There have been two major critiques of this work.
The first is that it is possible to carry out hygiene practices with less than the health hardware standards we define. At the 2007 National Indigenous Housing Conference in Australia, this was succinctly raised by a prominent anthropologist when he stated that he could keep himself “clean” in the bush with minimal water and a bucket. Of course this might be true. However this ignores the fact that managing a family of children is an order of magnitude more difficult. In addition it implies that encouragement and facilitation of healthy living practices is unnecessary or even somehow unwarranted. It seems to us that in populations who live in poverty and have a mass of health and social problems, we should do everything that can be done to encourage and facilitate healthy living practices. We should try to make it easy not hard!
The second is the proposition that the work should not proceed unless we can prove a health benefit in all communities. Measuring health outcomes in disparate, small denominator communities is fraught with multiple methodological problems. In our view this should not detract from the implications of these findings since there are two centuries of public health literature on the relationship between housing and health. The bulk of this evidence confirms that improved housing improves health. What varies is effect size and the precise nature of the health benefit demonstrated in a very heterogeneous literature all of which has methodological limitations.
Sixty years ago in a conclusion that should be noted by some current researchers and policy makers in Australia, Britten observed, “the inability to define the precise influence of the various elements of bad housing must not be an excuse for failing to make progress in improving housing conditions” (16).
Dr Paul Torzillo