1. 1 Better Homes, Better Health The impact of housing on health and social care: overview of the evidence Professor Tim Blackman Wolfson Research Institute Durham University www.durham.ac.uk/wolfson.institute York, 9 July 2008

2. 2 Reviewing the evidence Where you live matters to your health and wellbeing It’s not as important as income, work or marriage but: –Multiple housing problems damage health as much as smoking –Housing deprivation early in life increases the risk of health problems in adulthood –Where you live matters more if you’re workless, low paid, very young or disabled –If you’re employed and well paid you’ll avoid unhealthy housing, which is left for others –Many housing improvements are likely to create savings for NHS and social care budgets

3. 3 What are the impacts of housing on health and wellbeing? Homelessness Overcrowding Defects such as damp and draughts Cold Indoor pollutants and infestation Housing form – stairs, narrow doorways, inaccessible toilets and bathrooms Relative location Crime and safety Neighbourhood condition – ‘liveability’

4. 4 Health effects of poor housing: cold Diminished resistance to respiratory infection Hypothermia Bronchospasm Ischaemic heart disease, myocardial infarction and strokes After several years of progress, fuel poverty is now increasing Energy efficiency and fuel prices are important but most progress has been made by raising incomes among low income groups

5. 5 Excess winter mortality, England and Wales, 1997/98 to 2006/07

6. 6 Physical health risks of poor housing –Overcrowding Increased risk of infectious or respiratory disease Possible link with stomach cancer Reduced stature BME households particularly at risk –Damp and mould Respiratory problems e.g. wheeze Asthma, rhinitis and alveolitis Eczema –Ventilation Tobacco smoke Radon Condensation and mould Pests –Indoor pollutants and infestation Asthma

7. 7 Physical health risks of poor housing –Homelessness – rooflessness Problems resulting from facing the elements without protection –Homelessness – temporary accommodation Problems resulting from overcrowding, noise, inadequate cooking and washing facilities

8. 8 Mental health risks of poor housing –Relatively poor quality housing in each tenure Residents’ mental well-being reduced –Difficult-to-let housing Poorer emotional well-being than people in better areas –Draughts Poorer general mental health –Damp Depression in women

9. 9 Mental health risks of poor housing –Overcrowding Risk of emotional problems, developmental delay and bed-wetting, poorer educational attainment and mental adjustment in children Relationship tensions, irritability, impairment of social relations –Flatted accommodation Increased GP consultation by women for emotional symptoms Social isolation and psychiatric disturbance among women

10. 10 Unadapted housing Pain – often linked to arthritis –Climbing stairs –Bathing –Exacerbated by cold Accidents –Especially falls –Fear of falling is limiting –Bathrooms most hazardous Exacerbated illness Depression –Asking for help –Humiliation Mental and physical strain on carers Restorative effects of adaptations: –Adapted toilets and bathrooms restoring dignity and relationships –Widened doors and extensions giving the chance to move about –Lifts and ramps giving access to the house, the garden or the outside world

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12. 12 Crime –Emotional stress and encourages smoking –Better-off households in all areas –Lone parents most vulnerable Home accidents –Older people and very young children, especially low income. –Most fatal falls are on stairs/steps among people aged 75 plus. Fires –Most injuries due to smoke inhalation. –Very young children, older people and flats are most at risk

13. 13 Poor environment –Depressed mental health –Less physical activity and more smoking –Speeding causes accidents, discourages walking and cycling, and impairs quality of life. Older people are vulnerable to stress from speeding traffic. –Noise –For every 10% reduction in greenspace health deteriorates equivalent to ageing by 5 years –Greenspace linked to better child development and less adult stress –Every 10% increase in middle/upper income families raises odds of better health for everyone by 10% –Improvement and renewal work Stress and anxiety Higher costs

14. 14 Nature contact in housing Robert Taylor Homes, Chicago 28 identical high-rise buildings along a 3-mile corridor Some with nearby vegetation, others without Residents randomly assigned to apartments

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19. 19 Know People on Floor Know Next Door Neighbor Unity / Cohesion not at all a little quite very somewhat trees no trees Strength of community

20. 20 Many Visitors Daily Socialize within Bldg. Know People in Bldg. Strength of community not at all a little quite very somewhat trees no trees

21. 21 Acknowledge Each Other Help Each Other not at all a little quite very somewhat Strength of community trees no trees

22. 22 0.1.2.3.4.5.6 SpitefulThreatened to hit Threw or smashed Threw at partner Proportion Yes Aggressive behaviour against partner trees no trees

23. 23 0.1.2.3.4.5.6 Hit with something Hit with fist Beat them up Used gun or knife Proportion Yes Aggressive behaviour against partner

24. 24 Aggressive and Violent Behavior trees no trees 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Psychological Aggression Mild ViolenceSevere Violence Mean Values Aggressive behaviour against partner