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10 things you should know about housing and health

Jill Stewart03/12/2014 - 13:00

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Property prices are rarely out of the headlines. But houses are not just investments – they shape our health. Jill Stewart, a senior lecturer at University of Greenwich, lists ten facts about housing and health.

1) Housing determines health


A house should provide foundations for a healthy life in all senses of the word. It should provide good physical standards, be affordable and offer security for the long term. Housing should also be able to adapt to changing or specific need such as disability and ageing across the life-course.

2) Housing should provide access


Housing should be situated in a good sustainable environment, which includes green and/or blue spaces. Where we live should have ready access into local services including health care, education, social services, leisure and cultural activities and social capital should be able to develop and flourish. Housing should help promote health, and not further hinder, inequality or inequity. Housing location, design and its management can also have negative effects on health, social and behavioural development. Low income households, lone parent families and ethnic minorities are over represented in poor and marginal housing, compounding their situation.

3) Children deserve good housing

Children and families should be a priority in housing that provides a foundation for growth and development and Marmot reminds us that every child should have the best start in their life. Poor housing can have a detrimental effect on children’s health for the rest of their lives. For example damp and mould can trigger respiratory disease and once sensitised, a child is likely to be affected for life. Children need physical space indoors and out to develop physically, emotionally and socially. Children in temporary accommodation are more likely to be lower birth weight and miss out on routine health care and access to early social and educational services.

4) Housing needs to change.


As we become older we are likely to be more frail and be at greater risk of home accidents. If owner occupiers, we may be sitting on a lot of capital but have little resource available day to day although we may select different supported housing provision. We are more likely to develop degenerative disease such as dementia. The combination of this means that interventions need to be more than just about housing, and also about our changing health and social care needs – including tackling loneliness and isolation. What about becoming a Dementia Friendly Community?

5) Housing health and safety rating system


 Health has not traditionally been explicitly factored into housing regeneration and public health interventions remain erratic. However the HHSRS – which focuses in hazards and risks – provides a sound evidence base for where and how to best intervene into housing conditions and the cost effectiveness. If there is one or more HHSRS Category 1 hazard present a house would fail the minimum safety standard component of the Decent Homes standard. The English Housing Survey tells us that most of these are in the private housing sector, particularly privately rented. In addition, privately rented housing is particularly problematic with 15% failing for poor thermal properties and 8% for disrepair. Condensation and mould are the most common type of damp, found more in privately rented housing than any other tenure.

6) Poor housing is a waste of money


Building Research Establishment research (2010) about the costs of poor housing and how these can be quantified based on HHSRS and (the then) English House Condition Survey data tells us that the health cost to the NHS of poor housing in England exceeds £600m per year and the total cost to society may be in excess of £1.5bn. BRE research also suggests further savings could be made if domestic heating and insulation improvements were undertaken.

7) Fuel poverty

Fuel poverty is particularly problematic and a combination of poor thermal qualities, inadequate heating systems and low income. Despite the fact that we can expect some 30,000 cold related excess deaths in England and Wales each winter, we do not have a national mandatory strategy to tackle this but we can apply HHSRS and refer to Green Deal. Fuel poverty has both physical and mental health effects, including hypothermia and depression as well as knock on effects psychologically from multiple combination of poor housing and poverty and the dilemma of ‘heat or eat?’ Psychologist Professor Christine Liddell continues to do excellent research in this area. Dealing with fuel poverty can have knock on effects elsewhere in health protection and improvement, such as tackling tuberculosis (alongside appropriate medical intervention).

8) Temporary accommodation is bad for health


Conditions are generally worst at the bottom end of the privately rented sector and tenancies are normally short term. This aggravates stress levels amongst already vulnerable households (such as frequent movers and those with chaotic lives) and means that it is difficult to put down roots and develop social networks, leading to anomie, loneliness and isolation. Social capital can be a real buffer again the effects of deprivation so this doubly detrimental. Campaign against what is wrong (e.g. retaliatory evictions) but remember this is only part of the story.

9) Bedsits are also bad for health

There are inevitable physical health effects of living in shared accommodation at the bottom end of the privately rented sector where conditions can be at their most acute. Physical risks arise from poor conditions, overcrowding, over-occupation (not enough amenities for the number of occupiers) – but there are also risks to mental health from living with people you don’t know, especially if there are children there. Use HHSRS, Licencing and other legal powers but consider wider options to help mitigate against some of the worst effects of living in bedsits on mental health.

10) EHPs already do great things


We know lots about the links between housing and health, what is important is what we effectively do about it and how we also respond to the complexities of people’s lives. ‘Effective Strategies and Interventions: Environmental Health and the Private Housing Sector‘ now appears on the NICE evidence base as well (as many other online locations), and shows how our work is regarded.

More information below:

· Public Health England

· National Institute for Health and Care Excellence

· CIEH Private Sector Housing Evidence Base (available to CIEH members only)

· Environmental Health Research Network

· DCLG English Housing Survey

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