Housing as a determinant for development and health outcomes in Bhutan

Abstract

This study examines housing as more than a physical asset by evaluating its role as a determinant of socioeconomic development and health expenditure in Bhutan. Using nationally representative temporal data of 2003, 2007, 2012 and 2017 from the Bhutan Living Standard Surveys (BLSS), the analysis is conducted in two parts. The first part assesses housing characteristics as upstream indicators of development, proxied by mean monthly household expenditure (MMHE). The findings show that households with higher MMHE are more likely to occupy dwellings with improved construction materials, greater living space, cleaner energy sources and better sanitation. This highlights physical housing quality as a strong correlate of broader socioeconomic progress. The second part uses the 2017 BLSS data and applies propensity score matching (PSM) to examine how housing conditions effect total health expenditure which is considered as a proxy for financial health burden or healthcare utilization. Households with three or fewer rooms, cement, concrete or tile flooring and reliance on dirty cooking fuels have significantly higher health expenditure. The results indicate that housing conditions shape health burdens even where healthcare is provided free of charge in Bhutan. The study positions housing as an upstream driver of socioeconomic development and health, reinforcing its relevance for national housing policies, sustainable development planning and the Gross National Happiness framework.