1. Public Health Wales Poor housing and asthma Huw Brunt, Consultant in Environmental Health Protection

2. Background Links between poor housing and ill-health well documented Numerous housing and health risk factors Effects can last a lifetime Evidence of effective interventions Public health priority that warrants recognition and action Case for collaboration

3. Risk factors Damp, mould, ventilation and allergensAsthma and other respiratory illnesses Injury hazardsInjuries OvercrowdingTuberculosis Cold and heatPrem mortality and morbidity NoiseIschaemic heart disease + others RadonLung cancer LeadNeurological impacts Carbon monoxidePoisoning and mortality FormaldehydeRespiratory symptoms Indoor smoke from solid fuel useRespiratory symptoms Psychological impacts

4. Focus Damp, mould, inadequate ventilation and allergens Links with asthma: -disease characterised by recurrent attacks of breathlessness and wheezing -vary in severity and frequency from person to person -inflammation of air ways in lungs affects sensitivity of the nerve endings in the airways so they become easily irritated -in an attack, the lining of the passages swell causing the airways to narrow and reducing air flows in and out of lungs

5. Asthma scope Respiratory disease is UK’s 3 rd most common long-term illness Most common long-term illness in children Wales has highest childhood prevalence rates in world 260,000 people live with it (55,000 children) 4,000 hospital admissions/yr Rate for adult admissions one third higher than rest of UK Death rate higher than rest of UK Hospital admissions and deaths preventable Significant public health impacts Significant burden on health and care service

6. Housing scope Living in Wales surveys 2004 and 2008 – 5,200 properties 5% ‘unfit’ 60% of those ‘unfit’ had significant damp problems, inadequate ventilation and/or heating

7. What does the evidence say? Reducing exposure to damp and moulds and improving ventilation can be effective in improving health. A tailored package of ventilation and heating improvements was made after a visit from a housing officer. Visible indoor mould removal, fungicide application and installing a fan in the loft space has health benefits. At present, available evidence suggests that chemical methods to reduce exposure to dust mites cannot be recommended. Washing bedding in hot water, putting allergen-impermeable covers on pillows and mattresses and vacuuming and steam cleaning carpets and upholstered furniture are believed to reduce dust mite allergen levels. A package of two or more home visits by staff trained to assess and change the home environment, combined with education about asthma, is effective.

8. Is action cost effective? Total cost to the NHS in England attributable to health outcomes from unhealthy housing estimated at £600m pa Few rigorous economic studies of the relationship between asthma and improved housing mainly due to the difficulties of undertaking them Fitting houses with particular modifications yielded benefits worth up to twice the cost Tailored housing improvements in the homes of children with moderate or severe asthma are likely to be a cost effective use of public resources

9. Proposed action Increase awareness Encourage those affected to seek advice and support Disseminate information on what interventions ‘work’ Strengthen Public Health/Local Authority links Influence policy implications Support work to obtain more data on housing quality Encourage and support local action (including evaluation) Gather more evidence More....

10. What else? Who needs to be involved? What do they need to know? What’s already happening? Develop ‘healthy homes’ information package? - e.g. CO, injuries, indoor air quality, noise, radon etc. What else should be done? - e.g. assess cost effectiveness How should we take this forward? Public health (housing) working group? Practical actions? More...

11. Public Health Wales Poor housing and asthma Huw Brunt, Consultant in Environmental Health Protection