Housing, Health and Health Inequalities - PowerPoint Presentation

Slide1

Housing, Health and Health Inequalities

Stephen Battersby MBE PhD FCIEH FRSPH

A tale of two citiesSlide2

Good health starts at home

The home is the main setting for our health throughout our lives – it is fundamental to our health

Housing is a social determinant of health - the “conditions in which people are born, grow, live, work and age, including the health system”

(Marmot)Slide3

Good health starts at home

Social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status

Persisting inequalities across key domains underscore this

Inequalities in early child development & education, employment & working conditions reflect housing & neighbourhood conditions which also affect affect mental health Slide4

A health map for the local human habitat

Source: Barton H & Marcus Grant M, 2006, JRSPH, 126 (6) Slide5

Number of people killed or injured by location

Per year

UK

Killed

Injured

At work

380

1,500,000

On the road

3,600

317,000

At home4,1002,700,000

Source: WHO Europe 2005Slide6

Housing and Health

DWELLING

– the physical structure providing shelter, the necessary space, facilities and amenities for the household. Unsatisfactory conditions may lead to one or more direct health effects

(WHO)Slide7

Housing and Health

HOME

- the social cultural and economic structure created by the household, representing a refuge from the outside & enabling the development of a sense of identity; any intrusion of external factors or stressors limits the feeling of safety etc

(WHO)Slide8

Some issues

Housing condition – direct and indirect effects

Cost of housing - increasing debt and reduced ability to have control over one’s life (increasing health inequality)

Security – tenure relevant & frequent moves in PRS not conducive to stable home life – psychological stress (& end of AST most common reason for homelessness (32%) the “defining characteristic”

(NAO)

)

Local environment – no green space, poor air quality, noise, crimeSlide9

Homelessness

65,000 families, 125,00 children currently homeless

More than 300,000 people in Britain sleeping rough or in temporary accommodation

Temporary accommodation often not properly assessed & can be hazardous

Children in temporary accommodation for > one year 3x more likely to demonstrate mental ill health

Moving home many times in early life affects child behaviour

and mental health

(Shelter)Slide10

House to be used for homeless family – (

roof space converted to two bedrooms)

Open riser stair (of varying heights) to first floor from behind rear door in kitchen area of single ground floor room + irregular tread at top step & “ranch” style climbable guardingSlide11

Dampness

Dampness is more likely to occur in houses that are overcrowded and lack appropriate heating, ventilation and insulation

(Institute of Medicine 2004)

,

The

prevalence of indoor damp in low-income communities can be substantially higher than the national

average

(WHO Guidelines for Indoor Air Quality - Dampness and Mould, WHO, 2009)

A damp home is also more likely to be a cold home

Slide12

Cold – Direct impacts

Excess winter deaths

3x higher in coldest quarter than warmest quarter; 40% attributable to cardio-vascular disease &33% attributable to respiratory disease

Children

- >2x more likely to have respiratory problems

Adolescents

>1 in 4 at risk of multiple mental health problems (1 in 20 in warm homes)

Increased COPD, & cardio vascular diseases

Mental ill-health

Arthritis & rheumatism exacerbated

(IHE, UCL)Slide13

Cold – Indirect impacts

Cold homes negatively affects

children’s educational attainment & emotional wellbeing & resilience

family dietary opportunities and choices (to eat or heat dilemma)

dexterity: increases risk of accidents & unintentional injuries

Time off work and loss of earning for occupiers as the result of ill-health (reinforcing poverty & health inequity)

(IHE, UCL)Slide14

(Over)crowding & Lack of space

Adverse effects on children include negative educational performance and behaviour

(Ambrose & Farrell 2009)

Children up to 10 times more likely to contract meningitis

(

Harker

2006)

Overcrowding linked to spread of TB (in 2011 there were 8,963 cases reported

(HPA)

Increase risk of accidents & unintentional injuriesSlide15

Housing Health and Safety Rating System (HHSRS)

Underlying principle - a means of comparing different hazards arising from

deficiencies

and of reflecting the seriousness of these as identified by the ‘surveyor’ or building manager on inspection

It

is NOT a standard – it is a means of assessing dwellings (not actually enforced but underpins any action by local housing authority)Slide16

The HHSRS principles

Any residential premises should provide a safe and healthy environment for any potential occupier (or visitor)

Dwelling unit (letting) should be capable of providing adequate protection from all potential hazards prevailing in local external environment

Some hazards inevitable but risks should be minimised

Slide17

The HHSRS principles

A dwelling that is safe & healthy for the vulnerable age group will be safe and healthy for all

It is the effects of deficiencies that are important not the deficiencies themselves the HHSRS is solely about risks to health and safety Slide18

Potential Housing Hazards

Arranged into four groups -

A - Physiological Requirements

B - Psychological Requirements

C - Protection Against Infection

D - Protection Against AccidentsSlide19

Potential Housing Hazards

Hygrothermal

Conditions

Damp and Mould Growth

Excess Cold

Excess Heat

Pollutants (non-microbial

)

Asbestos (and MMFs)

Biocides

Carbon Monoxide etc

LeadRadiationUncombusted Fuel GasVolatile Organic CompoundsA - Physiological RequirementsSlide20

Potential Housing Hazards

Space, Security, Light & Noise

Crowding and Space

Entry by Intruders

Lighting

Noise

B - Psychological RequirementsSlide21

Potential Housing Hazards

Hygiene, Sanitation & Water Supply

Domestic Hygiene, Pests and Refuse

Food Safety

Personal Hygiene, Sanitation & Drainage

Water Supply for Domestic Purpose

C - Protection Against InfectionSlide22

Potential Housing Hazards

Falls

Falls associated with baths etc

Falling on the level

Falling associated with stairs and steps

Falling between levels

Collisions, Cuts and Strains

Collision & Entrapment

Explosions

Position and operability of amenities

Structural Collapse & Falling Elements

D - Protection Against AccidentsElectric Shocks, Fires, Burns & ScaldsElectrical HazardsFireFlames and Hot Surfaces etcSlide23

Deficiencies & Hazards

One deficiency could give rise to more than one hazard – disrepair to a door and frame & self-closer could give rise to “Entry by Intruders” “Noise” “Excess Cold” (draughts) “Domestic Hygiene Pests & Refuse” depending on the location and nature of disrepair

Many deficiencies could give rise to only one hazard – mould in the bathroom, penetrating damp under to window and through the ceiling all contribute to “Damp & mould” -

single hazard rated once, but greater exposure



greater riskSlide24

Relating People & Hazards

Potential hazards

are assessed

in relation

to the

most vulnerable class of

person (by age)

who might typically occupy or visit the

dwelling, regardless of who actually occupies

e.g.

~ potential hazard from gaps in banisters judged in terms of young

childThe principle is that if a dwelling is safe or healthy for the most vulnerable then it will be safe for allSlide25

“Harm” is

:

The possible health outcome(s) from an occurrence, whether temporary or permanent. That is, the adverse physical or mental effect on the health of a person, such as physical injury, illness, or other health condition or

symptom that would justify medical attentionSlide26

Hazard rating

Identified hazard is rated by a formula that takes account of:

Likelihood or probability of an occurrence (event or exposure that could cause harm) over next 12 months

Percentage spread of possible harm outcomes, from extreme to moderate

The formula produces a hazard score or ratingSlide27

Part 1 Housing Act 2004

Enforcement

by local authorities–

Category 1 Hazards (Bands A –

C or Hazard rating of 1000 or more)

duty

on LHA

to take the most appropriate enforcement action in Part 1 Housing Act 2004

Category 2 Hazards (Bands D –

J or Hazard rating of 999 or less) power on LHA to consider actionSlide28

Points to note

Hazard arises from deficiencies and is rated by reference to the “vulnerable age group” where this has been identified, regardless of actual occupation (an empty property could be rated)

The actual occupation will be taken into account when the LHA considers which if any course of action under Part 1 of Housing Act 2004 e.g. Hazard Awareness, Impro

vement Notice or Prohibition Order etcSlide29

Local authority action

2015-16, 4.5 million households were renting in the private sector (second largest tenure)

28% of private rented homes failed to meet the Decent Homes standard (0.795m with any Cat 1 hazard – 0.229m Excess Cold)

Evidence is many local authorities not using their powers effectively; in 2013/14

Median no. Improvement Notices = 6

Median no. Prohibition Orders = 1

Slide30

Cost of poor housing

The HHSRS Formula allows an assessment of the costs of poor housing to be made as harm outcomes can be “monetised”

– although “exported” or social costs not included

Country

No.

Cat 1 hazards

Total

cost of remedial action (£)

Savings

to NHS p.a. (£)

Payback period

England4,752,00017.6bn602m29.3Wales363,4331.5bn67m22.9N. Ireland144,4580.4bn33m12.8Scotland458,4341.5bn58m26.4Costs & benefits to the NHS of reducing Cat 1 Hazards to acceptable levelSlide31

Costs and savings for some Cat 1 hazards

Hazard

Av remedial cost per dwelling (£)

Total cost to remedy (£

bn

)

Saving

s to NHS p.a. if hazard remedied (£

bn

)

Payback (years)

Excess Cold4,5746.061,0.8487.14Falling on stairs8571.1590.2075.60Falling on level7800.4240.1273.32Dampness7,3820.3940.01525.27Noise1,4110.0080.00184.96CO5060.0080.00155.21Fire128,5900.460.02518.62Slide32

Costs to NHS of all homes with significant HHSRS hazards

No dwellings

%

Housing Stock

Cost to NHS p.a. (£)

Homes with 1+ Cat

1 hazard

3,472,765

15.3

1.413bn

Homes with 1+ Cat 2 (rated >500) Hazard but no

Cat 1 2,476,65510.9428mHomes with worse than average Hazard (<500) but no Cat 12,433,93910.7160mHomes with significant hazards (any of above)8,383,35936.92.0bnAll housing in England22,718,266100-Slide33

Housing and other health hazards

Risk Factor

Total cost burden to NHS p.a.

Physical inactivity

£0.9-£1bn

Overweight/obesity

£5.1-£5.2bn

Smoking

£2.3-£3.3bn

Alcohol

£3.2-£3.2bn

Housing£1.4-£2.5bnSource: Nicol, Roys & Garrett The cost of poor housing to the NHS, PHE Briefing PaperSlide34

Thank You

Any Questions?