A Healthy Hearth

There is increasing evidence to support the link between good homes and good health.

There is increasing evidence to support the link between good homes and good health – how should we act on this data?

The Story

If the greatest wealth is health, to quote the Roman poet Publius Vergilius Maro (more commonly known as Virgil) then the home might be thought of as a treasure chest – a strong and sturdy chest will keep the treasure of health secure; a broken chest will see that precious commodity quickly disappear.

I had originally intended to write and publish this article last week but was ironically felled by what transpired to be a kind of fever, and despite what you may have heard sung by Micahel Buble you do not want fever. I should explain out that my period of illness had nothing to do with the state of my property, but rather lay in the vicissitudes of my viscera. Still, the point remains: housing is essential to good health. Without a good home it is very difficult, if not impossible, to maintain optimal health.

This is not just conjecture. In April consultancy Building Research Establishment (BRE) published a report stating that the Decent Homes programme had saved the NHS £392 million by reducing the number of accidents and illnesses between 2001 and 2010.

The Report

The report, Quantifying the health benefits of the Decent Homes programme, focuses primarily on the removal of category one hazards and higher level category two hazards from homes between 2001 and 2010, and the extrapolated costs, savings, and benefits. According to building surveys, in 2001 there were 771,559 category one hazards present in social housing stock; a decade later, the total number of category one hazards had been reduced to 423,095, a reduction of almost 350,000 hazards.

There are further breakdowns: Carbon monoxide hazards reduced from 7,467 to 1,309; category one ‘excess cold’ hazards reduced from 321,149 incidents in 2001 to 113,035 in 2010.

This last point is important – cold homes have been linked to increased risk of cardio-vascular, respiratory and rheumatoid diseases, as well as hypothermia and poorer mental health, and one of the most measurable and demonstrable benefits of the Decent Homes programme was how it improved the heating provision of social housing stock.

Further Research

This is not the first time that a link between the quality of a home and its impact on health has been made. The Parliamentary Office of Science and Technology (POST) published a short note paper in 2011, Housing and Health, stating the potential impact that the Decent Homes programme, then reaching its natural end, could have on health. It suggested that poor housing conditions had a detrimental impact on health, costing the NHS at least £600 million per year (research that was, again, drawn from consultancy BRE).

Nor is the Decent Homes programme the only scheme to attempt to address the issues of poor housing for the sake of health. The award winning Health Through Warmth scheme, while sadly now only available to homeowners, did much to alleviate the suffering of those whose pulmonary-cardio conditions were affected by poor heating (often ‘gas warm air’ or gas duct heating, infamous for aggravating such conditions). ECO might also be thought of as a more modern initiative to improve heating and insulation.

Getting Warmer

But there is still work to be done. An estimated 31,100 excess winter deaths occurred in England and Wales in 2012/13 – a 29% increase compared with the previous winter. The work that was started by Decent Homes across social housing stock should now be expanded into the private sector, as this is where the majority of outstanding disrepair negatively impacting health now lies.

It makes financial sense as well. The Executive Summary of the BRE report claims that if all social sector stock were maintained so that decent homes remained decent and free of category one hazards, the NHS could save up to £71 million per year.

How to do this? Grania Long, Chief Executive of the Chartered Institute of Housing, has suggested introducing a new ‘decent homes’ standard, one that focused on cutting carbon emissions and making homes affordable to heat. With regard to the private sector, the POST note of 2011 suggested giving local authorities tools to grant loans, provide labour (i.e. the Council ‘handyman’), provide information on accredited builders, and potentially utilise an equity release loan scheme for owner-occupiers.

Given the majority of private rented sector landlords are small-scale landlords – 60% of known PRS landlords own no more than four properties – I would argue that any initiatives need to target the small-scale landlord:

  • Make membership of a national landlord registry contingent on a property being of a certain, minimum standard. This would slow the growth of small-scale landlords, which is eating away at all-too-limited housing supply, by requiring an often necessary investment in the quality of a property.
  • Provide a pot of money– a mini-Decent Homes fund, if you will – that private landlords can apply to access funds or subsidised loans to improve the condition of their stock. Again, you can only access the funds if a member of the above landlord registry or if proposed work would bring a property to a suitable minimum level to allow membership.

Potentially, you could restrict the money to being spent only through accredited building companies – the intention with this would be to also try and curb ‘cowboy’ tradesmen or landlords finding more hazards / work more costly than expected due to tradesman inexperience or bad workmanship. However, I worry how practical this would be, and besides, like PRS landlords many tradesmen don’t belong to large operations, but are small-scale independents.

  • Local authorities should use their influence to bring together building and maintenance contractors in the local area and sign them up to a ‘landlord loyalty’ scheme – in exchange for using those specific contractors to carry out repairs and maintenance, the work will be performed at a discounted rate. This ensures on-going work for local builders – keeping them economically active – while mitigating the cost of long-term asset maintenance work, necessary to ensure that ‘decent’ properties remain so.

Guarding The Greatest Wealth

“The home should be the treasure chest of living.” – Le Corbusier, Swiss Architect (1887-1965)

In 2002, an original national target of having 70% of private homes in which financially vulnerable people live meet the decent homes standard was set. In 2007, this national target was downgraded to a local optional target. By 2011, there was no central target for improving private sector housing.

It is within the government’s best interests to remedy this and, once again, set a central target for improving private sector stock. The BRE report suggests that the cost to the NHS of category one hazards still remaining in 2010 was £184 million…and that is just in the social housing sector, which had received huge investment from the decent homes programme to tackle those very issues.

How many more problems does the unregulated and largely unknown private sector have? If 33% of PRS homes would have failed the decent homes standard in 2010 – as we discussed last time – how many category one hazards are lurking in private sector properties across the country? How much money are they costing the NHS?

Forget money. How many excess winter deaths are caused that might otherwise be prevented?

Burying our treasure chest in the sand might keep it safe in the movies, but if we are to stay healthy we can’t hide from the increasing evidence linking homes to health – we have to work to protect this treasure.

References

A Licence to Rent? – How regulating the private rented sector can mean a better deal for tenants, landlords and taxpayers, Shelter, 2014

Briefing Note: Housing and Health, Parliamentary Office of Science & Technology, 2011

Excess Winter Mortality in England and Wales, 2012/13 (Provisional) and 2011/12 (Final), Office for National Statistics, November 2013

Quantifying the health benefits of the Decent Homes programme (Summary), BRE (Helen Garrett, Maggie Davidson, Mike Roys, Simon Nicol and Viv Mason), April 2014

Decent homes programme saved £392m, Inside Housing, Online: http://www.insidehousing.co.uk/repairs/decent-homes-programme-saved-%C2%A3392m/7003296.article, Available: April 2014

Welcome to Health Through Warmth, npower, Online: http://www.npower.com/health_through_warmth/, Available: May 2014

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