1. The Health Costs Associated with Poor Housing
John Bryson
(Housing and Health Consultant)

2. Possible because ~ English House Condition Survey (EHCS)
Sample survey, used to provide data on the state and condition of the English housing stock - managed by the Building Research Establishment (BRE)
Housing Health & Safety Rating System
Focuses on threats to health and safety
Introduced into the EHCS

3. Possible because ~ EHCS includes HHSRS includes
HHSRS Hazard assessments
Details of works necessary to mitigate Hazards
HHSRS includes
Likelihood and health outcomes

4. HHSRS Health Outcomes Class I Class II Class III Class IV
Extreme harm outcomes, including:
Death from any cause;
Lung cancer;
Permanent paralysis below the neck; Regular severe pneumonia;
80% burn injuries.
Class II
Severe harm outcomes, including:
Cardio-respiratory disease;
Asthma;
Lead poisoning;
Serious fractures;
Serious burns;
Loss of consciousness for days.
(HHSRS Operating Guidance, 2006, ODPM)
Class III
Serious harm outcomes, including:
Rhinitis;
Gastro-enteritis;
Diarrhoea and/or Vomiting;
Chronic severe stress;
Fractured skull and severe concussion;
Severe burns to hands.
Class IV
Moderate harm outcomes, including:
Occasional mild pneumonia;
Broken finger;
Slight concussion;
Moderate cuts to face or body;
Regular serious coughs or colds.

5. Costs
Cost of mitigation works known (available from sources such as Royal Institute of British Architects - RIBA)
Cost to National Health Service (NHS) of health outcomes known (see NHS website)
This made it possible to ~
Estimate the annual cost to the NHS attributable to poor housing
Compare the one-off cost of hazard mitigation with the notional annual cost saving to the NHS

6. BRE-CIEH Cost Calculator
(Downloaded from

7. Scenarios Initially, results shown for all mitigation costs in year 1
Alternatives provided for various options, such as mitigation costs spread over ten years

8. Costs
Using this methodology the BRE estimate that poor housing is costing the NHS in excess of £600million per year
The BRE suggest that this cost is around 40% of the total cost to society. This gives a figure of £1.5billion per year

9. Available from BRE bookshop

10. 4NW - Research Linking Housing Conditions with Health
Six local housing authorities (LHAs) provided ~
HHSRS hazard assessments
Cost of mitigation works
Using these, BRE calculated ~
Notional annual cost saving to NHS
Pay-back periods

12. (Pictures courtesy of Sheffield City Libraries Archives)

13. 4NW - Research In one of the Case Study LHAs it was found:-
The annual benefit to the NHS of hazard mitigation works was £58,972 against a one-off cost of £212,175
The average one-off cost of mitigation works was £1,020 and the average annual benefit was £278
The single lowest cost was £10 to address a Falling on level surfaces Hazard; and in this case the benefit to the NHS was £21 per year

14. 4NW - Research In other Case Study LHAs it was found:-
The highest one-off cost was £3,015 to deal with Excess Cold, giving an annual benefit of £312 to the NHS; a payback period of over 9.5 years
The lowest one-off cost to deal with Excess Cold was £1,011, giving an annual benefit of £512 to the NHS: a payback of just 2 years

15. 4NW - Research Things to note:-
Differences in mitigation costs and payback are a result of LHA policies, property construction, etc.
More expensive interventions to deal with Excess Cold have other policy and well-being benefits as well as the cost benefit to the NHS

16. Available from 4NW, Wigan Investment Centre, Waterside Drive, Wigan WN3 5BA

17. What now?
The costs of mitigation works are those to reduce Hazards to the (HHSRS Guidance) national average Further BRE research has determined that their original figures for Excess Cold are an under-estimate and using the current average provides a cost benefit of £750m for that hazard alone
Follow-up study to refine work? Linking Housing Conditions with Health

18. A Final Thought
Data from the English House Condition Survey shows that -
There are 21 million dwellings, occupied by 48 million people
50% of dwellings are over 50 years old, 20% are over 100 years old
100,000 new dwellings built each year, just 20,000 demolished
This means that, at current rates of clearance, dwellings will have to last, on average, around 1,000 years
(S.Nicol, BRE, Personal communication, 2010)