The impact of housing on health (Part 1)

Our homes and neighbourhoods are critical factors in our health and wellbeing. This has very much come to the fore during lockdown. In this two part series, first I touch on the current and emerging evidence of the impact of housing on health. I then put forward suggestions for where action is needed, now and in the longer term at both local and national levels.

The context

Disparities in living conditions have become all the more apparent during lockdown. Nearly a third, 31% of adults in Britain (15.9 million people) have had mental or physical health problems during lockdown as a result of poor quality and/or overcrowded housing (National Housing Federation, 2020a). Unless there is urgent change, this picture will only get worse as we move to targeted local lockdowns.

In response to this crisis, the National Housing Federation has launched a campaign, #HomesAtTheHeart. The aim is to put social housing at the heart of national economic and social recovery by investing in safe, affordable, and comfortable homes (National Housing Federation, 2020b). This is to be applauded. There is also the need for urgent action as we address the needs of those subject to local lockdowns, and as we approach winter.

The impact of housing on health

The impact of housing on health is significant. Leaving vulnerable people in the poorest 15% of England’s housing is estimated to cost the NHS £1.4bn each year in first-year treatment costs (Roys, Mike; Nicol, Simon; Garrett, Helen; Margoles, Susie, 2016). This is due to an array of factors – from homes with hazards which increase the risk of falls or fires, overcrowding, poor indoor temperature management resulting in overheated or cold homes, and damp.

In England, almost a fifth, that is 4.5 million homes, fail to meet the Decent Homes Standard. Again in England, there are 1.36 million children living in overcrowded homes – around 11.6% of all children. Of these, over half find it difficult to impossible to do homework.

In overcrowded homes, 26% of adults sleep in hallways, bathrooms or kitchens due to a lack of space (National Housing Federation, 2019). More than 60,000 families live in temporary accommodation (National Housing Federation, 2020b). These figures don’t factor in the homeless or the ‘hidden’ homeless – those ‘couch surfing’, living in sheds and so on.

And recent research from the Resolution Foundation demonstrates that while there is a generational divide in terms of housing quality with older people more likely to live in better quality housing, inequalities run deep. And income and ethnicity are strongly correlated with housing quality (Judge and Rahman, 2020, p.3). This cuts across not only housing, but access to private gardens and other green spaces.

Housing in lockdown

During the core lockdown period, restrictions meant that we were permitted outside once a day for exercise, to go to work if we had essential jobs, and go out for shopping for essentials and for medical appointments. Work sites and workplaces were largely shut as were non-essential cafes, cinemas and community spaces including libraries, leisure centres, religious centres and community halls. Some schools remained open for children of key workers, and for those children identified as being vulnerable (take up was low).

In the early days, and in the days leading up to the announcement of lockdown on 23 March, many grocery stores had their shelves cleared of essentials such as hand sanitiser, soap, nappies and sanitary items, pasta and rice, toilet paper, and tinned foods. Getting onto an online shopping list could take weeks if at all possible, and assuming that people have access to the internet. For many, even if they could get onto online shopping, much stock was not available, and minimum spend requirements would have been outside the budgets of many.

Added to this has been burdens including the need for home schooling, financial stress, and concerns about jobs. Also, many people would have found themselves socially isolated.

While research into the impact of lockdown is still emerging, early indicators are that for those living in homes that fail to meet decent housing standards, coupled with factors such as overcrowding or isolation, have been exacerbated by the closure of many public spaces including libraries and leisure centres (Judge and Rahman, 2020). And while the closure of such public spaces was necessary for reasons of public health, we have remarkably little understanding of how places like libraries are used and their importance as spaces for quiet study, or digital access, or indeed as a temperature regulated environments essential to many in the peak of summer, and in winter.

Conclusion

There is no easy solution in addressing the negative impacts of housing on health. And there are many issues to unpack. Solutions will need to be wide ranging and be both short and long term; and they must be targeted and address real need.

In the next article I address the question of what’s needed to mitigate some of the likely and negative health impacts of Covid-19 in the context of our homes as we move forward into local lockdowns. This is shaped partially in response to recent government announcements on the Green Homes Deal.

References

Judge, L. and Rahman, F. (2020) Lockdown living. Available at: https://www.resolutionfoundation.org/publications/lockdown-living/.

National Housing Federation (2019) Briefing : Overcrowding in England. Available at: https://s3-eu-west-1.amazonaws.com/doc.housing.org.uk/Overcrowding_briefing_2019.pdf.

National Housing Federation (2020a) Housing issues during lockdown: health, space and overcrowding. Available at: https://www.housing.org.uk/globalassets/files/homes-at-the-heart/housing-issues-during-lockdown—health-space-and-overcrowding.pdf.

National Housing Federation (2020b) Why homes must be at the heart of recovery. Available at: https://www.housing.org.uk/resources/homes-at-the-heart-factsheet/.

Roys, Mike; Nicol, Simon; Garrett, Helen; Margoles, Susie. (2016) ‘The Full Cost of Poor Housing’, in. BRE. Available at: https://www.brebookshop.com/samples/327672.pdf.