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“Housing and Public Health”. Outcomes. Combination of poor housing conditions and low income can lead to detrimental lifestyle choices such as smoking or domestic violence Little research into health and housing Greater understanding of effect of anti-poverty strategies.

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  • Combination of poor housing conditions and low income can lead to detrimental lifestyle choices such as smoking or domestic violence
  • Little research into health and housing
    • Greater understanding of effect of anti-poverty strategies
Living in poor housing or being homeless are not just housing problems they have profound implications for the health of people in society
  • Health of the Nation
    • No clarity on housing
  • Our Healthy Nation
    • Acknowledged social ,economic and environmental factors to health
  • Acheson Report
    • Recommended joined up government action including quality of housing, availability of social housing for less well off
who lives in poor housing
Who lives in poor housing?
  • More likely if
    • One parent families
    • Black and Asian minorities
    • Unemployed
    • Aged 16-24 years
  • Recent improvement in young and unemployed
  • Properties in poor condition occupied disproportionately by elderly

In 1997 there were 2,100,000 houses owned by local authorities and housing associations that did not meet the decent homes standard.

Local authorities had a £19 billion backlog of repairs and improvements

issues of property condition
Issues of Property Condition
  • Structure,fitness and amenities
  • Cold housing
  • Dampness
  • Indoor air quality
  • Infestation
  • Noise, insulation
effect of poor housing perceived wisdom
Effect of Poor housingPerceived wisdom
  • Excess winter deaths
    • Significantly higher where bedrooms seldom heated
  • Cold housing
    • Increased admissions for respiratory diseases, pneumonia, bronchitis, emphysema, heart disease
bmj editorial sep 04
BMJ Editorial Sep 04
  • Lower socio-economic groups do not have excess winter mortality.(higher absolute rates)
  • They do not have cooler houses
  • Poverty is associated with poor home heating, but no increased risk
  • Is it due to behaviour, and brief exposure so affects all groups
effect of poor housing
Effect of Poor housing
  • Damp homes
    • Wheeze and chronic cough 1.5 to 3 times normal rate
  • Air quality
    • Smoke
    • Carbon monoxide
  • Noise
  • Infestation
effect of poor housing1
Effect of Poor housing
  • Accidents
    • Falls (43% in under 5s)
      • Poor lighting,lack of handrails,poor stairs,straight stairs
    • Fires, burns,scalds
      • Old wiring, faulty heating, lack of fireguards
mental health problems
Mental Health Problems
  • Housing density
  • Overcrowding
    • Study in women in West London
    • In children, higher rates of emotional problems
rough sleepers
Rough Sleepers
  • Mental health problems 11 times more likely
  • Chronic chest and breathing problems 3 times
  • Ulcers and skin wounds 3times
  • Joint problems 2 times
  • Sight problems 3 times
temporary accommodation
Temporary Accommodation
  • Higher rate of chronic health problems (105%)
  • Higher rate of Acute health problems (78%)
  • Higher mental health problems (100%)
showing influential causes
Showing Influential Causes

Increased risk of accidents


Design of estate


Poor performance at work

Groups of young people with nothing to do

Fear of Crime/abuse



Domestic Violence

Single access point to estate

Isolation of individuals in community

Lack of facilities and services

Reduced social contact

Impaired childhood development

community safety
Community Safety

Difficulty moving from estate

Poor appearance of estate

Offenders evade capture

Negative reputation of estate

Single access point to estate

Police approach obvious


Increased volume of traffic

Poor bus service

Isolation of Community

Non-residents don’t visit

Car Crime

Vandalism Hooliganism

Reduced social contact in community

Poor diet

Lack of facilities:

shops, post office

Isolation of individuals in community

Groups of young people with nothing to do

Unsafe play area

Fire Service withdrawn

Lack of primary + pre-school education facilities

Impaired childhood development

Siting of disabled units

Poor lighting of football pitch


Lack of community participation

Alleyways on estate

Lack of play areas

Fear of crime

Loss of sleep

Fear of abuse/intimidation

Poor lighting on estate



Increased risk of road traffic accidents



Children on streets

Poor family functioning

Poor performance at work

Domestic violence

local facts 2003
Local Facts 2003
  • Average cost of house £175,733
  • Income of £30,500 needed to purchase a flat
  • Average gross earnings £22,300
  • Housing waiting list increased by 8%
  • 74% of single applicant assessed to be high housing need
care trust
Care Trust
  • Commenced October 2002
  • Comprises
    • All health services
    • Older people’s social work team,day care and home care
    • Local Authority Care Call
housing provision
Housing Provision
  • Social provision
  • Specialist Provision
    • Mother and Baby Unit
    • Women at risk
    • Difficult to house
housing provision1
Housing Provision
  • Supported
    • Sheltered
    • Part 2
    • Part 2.5
    • Residential
types of support
Types of support
  • Support tailored to meet needs
    • Home support; health and social care
    • Step up, step down flats
    • Community hospital support
  • Integration of health and social care
    • Generic workers
care call
Care Call
  • Historically alarm service
  • Expanded to incorporate tele-medicine
    • Falls
    • Wandering
    • Incontinence monitoring
  • Single point of access for health and social care services for elderly
  • Started with rapid assessment unit
community schemes
Community Schemes
  • Prompt home Care
  • Generic workers
  • Night owls
  • Tele medicine
what is sheltered housing
What is sheltered housing
  • 12 blocks
  • Warden managed ; part of Care Call
  • Variable dependency
  • Support
  • Social activities
extra care housing
Extra Care Housing
  • Living at home, not in a home
  • Care tailored to individual need
  • Maintain or improve Independent living skills
  • Use technology to support at home
extra care
Extra Care
  • Current sheltered housing
  • Young dementia
  • Secure environment and garden
  • Outreach day care
  • Tele link to Care Call
  • Current position
    • Little integration of partners
    • Little recognition of health need
  • Need to move to
    • Integrated long term planning
    • Real needs assessment of health and social care needs
  • How?
    • LSP
what else are we doing
What else are we doing?
  • Fuel poverty energy champion 2003-04
  • Public health advice and local needs assessments to Local Authorities housing strategies and Supporting People Programme
  • Develop a better referral system form Primary Care
  • Work with homeless team
need further work on
Need Further Work on
  • Planning applications to assess health need
  • Input into Housing Needs Assessment
  • Attend Housing Services meetings
  • Working with Health Visitors, Environmental Health Officers and Housing Officers on food hygiene and families living in poor quality housing