Search the website

Housing and health: building for the future

British Medical Association
Board of Science and Education
May 2003

Introduction
“Everyone has the right to a standard of living adequate for the health and well being of himself and of his family, including food, clothing, housing and medical care”.
Source - The universal declaration of human rights

The World Health Organisation has defined health as “a state of complete physical, mental and social well being”. This report deals with the important contribution made to health and illness by the standard of accommodation.

As with many health determinants, the quality of accommodation is strongly related to income. Minimising the adverse effects of poor housing remains a major challenge for national government, local government and other agencies, and sustained action is needed to narrow the inequality gap in the UK.

Recognition of the impact of poor housing on health is not recent. In 1842, Chadwick established a link between the appalling living conditions of the poor and their ill health.

Many of the most significant gains in health that followed stemmed from public health measures, notably clean water, sanitation, and reduced exposure to extreme cold and other factors associated with improved accommodation. However, the second half of the 20th century has seen a decline in political interest in the issue of poor housing, despite overwhelming evidence of widening inequalities in society and widening recognition of the health consequences of poor housing.

The government-commissioned Black Report placed particular emphasis on housing as a health inequality issue and saw decent housing as a prime requisite for health. Multiple housing deprivation appears to pose a health risk that is of the same magnitude as smoking and, on average, greater than that posed by excessive alcohol consumption.

The 1996 English House Condition Survey showed that 1,522,000 UK dwellings did not meet the required fitness standards. For many already deprived communities, the only housing available is substandard.

Vulnerable groups, including the elderly, the very young and those suffering from long-term ill health, are at particular risk. These groups also have the greatest exposure to many specific hazards due to the lengthy periods that they spend indoors.

People with health problems are disproportionately likely to occupy the least health-promoting segments of the housing stock, a factor that may exacerbate their health problems.

The social and physical characteristics of the surrounding area are also vital in maintaining good health. The fact that poor quality accommodation is often situated in impoverished surroundings with few local amenities contributes further to making vulnerable individuals housebound.

No one chooses to live in poor quality housing or in ‘unhealthy’ neighbourhoods, yet the shortage of affordable decent housing means that people from materially deprived groups are likely to find that this is the only housing available to them. Poor accommodation and a poor general environment each contribute to the other’s negative impact on health.

In addition to housing quality, character and location, housing tenure is an important social divide that is very relevant to the health debate in the UK.

A shrinking social housing sector no longer provides housing for a broad cross section of the community and has become characterised by deprivation and social exclusion. The owner-occupier sector has expanded and now includes more people on low income. The resulting increase in stress as a result of mortgage debt, arrears and repossession is a major public health issue.

Health inequalities are not reducing in the UK and the most socially and economically deprived are also those who suffer the worst health. As in the 19th century there is a profound need for concerted public health action. At the heart of this must be improved living standards and prevention of ill health.

The present government has acknowledged the consequences of health inequalities, and the need to address them.

The Acheson Report, Independent inquiry into inequalities in health, specifically recommends that policies should be established to improve insulation and heating systems in new and existing buildings.

The government white paper, Saving lives: our healthier nation, expressly recognises housing as a key health determinant, as do Scottish Office publications. The 2002 Spending Review recommendation that housing should be a focus of programmes and resources is another welcome indication of the government’s commitment.

Due to the complex interaction between housing and health, there is a need to develop cogent, workable and sustained programmes.

The government has set a number of long-term targets and embarked on initiatives across various departments to improve housing quality and address related issues of access. Provision of a reasonable standard of accommodation for all will have health benefits for the most disadvantaged in society; in the long term it may even lower health care costs.

This report examines evidence in relation to health and housing. It suggests ways of ensuring that all individuals can benefit from good quality housing and discusses ways in which government housing policy can be taken forward.