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“Can I have a letter for the housing, doctor?”
  1. SHEILA MCKENZIE
  1. Queen Elizabeth Hospital for Children
  2. Royal Hospitals Trust
  3. Hackney Road, London E2 8PS, UK
  4. email: mckenzie@rhtch.demon.co.uk

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    Doctors are often asked to appeal to housing departments to take a child’s ill health into consideration for rehousing points. Less frequently they are asked to provide evidence on behalf of a patient who is suing a housing authority for compensation because it is believed that poor housing conditions have caused a deterioration in their health. Children with asthma or other respiratory symptoms are the subject of this review.

    It is generally accepted that poor housing is associated with poor health.1 However, it is far harder to ascribe a specific illness such as asthma to factors believed to be adverse, such as dampness and mould. In a litigation case, it is not enough to say “it is well known that poor housing is related to poor health and no family, healthy or otherwise, should live in a damp and mouldy house”. What is required is a clear statement on whether “this child’s asthma was caused or exacerbated by damp and mould”.

    First, the diagnosis of asthma. A prospective litigant may be referred for assessment of chest disease and an opinion about whether this has been caused or exacerbated by adverse housing conditions. Quite often, in spite of a good history of respiratory symptoms, the physical examination, respiratory function tests, and evidence of atopy are negative or inconclusive. The report of the assessment could read, “although there is evidence of dampness and mould in this child’s home and reported respiratory symptoms consistent with asthma, I can find no objective evidence of asthma in this child”. Strachan has questioned the reliability of symptom reporting2 3 in studies that purport to demonstrate a relation between housing conditions and respiratory symptoms; if respondents know the purpose of a questionnaire they are more likely to provide a biased response. The difficulty of …

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