectious agents. Bed sharing by family members increases the transmission of airborne infections, and the risks are exacerbated by the wide variety of respiratory infections typically found in public places and the limited acquired immunity of the population to respiratory disease.

Crowding also promotes mental health disorders by creating confusion, noise and a lack of privacy, which can lead to depression, feelings of embarrassment, and interpersonal conflict. Overcrowding, lack of privacy and lack of housing often create a situation where violence can erupt when a trigger occurs. Overcrowding can also increase promiscuity and incestuous relationships, which can add more tension and stress to the family.

While residential density standards can be applied for new housing development plans, overcrowding issues cannot be overcome by planning controls alone. The problems of increasing densities in overcrowded cities are inextricably linked to the available supply of adequate housing and the demand for housing. When demand exceeds supply, it inevitably results in high residential densities and overcrowding.

Our spatial standards and overcrowded conditions reflect socio-economic status. Policymakers often deal with the effects of overpopulation without addressing the underlying causes: poverty, rapid population growth and unchecked urbanization. A comprehensive multi-year planning strategy must therefore tackle these problems by improving rural conditions, employment opportunities and fiscal support measures aimed at reducing poverty, reorienting urbanization and slowing population growth.

The long-term strategy must also include the adoption of a set of basic principles for healthy housing which should guide the development of policies, standards and regulations. These principles should address: 1. physiological needs (eg, for ventilation, lighting, sunlight, space, protection against excessive noise); 2. psychological needs (privacy, adequate space, cleanliness, peace of mind, normal family and household activities); 3. protection against contagion (disease, vermin, sewage, contaminated water, overcrowding); and 4. protection against accidents (fall, fire, burns, gas, electric shock, collapse of a building).

An integrated approach, in which reductions in overcrowding are supported by appropriate relocation that takes into account these considerations of unintended effects, is fundamental for health and equity. Reductions in overcrowding will be most effective when combined with policies that support employment and improve household incomes to increase the affordability of housing with adequate space.

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Nathaniel von Einsiedel ([email protected]) is a member of the Philippine Institute of Environmental Planners (PIEP) and principal planner of CONCEP Inc.

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