The link between housing and health
The causal link between poor housing conditions and poor health outcomes is long established. The independent Marmot Review (2010) said housing is a "social determinant of health’" meaning it can affect physical and mental health inequalities throughout life. The Marmot Review 10 Years On – Health Equity in England, recorded an expansion in research on the relationship between poor housing and health:
Poor-quality housing harms health and evidence shows that exposure to poor housing conditions (including damp, cold, mould, noise) is strongly associated with poor health, both physical and mental. The longer the exposure to poor conditions, including cold, the greater the impact on mental and physical health. Specific physical effects are morbidity including respiratory conditions, cardiovascular disease and communicable disease transmission, and increased mortality. In terms of mental health impacts, living in non-decent, cold or overcrowded housing and in unaffordable housing has been associated with increased stress and a reduction in a sense of empowerment and control over one’s life and with depression and anxiety. Children living in overcrowded homes are more likely to be stressed, anxious and depressed, have poorer physical health, attain less well at school and have a greater risk of behavioural problems than those in uncrowded homes.
The Library paper, Housing and health: a reading list provides links to key research on the interconnectedness of housing conditions and health.
Statistics on housing and health
Treating health problems caused by poor housing in England costs the NHS £1.4 billion per year, according to an estimate by the Building Research Establishment (BRE).
The English Housing Survey (EHS) provides estimates of the quality of housing stock in England. In 2020, an estimated 2.2 million homes in England had at least one Category 1 hazard under the Housing Health and Safety Rating System (9% of all stock).
Category 1 hazards are those which pose a serious risk to health and safety.
Across England, the regions with the highest proportions of homes with Category 1 hazards were Yorkshire and the Humber (15%), the East Midlands (13%) and the North West (12%). The South East and London had the lowest proportion (each 5%).
The most recent equivalent estimates for Wales are for 2017/18. At this time, an estimated 18% of homes had a Category 1 hazard.
The most recent Northern Ireland House Condition Survey was carried out in 2016, at which time 9% of all homes in Northern Ireland were estimated to have a Category 1 hazard (70,000 homes).
Scotland does not use the same system for measuring housing health and safety, but housing conditions and disrepair are discussed in the findings of the 2019 Scottish House Condition Survey.
Housing, levelling up and health inequalities
In the context of the levelling up agenda, several organisations have argued for a more significant role for housing in addressing regional inequalities, inlcuding in relation to health.
The housing charity, Shelter, is campaigning for more social housing development:
For people like those in our report struggling with rising rents and stuck in unfit accommodation, a tangible improvement in their housing situation would significantly boost living standards. It would increase opportunities and truly represent levelling up.
That’s why we need a new generation of good quality, cheap to heat, genuinely affordable social homes. Social homes with rents pegged to local incomes that stay affordable over time. Only then will everyone have a safe, permanent place to live and the foundations to thrive.
A Rethinking 'levelling up' survey conducted by PricewaterhouseCoopers (PwC) found consideral public support for "housing, high streets, jobs and skills to top the agenda". PwC subsequently considered how the housing system might best respond and identified a need to look beyond housing targets to a more localised approach:
Housing was the stand out priority for our respondents: 74% agree that the quality and affordability of housing is an important factor in the area they live and 70% agree a focus on housing would be the most effective in levelling up the country and reducing inequality.
This figure climbed even higher in some regions, including those where housing is relatively more affordable compared to other parts of the UK, including Scotland (76%), Northern Ireland (75%) and the North West (74%), highlighting the need to unpack issues around housing affordability and consider local housing market dynamics as well as regional. Housing is also notably a bigger levelling up priority for 18-24 year olds (76%) than over-55s (68%), highlighting a generational divide with young people struggling to get on to the housing ladder, as well as a geographic one.
Good quality and affordable housing, along with good jobs and a vibrant high street/town centre, are three of the five factors where the public expressed lower satisfaction in our survey (42% nationally, falling as low as 33% in the South East). Building housing across a range of tenures in the right places, balancing both affordability and quality concerns, will be key as people reassess where they live and remote working potentially opens up new opportunities away from major cities, as we are starting to see in relation to London.
Legal and General's fifth Rebuilding Britain Index report, Levelling up through health and housing "found a strong link between housing and reducing health and wellbeing inequalities." Their research found "investing in housing – and particularly affordable housing – yields a “multiplier effect” which creates jobs, boosting the economy as well as public wellbeing."
The National Institute for Health and Care Reserach published new research in September 2022 which "offers practical advice on how to ‘level up' health at an area level." Levelling Up Health: A practical, evidence based framework (PDF, December 2021) identified eight policy recommendations, one of which calls for priority to be given to cross-government domains and actions:
A prioritisation process should be undertaken to identify a set of cross-government priority domains and actions (eg housing, education, or welfare) which are likely to have the greatest impact on levelling up health. This may include a combination of stakeholder engagement, literature review and data analysis to identify those domains which are likely to have the biggest impact in the short, medium and long term.
The Government's position
The Levelling Up white paper was published in Februrary 2022.
On 19 April 2022, Maggie Throup, then Parliamentary Under-Secretary of State for Health and Social Care, was asked a series a questions about action being taken "with Cabinet colleagues to tackle the effect of poor housing conditions on health outcomes". She said:
The Government are committed to tackling poor-quality housing. In the social housing White Paper, we committed to a review of the decent homes standard to test whether it is up to date and reflects current needs and expectations. The levelling-up White Paper sets out a commitment to halve levels of non-decency in all rented homes by 2030, with the biggest improvements in the poorest-performing areas. These reforms will have a positive impact on health, and we will work closely with the Department for Levelling Up, Housing and Communities to support their implementation.
The white paper, A fairer private rented sector was published in June 2022 and commits the Government to:
- Deliver on our Levelling Up housing mission to halve the number of non- decent rented homes by 2030 and require privately rented homes to meet the Decent Homes Standard for the first time.
- Accelerate quality improvements in the areas that need it most. This will involve pilot schemes with local authorities to trial improvements to enforcing existing standards.
Forthcoming legislation will introduce a legally binding Decent Homes Standard (DHS) in the private rented sector in England. Information on action to improve standards in social rented housing in England can be found in the Library paper Social housing reform in England: What next?
Ian lavery MP asked how the Government’s levelling-up policy planed to tackle illnesses "directly linked to living in cold, damp and dangerous conditions." The Minister said:
The hon. Gentleman raises a really important issue that we are determined to tackle. Housing is one of the key determinants of health. A decent home can promote good health and protect from illness and harm. As he said, poor housing conditions have severe consequences for mental and physical health. That is why we are determined, not just through the levelling-up White Paper but through the health disparities White Paper that will be published later this year, to set out a bold ambition to reduce the gap in health outcomes and the actions that the Government will be taking to address the wider determinants of health, including the impact of poor housing on health.
Selaine Saxby MP referred to the impact of a lack of affordable housing in her area (North Devon) and "the complete collapse of the private rental sector, which is creating mental health issues among my constituents and also means that my much-loved North Devon District Hospital is struggling to recruit adequate local medical services." The Minister said:
My hon. Friend raises an important issue specific to her area, and other areas that attract people who go there for their holidays and are perhaps not there on a permanent basis. We are determined through our White Papers to address every health inequality, whether caused by a moving population or a static population, in the sorts of areas that the hon. Member for Wansbeck (Ian Lavery) talked about.