Reducing inequalities and improving health Housing Jessica Allen UCL Institute of Health Equity

Life expectancy and disability-free life expectancy (DFLE) at birth, males by neighborhood deprivation, England, 1999–2003 and

Low well being 4.8% average in , compared to 5.6% 2013/14 Ranged from 2.8% in Bath and North East Somerset, to 8.7% in Wolverhampton. Most deprived Least deprived 0% 10%

England Cost of inaction on health inequalities In England, dying prematurely each year as a result of health inequalities, between 1.3 and 2.5 million extra years of life. Each year in England Economic costs of health inequalities account for: –productivity losses of £31-33B –reduced tax revenue and higher welfare payments of £20-32B and –increased treatment costs well in excess of £5B.

A.Give every child the best start in life B.Enable all children, young people and adults to maximise their capabilities and have control over their lives C.Create fair employment and good work for all D.Ensure healthy standard of living for all E.Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill health prevention Fair Society: Healthy Lives 6 Policy Objectives

Poor quality Housing Approximately 3 in 10 people in England live in poor quality housing – either non-decent or overcrowded. - this comprises 3.6m children, 9.2m working age adults and 2m pensioners. Poor quality Overcrowded Temperature Damp, mould, condensation Disrepair Noise, lighting Unsafe Pests, draughts, electrical faults

Housing conditions and poverty improvements in the socially rented sector not in the private rented sector, 30% of homes in the private rented sector fail to meet the Decent Homes Standard in 2013 compared to 19% of owner occupied homes and 15% in the social rented sector. Those in lower social groups are also significantly less likely to report a problem to a private sector landlord, due to fears of retaliatory eviction

Costs of poor housing Estimates published in 2015 suggest that poor housing costs the NHS £1.4bn a year. “if we could find £10 billion now to improve all of the 3.5 million ‘poor’ homes in England, this would save the NHS £1.4 billion in first year treatment costs alone. It is estimated that such an investment would pay for itself in just over seven years and then continue to accrue benefits into the future” [32].32

Other reports cite high costs of poor housing to other services– for example, a cost of £1.8bn each year in crime and offending, and £14.8bn in lost earnings for one generation as a result of educational under-attainment. Tackling excess cold in homes would result in approximate savings of £1,571,180 to the NHS and £3,927,950 to wider society.

Housing impacts Physical health Trips and falls Heightened risk of cardio vascular disease Stroke Respiratory conditions – asthma Infectious diseases – flu, colds, bronchitis, TB Slower recovery from ill health

Mental health Stress, Anxiety, Depression Low self rated health and wellbeing Family conflict

Wider impacts Young peoples development Family functioning Educational attainment Health behaviours Employment and Income Crime and antisocial behaviour In one study, 28% of young people who lacked affordable warmth had four or more negative mental health symptoms, compared to 4% of young people who had always lived in warm homes.

Impacts – gender, age, ethnicity in addition to income Women more at risk of impacts – spending more time at home Children at risk Older people

Focus on housing quality, not just quantity Fuel poverty and cold homes –Cost of fuel –Insulation –Income Regulation of private rental sector –Registering landlords –Ensuring compliance with existing legislation –Encouraging complaints and supporting tenants subsequently –Security of tenure Overcrowding Understand impacts – life long and varied

The English Housing Survey states that “the decrease in Category 1 hazards since 2008 is likely due to energy efficiency improvements by councils, homeowners and landlords (which decreases cold), work associated with the Decent Homes programme in the social rented sector, local authority enforcement action against private landlords, and local housing renewal programmes”. However, evidence shows that many local authorities are not using all their powers. In 2009/10, the median number of improvement notices served by a local authority was 4, and 18% of local authorities served none.

There was an average of less than 3 prohibition orders per local authority, 71% of local authorities took no prosecutions and 60% did not carry out work in default of compliance

Taking action Involve all sectors Public health NHS Primary care and partnerships Nationally – advocacy and costs of poor housing – Dept CLG Fire services Education and early years

Health impacts of cold homes (Friends of the earth) fuel poverty report (PHE) Housing and mental health impacts (DH)