1. Poor housing and asthma
Public Health Wales
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 allergens
Asthma and other respiratory illnesses
Injury hazards
Injuries
Overcrowding
Tuberculosis
Cold and heat
Prem mortality and morbidity
Noise
Ischaemic heart disease + others
Radon
Lung cancer
Lead
Neurological impacts
Carbon monoxide
Poisoning and mortality
Formaldehyde
Respiratory symptoms
Indoor smoke from solid fuel use
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 3rd 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. Poor housing and asthma
Public Health Wales
Huw Brunt,
Consultant in Environmental Health Protection