Housing and health resources

Online housing tools help improve housing and the health of residents, says Bob Mayho, Principal Policy Officer for the Chartered Institute of Environmental Health.

We spend a considerable amount of time in our homes but how many of us stop to think about what effect living conditions can have on our health and well-being? Not everyone is fortunate enough to own their own property and there are more and more people who are reliant on the private rented sector in order to secure a roof over their heads, in particular the most vulnerable in society.

The private rental sector is booming and has been rapidly expanding over the past few years, second only to owner-occupation in terms of housing tenure. The vast majority of landlords provide decent accommodation that is safe and secure and it is important that we recognise this fact. Nonetheless, there are a substantial number of properties in the UK that have a negative impact on health and well-being and the private rented sector has some of the worse conditions of all housing.

The Chartered Institute of Environmental Health (CIEH), supported by Public Health England (PHE), therefore created the ‘Housing and Health Resource’. This is an online resource intended to help local housing officers make the link between bad housing and poor health, as well as provide the tools and tactics to help them address harmful housing conditions. The ultimate aim is to help housing officers improve the health and well-being of tenants in their local areas.

The CIEH is a professional membership organisation representing and maintaining professional standards for Environmental Health Practitioners (EHPs) working across the public and private sectors.

Physical health
Housing is a key interest for the CIEH as its EHPs working for local authorities that are on the front-line inspecting accommodation in the private-rented sector. Where problems are found, such as unsafe staircases, broken boilers or unsanitary kitchens, EHPs have powers under the Housing Act 2004 to hold the owner to account and force them to make repairs. As we mentioned previously, the private rental sector has been rapidly expanding and there are now approximately four million households in the sector. The number of people renting has nearly doubled in the past ten years and the sector is increasingly being used by local authorities and agencies to house homeless and vulnerable people. Additionally, the number of families with young children now renting has more than doubled in the same period.

Whilst the vast majority of privately rented accommodation is safe and secure, evidence from the 2014 English Housing Survey demonstrates that proportionately the poorest housing standards are in this sector, which is of further concern. Homes can fail the ‘Decent Homes’ standard because of problems such as disrepair or outdated fittings, poor sound insulation etc. These issues therefore can have a detrimental impact on our physical health and safety, leading to slips, trips and falls.

Particular risks are associated with houses converted into flats or houses in multiple occupation (HMOs), where too many people share a limited amount of facilities. There is evidence to suggest that where people are found to live in poor housing conditions, such as overcrowding, damp carpets and walls, indoor pollutants and no reliable source of heat or ventilation, have all been shown to be associated with physical illnesses including respiratory disease, hypothermia and heart disease.

It is estimated that poor housing costs the NHS at least £2 billion per year so we can we already see there is a significant financial impact of poor housing and a significant re-evaluation from the previous £600 million that was quoted.

Other issues
But it’s not just physical health we’re concerned about. Mental health issues are rising up the national agenda and are increasingly being included into conversations around the problems connected with poor housing.

The evidence on the links between poor housing and mental health is generally less developed compared to physical health impacts. However, there is strong evidence of a relationship between cold homes and mental health, and some evidence of pathways that might link poor housing conditions to mental health outcomes.

Living in poor housing conditions has been shown to increase stress, as well as reduce empowerment and control, each of which have clear links with mental health outcomes. There are also tenants who have a lack of security regarding tenure and often fear the risk of retaliatory eviction by landlords, which can cause undue stress and anxiety.

Overcrowding is another issue which has links to stress, tension, anxiety and depression. A lack of privacy, particularly for adolescents, disrupted sleep patterns and chaotic sleeping arrangements are all underlying causes that can have an adverse effect on mental health.

It is estimated that mental illness costs England at least £105 billion each year and if we could extrapolate how much of this figure is caused by poor housing, then the £2 billion figure we quoted previously with regards to the cost of physical health caused by poor housing could increase dramatically.

The online resource
As you can see, there is clear evidence linking housing conditions to our health and well‑being. Both the CIEH and PHE, therefore, wanted to provide local officers a robust online resource that would boost their knowledge and expertise so as to enable them to spot the signs of poor housing. Additionally, this online resource would also arm local officers with tactics to help stop and prevent these type of things from happening.

In essence, the online resource, which was launched in October 2015 at the CIEH’s National Conference, is a specially designed website that allows easy access to information on three central health topics and their relationship between housing, including: physical health; mental health and well‑being; as well as community and place.

Within each of these themes, there is further information looking at key issues that link to housing and health, such as fuel poverty, crime and access to green spaces. From there, housing officers will then be able to review a ‘policy and guidance’ section, which highlights national policy strategies and frameworks, as well as government departments and agencies, which will help people understand key governmental policies.

In time the online resource will also provide advice and guidance upon developing a housing and health profile for local areas which can be used to inform decision-making or targeting resources and policy initiatives. Another critical component of the online resource is the wide range of case studies, where local authorities across the country have shared details of their innovative schemes to address poor housing in their local patches. Liverpool and Thurrock are just two examples within the online resource of local authorities carrying out pioneering housing schemes to improve health and well-being.

Liverpool Council’s multi-organisation ‘Healthy Homes Programme’ aimed to improve housing conditions in the city, as well as engage with residents to offer health and well-being related services. Deprived areas of the city were pro-actively targeted, with advocates visiting every property and where health issues were discovered, referrals were made to a range of partners, while a team of Environmental Health Officers dealt with the sub-standard housing conditions.

As a result, in Liverpool there have been more than 28,000 referrals to various partners and this has led to more than 6,000 home risk assessments, which has then identified nearly 4,400 serious housing hazards that have been remedied. Furthermore, nearly £5.4 million of private sector investment has been made by landlords in Liverpool towards improving the condition and safety in properties.

In the face of on-going regeneration in Thurrock, the local authority’s housing service wanted to try a new way of working to improve housing conditions in its private sector but also improve residents’ access to a range of other services, including local health provisions.

Having received 100 per cent funding from Thurrock’s Public Health budgets, the new Well Homes scheme saw the appointment of a ‘Well Homes Advisor’ who visited people in their homes. During the visits, the Advisor would provide information about a broad range of housing, safety and health services, with a focus on what would make them feel better at home. Where problems were discovered, residents were then referred, signposted or offered one of the new range of Well Homes financial offers, such as improving security measures or gardening services.

Well homes
In the first year, the single Advisor completed 466 assessments and visited more than 1,500 people, with 85 per cent of residents confirming that they felt healthier and safer at home, as a result of their Well Homes assessment. At the end of its first year and with an initial investment of £45,000, the Well Homes scheme has led to savings of more than £640,000 for the NHS and other services, as well as removing more than 120 severe housing hazards. These successful results have resulted in a further two years of guaranteed funding from Public Health.

To ensure the continued success and relevance of the ‘Housing and Health Resource’, both the CIEH and PHE will continue to update the online resource to reflect any changes at a national government level and any new lessons learnt. And at the same time, the two organisations want housing professionals to share their experiences so the online resource can continually be fresh and engaging.

The online resource is a brand new approach to deal with housing conditions as not only does it inform housing professionals of the theory but at the same time provides practical tools to help them deal with the issues in their local areas. Poor housing conditions affects health and well-being, but if all stakeholders pull together and fully utilise the ‘Housing and Health Resource’ then this will go a long way to creating healthy and happier tenants and local communities.

Further Information