Housing and Public Health

1
Housing and Public Health
2
Outcomes

• Combination of poor housing conditions and low
  income can lead to detrimental lifestyle choices
  such as smoking or domestic violence
• Little research into health and housing
• Greater understanding of effect of anti-poverty
  strategies

3

• Living in poor housing or being homeless are not
  just housing problems they have profound
  implications for the health of people in society

4
Policy

• Health of the Nation
• No clarity on housing
• Our Healthy Nation
• Acknowledged social ,economic and environmental
  factors to health
• Acheson Report
• Recommended joined up government action including
  quality of housing, availability of social
  housing for less well off

5
Who lives in poor housing?

• More likely if
• One parent families
• Black and Asian minorities
• Unemployed
• Aged 16-24 years
• Recent improvement in young and unemployed
• Properties in poor condition occupied
  disproportionately by elderly

6

• In 1997 there were 2,100,000 houses owned by
  local authorities and housing associations that
  did not meet the decent homes standard.
• Local authorities had a 19 billion backlog of
  repairs and improvements

7
Issues of Property Condition

• Structure,fitness and amenities
• Cold housing
• Dampness
• Indoor air quality
• Infestation
• Noise, insulation

8
Effect of Poor housingPerceived wisdom

• Excess winter deaths
• Significantly higher where bedrooms seldom heated
• Cold housing
• Increased admissions for respiratory diseases,
  pneumonia, bronchitis, emphysema, heart disease

9
BMJ Editorial Sep 04

• Lower socio-economic groups do not have excess
  winter mortality.(higher absolute rates)
• They do not have cooler houses
• Poverty is associated with poor home heating, but
  no increased risk
• Is it due to behaviour, and brief exposure so
  affects all groups

10
Effect of Poor housing

• Damp homes
• Wheeze and chronic cough 1.5 to 3 times normal
  rate
• Air quality
• Smoke
• Carbon monoxide
• Noise
• Infestation

11
Effect of Poor housing

• Accidents
• Falls (43 in under 5s)
• Poor lighting,lack of handrails,poor
  stairs,straight stairs
• Fires, burns,scalds
• Old wiring, faulty heating, lack of fireguards

12
Mental Health Problems

• Housing density
• Overcrowding
• Study in women in West London
• In children, higher rates of emotional problems

13
Rough Sleepers

• Mental health problems 11 times more
  likely
• Chronic chest and breathing problems 3
  times
• Ulcers and skin wounds 3times
• Joint problems 2 times
• Sight problems 3 times

14
Temporary Accommodation

• Higher rate of chronic health problems (105)
• Higher rate of Acute health problems (78)
• Higher mental health problems (100)

15
Showing Influential Causes
Increased risk of accidents
Vandalism/Hooliganism
Design of estate
Burglaries
Poor performance at work
Groups of young people with nothing to do
Fear of Crime/abuse
Stress
Anxiety
Domestic Violence
Single access point to estate
Isolation of individuals in community
Lack of facilities and services
Reduced social contact
Impaired childhood development
16
Community Safety
Difficulty moving from estate
Poor appearance of estate
Offenders evade capture
Negative reputation of estate
Single access point to estate
Police approach obvious
Stigmatisation
Vandalism Hooliganism
Isolation of Community
Non-residents dont visit
Car Crime
Poor bus service
Increased volume of traffic
Reduced social contact in community
Isolation of individuals in community
Poor diet
Lack of facilities shops, post office
Groups of young people with nothing to do
Unsafe play area
Fire Service withdrawn
Lack of primary pre-school education facilities
Impaired childhood development
Siting of disabled units
Poor lighting of football pitch
Nuisance
Lack of community participation
Alleyways on estate
Lack of play areas
Fear of crime
Loss of sleep
Fear of abuse/intimidation
Poor lighting on estate
Burglaries
Anxiety
Increased risk of road traffic accidents
Stress
Irritability/tiredness
Children on streets
Poor family functioning
Poor performance at work
Domestic violence
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Local Facts 2003

• Average cost of house 175,733
• Income of 30,500 needed to purchase a flat
• Average gross earnings 22,300
• Housing waiting list increased by 8
• 74 of single applicant assessed to be high
  housing need

18
Care Trust

• Commenced October 2002
• Comprises
• All health services
• Older peoples social work team,day care and home
  care
• Local Authority Care Call

19
Housing Provision

• Social provision
• Specialist Provision
• Mother and Baby Unit
• Women at risk
• Difficult to house

20
Housing Provision

• Supported
• Sheltered
• Part 2
• Part 2.5
• Residential

21
Types of support

• Support tailored to meet needs
• Home support health and social care
• Step up, step down flats
• Community hospital support
• Integration of health and social care
• Generic workers

22
Care Call

• Historically alarm service
• Expanded to incorporate tele-medicine
• Falls
• Wandering
• Incontinence monitoring
• Single point of access for health and social care
  services for elderly
• Started with rapid assessment unit

23
Community Schemes

• Prompt home Care
• Generic workers
• Night owls
• Tele medicine

24
What is sheltered housing

• 12 blocks
• Warden managed part of Care Call
• Variable dependency
• Support
• Social activities

25
Extra Care Housing

• Living at home, not in a home
• Care tailored to individual need
• Maintain or improve Independent living skills
• Use technology to support at home

26
Extra Care

• Current sheltered housing
• Young dementia
• Secure environment and garden
• Outreach day care
• Tele link to Care Call

27
Planning

• Current position
• Little integration of partners
• Little recognition of health need
• Need to move to
• Integrated long term planning
• Real needs assessment of health and social care
  needs
• How?
• LSP

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What else are we doing?

• Fuel poverty energy champion 2003-04
• Public health advice and local needs assessments
  to Local Authorities housing strategies and
  Supporting People Programme
• Develop a better referral system form Primary
  Care
• Work with homeless team

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Need Further Work on

• Planning applications to assess health need
• Input into Housing Needs Assessment
• Attend Housing Services meetings
• Working with Health Visitors, Environmental
  Health Officers and Housing Officers on food
  hygiene and families living in poor quality
  housing