Inadequate provision of environmental health facilities for rapidly growing urban populations is a major constraint of socio-economic development in the less developed world. The situation leads to deteriorating urban environment and attendant health threats. The study examines household environmental problems in Accra, and the impacts on the health of identifiable different social classes. As a result of rapid increase in the population of Accra, and inadequate provision of facilities, the majority of the city’s residents live under deplorable environmental conditions which are detrimental to health. Only 39.8 percent of respondents have indoor private pipe and 30.1 percent depend on vended water to meet their needs. About 35.0 percent of the respondents depend on unsanitary public latrines. Lack of adequate sanitation facilities, results in high sharing of facilities among households, and this exerts pressure on facilities which often results in poor sanitary conditions and pest infestation. Other environmental problems which affect health include indiscriminate disposal of waste which facilitate the breeding of disease organisms and spread of infections. Deteriorating environmental quality is a major cause of high incidence of infectious and parasitic diseases. Children are the victims of diseases resulting from inadequate water supply and sanitation, particularly, diarrhoea which has become a major cause of childhood morbidity in Accra in recent times. It was found that 19.2 percent of the children covered in the study have had diarrhea in the preceding two weeks of the study. High incidence of diarrhoea is associated with inadequate access to safe drinking water and sanitation facilities. Inadequate access to water, sanitation and hygiene facilities is closely related to poverty since the urban poor and less educated are the most likely to lack access to basic environmental health facilities and services. Whereas 71.1 percent of medium wealth and 94.8 percent of high wealth households have private indoor pipe, only 28.8 percent of poor households have indoor pipe. Access to sanitary facilities is wealth dependent. Only 24.1 percent of poor households use flush toilets compared with over 80 percent of wealthy households. About 44.6 percent of poor households use the public latrine. Only 2.2 percent of poor households have home collection of solid waste compared with 40.3 percent of medium wealth and 86.2 percent of high wealth households. Due to their inability to secure the facilities and services which support a healthy living environment, the poor are more susceptible to a range of environment related diseases particularly childhood diarrhoea. About 86.2 percent of childhood diarrhoeal cases are from poor households, 10.6 percent from medium wealth households and only 3.2 percent from high wealth households. The majority of households depend on solid fuels for cooking in poorly vented kitchens and this leads to indoor air pollution and high incidence of respiratory infections, particularly among the poor. Coupled with inefficient stoves, households require burning large amounts of firewood and charcoal to meet their energy needs and this exposes women in particular to high levels of air pollution. The poor are the worst affected by respiratory health infections than their wealthy counterparts. Poverty, inadequate provision of facilities, lack of environmental health awareness and the neglect of the needs of the poor in decision making are the major obstacles to achieving sound environmental health in Accra. Measures to improve environmental health must include improved water supply, sanitation, waste management, proper ventilation, preventive health care services in deprived neighbourhoods and environmental health awareness programmes.