From the Ground Up: Stakeholder Perspectives on Housing Interventions to Reduce Environmentally Mediated Infections.

Background: Housing conditions are intrinsically linked to human health, with inadequate housing potentially increasing exposure to environmentally mediated pathogens. Housing interventions that aim to improve housing and reduce environmentally mediated infections, such as finished floors and housing upgrades for vector-borne diseases, remain relatively under-explored as health interventions. This study explored facilitators of and barriers to funding, implementing, and scaling up housing improvements as health interventions to reduce environmentally mediated infectious diseases. Methods: Sixteen key informants (KIs) with direct experience in implementing or working within housing interventions and environmentally mediated infectious diseases in low- and middle-income countries were interviewed using a semi-structured interview format. KIs had diverse backgrounds, including academics researching housing interventions, housing policy advisors, and practitioners implementing housing interventions. A thematic analysis approach was used to identify key themes in interview transcripts, highlighting patterns, commonalities, and variations in participants' responses. Results: KIs emphasized the multi-dimensional impacts of housing interventions that are intrinsically linked to Sustainable Development Goals (SDGs), including physical and mental health, as well as environmental, social, and economic dimensions. Moreover, a pronounced shortage of funding and financial systems to address housing interventions was highlighted, alongside the urgent need for more rigorous evidence and cost-benefit analyses. Furthermore, the imperative to raise awareness of the significance of housing and the critical importance of strong collaboration across sectors and stakeholders were stressed. Emphasizing the necessity for project-based and context-specific housing policies, the interviews revealed that contextualizing interventions to their specific setting and fostering community involvement are essential for successful implementation and scale-up. Conclusions: Housing interventions play a pivotal role in mitigating environmentally mediated diseases. These interventions can complement existing strategies like water, sanitation, and hygiene (WASH) interventions, ensuring comprehensive approaches to healthy housing and sustainable development goals amidst climate change.