The government has made health and care a national priority with pledges to cut waiting lists and to invest £1 billion to provide 40,000 more appointments, operations and scans every week (Holden & Wickens, 2024). Often overlooked, improving issues around the wider determinants of health can play a significant role in reducing strain on the NHS and improving public health.
The wider determinants of health are the social, economic and environmental factors which influence people’s mental and physical health (GOV.UK, 2018). They include education, employment and working conditions, and housing, which is the starting point for good health. In England in 2023, 3.7 million households (14.6%) were classed in a study by the Health Foundation as “non-decent”, causing avoidable ill health and inequalities. This article highlights the impact of housing on health, costs to the NHS, and its impacts on health inequality.
Impact of poor-quality housing on health
The physical environment in which people live has a direct impact on their health. Homes with hazards increase the risk of falls and injuries. Cold and mouldy homes or homes with poor air quality all carry the risk of developing or exacerbating respiratory conditions such as asthma (Wimalasena et al, 2021). These issues are particularly prevalent in the private sector due to difficulties in enforcing regulations, with around a third of properties in England failing to meet basic health and safety standards (The Independent, 2017). Respiratory disorders, cardiovascular illnesses, dementia, hypothermia, and developmental issues in children have all been found to be brought on by or made worse by cold living environments (Wimalasena et al, 2021).
Beyond impacts on physical health, poor housing quality and living environments have been found to negatively affect mental health. 40% of renters in England say they have felt stressed because of damp, mould and excessively cold conditions in their homes, with 36% saying they felt anxious about it (Homebrite, 2023). To devise effective interventions encompassing housing and health, it is therefore essential that a holistic view of the impacts of housing on wellbeing is taken, to improve renters’ physical and mental health.
Cost to the NHS
The conditions and ill health exacerbated or developed as a result of poor living conditions are ultimately treated through the NHS and increase pressure on the service. These conditions further add to the already high number of people waiting to be treated. The presence of damp or mould in residences in England is estimated to be associated with 5,000 cases of asthma and 8,500 lower respiratory infections among children and adults in 2019 (GOV.UK, 2023). Improving housing can significantly reduce some of the pressure faced by the service as it is estimated to cost the NHS £1.4bn per year to treat people who are affected by poor housing (BRE Group, 2021).
Similarly, in 2019, the Local Government Association estimated the NHS spends £2.5 billion per year as a minimum on treating illnesses that are directly linked to cold, damp and unsafe homes (Institute of Health Equity, 2022). These hazards and housing issues not only represent a financial cost but also contribute to avoidable deaths with over a fifth (21.5%) of excess winter deaths estimated to be due to cold homes (The Health Foundation, 2023).
Impact of housing on health inequality
Issues with housing that are associated with poor health do not impact everyone equally. Lower income households are more likely to bear the burden of increased housing costs, live in inadequate, overcrowded environments, and suffer from housing-related issues that are detrimental to their health. For instance, fire and accidents are more likely to occur in poorly built and maintained homes, and in more deprived neighbourhoods (Kineara, 2024). Households with lower incomes are faced with proportionately higher housing costs. 26% of households with the lowest incomes spent more than a third of their income on housing costs in 2019/20, compared with only 3% for households with the highest incomes (The Health Foundation, 2024).
Similarly, households with the lowest incomes spend more of their income on heating and fuel than better-off households. High costs and a shortage of affordable homes mean many people fall into debt because costs are too high, they have to move frequently, or may face repossessions or evictions. This all creates further instability and stress, with a significant impact on people’s physical and mental health and wellbeing.
Housing issues and costs disproportionately affect people on the lowest incomes but also those in minority groups and younger people. Over a fifth (23%) of people from black, black British, Caribbean or African groups as well as people from ‘other’ ethnic groups (28%) spend more than a third of their income on housing. This is also the case for 15% of people from mixed or multiple ethnic groups and 16% for people from Asian or Asian British groups. This compares with only 8% of white people (The Health Foundation, 2024).
Younger people are also more prone to living in places with housing issues: around one-in-six people (18%) aged 18-34 live in poor quality housing (rising to 26% among 18-24 year olds) – three times the rate of people aged 45+ (6%) (Resolution Foundation, 2023). Health is impacted by affordable housing in both direct and indirect ways. People's mental health can be negatively impacted by difficulties paying their rent or mortgage, and higher housing costs take away from other necessities that can improve health, such as social interaction and food (ibid).
Good housing is the starting point for good health. Poor quality housing and inadequate conditions pose a direct threat to people’s wellbeing, putting further resource and financial pressure on an already strained NHS and ultimately leading to avoidable death. The repercussions of poor-quality housing disproportionately affect ethnic minority groups, young people, and those living on lower incomes. It’s therefore essential that initiatives developed consider this to prevent inequalities further widening.
References
Wimalasena, Nipuni Nilakshini et al. “Housing Risk Factors Associated with Respiratory Disease: A Systematic Review.” International journal of environmental research and public health vol. 18,6 2815. 10 Mar. 2021, https://www.mdpi.com/1660-4601/18/6/2815
Kentish, B. (2017) A third of rented homes in Britain fail basic health and safety standards, new analysis finds, The Independent. Available at: https://www.independent.co.uk/news/uk/home-news/private-rental-homes-health-safety-standards-fail-third-landlords-lease-flats-houses-a7883016.html (Accessed: 12 August 2024).
Homebrite (2023) UK damp and mould statistics 2023 - homebrite windows, Homebrite Windows - Conservatories, Double Glazing, uPVC Windows, Doors in Kent, Maidstone. Available at: https://homebritewindows.co.uk/news/uk-damp-and-mould-statistics/ (Accessed: 12 August 2024).
GOV.UK (2023) Chapter 6: Wider determinants of health, GOV.UK. Available at: https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-6-wider-determinants-of-health (Accessed: 12 August 2024).
GOV.UK (2023) Housing targets increased to get Britain building again, GOV.UK. Available at: https://www.gov.uk/government/news/housing-targets-increased-to-get-britain-building-again (Accessed: 12 August 2024).
Alice Lee, Ian Sinha, Tammy Boyce, Jessica Allen, Peter Goldblatt (2022) Fuel poverty, cold homes and health inequalities. London: Institute of Health Equity.
Institute of Health Equity (2022) Fuel poverty, cold homes and health inequalities in the UK, Institute of Health Equity. Available at: https://www.instituteofhealthequity.org/resources-reports/fuel-poverty-cold-homes-and-health-inequalities-in-the-uk/read-the-report.pdf (Accessed: 12 August 2024).
The Health Foundation (2023) Moving to healthy homes, The Health Foundation. Available at: https://www.health.org.uk/publications/long-reads/moving-to-healthy-homes (Accessed: 12 August 2024).
Holden, J. and Wickens, C. (2024) Health and Care Manifesto pledges | general election 2024, The King’s Fund. Available at: https://www.kingsfund.org.uk/insight-and-analysis/long-reads/health-care-manifesto-pledges-election-2024 (Accessed: 12 August 2024).
Kineara (2024) How housing affects our health, Kineara. Available at: https://kineara.co.uk/how-housing-effects-our-health/ (Accessed: 12 August 2024).
The Health Foundation (2024) Inequalities in housing affordability, The Health Foundation. Available at: https://www.health.org.uk/evidence-hub/housing/housing-affordability/inequalities-in-housing-affordability (Accessed: 12 August 2024).
Resolution Foundation (2024) One-in-six young people live in poor quality housing, and it is worsening their physical and Mental Health • Resolution Foundation, Resolution Foundation. Available at: https://www.resolutionfoundation.org/press-releases/one-in-six-young-people-live-in-poor-quality-housing-and-it-is-worsening-their-physical-and-mental-health/ (Accessed: 12 August 2024).
