Assessing the Intermediate Pathways Linking Place of Residence to Health in India

Abstract Housing is a WHO-recognised social determinant of health, yet its role in linking household socioeconomic status (SES) and disease burden remains unexplored across Indian’s diverse residential settings. This study examines whether housing amenities mediate the relationship between household SES and prevalence of ailments in India, and whether this pathway varies between rural, urban and slum areas. Using the NSSO’s 76th round survey data on housing, sanitation, and hygiene (2018; N = 106,838 households: 63,736 rural, 40,444 urban, 2,658 slum). Structural equation modelling employed to estimate latent construct of SES, housing amenities, and disease burden represented by separate models for each resident type. Urban households recorded the highest housing amenity scores, followed by slums, with rural households having the lowest. SES is highly positively associated with housing amenities across place of residence (path coefficients: rural = 0.83, urban = 0.75, slum = 0.68), and inversely associated, with disease burden (rural= -0.21, urban = -0.20, slum= -0.14). The SES was inversely associated with disease burden through housing was weakest in slums, indicating that overcrowding and inadequate environmental comfort limit the health returns to increase in socio-economic status in the slum areas. Good Model fit was found across all places of residence (CFI = 0.92–0.97; RMSEA = 0.04–0.06). These findings highlight housing as a critical pathway through which socioeconomic inequalities influence health. Policies addressing income and education should therefore be complemented by improvements in housing quality, sanitation, clean water supply, environmental management, and shelter comfort particularly in rural and slum areas.