Scale used to select CADASIL patients for genetic screening of NOTCH3 mutations [110].
\r\n\tThe emergence of novel prion strains in animals, which include the only evidenced zoonotic prion C-BSE causing vCJD in humans, has created an important public health concern. Currently, new threats to human and animals may develop because of the plausible zoonotic properties of scrapie, L-BSE and the recently emerging chronic wasting disease in Europe.
\r\n\tThis book will gather experts in prion diseases and present new scientific advances in the field and relations with other amyloid neuropathologies.
Migraine is a primary headache disorder and one of the most common neurological diseases because it affects 11% of the adult population worldwide. Due to clinical manifestation, the disease is divided into two main subtypes: migraine with aura (MA), the classic form, and migraine without aura (MO), the common form [1]. The exact pathomechanism of migraine remains unclear, but the new explanation underlines the neurovascular background with an important role of trigeminovascular system and cortical spreading depression (CSD). CSD is a wave of electrophysiological hyperactivity followed by depression spreading across the cortex. This process leads to decrease in blood flow and is manifested in the aura. Migraine is a polygenetic disease with the contribution of environmental factors [2].
\nThe most significant risk factor of migraine is gender, as migraine is more prevalent in females than in males, but a female: male ratio ranging from 2:1 to 4:1 in several populations [3, 4]. The ratio is not consistent across the age because there is no difference in the percentage of boys and girls among children aged 7–9 affected by migraine. After that age, the migraine is more common in females. The prevalence of migraine is the highest in girls after puberty and among women aged 30–50, and declines in post-menopausal period. However, the similar trend in prevalence of migraine is observed in adult men, but the absolute values are lower (\nFigure 1\n) [5].
\nMigraine prevalence by age and sex, based on [5].
Moreover, female patients with migraine are more prone to vascular diseases as compare to males. The correlation between migraine and vascular diseases, especially cerebrovascular, has been studied from ages due to similar features, such as neurovascular component, a decrease in blood flow and platelet aggregation. MA is often associated with stroke symptoms and ischemic, or rarely hemorrhagic stroke events. No such strong relation was found in MO or other headaches [6, 7]. Numerous meta-analyses underline that MA doubles the risk of ischemic stroke [8–10]. This association is stronger in younger adults, especially women <45 years of age. In the young woman with MA, the combination of smoking and oral contraceptive use has a prominent role in stroke developing [8, 9]. The high frequency of migraine attacks and longstanding history of migraine are also the risk factors for stroke [6, 11]. It may be explained by subclinical ischemic brain lesions observed in magnetic resonance imaging (MRI) of those patients [6].
\nThe risk of ischemic stroke in migraine patients may also be increased by cardiovascular risk factors, e.g., diabetes, hypertension, obesity and dyslipidemia [12], hyperhomocysteinemia, as well as genetic factors, e.g., C677T polymorphism in MTHFR, insertion/deletion polymorphism in ACE or mutations in NOTCH3 [13].
\nThe cardiovascular diseases (CVD) and MA often coexist. The CSD involved in MA pathophysiology, migraine attacks frequency, prothrombotic effects, and impaired vascular reactivity in migraine patients or even migraine-specific treatments may increase the risk of CVD [14]. The risk factors for vascular diseases include changes in female sex hormones, hypertension, obesity, dyslipidemia and diabetes mellitus or elevated concentration of homocysteine (Hcy) and asymmetric dimethylarginine (ADMA).
\nGender differences in migraine prevalence can be explained by the influence of female hormones. Fluctuation in female sex hormones levels correlates with migraine, as attacks frequency is higher during menstruation [15, 16]. The peak estradiol level in women with menstrual related migraine is lower than in healthy group [17]. Another sex hormone, estrogen is also indirectly involved in pain transmission and pathophysiology of migraine. Additionally, estrogen, which is involved in thrombotic propensity and vasodilatory response, play the protective role against CVD risk. The CVD prevalence surges during menopause, when hormone balance is changed. This relation can explain the higher risk of CVD among younger women suffering from migraine [16].
\nThe prospective cohort study of Kurth et al. [18] shows a consistent link between migraine and CVD events and cardiovascular mortality in women with more than 20 years of follow-up. The authors found that an approximately 50% increased risk of major CVD like myocardial infarction, stroke, coronary artery procedures, and angina pectoris. The previous study in women indicates that only MA is associated with elevated risk of CVD [14, 19]. However, in the men group, migraine is correlated with increased risk of subsequent major CVD, which was driven by the increased risk of myocardial infarction [20].
\nThe major CVD risk is hypertension, which high appearance was found in individuals with migraine [21]. Hypertension occurs in migraine patients, both females and males, in younger age than in the non-migraine population. The 5-year prospective cohort study in Finland demonstrated that migraine is associated with an increased risk of hypertension among working-age population [22]. Among patients suffered from hypertension-migraine comorbidity the onset of both disorders occur at about 45 years of age, with the migraine starting significantly later than in only migraine patients and hypertension significantly earlier than in the hypertension-only group. Moreover, comorbidity group has a higher occurrence of the history of cerebrovascular events [23]. It is important to control hypertension in migraine and apply the proper treatment, because uncontrolled may lead to worsening of a headache and therapeutic failure. It is also crucial for the control of cerebrovascular risk, which is already increased in patients with MA [24].
\nModifiable risk factor for both CVD and migraine is obesity. Migraine and obesity are associated in several ways [25]. Obesity is related to higher migraine prevalence, higher attacks frequency, and also with elevated risk for developing chronic daily headache with migrainous features or transformation from an episodic migraine to chronic form [26, 27]. According to Bigal et al. [28], only 4.4% of migraneous with normal weight had 10–15 headache days per month, but percentage increases with bigger weight, in the overweight group it was 5.8%, in the obese 13.6%, and the morbidly obese 20.7%. The age and sex are also important covariates in associations between obesity and migraine [25].
\nThe literature indicates that MA and obesity seem to be connected with CVD. It is known that such inflammatory mediators, like cytokines (interleukin 6—IL-6 and tumor necrosis factor-α—TNF-α), and calcitonin gene-related peptide (CGRP), which levels are increased in obese individuals, play important role in migraine pathophysiology. They may enlarge the number and duration of migraine attacks, which in turn cause central sensitization. Repeated central sensitization may be associated with neuronal damage and with poor modulation to pain. Plasma CGRP level is mostly elevated in women and its secretion can be increased by fat intake. Other peptides, the hypocretins (hypocretin-1 and -2) may also link the metabolism and pain. They control nociception and release of CGRP from trigeminal neurons. Hypocretins regulates appetite and energy metabolism: their activity is decreased in obesity. It is postulated that the dysmodulation in the hypocretinergic pathways is associated with increased susceptibility to neurogenic inflammation and migraine attacks [27, 28].
\nObesity is directly connected with dyslipidemia. Several studies explored the relationship between dyslipidemia and migraine in a cardiovascular context. The population-based study of men and women aged 20–65 year in the Netherlands s found that adult MA patients have “riskier” profile for CVD than MO [29]. The authors indicated that increased total cholesterol (≥240 mg/dL) and the total cholesterol to high-density lipoprotein cholesterol (HDL-C) ratio (>5) had been associated with MA. The study of Gruber et al. [30] showed that in normal weight MA patients, not only total cholesterol level is elevated, but also low density lipoprotein cholesterol (LDL-C) and oxidized LDL-C levels as compared to normal weight controls. It was demonstrated that elevated oxidized LDL-C increases the risk of migraine almost eight times. In the cross-sectional study from France, elevated levels of total cholesterol and triglycerides were associated with MA, but not with other headaches in the elderly [31]. There is also a correlation between cholesterol levels (total and LDL-C) and degree of migraine severity, with higher cholesterol values for more frequent and intense migraine attacks [32]. Moreover, the positive associations among MO, and VLDL cholesterol (VLDL-C) and remnant VLDL particles (VLDL3) were observed in women and men, respectively. VLDL is fractioned into IDL and VLDL3, which has been previously connected with higher CVD risk [33].
\nIt is postulated that diabetes mellitus (DM) is associated with migraine, but there are conflicting results that relationship is interesting because DM affects vascular reactivity, induces neuropathy, and can be important in the pathophysiology of migraine [34]. The prospective cohort study from Finland observed that women with a headache are more often diabetic [35]. Haghighi et al. [36] showed no significant differences in the prevalence of migraine between diabetic and non-diabetic patients, these results confirmed previous study [37]. However, the authors indicated that migraine prevalence is related to the family history of migraine in the first-degree relatives, the history of hypoglycemia and durations of DM type 2. Other results demonstrated that migraine is significantly less prevalent in patients with DM than without DM [34, 38]. The study of Aamondt et al. [34] also showed that migraine prevalence is lower among patients with duration of DM ≥ 13 years or HbA1c levels >6.6%.
\nHcy is an endogenous sulfur amino acid, which is formed as the intermediate product during metabolism of methionine in kidney, liver, small intestine, pancreas, blood vessels, and skin [39]. In its transformation, some enzymes and co-factors are involved, e.g., methylenetetrahydrofolate reductase (MTHFR), cystathionine beta synthase (CBS), methionine synthase (MS), also known as 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR), folic acid, and vitamins B6 and B12 [40]. Increased level of Hcy (which can lead to hyperhomocysteinemia) is an important risk factor for ischemic heart disease, venous thromboembolism, ischemic stroke, and other CVD [41]. The elevated Hcy level has also been reported in patients suffering from MA [42], which may indicate an increased risk of CVD in this group. Mechanisms of adverse effects of Hcy on blood vessels are seen in the intensification of oxidative stress, reduced amount of nitric oxide (NO), the cytotoxic effect on endothelial cells, inflammation in the vascular walls, and abnormalities of the coagulation process [43]. The level of Hcy may be regulated by polymorphisms in genes encoding enzymes necessary for its metabolism, e.g., MTHFR, MTR.
\nADMA is a naturally occurring amino acid, an analog of L-arginine that competitively inhibits endothelial nitric oxide synthase (eNOS) activity, causing vasoconstriction and endothelial dysfunction leading to CVD [44]. eNOS catalyzes arginine oxidation to NO, which is one of the strongest vasodilators in the human body. Studies have confirmed that NO, changing cerebral blood flow, is responsible for migraine headaches [45]. Elevated levels of ADMA have been reported in patients with migraine compared to the control group, without any difference between MA and MO. It is interesting that the same studies also showed higher NO level in migraineurs than in control. The possible reason for increase in both ADMA and NO concentrations may be an attempt to compensate for elevated NO level and excessive vasodilatation [46]. However, there are also reports that ADMA and NO levels in migraine patients do not differ from the control group [47]. Higher concentration of ADMA may be caused by abnormalities in the function of dimethylarginine dimethylaminohydrolase (DDAH) whose role is to degrade ADMA to dimethylamine and citruline [48]. There are two forms of this enzyme: DDAH1 and DDAH2, encoded by different genes: DDAH1 and DDAH2, respectively. It was found that polymorphisms (rs233109, rs6669293, and rs12140935) in the DDAH1 gene may influence the ADMA level [49]. The interaction among Hcy, DDAH, and ADMA was also investigated. Studies conducted on neuronal cell cultures show that DDAH inhibition by Hcy results in higher ADMA accumulation and a decrease in NO production [50]. Overexpression of DDAH protects from adverse effects for cerebral blood vessels, that results from elevated levels of Hcy [51].
\nMigraine is a polygenetic disease. According to population-based family studies, MA is four-times more common in individuals with first-degree relatives suffering from MA, while the risk for MO increases two-times in terms of having first-degree relatives with MO [52]. Therefore, numerous studies investigated the association between genetic polymorphisms or mutations and MA, MO. Polymorphisms in gene coding angiotensin I—converting enzyme (ACE) and in genes related to Hcy metabolism, may increase risk both for migraine and vascular diseases. Moreover, the strict relation between migraine, especially MA and stroke, is presented in patients with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).
\nACE, which is a part of the renin-angiotensin system (RAS), converts the inactive angiotensin I to angiotensin II. Angiotensin II is an active peptide responsible for vasoconstriction, regulation of blood pressure and blood volume [53]. The ACE inhibitors are used in migraine prophylaxis, and for hypertension and coronary artery disease treatment [54]. The activity of ACE may be controlled by insertion/deletion (I/D) polymorphism (rs1799752) in the ACE gene. The DD genotype of ACE I/D polymorphism is associated with the higher ACE activity, which increases angiotensin II level and in result leads to the imbalance in RAS [55]. The I/D polymorphism was linked to numerous diseases, e.g., hypertension, ischemic stroke, and migraine (MA, MO or an overall migraine, depending on the study) [56]. Thus, there is a possible association between this polymorphism, migraine, and CVD. According to Schurks et al. [57], the MA patients carrying D allele have the two-fold increased risk of CVD. The data about DD genotype and migraine attack frequency are inconsistent. Schürks et al. [58] showed that ACE D allele does not influence the MA or MO attack frequency while Paterna et al. [56] found that carrying the D allele determines more frequent MO attacks. The protective effect of II genotype may contribute to the reduction of the dose of ACE inhibitors in migraine prophylaxis [59].
\nBoth polymorphisms in MTHFR and ACE genes promote oxidative stress, endothelial dysfunction and in consequence, may predispose to stroke. It was suggested that MTHFR C667T TT and ACE DD genotypes in combination might increase the migraine susceptibility, especially MA [60]; while the other study did not confirm this conclusion [61]. The meta-analysis indicated that MTHFR C667T TT genotype increases the MA risk, while the ACE II genotype protects against both MA and MO, but only in non-Caucasian populations [62].
\nMTHFR is responsible for the conversion of 5,10-methylenetetrahydrofolate (CH2THF) to 5-methyltetrahydrofolate (CH3THF), which is a donor of the methyl group in remethylation of Hcy to methionine. Polymorphisms in MTHFR gene may be the reason of higher level of Hcy in blood. Fourteen rare mutations of MTHFR gene and one common C677T polymorphism in MTHFR gene were associated with severe enzymatic deficiency [63]. The MTHFR C677T polymorphism (Ala222Val) is associated with the decreased enzymatic activity to 30% in TT homozygous subject and 60% in individuals with CT genotype as compared to wild type genotype CC [64]. Several studies analyzed the association between MTHFR gene polymorphisms and migraine and obtained different results. Studies carried out in Japanese and Turkish population showed the higher frequency of TT genotype in migraine patients than in the controls [65, 66]. Moreover, Kowa et al. [65] found the particularly high frequency of MTHFR C677T TT genotype in MA, what correlates with results of Caucasian population studies [67, 68] reporting that TT genotype may be a risk factor for MA, but not for MO. On the other hand, studies conducted on the group of Finns excluded the association between MTHFR C667T polymorphism and migraine [69]. Recent meta-analyzes confirmed that the TT genotype of MTHFR C677T polymorphism is significantly associated with the risk of MA both in Caucasian [70] and non-Caucasian group [71] and total migraine in the non-Caucasian group [70, 71].
\nAnother, less common MTHFR gene polymorphism that may be associated with migraine is A1298C (Glu429Ala). Studies by Kara et al. [66] showed that CC genotype is more common in migraine patients than in control subjects. The MTHFR A1296C polymorphism also reduces the activity of MTHFR without the increase in Hcy level and decrease in folate level in individuals with CC genotype. However, heterozygous patients with both MTHFR C677T and A1298C polymorphisms had higher levels of Hcy as compared to those who carried only C677T MTHFR polymorphism [72, 73].
\nThe level of Hcy and folate may also be altered by the polymorphism in MTR gene encoding MTR enzyme responsible for remethylation of Hcy to methionine with the participation of vitamin B12 and 5-methyltetrahydrofolate [74]. So far, one common polymorphism A2756G (Asp919Gly), has been described in the MTR gene [75]. However, the effect of this polymorphism on Hcy and folate levels is not entirely clear. Li et al. [76] showed an association of MTR A2756G with increased Hcy and decreased folate level. On the other hand, Klerk et al. [77] denied that G allele of MTR A2756G affects Hcy level. Also, there was no association between MTR A2756G and migraine [42, 78], even in the coexistence of MTHFR 677CT TT genotype [79].
\nAnother enzyme involved in Hcy metabolism is 5-methyltetrahydrofolate-homocysteine methyltransferase reductase (MTRR), encoded by MTRR gene. The MTRR A66G (Ile22Met) polymorphism may lead to elevated Hcy level [80, 81], with greater effects observed in individuals with GG genotype than GA [80]. Furthermore, the coexistence of MTRR A66G AG or GG genotypes with the MTHFR A677T TT genotype increases the adverse effect of the MTHFR variant [82].
\nMTHFD1 is a trifunctional enzyme composed of methylenetetrahydrofolate dehydrogenase, methyltetrahydrofolate cyclohydrolase, and formyltetrahydrofolate synthetase, encoded by MTHFD1 gene. The most commonly analyzed polymorphisms of the MTHFD gene are G1958A (R653Q) and C401T (R134K). The G1958A or C401T polymorphism individually does not increase the risk of migraine [79, 83]. However, the risk of migraine, especially MO, increases when the A allele of MTHFD G1958A polymorphism occurs together with the T allele of MTHFR C677T polymorphism. On the other hand, the group of Australian scientists found no association of MTHFD C401T and G1958A with the increased risk of suffering migraine [79].
\nCBS is an enzyme responsible for the conversion of Hcy to cystathionine, a cysteine precursor, and is encoded by CBS gene. Numerous genetic variants in this gene have been described, including silent polymorphisms (C699T, C1080T) [84], sense change mutations (T833C, G919A) and insertions (844ins68) [85, 86]. The most common polymorphism of the CBS gene, the T833C, results in the elevated level of Hcy [87] and predisposes to stroke [88]. The 844ins68 polymorphism alone does not affect Hcy plasma levels [89], whereas T833C/844ins68 induces mild hyperhomocysteinemia [90]. The occurrence of this insertion together with T allele of MTHFR C677T polymorphism results in lower Hcy levels as compared to the subject carrying only insertion [91]. The silent polymorphism in CBS gene seems to have a protective effect against CVD. Subjects with C699T TT genotype had lower Hcy level than subjects with the CC genotype [92] and consequently lower risk of CVD [93]. Also, CBS C1080T polymorphism leads to decrease in Hcy level, but this effect is endured by of 844ins68 mutation carriers [92]. On the other hand, the study conducted by Lievers et al. [94] showed no association between the occurrence of the silent polymorphisms and the change in plasma Hcy levels [94].
\n\neNOS gene encoded endothelial NO synthase. Several polymorphisms in the eNOS gene were described, including T786C and G894T (Glu298Asp), but their relevance to migraine pathomechanism remains ambiguous. According to Eröz et al. [95], presentence of T alleles of eNOS T786C and eNOS G894T polymorphisms are more common in migraine patients than in controls. Other studies indicated that the TT genotype of eNOS G894T is associated only with a higher risk of MA [96] or there is no association [97].
\nThe strict relation between MA and stroke was observed in CADASIL syndrome. It belongs to the group of leukodystrophies and is caused by mutations in NOTCH3 gene [98].
\nCADASIL is the most frequent inherited ischemic disease of a small vessel of the brain [98]. The key features of CADASIL are MA, recurrent subcortical ischemic events and vascular dementia. The subcortical ischemic stroke is presented in 85% CADASIL patients in mean age 46 without atherosclerosis risk factors. Two of three cases are the lacunar stroke, while one of three is ishemispheric stroke. 20–40% of individuals suffer from psychiatric disorders, mostly depression or apathy. Dementia is presented in 31–60% of CADASIL patients, aged between 50 and 60, as a result of stroke history, leading to severe disability and premature death [99, 100].
\nOften (20–40% of cases) the inaugural symptom of CADASIL is MA started in the second–third decade of life (females: 25; males: 30–35 year of life). Interestingly, MA is five-times more frequent in CADASIL patients than in general population and may remain as the isolated symptom [100]. CADASIL patients may experience aura without a headache or atypical aura (e.g., hemiplegic, basilar, or prolonged) or even acute confusional migraine. Thus it is suggested that atypical aura should indicate the diagnosis of CADASIL [101–104]. The frequency of MA attacks decreases after the disease progression (stroke event). Unfortunately, migraine as a common neurological disease is not a specific symptom of CADASIL, which often is misdiagnosed [100].
\nAs mentioned before, CADASIL is a result of the mutation in the NOTCH3 gene (19p13.12), encoding receptor protein NOTCH3. NOTCH receptors are made up of the functional extracellular domain (ECD)—containing multiple epidermal growth factor-like (EGF-like) repeats, the transmembrane domain and intracellular domain (ICD). The variants of NOTCH (NOTCH1–4) differ in the number of EGF repeats [105]. The NOTCH3 is essential for the development of vascular smooth muscle cells (VSMC) and maintenance of their function. Moreover, it protects against apoptosis and regulates the response of smooth muscle cells to external factors. NOTCH3 occurs mostly in the arteries and capillaries.
\nAt least 200 mutations have been identified in NOTCH3 and are located in N3-ECD. Those missense mutations create or destroy cysteine residues. As the name of disease indicates, they are inherited in the autosomal dominant pattern. NOTCH3 consists of 33 exons, but 73% of mutations are localized in exon 4, 8% in exon 3, 6% in exons 5 and 6 [99, 106, 107]. The first step of genetic screening is analyze of exon 4, if there are no mutations the analysis is extended to exons 2, 3, 5, 6, and 11. The last step may be the screening of all exons using next generation sequencing (NGS). Different NOTCH3 mutations were revealed among Asian of Caucasian populations [108, 109].
\nThe CADASIL scale proposed by Pescini et al. [110] for selecting patients for genetic analysis is summarized in \nTable 1\n. A total score of ≥15 is an indication for genetic testing. The clinical course of CADASIL may vary between individuals with the same mutation in NOTCH3 gene. The heterogenic manifestation of clinical symptoms makes the CADASIL underdiagnosed due to difficulties in distinguishing with, e.g., MA, familial hemiplegic migraine, or progressive ataxia [107]. The NOTCH3 mutation analysis should be performed in cases with clinical features of CADASIL, even with the negative disease history.
\nCADASIL scale | \nPoints | \n
---|---|
Migraine Migraine with aura Stroke Stroke onset ≤50 years Psychiatric disturbances Cognitive decline/dementia Leukoencephalopathy Leukoencephalopathy extended to temporal pole Leukoencephalopathy extended to external capsule Subcortical infarcts Family history in at least one generation Family history in at least two generations | \n1 3 1 2 1 3 3 1 5 2 1 2 | \n
Scale used to select CADASIL patients for genetic screening of NOTCH3 mutations [110].
There are two hypothesis explaining the role of NOTCH3 mutations in CADASIL pathomechanism. According to the first of them, the mutated NOTCH3 receptor gains new functions leading to the development of degenerative changes in blood vessels. The signaling pathway is unchanged, but the cerebral blood flow autoregulation is disturbed due to the decline of VSMC functions. The persistent stress conditions lead to VSMC remodeling, reduction of cerebral vasoreactivity, the decrease in blood flow in white matter, and in consequence to chronic ischemia. The second hypothesis assumes proteinopathy as a result of N3-ECD and granular osmiophilic material (GOM) deposition in walls of blood vessels. The GOM is also presented in skin biopsy. Abnormal folded NOTCH3 protein tends to create aggregates and is not removed because of dysfunction of the ubiquitin-proteasome system. The deposition begins in 20-year-old CADASIL patients, while the changes in MRI are visible in 30-year-old patients. Interestingly, almost all CADASIL patients aged 35 with NOTCH3 mutations have changes in MRI, e.g., white matter hyperintensities (WMH), lacunar infarcts or microbleeds. WMH lesions in T2 and FLAIR sequences may be presented even 15 years before stroke [111–113]. Four case-studies indicated that the brain MRI may be unremarkable [114].
\nMigraine is a multifactorial disease with both genetic and environmental background. Polymorphisms and mutations in numerous genes, e.g., ACE, NOTCH3, MTHFR, MTR, MTRR, MTHFD1, CBS, and eNOS are the genetic factors involved in its pathomechanism. Changes in biochemical parameters, such as Hcy and ADMA leading to CVD, stroke and migraine may be a result of lifestyle. Migraine alone can also lead to CVD and stroke. It seems that better knowledge of the migraine pathomechanism may lead to early diagnosis of migraine and the introduction of more effective pharmacotherapy and, in consequence, to the prevention of common vascular disease (\nFigure 2\n).
\nAssociation between migraine and cardiovascular diseases, stroke and genetic, or biochemical risk factors. ACE: angiotensin I-converting enzyme; CADASIL: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; MTHFR: methylenetetrahydrofolate reductase; MTR: 5-methyltetrahydrofolate-homocysteine methyltransferase; MTRR-5: methyltetrahydrofolate-homocysteine methyltransferase reductase; CBS: cystathionine β-synthase; eNOS: endothelial NO synthase; Hcy: homocysteine; ADMA: asymmetric dimethylarginine.
Housing policy is naturally a top-down process since government should be seen or at least perceived as taking care of all the people in any country. The mode of carrying out this laudable ideal of ensuring housing provision for all citizens irrespective of income varies in different contexts depending on the housing policy-success-failure history, objectives set, the desires and mode of government in place.
This chapter examines housing strategies in the developing world, especially for low-income people in sub-Saharan Africa. It x-rays the housing problem in the developing world and policy prescriptions vis-a-vis the housing solutions of low-income people. Whereas public authority approaches have limited success in housing supply, cross sections of low-income people in the developing world have succeeded in housing production in informal ways. It is important to understand how these low-income people succeed to device housing strategies that work for the poor. The social totality concept derivable from Lefebvre’s theory of space provides an explanation of how these low-income people negotiate housing from the social context [1, 2]. The concept is also examined and the relations with housing discussed to illustrate how housing strategies can be synthesised from understanding the housing process of low-income people in different contexts. The literature review is international to situate the housing situation in a global perspective since many housing strategies in the developing world emanate directly or indirectly from the developed world. The United Nations, the World Bank and other global agencies, consultants, researchers and professionals from different regions of the world in the spirit of globalisation are understandably active in recommending policies and solutions to the housing problem in the developing world. The conventional solution is that government and private sector are expected to be major actors in housing supply.
Formal housing provision by government and or private organisations have direct beneficiaries: families who possess the willingness and ability to buy from the market, consultants, contractors, skilled and unskilled workmen in the construction industry, loan and credit institutions, building material producers and allied industries [3]. Public housing estates are known to be large homogenous enclaves of poverty in unattractive locations but are justified by supply side political idealists for affordable housing [4]. The political ideals that shape public housing are related to the political, social, legal and economic indices of different countries. Significantly, private housing and informal housing in different contexts are affected by the same factors with the people at the centre of the ping pong impacts of these different factors. The peoples housing is the product of their reaction and manipulation of these different factors to attain a human life necessity. Low-income housing covers between 60 and 80% of towns’ and cities’ developed land areas in Africa, Asia, Latin America and the Caribbean and accounts for 50–70% of the fixed capital formation of urban areas (UN-Habitat, 2003). In spite of this, there is a wide gap between supply and demand of low-income housing. Obviously, strategies that alleviate low-income housing problem will also contribute to the development efforts of these developing countries.
The goal of housing strategy for low-income housing as stated for public housing should be to ensure that the disadvantaged have decent, affordable housing through political support and policy [4]. This goal has been difficult to achieve in most developing countries. For example, most of the houses built for the poor, which constitute only 4% of the housing stock, in Ghana ended up with the middle-income group; the growing private sector only build for high-income groups, while the informal sector accounts for 90% of the housing stock [5]. Actually, low-income people who need housing should be the anchor point of studies to redirect housing policies and strategies. The people who have succeeded in what public authorities, private corporations, international organisations, and their collaborations whether Public Private Participation (PPP) or International Institutions Assisted Programmes have failed in should be studied. Their profile, individual and communal, the process they adopted, the different stages of the product and how this profile, process and product are continually defined and negotiated in the social context need to be understood to synthesise appropriate housing strategies for low-income people. Studying low-income people with the conceptual viewpoint of social totality that builds upon the idea of everything in space including housing as socially produced will help to overcome the housing challenge in the developing world.
The housing situation in the developing world is presently worrisome, and the prospects of escalation of the problem are obvious considering that most of the urban population increase in the world, in fact 95%, will be in the developing world [6]. The quantitative deficit in housing has been escalating: 650 million in 1990, 760 million in 2000 and 863 million in 2014 [7, 8].
The housing inadequacy of the developing world is such that the UN-Habitat 2015 report documents 880 million living in slums against 792 million in 2000 [9]. This fact among others may have informed the integration of ‘housing for all’ target towards 2030 in the Sustainable Development Goals [10]. Urbanisation in the developing countries is often associated with increasing concentration of ‘slums’, a term that is so generally employed that more than half of the settlements in a few large urban centres may be so classified. It reflects how bad the housing situation in the cities of the developing world is. Globally, there was an increase of 14% in the number of people living in slums in cities across the world between 2000 and 2014 [6]. Most of these slums are habitat to low-income people in the developing world.
The classification of most low-income housing areas as slums is one that has been debated often since the John Turner studies [8, 9, 10] in Latin America that highlight the immense resources possessed and expended on the production of the existing housing by poor people [11, 12, 13]. Also, a lot of capital is locked up in these settlements that could be tapped into through regularisation and legalisation [14]. It is significant that in parts of the developing world, unlike the squatter settlements in Latin America, most houses produced by the low-income are not necessarily ‘illegal’ in the sense that the land is purchased and there were attempts by the producers to legalise the process.
Quantitatively speaking, the housing problem may have disappeared after the industrial revolution with mass production techniques, but economists argue that there are competing sectors and uses for the limited and scarce resources of countries. Countries in the developing world have more limited resources that are unreasonably mismanaged to exclude more proportion of citizens from housing solutions. It was therefore convenient for governments in these countries to adopt the enabling shelter strategy as advocated in Global Shelter Strategies in the 1990s and put together in UN and World Bank reports. The philosophy was for government to tactically withdraw from housing provision and housing subsidy, manage institutional, legislative and regulatory environment as part of the economy but empower the private sector and the housing market to produce housing for all [15].
The enabling strategy has been largely unsuccessful for low-income housing since houses meant for them have been taken up by higher income groups due to lower housing production, lack of institutional infrastructure, non-transparency of the housing market in the midst of more social, economic and environmental exclusion and therefore growing numbers of the poor in inadequate housing or homeless [15, 16, 17, 18].
The housing problem in the developing world is not only quantitative, it is associated with rapid urbanisation in poorly managed economies and inequitable distribution of wealth exacerbating poverty and therefore housing affordability. In the case of Africa, urbanisation is not associated with industrialisation (except in Johannesburg, South Africa) which means that it does not translate to higher wages like in Europe and Asia. Rather, things are more expensive with people spending more for daily needs such as food, water, electricity and other sources of power. An experiential survey shows that the rental value of minimal accommodation may account for up to 40–60% of gross income in big cities [19]. Developing nations are also bedevilled with political, religious and other developmental problems that mask and divert attention from the actual problems including housing. There are policies on paper to address these main problems, but the implementation falls short of the goal, objectives and targets due to inadequate database, manpower, technological resources, and especially financial resources sometimes related to unaccountable resource allocation. In addition, developing countries especially in sub-Saharan Africa feature high level of informality in the economy. Many activities in the informal sector occur outside the radar of public authorities, institutions and agencies and are therefore not accounted for in government balance sheets of production, consumption nor taxation. This informal sector is where most low-income people work. By contrast, the governance, urban planning and economy are controlled by diverse and fragmented actors and formal and informal processes in the public, private and civic sectors. Navigating these complex institutions is accomplished depending on the level of power; in principle, low-income people are the lowest in the ladder of power considering their level of political exclusion.
Furthermore, in most developing countries, there is a lack of political will, resources and manpower for futuristic planning, especially for urban areas. This results in the continued use of outdated and colonial era planning laws, regulations and building codes. Also, when there are new laws, there is a lack of capacity, equipment and manpower to enforce these laws and associated regulations. Even formal developments lack access to adequate, properly located land as was the case in Raipur, India [3]. Also, too much land is consumed by adhering to regulation that increases ‘generosity’ of land use in low density, generous parking, setbacks, air space in between buildings causing urban sprawl, high land, service and infrastructure costs [3]. Sometimes ownership and control of land for housing are still contested between traditional authorities and different levels of government. For example, Nigeria has a land use decree that vests the power to release land for development on the state governors [20]. This position sometimes sets the federal institutions against the state ones and both against traditional family-owned property owners for housing development. Most informal developments are therefore at the outskirts of cities where land costs are cheaper and development control is weaker making it possible to continue construction with or without planning permit or approval or where extremely high standard regulations are yet to be enforced. The outskirt of cities is poorly served with infrastructure since the cost of servicing the urban areas itself is already so high that government is just managing to cope, if they are coping at all. Politics, power play and election success are interwoven with the formal and informal housing provision processes. This is most prominent in situations of illegal occupation of urban land, squatters and slums as it relates to Latin America, Asia and a few very large urban areas in Africa. In the Raphur case study in India, new clientelism has replaced the old clientelism of feudal lords where the slum dwellers bargain with politicians, political office holders and political parties for goods, services, protection and individual needs in contrast to systemic changes with the promise of political support during elections [3]. Also, slum dwellers are said to have realised that their vote is the source of power to bargain with politicians and possibly build outside the law.
Political motivation and segregation which were overriding factors in early public housing in the twentieth century in United States and European countries in large urban projects are being repeated now in developing countries. Finished houses are being built for the housing market to be purchased at sometimes subsidised rates and with loan, mortgage or other forms of formal credit, often in uninteresting locations. The merits of finished houses built by the private, public and the public-private sectors are many. They provide houses with standardised plans and basic services in a more efficient and systematic way than the incremental process adopted by many private housing producers. Necessarily such housing can only be acquired through mortgage, loan and credit schemes often associated with some form of subsidy for either the provider or the consumer or both. Apart from the financial inefficiency and inequities that subsidies allow, there is also inequity in access to loan and credit schemes by those in the formal and informal sectors and the type and location of housing that can be purchased. Using provident fund as the source of finance is known to have accentuated the global financial crises in 2008 and gave birth to repetitive, standardised soulless housing on the outskirts of cities without other necessary uses critical for healthy living [21].
These projects featured a homogenous sector of the population in unattractive locations that later degenerated into slums and concentrations of poverty [22, 23, 24]. While the recent development of mixed tenure is not being adopted in the most recent projects, especially in Sub-Saharan Africa, however, public/private partnerships and more private developers are involved in delivering greater mix of typologies. The new millennium and post global financial crisis and the resulting demand for affordable housing made these countries, especially Western Europe, utilise the urban-diversity approach with all of its merits as a response to past mistakes [25]. The estates are diverse in terms of people (ethnicity, income, age) and land uses [25]. Negative effects are known to arise from urban diversity in public housing estates which may not be true about privately developed areas. Not learning from history seems to be a problem with respect to housing strategies in the developing world, especially sub-Saharan Africa.
Many approaches to alleviating the housing problem are being taken in different parts of the world and the Latin American experience has always been in focus since the John Turner studies in the 1960s. These studies brought to the fore an awareness of the immense resources possessed by people as individuals or community in housing. The political implications of this in relation to distribution of power and control at the local, national and global levels are a continuous debate among the political left, right and the non-aligned. Turners exposes were in the context of Latin America where group illegal invasion, occupation and building of houses in rapidly urbanising cities became the norm in the middle of the twentieth century and the political leadership and the then East-West divide ignited housing-political debates.
Government assistance in housing production and housing finance as implemented in Argentina, Brazil, Colombia and Mexico and government-subsidised new housing production coupled with slum improvements in India and South Africa [8]. The slum dwellers association in Thailand, India, South Africa and other places attempts to collectivise housing solution efforts for housing and the necessary infrastructure.
The World Bank’s intention of making the private sector to invest in low-income housing by demonstrating public assistance for private housing, cost recovery, replicability and profitability in sites-and-services schemes and slum upgrading in the 1970s through self-help efforts did not materialise [10, 26, 27]. Limitations of sites-and-services schemes include: wrong location on the outskirts of cities because of lower cost of land but resulting in separation of occupants from the job market and their social networks, lack of infrastructure and high costs of later service and infrastructure connection. In fact, on this basis, many of these schemes had low initial uptake and some remained under developed [28]. Also, impossibly high planning standards and unaffordable construction standards beyond the unusual for low-income housing are imposed. The subsequent evaluation of these projects was also short term without consideration of the usual construction period of between 15 and 20 years of incremental construction of low-income people. These projects were pronounced unsuccessful, discredited and abandoned too early. The evaluation was also based on the quality of the different transitional levels of the houses and the end product, which in many ways resembles the informally produced private housing [29]. Government-supported projects are also said to be cumbersome to administer according to the donor agencies including the World Bank. They were regarded as unconventional and by the early 1990s the World Bank started withdrawing support for such projects including the sites-and-services schemes [20, 22].
Another policy response is for low-income estates or affordable housing to be built as a means of increasing housing provision for low-income people. Whenever the private sector or the public-private sector puts a housing estate in the market as low-income estate, especially with the Nigerian experience, it is predominantly occupied or commodified by higher income groups.
There is a perception within the professional circles that the low-income need single family-dwelling typology desired by educated middle- and high-income people because of the prevailing emphasis on nuclear family over the extended family. As confirmed in Ghana, and also common in Nigeria, multi-habited houses rented or owned are the predominant house type of urban low-income households [30, 31]. This perception is what accounts for the typology of buildings made available in the housing market in the developing world, especially sub-Saharan Africa.
The latest effort of ‘natural resource-backed financial deals for the provision of infrastructure and housing’ in sub-Saharan Africa with Democratic Republic of Congo (DRC), Kenya and Nigeria as examples was examined by Quigley [32]. These efforts are geared towards creating massive estates on the outskirts of towns with funds sourced externally from other places, especially China. Far-reaching questions are being raised concerning these efforts including not understanding the historical context of policy [32]. Furthermore, these efforts rarely improve housing affordability and access to the needy and are out of tune with urban planning, especially sustainability and inclusiveness. Therefore, effective housing solutions and inclusive urbanisation should be sought in a broader understanding of the policy, regulatory and urban planning environment and income levels in the context [8].
Also, a better understanding of the equity effects of the housing strategy financialisaton in the developing world is necessary. Global interactions with country-specific local institutions, structures, agents and housing outcomes need to be understood in the search for alternative international housing policies not dominated by finance [10]. Above all, formal authorities should respect and seek understanding of how low-income people cross the barrier to becoming ‘landlords’—a term that signifies success in housing production.
The poor and the low income in various places have different housing strategies peculiar to their needs, degree of exclusion and contextually determined ability to pay for housing. Many have argued that the rental mode of tenure is the most appropriate for the low income [33]. However, in a situation where even that mode is not being considered by government and its institutions, low-income households have to solve their own housing problem. Whatever tenure status is preferred anyway, public authorities lack the data and the wherewithal to provide. The low income has found a way of fending for themselves either as landlord (owned housing and provider of rental housing), tenant, through shared accommodation or squat in any available private or public physical space. The generic term ‘slums’ is interchangeably used for these different housing strategies of the poor resulting in the distinguishing characteristics of these strategies being lost [34]. The challenges of accessing rental accommodation in a context where private ‘shylock’ landlords and caretakers—informal estate agents—rule the market are many. Rental accommodation remains in short supply due to lack of financial support either from the public or private sector and sometimes due to rent control laws. Rent control laws discourage present providers from further investing in new or maintaining properties [35, 36, 37]. This causes a shortage of rental accommodation relative to demand. Many landlords who are bent on buying a new land or continue incremental construction of another building for rent sometimes aided by the estate agents who may have their own objective of maximising returns through legal and illegal commissions ask for advance of 1 year or more yearly rent. This makes it very difficult for low-income people to put together the rent since it amounts to many months of income assuming there are no necessary expenditures like food for the family, transportation, education and health costs, among others. In a case study, those that cross this hurdle in Ghana were found to do so ‘by the Grace of God’, friend and family support considering their irregular income that makes it difficult to pay monthly rent [4]. In another case study in Nigeria deploying multidimensional explanations of Lefebvre’s theory of space describes how indigenous knowledge, residential history, culture of home ownership in the fatherland, motivation to be a landlord, provide for the family and be self-actualised were implicated when low-income people utilised multiple resources to negotiate housing from the context of Ibadan, Nigeria [31]. The motivation to have self-owned housing by the low income is high in the developing world since it is sometimes seen as a cultural imperative by some ethnic groups, especially with high rental, food and infrastructure costs coupled with generally expensive cost of living in the urban areas. For example, the Yorubas of Western Nigeria believe that if you simply soak cassava flour in cold water and eat in the corner of your own house, anybody can be made to believe the meal was an international cuisine or delicacy.
If renting is a tough task for low-income people, home ownership is more difficult. Public sector provision is negligible, mortgage system is either non-existent, non-functional or not realistic because of high interest rates due to the value of the local currency and other distortions in national economies. Also, only people in the public and organised private sector can meet the administrative requirements and the conditionalities for the mortgage. In addition, the low-income people that lack collateral in the formal sense and ability to follow up on the sometimes-cumbersome administrative processes do not qualify for other formal financing options like from commercial banks and similar agencies. Designers of low-income housing need to invent or reinvent their role in low-income housing provision to propose appropriate solutions [38]. Whereas public and private sector low-income or affordable housing in Nigeria is the nuclear, single-family 2- or 3-bedroom apartment, most low-income people actually build the rooming house. The typical house in a case study in Nigeria is six-room (41.1%) and eight-room (38.2%) rectangular, one-level house (90.1%) with shared bathroom, toilet and cooking spaces grouped together at the back. This typology is a product of multiple considerations including their residential history [38]. The modal group (29.8%) started construction the same year land was bought and majority (61.5%) started using the house within 3 years of starting construction with the mean duration being 4.62 years. The typology built is a transformation of the Yoruba vernacular house as described by earlier authors [39].
Generally, the middle- and high-income people in the case of Nigeria have since learnt that if you want to own a house you may have to do it through the private sector since the private sector produces 90% of housing [40]. The person will search for land through individual and family network depending on income, desired location and taste considering job location of the breadwinners of the family, the children’s school and the proposed location of retirement. The house is also planned to be self-sustaining in infrastructure—water supply, power supply, sewage and waste disposal. The overall financial demand makes income the overriding determinant of homeownership and the level of housing infrastructure.
The big question to be answered is: if the middle- and high-income groups are finding it difficult to access housing, how much more difficult can it be for the different categories of low-income people? To attempt a workable housing strategy for low-income people, how members of this group attained success in this regard in different contexts needs to be understood.
Whether owned or rental mode of tenure, the informal sector remains the most prominent housing provider in sub-Saharan Africa. In the case of Brazil and India, even the housing-enabling strategies and government provision are shrouded in misconceptions and a trial and error process. Debt management and structural adjustment programmes are part of the many challenges obscuring low-income housing policies in the Global South [15]. These misconceptions include that poor people need modern finished homes; more emphasis on the national economy boosting potential of housing construction and market; illusion that a conducive environment for private sector absorbing housing poverty in the housing market is in place and that there is sufficient public and civic participation in planning and decision making in the housing process. In the midst of these misconceptions in public authorities and private institutions housing provision, low-income people have been engaging the system and self-providing [41]. The concept of social totality explains how low-income people succeed in negotiating housing from the societal context.
Social totality as a concept emanates from the critical theory idea that social issues should not be isolated from the socio-historical processes and developments in the society, especially as a critique of capitalism now branded neoliberalism. It advocates that any attempt to explain and understand social phenomenon needs a broad theoretical framework that allows all social issues to be examined for analysis and critique. The Hegelian-Marxian concept of totality is often antagonised with its economic and political critic of capitalism as an exploitative and oppressive system to the working class that benefits only the rich without appreciating the merits of freedom and reward for innovation and creativity [35].
It is possible to analyse the different ways ‘totality’ is used in different contexts by critical theorists. In the critique of production processes in the capitalist political economy, ‘totality’ refers to the structure of the society and the economy that governs other aspects of social life. In the same vein, totality refers to the diachronic or historical perspective, which describes historical conditions before the present capitalist society and projected growth of capitalism in different contexts and possible indices for transition to socialism [42]. Totality allows theory and practice to dig deep beyond how social issues appear to different viewers into the disconnections and divisions in viewpoints within and without the issue to apprehend the reality. Totality is the avenue to comprehend reality as an interrelated whole to avoid partial and fragmented views of reality [43].
Overall, the whole idea is to avoid explanations that focus only on economic terms but trace linkages with the social, political, cultural and psychic in ways that dwarf the boundaries of knowledge reproduced by disciplinary fragmentation. As aptly put by Kellner, the implication of totality in critical theory to social theory is that,
‘Social theory therefore involves construction of a model of the current society and a demonstration of the fundamental connections—as well as of the contradictions and conflicts—among the various domains of the current social system. Consequently, critical theory provides analyses of a mediated social totality that describe various relations among spheres of reality, rather than reducing all of society to the dynamics of the economy’ [42].
Lefebvre’s theory of space is one of such social theories that believes in the interrelatedness of issues and the non-fragmentary approach to analysis of social issues including housing [44].
In Marxian analysis, the housing crisis emanates from the ‘capital logic’ that the state has competing problems deserving state resources so much that each need should be satisfied in a market approach in an environment enabled by government to allow private enterprise to flourish.
Lefebvre does not believe in the fragmentation of knowledge or disciplines in looking at social problems. Specialised categories of economics, philosophy, architecture, sociology, psychology, planning or history cannot confine totality of knowledge within its boundaries since totality is fragmented. The human beings that make up the society are in income classes with divisions in each class, the government and institutions are hierarchical and relative to housing there is public sector, private sector and partnerships between them. The real sector in informal housing can actually be described as non-public, non-private since it sometimes operates independently of both. Totality is in an unending transition with every aspect of life related to the total character of reality [45]. Many aspects of Lefebvre’s theory of production of space have been thrown at housing with various interpretations, concepts and future research problems emanating. The contribution of Turner to informal development theory, sustainable development, participatory housing and architecture can be summarised by the title of his academic publications—‘Freedom to Build’ and ‘Housing by People’. Also, Turner’s challenge of assumptions of public authorities on control and social hierarchy at local and national levels is based on the dual questions ‘who decides and who provides’. Turner’s spontaneous housing advocacy and Lefebvre’s all-embracing ‘spatial appropriation of autogestion’ gives an imperative to explore alternative relations between architectural practices, social relationships and global inequality [46]. Low-income housing provision and strategy can benefit a lot from this proposition.
Also, every aspect of modern life is in a crisis of change and transitions, in all sectors, which are all interrelated. In fact, crisis is both total and permanent [47]. Perhaps if low-income housing is defined as a crisis in the developing world like terrorism, natural disasters and climate change, more strategies that are people-centred would have come up. Production is reconceptualised beyond economics to include the built environment, artistic forms and the social relations of production in Lefebvre’s conception of space. Abstract economic laws and social structures alone cannot explain production without human agency and human activities cannot be adduced to causes [48, 49]. The natural environment is slowly but surely converted by human beings to the built environment which includes housing and social relations is involved. Lefebvre provides explanations of how the built environment as a portion of space is produced by human agency and the social forces as social space—where space is both lived and produced [49, 50]. Housing as a substantial part of the built environment is therefore socially produced. Also, economic exclusion of low-income people is insufficient to understand the difficulty in accessing housing. The multidimensional exclusion can only be apprehended by considering social, economic, political, cultural, technological and financial issues, the relations between them and other emerging forces in the societal context. Therefore, to understand the problems of low-income housing access and negotiated production by successful low-income people, a social totality concept is required.
This chapter introduces a new perspective developed from Lefebvre’s social theory of space in seeing housing as being socially produced in different contexts and needing a social totality concept to analyse and synthesise strategies that can guide people-centred solutions to low-income housing crisis in the developing world.
The prevailing idea is that adopting a variety of housing strategies is needed in the developing world to overcome the housing problem. However, these strategies should emanate from an understanding of the real housing need and the people’s process as constrained by factors in the social context. For example, it was observed that China’s urban housing policy is deficient in not assisting the rural to urban migrants who mostly live in slums though the central government is embarking on large-scale projects to house them. It was suggested that market-housing programmes such as enabling or self-help strategies, land reform and micro finance will have to be adapted to the Chinese context rather than direct comparison with similarly transitioning European countries since the context is different [51]. Context has long been established as critical to housing strategy and it is even more important in countries of the developing world where most housing is provided by the people with little or no support from government at all levels.
Understanding of specific locations, the low-income people’s behaviour, priorities and housing standards and the informal housing process and success rate of policies on ground give better information than aggregate conditions given by UN-Habitat [8]. The World Bank’s intention of building on the strength of the informal sector by the aided self-help projects of the 1950s and the sites-and-services schemes with upgrading schemes of the 1970s should have been preceded by social totality studies in different countries with the low-income people’s housing process and product at the centre of it. A demand-driven housing strategy approach to prevent wrongly targeted and sometimes abandoned or uninhabited housing supply will reduce the housing crisis in the developing world. Also, there is an existing structure of housing provision that can be restructured by studying the constraints beyond identifying and addressing the supply and demand constraints and designing affordable housing markets. While policies try to address core economic principles with institutionally based market-enabling efforts, rules and procedures, they fail because actors and informal institutions in housing provision are not fully brought into view [3].
The social totality approach includes identifying low-income people who already initiated housing production, especially after acquiring land, started a foundation and belong to a community or home-based organisation. For example, in a Nigerian case study, the most difficult stages in the housing production process are land acquisition, foundation laying and roofing [26]. After overcoming the first two, low-income people that belong to home town organisations, community groups, skilled workers guild or union, trader’s association and similar recognisable local organisations or cooperatives should be able to access a consolidated revolving credit. Their property, whatever state it is, and the local organisation or cooperative they belong to will be collateral for the credit. These same local organisations are well recognised by politicians during electioneering campaigns, especially close to election time. When the election is over and they are in political position and it is time to implement promises in their manifesto, they forget these organisations they exploited just to achieve their own end of winning elections.
This necessitates contextual studies working backwards from data collection on the field to data analysis in the administrative and academic offices before planning and housing strategies can evolve from the synthesis of analysed information. Planning and housing strategies are then implemented on the field and the cycle starts all over again as shown in Figure 1. This can only be possible with town and gown collaboration in the developing countries. Many disciplines in the design, planning and environmental field rarely collaborate on academics in the developing world and the schism between theory and practice is even more. Academics in educational institutions and practitioners on the field and in public institutions and authorities have to work together in this cyclic process for workable low-income housing strategies to continuously evolve until the situation improves.
A cyclic people-centred housing strategy framework.
The enabling approach as presently operated is focused on the housing market, especially the private sector, to deliver houses and make positive contribution to the economy at different levels. This approach has to be redirected at individuals and families that need housing and their social profile in relation to actions already initiated to actualise housing desire. In the interim, it will be beneficial to do a comprehensive survey of rapidly growing and developing outskirts and suburb of cities. This means working backwards from the field to devising strategies and policies to aid the self-producers of housing and master plan these newly developing areas in ways of reintegrating them to city, regional or national comprehensive plans. In places where the people are building houses on cheap land on the outskirts, government should acquire land for public housing and map out future light industrial areas and other uses like educational, commercial, health and recreational spaces since housing problem is solved individually in these contexts. The resources to execute sites-and-services schemes is rarely available and, if executed, results in over valuing of land beyond the reach of the low income. In practice, cheaper land beyond the sites-and-services scheme is usually the next target of the poor resulting in rapid expansion of low-density cities. Also, the rural and urban areas in these cities are socially interconnected—economically, financially, politically, culturally and technologically. The housing environment on the outskirts has houses belonging to different income groups in an indistinctive way but predominantly to low-income people. Therefore, housing solution should not be seen in isolation of other aspects of development to ensure urban sustainability. Academics and researchers are in a position to bring to the fore negative effects of neoliberal housing processes on the society and policies with class interest through people’s perspectives and collaborate with community groups to negotiate better alternative strategies [52].
As shown in Figure 1, researchers and public administrators will collaborate in collecting data about family size and composition, occupation, income, education level, residential history and other socio-economic characteristics of the low-income people in rapidly developing outskirts of the city. Data will be collected on the housing process starting from how the land was acquired, the legalisation process, the construction process, who are the actors and participants in the process and how much support they enjoyed from their networks and community. In such informal developments, the houses will be in different stages of completion. The location and environment have to be studied. Data will be collected on the design type of houses, the uses accommodated, the completion and occupying schedule and whether it is occupied by the owner family with or without renters. This list of data needed is not exhaustive depending on the context. These data will be collected simultaneously with information on the history, social, economic, political, cultural and technological situation of the immediate local context and the overall context of the country.
These data will be subjected to univariate, bivariate and multivariate analyses to synthesise information on motivation for housing production, desired housing typologies and process, stages in life cycle and housing production correlation. Other synthesised information will include sources of credit commonly utilised and corresponding modes of collateral security, the communal support the people enjoy including indigenous organisations, the common home-based enterprises, the indigenous or local knowledge in the process and other unexpected information not envisaged that will be useful in formulating housing strategies.
Housing strategies that will emanate from this synthesis will include determination of housing need components, intervention strategies after defining the people that really need housing, what they need, why they need it and their preferred process. Others include finance strategies, urban planning and administration strategies, the meeting and departure points of the informal and formal processes and formalisation strategies that may facilitate equitable housing provision and overall development.
These housing, urban planning and development strategies are implemented and the whole cycle is repeated to review, update, improve and alleviate the housing crisis in these developing countries. Fresh public, private and public-private collaboration housing strategies can evolve independently from better studies and cyclic implementation of this people-centred housing strategy framework after a few cycles in the same location or cycles in different local contexts of the same country.
This chapter has highlighted the crisis level of housing shortfall in the developing world, especially concerning low-income people. It took a panoramic view of housing strategies implemented in these countries, evaluated them and pointed to why there is marginal success of internationally backed national housing strategies compared to people’s negotiated self-produced housing. The chapter proposes a people-centred approach and a cyclic people-centred housing strategy framework based on the social totality concept of Lefebvre’s theory of space. The implementation of the framework needs town and gown collaboration of researchers and professionals in academics, private and public sectors. The cycle starts from collecting data about the people, the process and the houses produced by people and the social, economic, political, cultural and technological characteristics of the immediate local and larger national context. This information is analysed and synthesised to discover people, housing production, housing process, housing uses and typologies, sources of finance, community support, motivation and life cycle correlates. These correlates are critical to deriving housing strategies in defining who needs housing, for what purpose or purposes and when it is needed. It also helps to arrive at appropriate intervention strategies for the process, finance, urban and infrastructure planning and formalisation in ways that will positively affect housing solutions and overall development.
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\n\nAll the above rules are subject to change, IntechOpen reserves the right to take appropriate action if any of the conditions outlined above are not met.
\n\nPolicy last updated: 2016-06-09
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