Why Maintenance Matters: Disorder in the Built Environment and Physical Health

Over the last decade there has been a renewed interest in identifying exactly how aspects of the residential built environment “get under the skin” and affect the health of not only those who dwell within, but reside and commute among, disorderly and deteriorating buildings. In parallel, across the different disciplines that constitute the neighbourhood effects literature, there is a growing acknowledgement that unpacking the “black box” of the phenomenon will require a principled theoretical approach that proposes plausible causal pathways between the area-level neighbourhood context and individual-level health; that is a concerted effort to answer not only the “why?” (ultimate) question, but the “how?” (proximate) question, too. Building on Wilson and O’Brien’s explicitly evolutionary construct of Community Perception, we introduce Jos Brosschot’s Generalised Unsafety Theory of Stress to propose and test a novel account of the causal pathway we believe residential maintenance plays between a place and its people. We use C-reactive protein (CRP), a biomarker associated with infection and stress, alongside information relating to neighbourhood maintenance, demographic characteristics, and health behaviours, all drawn from the UK Household Longitudinal Study. Hierarchical multiple regression models estimate CRP for exposure to poor maintenance conditions, controlling for known predictors and confounders. Results indicate that poor maintenance is associated with elevated CRP. Residential maintenance matters to people’s physical health. Future work will look to further elucidate the proximate mechanisms that underlie this pathway, in the hope that it will lead to impactful evidence-based policy proposals.