Health, housing and local area: the inequalities 13th June 2011
Ellen Bloomer, Marmot Review Team e.bloomer@ucl.ac.uk
The Marmot Review
The Neighbourhood • There is an inter-relationship between poor housing and disadvantaged environments. • Poor housing is likely to be situated in areas that negatively affect health. • The local environment affects health in a variety of ways…
The social gradient in Environmental Disadvantage
The benefits of exposure to green space – affecting the gradient Income group 4 is most deprived
Source: Mitchell & Popham, Lancet 2008
Pollution • 66% of carcinogenic chemicals emitted into the air are released into the 10% most deprived wards. • Noise pollution is also worse in areas of deprivation, and has adverse affects on educational outcomes in children and mental health.
Affecting the gradient in exposure to pollution – the congestion charge
Fuel Poverty
The Health Impacts of Cold Homes and Fuel Poverty Published 12th May • Number of fuel poor households in England dramatically increased between 2004 and 2010 from 1.2 million to 4.6 million. • Found evidence of impacts on mortality, morbidity, and other social impacts.
Excess winter deaths (EWDs) 1999-2010
25,400 excess deaths in England and Wales in winter of 200 Source: ONS
Direct health impacts - Mortality • Relationship between excess winter deaths and low indoor temperature and low energy efficiency
• Excess winter deaths are almost three times higher in the coldest quarter of housing than in the warmest quarter • 40% excess winter deaths attributable to cardio-vascular diseases • 33% excess winter deaths attributable to respiratory diseases • “We could prevent many of the yearly EWDs – 35,000 in 08/09 – through warmer housing…” [Public Health White Paper, 2010]
International comparison CSVM
Cavity wall insulation (% houses)
Roof insulation (% houses)
Floor insulation (% houses)
Double glazing (% house)
Finland
0.10
100
100
100
100
Germany
0.11
24
42
15
88
Netherlands
0.11
47
53
27
78
Sweden
0.12
100
100
100
100
Norway
0.12
85
77
88
98
Denmark
0.12
65
76
63
91
Belgium
0.13
42
43
12
62
France
0.13
68
71
24
52
Austria
0.14
26
37
11
53
Greece
0.18
12
16
6
8
UK
0.18
25
90
4
61
Ireland
0.21
42
72
22
33
Portugal
0.28
6
6
2
3
Countries which have more energy efficient housing have lower Excess Winter Deaths.
Direct health impacts - Morbidity • Children living in cold homes more than twice as likely to suffer from respiratory problems than children living in warm homes • More than 1 in 4 adolescents living in cold housing are at risk of multiple mental health problems, compared to 1 in 20 adolescents in warm housing • Cardio-vascular and respiratory diseases • Mental health • Colds and flu, exacerbates existing conditions such as arthritis and rheumatisms
Indirect health and social impacts • Cold housing negatively affects: – children’s educational attainment, emotional wellbeing and resilience – family dietary opportunities and choices – dexterity; and increases the risk of accidents and injuries in the home
• Investing in the energy efficiency of housing can help stimulate the labour market and economy, as well as creating opportunities for skilling up the construction workforce
An Aligned Agenda: fuel poverty, climate change and health inequalities Improving energy-efficiency of the new and existing housing stock
Reduced CO2 emissions: A third of CO2 emissions from housing relate to domestic space heating and could be reduced through making the existing stock more energy efficient. Improved health of the most vulnerable who will no longer need to spend more than 10% of their income on fuel: It has been estimated that raising all properties in England to SAP 81 would lift 83% of households out of fuel poverty. Reduced impact of climate change, the negative impacts of which will be more evident on the most deprived populations.
Tackling cold housing and fuel poverty • Improve energy efficiency - All homes that are of an F or G standard should be brought up to a level E by 2016. • Improvements to energy efficiency should come at no cost to vulnerable consumers. Eg: – Renewed Warm Front Scheme. This has been shown to have a positive impact on mental health, alleviate respiratory problems in children, and reduce deaths among older people • Tenants in private rented accommodation need better legislation to help them improve the energy efficiency of their homes
• The national indicator on fuel poverty should be maintained as mandatory and there should be a new national indicator of housing quality. • Don’t forget rural communities and hard-to-reach properties.
Financial cost of cold homes - private accommodation “The annual cost to the NHS of treating winter related disease due to cold private housing is £859 million. This does not include additional spending by social services, or economic losses through missed work. The total costs to the NHS and the country are unknown. A recent study showed that investing £1 in keeping homes warm saved the NHS 42 pence in health costs...” [Chief Medical Officer Report, 2009]
The Financial Cost of Cold Homes – private rented accommodation Caring for people made ill by cold rented homes costs the NHS £145m a year.
Source – CIEH submission to the House of Commons Select Committee on Communities and Local Government Inquiry into Regeneration, March 2011
Poor housing conditions It costs the NHS in England an estimated ÂŁ600m per year to treat the health impacts of poor housing (CIEH 2011)
The causes: Shortage of housing
Increasing house prices
Privately rented homes • 12% of households in England live in privately rented housing (English house condition survey 2008) Increasing. • 45% of private rented homes in London don’t meet the Government’s decent homes standard (the highest proportion of any group) (London’s housing strategy 2010)
• Why?
Retaliatory Eviction: Tenants have a right to have their property improved, but they can be evicted by their landlords if they complain. Landlords do not have to provide a reason for eviction.
It has often been reported that landlords take advantage of legislation to evict a tenant inappropriately if they have recently taken steps to enforce their statutory rights on disrepair and health and safety issues. • 98% of CAB workers surveyed said that they believed a change in the law was needed
Comparison with other European countries
Overcrowded Housing. • Many people are forced to live in unsuitable conditions due to a lack of housing. • Almost 2 million people are on council waiting lists, with 500,000 of them in overcrowded conditions and 70,000 in temporary accommodation. • Nearly a third of all London’s children live in overcrowded households that lack at least one room.
Ethnicity and Overcrowded Housing: The Inequalities
Overcrowding is most severe amongst London’s Bangladeshi and African households. 53% of Bangladeshi households, 46% of black African households and 39% of mixed white and black African households in London are living in overcrowded housing of all tenures.
Health effects of overcrowding: Tuberculosis
London boroughs with above average overcrowding also have an above average tuberculosis infection rate.
• Educational attainment
• Child health and development – Meningitis – Respiratory conditions – Slow growth rate
• Accidents in the home • Stress, anxiety & depression • Poor adult health
Homelessness THE HEALTH AND WELLBEING OF PEOPLE WHO ARE HOMELESS: EVIDENCE FROM A NATIONAL AUDIT – INTERIM REPORT IN GOOD HEALTH? • 8 out of 10 homeless clients have one or more physical health need • 7 out of 10 clients have one or more mental health need • In the past 6 months, 4 in 10 had been to A&E at least once and 3 in 10 had been admitted to hospital • Almost 1 in 3 regularly eat less than 2 meals per day The health of people who are homeless is among the poorest in our communities. Being homeless means you are more likely to suffer from mental and physical ill health, and at the same time unable to access the health services you need.
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