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

2. Loneliness

3. (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).

4. 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

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

6. Loneliness as a determinant of health?

7. 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

8. 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)

9. 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

10. 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.

11. 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.

12. 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

13. 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

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

15. 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

16. 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

17. 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’)

18. 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

19. 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!

20. Questions?