The Role of Housing in Public Health Janet Baker Deputy Regional Director of Public Health

Overview The relationship between health and housing Key Health issues and Facts for the region Regional Health and Well- Being Strategy Examples of some initiatives

Factors affecting health

Excess Winter Deaths 3000 excess winter deaths –avoidable Variation across PCTs in their rates and also uptake of flu vaccination

Mental ill-health in the West Midlands Recent report ‘Choosing Health in the West Midlands’ 1 Link to deprivation. But difficult to get a picture: –Most data from service contact –Mainly severe illness in contact –Mostly acute service data –Few reliable community data –‘Service’ data tend to reflect access rather than incidence or prevalence –Homelessness & health data mainly from community surveys

Housing- key facts In the social sector, in 2004 an estimated 120,000 dwellings in the West Midlands failed to meet the Decent Homes Standard. 9.6% of houses in Birmingham are overcrowded. Compared to the national average of 9.8%, around 12% of all dwellings in the region have poor ratings for energy efficiency Each winter in the West Midlands there are over 3000 avoidable deaths. In 2004 there were 16,469 fires resulting 28 fatal casualties

More Key Facts About 70 % of homeless people misuse drugs. About 50% of homeless people are dependent on alcohol. [i][i] Rough sleepers are 35 times more likely to kill themselves than the general population and have an average life expectancy of 42 years. [ii][ii] Recent research form “Crisis” showed that in spite of this level of poor health single homeless people are 40 times more likely than the general population not to be registered with a GP. [iii].[iii] Mental health problems are significantly higher among homeless mothers and children.

Homelessness & Mental Illness Roofless & insecure accommodation Homelessness Mental ill-health

Supporting people The programme is targeted at Frail elderly Homeless families Mentally disordered offenders People at risk of offending Older people with mental health problems Older people with support needs People with physical or sensory needs People with alcohol problems People with HIV/AIDS People with mental health problems Refugees Teenage parents Women at risk of domestic violence +++

Housing - Priorities Support the provision of decent homes, Reduce the excess number of winter deaths. Reduce homelessness and improve the health of homeless people Promote the housing needs of diverse and vulnerable groups and support people to remain in their own homes. Support and encourage better design of new developments Ensure that NHS and social care bodies are engaged in the design of major new housing developments

Key Issues in Action Plan Implementation plan for housing and health Lobby for home safety and secure improvements in housing developments Monitor excess winter deaths and deaths through excess heat as a measure to lobby for action nationally, regionally and locally. Advocate for programmes for youth homelessness and supporting people to live in communities and specific groups e.g. travelers Lobby to promote independent living

Spatial Planning and Health Green spaces Footpaths Visual quality Design of homes and community Local shops Design out crime infrastructure

Quotes No longer “afraid to bring people in because the house is warm whereas before I didn’t like bringing in people because it was cold”. “ “you can get out of the shower and out of bed in the morning …. You’re not dithering with cold when you get out of bed…..when you come in you’re not coming into a cold house.” “I don’t have to put so many clothes on the bed now. I used to sleep in my socks and my drawers, but now I’m happy with just my nightie” “the house is warm day and night – it wasn’t like this before. Even the bathroom is nice and warm to go in”.

Home Accidents and prevention of falls Worked with Sure Start programmes to focus on primary prevention of accidents. With the Royal Society for the Prevention of Accidents child safety courses were run during 2005/06. [i] The content of the courses included causes of home accidents and their costs, who is at risk, types of accidents and injuries to children, risk assessment and prevention and interventions. Evaluation was positive.[i] There are many prevention of falls programmes across the region but quality of housing and design important

Smoke Free law Introduced in July 2007 and covers indoor workplaces and public places but NOT homes However, effect on health is as great Some evidence that people have reduced smoking in front of others generally but there are still many people exposed to SHS in the home.

Smoking and fires A cigarette burns at 700°C Fires started by cigarettes kill more people than any other kind of fire Every three days someone in the UK dies because of a cigarette fire 800 injuries each year occur as a result of fires caused by smoking Households with a smoker are almost one and a half times more likely to suffer a fire than non-smoking households Smokers are almost one and a half times less likely to own a smoke alarm The highest injury rate in smoking material fires is among young people (25 to 34 year olds)

Smoke Free Homes ~40% of children are exposed to tobacco smoke in their home. 1 (Around 500,000 in WM) Each year about 1700 children are admitted to WM hospitals as a result of SHS Smoking in the home is a major contributing factor to Cot Death Children whose parents smoke are three times more likely to smoke themselves in later life Lone parents and people from disadvantaged groups are more likely to smoke 1 – Children and secondhand smoke Position Statement FPH/ASH 2008

Project 2(A) Commissioner Collaboration on Upstream The overall aim of the Commission Collaboration on Upstream Interventions - Excess Winter Deaths project is to : Reduce the number of avoidable excess winter deaths in the West Midlands by identifying effective prevention and early intervention services There are three specific areas on which the project will focus. These are: Case Finding(i) Development of a housing occupancy measure (ii) Support on case finding techniques Healthy Outlook(i) A service to identify and support self care management of COPD patients during extreme weather conditions Fuel Poverty(i) A service for identifying and ensuring uptake of fuel poverty measures and benefits by COPD patients Investing for Health

West Midlands Regional telecare Network Community alarms Switch off gas automatically Release water in bath before it overflows Alert families via a call centre Sensors around heat to be studied

Acknowledgements Rowena Clayton – DH West Midlands Karen Saunders – DH West Midlands Paul Hooper – DH West Midlands Yvonne Thomas – NHS West Midlands