Health Codes

The justification for public involvement in setting construction and maintenance standards through building, housing, and other codes has its origins in 19th-century concerns about the spread of disease and pestilence in densely populated cities. Outbreaks of tuberculosis, typhoid, cholera, and smallpox drew reformers’ attention to deplorable housing conditions. These included extreme overcrowding; little, if any, ventilation; the absence of sanitation facilities (in many cases resulting in defecation and urination in public hallways); and dangerous accumulations of garbage and waste that attracted rats and other pests. Some cities tried to address the worst of these concerns by adopting building and health regulations.

Health codes, sometimes known as sanitary codes, include development and management standards directed toward avoiding environmental degradation, improving safety, and ensuring healthy living environments. Health codes can be adopted by state or local governments with widely varying content. The provisions of a health code may overlap with housing codes, which address maintenance requirements for existing dwellings and building codes, which set new construction standards specifically directed toward health and safety. Thus, the sources of standards affecting housing quality will differ from one jurisdiction to another.

The state of California's Health and Safety Code (n.d.) is one of 29 codes that constitute state law. This code includes over 120 sections covering a wide range of concerns such as nursing home administration, handling blood, sanitation districts, air pollution control, food processing, and housing authorities. In contrast, the Massachusetts State Sanitary Code (105 CMR 400.000–499.999) is more narrowly focused with attention to residential housing, farm and migrant workers, recreation facilities, prisons, managing infectious wastes, and lead poisoning prevention. Chapter 2 of this code establishes minimum standards of fitness for human habitation applying to all owner-occupied or rented dwellings, mobile homes, condominiums, and rooming houses used for living, sleeping, cooking, and eating. The standards address kitchen and bathroom facilities, water and energy supply, lighting, minimum and maximum room temperatures, asbestos maintenance, fire safety, rodent control, garbage removal, security, and maintenance of structural elements. The local board of health is responsible for enforcing these requirements. This code is considered the leading example of a state health or sanitation code, according to a 2009 report by the National Center for Healthy Housing.

At the county level, health codes are more often focused on sanitation issues, which explains the tendency for these to be referred to as sanitation, sanitary, or environmental codes. Typical requirements address on-site management of wastewater, licensure of septic system installers and cleaners, and separation requirements for water supply systems and pollution sources, such as septic systems, sewer lines, and barnyards. More rigid requirements may be in place for on-site wastewater management in aquifer recharge areas where natural conditions enable rainwater to permeate easily into the ground [Page 260]allowing for the replenishment of the groundwater supply. In this case, special efforts need to be made to ensure that the water supply is not polluted by wastewater. This might involve more sophisticated septic system design and scheduled maintenance.

According to the National Center for Healthy Housing, the only model health and sanitation code, Basic Principles of Healthful Housing, was adopted by the American Public Health Association (APHA) in 1938. The APHA defined fundamental needs as including physiological needs, which speak to concerns for temperature control, air quality, natural light, space for exercise, and avoiding excessive noise, and physiological needs addressing privacy, normal family and community life, ability to maintain cleanliness, and aesthetic satisfaction. Other fundamental needs included protection against disease and injury and provision of security. The APHA then established specific requirements and methods of attainment for each of 30 principles of healthful housing.

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