Toward An Equity-Centered Healthy Housing Design Policy Framework for Climate and Pandemic Resilience: Lessons from Covid-19 And Frequent Climate-Related Hazards in Bangladesh’s Urban Informal Settlements and Rural Communities

Abstract

Healthy housing represents a critical intersection between public health, socioeconomic equity, climate resilience, and emergency preparedness, particularly in Bangladesh, where urban informal settlements and rural communities experience distinct but overlapping residential vulnerabilities. This quantitative cross-sectional comparative study examined the relationships among housing quality, socioeconomic inequality, climate-hazard exposure, household health, pandemic-related housing functionality, and residential resilience among 500 households, comprising 250 households from urban informal settlements and 250 from rural climate-exposed communities. Data were collected through structured household questionnaires, housing observations, and environmental assessments and were analyzed using descriptive statistics, group-comparison tests, multivariable regression, mediation analysis, interaction analysis, and sensitivity testing. The overall Healthy Housing Index (HHI) was 53.7 ± 14.2, with urban households recording significantly lower scores than rural households (50.8 vs. 56.6; p < 0.001; d = 0.42). Urban households showed particularly pronounced deficiencies in spatial adequacy, ventilation, drainage, sanitation, and indoor thermal conditions, whereas rural households experienced greater structural weakness and exposure to floods, cyclones, erosion, and salinity. The mean Climate-Hazard Exposure Index was 61.4 ± 17.3, while the Household Resilience Index averaged 50.3 ± 15.6. Each 10-point increase in HHI was associated with lower adjusted odds of respiratory symptoms (AOR = 0.76, 95% CI: 0.65–0.89), diarrheal or infectious illness (AOR = 0.71, 95% CI: 0.59–0.85), and heat-related symptoms (AOR = 0.69, 95% CI: 0.59–0.81). Healthy housing positively predicted household resilience (β = 0.34, p < 0.001), whereas climate-hazard exposure showed a negative association (β = −0.29, p < 0.001). Kutcha dwellings experienced substantially greater mean structural damage (44.7%) than semi-pucca (29.6%) and pucca dwellings (16.3%; p < 0.001). Housing deprivation also partially mediated the association between socioeconomic disadvantage and residential vulnerability, accounting for approximately 42.9% of the total association. The final multivariable model explained 46.8% of variation in household resilience.