Health Inequalities and Housing Ursula Humphreys Public Health Programme Manager 30th April 2015

Loneliness

(Faculty of Public Health). “The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.” (Faculty of Public Health).

Three ‘Pillars’ of Public Health Health improvement Health protection Health services Health Improvement Inequalities Education Housing Employment Family/community Lifestyles Surveillance and monitoring of specific diseases and risk factors Improving services Clinical effectiveness Efficiency Service planning Audit and evaluation Clinical governance Equity Health Protection Infectious diseases Chemicals and poisons Radiation Emergency response Environmental health hazards

Wider Determinants of Health Economic and social status: Housing Income Education Social isolation Disability Inequalities Employment Family/community Lifestyles

Loneliness as a determinant of health?

Social Isolation Objective Measure of the number of contacts or interactions a person has Something you ‘are’. Loneliness (“Discrepancy Theory”) Subjective Mismatch between the quantity and quality of relationships and social contacts a person has, against how much and what type they would like to have Something you feel

Loneliness –v- Solitude “Language...has created the word "loneliness" to express the pain of being alone.  And it has created the word "solitude" to express the glory of being alone.” (Paul Johannes Tillich)

Situational or chronic? Life changing triggers: Bereavement Loss Redundancy Retirement Moving home Chronic Risky lifestyle behaviours: Smoking Alcohol misuse Drug misuse Poor diet and nutrition Lack of physical activity

Associations with poor health: Depression High blood pressure Cognitive decline/dementia Heart disease Cardio-vascular ill health Suicide (particularly in men) Worse than 15 cigarettes per day.

Key determinant of health Loneliness perspectives challenge how we understand health to be about ‘illness’, or ‘disease’. Requires a shift in discourse away from ‘acute beds’ to social determinants of need. Requiring greater investment in prevention and early intervention.

Some Key Loneliness Facts 7 million people live alone 4.3 million people have no close friends Half of people over 65 say TV is their main form of company 17% of this age group see friends, family and neighbours less than once a week Experience of loneliness increases with age

Role for Housing? Many vulnerable older people living in social housing Role to support independence and manage in own homes Independence does not mean being alone

Extra Care Housing- What is the evidence? Handful of studies on whether housing can reduce levels of isolation and loneliness Differing findings

Longevity Centre UK, June 2013 “What role for extra care housing in a socially isolated landscape?” Design of extra care housing should promote social contact and communal activities Reduce isolation and loneliness: Ethos Design Activities Community Improved health/functional ability

Burholt et al (2013), University of Swansea Investigated relationship between marital status, social resources and loneliness in three different types of housing (residential care; extra care sheltered housing; own homes in community). No significant difference in levels of loneliness in either setting Did not make intimate new friendships Real friends considered to be those outside of scheme No significant difference across levels in residential care, extra care sheltered housing

Implications for Practice? Support for older people to maintain existing friendships during after transition to supported housing Provide social activities that fosters the formation of new relationships Help residents maintain long-term friendships outside of scheme (e.g. assist with transport, other ‘connectors’)

Tameside Example – New Charter 50% residents over age 50 Context of reduced Supporting People monies New staffing model – activity co-ordinators instead of wardens Extra care and sheltered scheme One year project-based funding to support activity co-ordinators to foster “connections” Development of activities to bring people together and prevent loneliness Promotion of schemes as community resource

How do we know if it works? We don’t yet! Faith-based commissioning One contributor to reducing health inequalities Population based health improvements take generations to prevail Evaluation tools utilised to assess impact on loneliness (e.g. DeJong Gierveld Scale of Loneliness) deJong scale – 6 factors, no mention of loneliness!

Questions?