Healthy lives need healthy homes

29 October 2018

The link between decent homes and good health was spotted long ago. Despite the pace of change accelerating around the world today, making the housing-health link remains as vital as ever. 

Tony Cooke, Chief Officer, Health Partnerships, Leeds City Council and Chief Operating Officer at Leeds Academic Health Partnership, considers the issue and how it is being addressed through partnership working in Leeds.

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Back in 1883, Joseph Rowntree’s business in chocolate employed 200 people. By the end of that century, and still long before a welfare state or NHS, that number had risen to 2,000.  Seeing the potential for a rapid deterioration of their workers’ housing into future slums, “Joseph was anxious to demonstrate that well-built houses within the means of men earning 25 shillings a week could be an economic proposition.”

Today, the Joseph Rowntree Housing Trust is a registered housing association managing 2,500 homes and providing care.

While ‘slums’ are not readily associated with the UK,  charity Habitat for Humanity describes Great Britain’s housing poverty as including those which are unsafe, cold, damp, infested, lacking in modern facilities or has issues of overcrowding and homelessness.

As well as the impact on people’s health, the financial impact of housing poverty is well documented. The King’s Fund’s ‘Housing and Health’ (2018) reports that ‘reducing excess cold in homes to an acceptable level would save the NHS £848 million per annum (BRE 2015, Table 2).’

Similarly, where homes are poorly designed against hazards, older people are particularly vulnerable to accidents in the home, the impact of which can be most severe. The National Institute of Health and Care Excellence 2013 reports that falls are estimated to cost the NHS more than £2.3 billion per year.

With health and social care services strained under the pressures of rising demand and limited resources, the focus on preventing ill health by strengthening the housing-health link is becoming more urgent.

Focusing on residential care homes and extra care housing, The Centre for Policy on Ageing’s recent study ‘Essentially it’s just a lot of bedrooms’ explores how ideas about care influence housing design.

From another angle, citing the Royal Institute of British Architects (RIBA), The Independent reports a clear correlation between the amount of green space, density of housing in urban areas, and the overall health of the local population.

RIBA compared rates of physical activity, childhood obesity and diabetes in England’s nine most populous cities. While RIBA found that the citizens of Leeds had the highest levels of activity, it said that nationally an estimated £1billion saving for the health service is possible through better town planning.

Indeed, NHS England’s Putting Health Into Place last month made similar observations. It reported that UK school children are among the least active in the world and, as a nation, we are among the most overweight in Western Europe.

Offering one solution, it highlights how planning and developing high quality places, safe routes for walking to school or cycling to work help promote physical activity.

Children themselves, commenting on planning decisions for health, told the Royal College of Paediatrics and Child Health’s children’s forum (RCPCH&Us) “there are loads of burger and chicken shops near my school”. They said government had a role to play in making them less accessible.

As part of Leeds’ ambition to be the best city for health and wellbeing, the Leeds Health and Wellbeing Board last month heard about the work to strengthen this vital link between health, housing and urban planning.

Partners across Leeds are exploring the best ways to join up services across housing, public health, planning and design and adult social care with a focus on preventing ill health and helping people care for themselves better.

The Leeds Healthy Weight Declaration will drive a new approach in Leeds to promote healthy weight especially among children, ensuring responsible food retail and marketing, and town planning which encourages physical activity.

The needs of older residents is one of the core themes of Leeds’ Housing Strategy including building ‘extra care’ homes.  These are designed to help people stay independent in retirement by offering apartments with communal facilities and round-the-clock care to suit each resident’s needs.

Residents’ feedback on living in Leeds’ first ‘extra care’ homes, opened in 2017, is positive, with nearly two-thirds of those surveyed saying their quality of life couldn’t be better. This is underpinned by national research which shows this model leads to significantly lower demand for health and care services and to overall improvements in people’s health.

The quality of housing stock is fundamental to influencing health. In Leeds, the private rented sector is growing, yet conditions in some areas remain poor. Indeed homes in the private rented sector have worse housing conditions than any other sector, where homes tend to be older, less energy efficient and have more serious hazards. To address this, a consultation is underway to explore proposals to potentially introduce selective licensing to help drive up standards in Beeston and Harehills.

To improve support at home for people with disabilities, occupational therapists will work directly with the housing and health colleagues for the first time on a faster, bespoke service. Together they will ensure homes are fitted safely and quickly with any necessary adaptations, which is also expected to ease delays for those waiting to return home from hospital.

While the number of homeless people in Leeds is lower than in other major cities such as Birmingham and Manchester, one homeless person is one too many.  Last month, Leeds launched a medical bus service to provide healthcare to the most vulnerable, as part of a wider Street Support Service. This approach brings together voluntary, local authority, police and health colleagues, working together in partnership to deliver a holistic, targeted service.

Strengthening the essential link between health and housing is clearly fundamental to reducing health inequalities.  Regardless of people’s life circumstances or where they live, everyone should be able to start, live and end life as well and as healthy as possible.  This is at the heart of the city’s partnership approach to make Leeds the best city for health and wellbeing.