1. Homelessness is health inequality Sussex rough sleeping, single homelessness & street community event, 18 July Gill National lead: housing & health

2. Why public health interest?
“The science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society”
Public health is ‘everyone’s business’
Public health outcomes focus on
increased healthy life expectancy
reduced differences in life expectancy
healthy life expectancy between communities
As professions
Share the same origins
Same desire but better quality of life
Environmental health is the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health.
Response to inquiry into the causes of poverty which concluded that people often became poor because of ill health due to a bad environment
Response to 1842 inquiry into the causes of poverty
First public health act 1848: public & environmental health
Mid 1800’s: social housing
1875: public health act & slum clearance: council housing

3. Must end homelessness to improve health & reduce inequalities
Why PHE interest?
PHE mission: to protect and improve the public’s health and wellbeing and reduce health inequalities
Homelessness is bad for our health
Ill health can lead to homelessness
A number of our roles relate to homelessness eg,
Emergencies eg, floods
Infectious disease eg, TB
NHS eg, greater use if homeless
Improve health eg, alcohol, smoking, mental health, suicide prevention
Must end homelessness to improve health & reduce inequalities

4. Partnership interest
“The right home environment is essential to health and wellbeing, throughout life”
Describes
Key features of the home
Evidence of the difference it can make
Contribution to health and social care
Context for change
Commits national partners to joint action
Leadership
Evidence
Solutions
Key features of home (permanent & temporary):
Warm & affordable to heat
Free from hazards, safe from harm
Enables movement around the home and is accessible, including to visitors
Promotes a sense of security and stability
Support available if needed
Evidence suggests it can:
Improve health & wellbeing & prevent ill-health
Enable people to manage their health and care needs
Allow people to remain in their own home for as long as they choose
Ensure positive care experiences
It contributes to:
Delayed & reduced need for primary care & social care interventions, including admission to long-term care
Timely discharge & reduced hospital re-admissions
Rapid recovery from periods of ill-health or planned admissions

5. Good health is not just the NHS A home is not just a house
Behaviours 30%
Socioeconomic Factors 40%
Clinical Care 20%
Built Environment 10%
Smoking 10%
Education 10%
Access to care 10%
Environmental Quality 5%
Diet/Exercise 10%
Employment 10%
Quality of care 10%
Built Environment 5%
Income 10%
Alcohol use 5%
Poor sexual health 5%
Family/Social Support 5%
Community Safety 5%
Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute

6. Good health: work of a life time
The house
Cold & disrepair
Cold & disrepair
Overcrowded
Paying the mortgage
On own & Isolated
Living in TA
Sharing poor PRS
Can’t get upstairs
00-04
31-45
16-30
66-85
46-65
05-15
86+
The home
Family experience
Individual experience
Abuse and neglect
Relationship with place, impact on health and wellbeing, and opportunities to influence/intervene to improve outcomes and reduce inequalities changes across lifecourse
Examples of evidence
Born into homeless family living in bed and breakfast: inequalities from this point onwards in terms of health, wellbeing, educational attainment etc
Cold homes: affecting physical and mental health of those who spend a lot of time at home
Stress of paying mortgage/being able to pay rent (and often living in poor housing too): mental health & wellbeing
Get older and less mobile: home can become prison – can’t move around within it, can’t leave it
Drug or alcohol use
Mental ill-health
Criminal justice
Poverty

7. Beyond integrated care
Source: King’s Fund: Population Health; going beyond integrated care, 2015

8. Good health through the home
People
Interventions
Health, care & other institutional settings
End of life care
People leaving a health, care or other institutional setting move on to a healthy home environment
Hospital discharge, prison resettlement etc,
People who become ill, face crisis or other life change manage their health & wellbeing at home
Step down, specialist & supported housing
Healthy homes and neighbourhoods
Integrated ‘health and wealth’ services
Information, advice, support in PIE
Support from people with lived experience
Homeless response
People with long term conditions are able to manage their health at home
Housing support/tenancy sustainment
Use this to communicate the central role of healthy homes and neighbourhoods in everyone’s lives, and the need for information, advice and support to inform decisions and enable control, and the range of housing interventions available for people if and when they have health, care or associated needs eg, face other crisis such as homelessness.
Where are communities in this model?
What would applying the NICE community engagement guidelines look like? (Next slide)
Homeless prevention
Everyone’s home promotes good health & prevents ill-health
Making every contact count
Healthy communities and health equity

9. Action? Systems leadership
Outcome: There is national and local systems leadership and accountability for homelessness and inclusion health
PHE:
‘Improving health through the home’ Memorandum
Public Health Minister on cross-government group
Leadership meetings – first in Feb 2016, next in July
Embedded homelessness in related priority areas
Drug and alcohol commissioning prompts and data
Enabling right home environment for TB treatment (2016)
Population health framework for single homeless (2016)
Regional support programme in 2016/17
Support small number of areas to lead by example
Support other PHE priorities eg, mental health & suicide prevent

10. Action: intelligent commissioning
Outcome: Local commissioning is informed by
Full understanding of homeless & inclusion health needs
Evidence of effective prevention & response measures
Involvement of people with lived experience & agencies which support them
PHE:
Revised homeless health needs audit (Homeless Link)
Rapid review of homeless prevention interventions in health and other community settings
Standards of evidence in housing (HACT)
Contributing to relevant research eg, KCL health care
16/17 reviewed health data to understand what tells us

11. Action: homes and services
Outcome: High quality services across the system, and homes, are commissioned to enable prevention and support recovery and rehabilitation for men and women, supporting people to improve their own health and wellbeing
PHE: we know enough about what works: why not adopted?
2016/17 programme
Action to translate models that work eg, hospital discharge
Joint work with NHSE to engage CCGs
Workforce development with partners eg, HEE, RSPH
Supportive of partners approaches
Crisis – access to the private rented sector
Homeless Link - Housing First model
Engaged in future of supported housing review

12. Local examples of public health engagement
DsPH may be responsible for local homelessness & housing related support budgets
Specific examples (not exhaustive!)
Bradford (BRICCs): Supporting homeless health pathway
West Midlands
Homelessness Network
Regional Offender Housing Protocol
Blackburn with Darwen: MEAM approach
Brighton and Hove: Systems-based approach to single homelessness
LB Richmond: Robust homelessness JSNA
London homeless health: Informed response to Health Commission healthcare recommendation

13. Contact Gill Leng Tel: 07766 660799 @gill_leng