Housing, Health and Well-Being

Stephen Battersby, Véronique Ezratty, David Ormandy

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351600118
• Edition: 1
• Topic: Sozialwissenschaften
• Subtopic: Soziologie

Housing is a social determinant of health and this book aims to provide a concise source of the theory and evidence on safe and healthy housing to inform students, academics, public and environmental health practitioners, and policy-makers, nationally and internationally.

The book reviews the functions of housing and its relationship with the health and well-being of residents. It examines the implications of failures to satisfy those functions, including the potential impact on individuals, households, and society. It assesses options directed at avoiding, removing, or reducing threats and at promoting healthy indoor environments, particularly for the most susceptible and vulnerable members of society. It is essential reading for students, academics, and professionals within the areas of environmental health, public health, housing, built environment, social policy, housing policy, health policy, and law.

Part 1

Introduction

In 1968 a World Health Organization publication stated that “as a society advances, the rise in its cultural level and standard of living is accompanied by an immense increase in the demands made upon the home in which most a person’s life is spent”.¹ This continues to be true, but the speed and assortment of changes are increasing. The predicted effects of climate change will create new stresses on dwellings and their occupiers. These include what were seen as extreme events, such as heat waves, cold events, very high winds, and torrential rainfall leading to flooding, and so on; the changes in energy supplies and its use, such as the proposed banning of gas space heating in the UK; and the promotion of smart technology to control our energy use. Alongside this are the sociological changes such as housing becoming the workplace as well as the “home”.

Housing is recognised as a social determinant of the health and well-being of individuals and households. Living in an inadequate dwelling that fails to meet the needs of occupiers has potentially serious consequences for health, well-being, and life chances.^2,3 Dwellings should provide a safe and healthy environment; providing shelter where the household can relax after work and school, be a place to enjoy family life, and feel safe; and should allow (and encourage) connection with the community, promoting social inclusion. Not only should dwellings not have a prejudicial effect on physical and mental health, they should have positive effect – good housing can lead to better health.

Housing and poverty are strongly connected and the likelihood of living in an inappropriate, unsatisfactory dwelling is greater among those on low incomes, particularly those below the poverty line. This in turn diminishes the opportunities for children and the young. It is not just a matter of the condition of the dwelling, but a number of interrelated issues. Households with low incomes can struggle to afford the rent or mortgage repayments, the local taxes, the charges for services (water, sewerage, etc.), and energy costs. Such problems are particularly exacerbated in energy inefficient dwellings, where the cost of trying to attain and maintain safe indoor ­temperatures can lead unacceptable decisions such as “heat or eat”. The result is often poor diet, exposure to low indoor temperatures, increased risk of dampness and mould, self-imposed social exclusion, stress, days off work, and days off school.

There is also the potential increase in overheating in both older and new dwellings. With the anticipated changes to climate, heat waves are likely to become more common. In many temperate countries, dwellings were not, and are not currently, designed to protect against the consequential possibility of overheating. Adapting existing dwellings to provide protection can be difficult, and building codes for new (yet to be built) dwellings are not always taken into account. However, exposure to high indoor temperatures has serious health implications for the elderly, the very young, and other vulnerable members of the population.

The objective of this monograph is to provide a review of the theory and evidence relating to safe and healthy housing and what healthy housing should look like. It is intended to be a resource for students, academics, public and environmental health practitioners, housing professionals, and policy-makers. While the majority of sources used are based on housing in the developed countries, the principles are international. As environmental health and housing professionals have to be able to assess housing at an individual level, and also contribute to and inform policies and strategies, this monograph is wide-ranging in its approach.

The range of functions of housing are reviewed, and the relationship between housing conditions and the health and well-being of residents discussed. This includes examining the implications of a failure to satisfy the basic functions, with a focus on the potential impact on individuals, on households, and on society. Options for avoiding, removing, or reducing threats are also discussed, with particular emphasis on those who may be more susceptible.

As well as a place of residence, housing (specifically, a dwelling) is a financial and social asset. It is a financial asset (an investment) to the owner, either as a place to live, or as a source of income (from rent). Dwellings are also social assets, both locally and nationally.

This monograph however will concentrate on the physical structures and environment – i.e., the dwelling and the neighbourhood – as these provide the backdrop and the framework to housing. Deficiencies in these interfere with the development of the social structures – the home and the community. It also highlights the connections and relationship between the various aspects and disciplines involved in housing – those concerned with the structure, those concerned with the sociology, and those involved with health and well-being.

Notes

1 Goromosov MS (1968) The Physiological Basis of Health Standards for Dwellings, Public Health Papers 33, World Health Organization, Geneva.

2 Marmot Review Team (2011) The Health Impacts of Cold Homes and Fuel Poverty. Friends of the Earth and the Marmot Review Team, London. https://friendsoftheearth.uk/sites/default/files/downloads/cold_homes_health.pdf.

3 https://www.who.int/sustainable-development/publications/housing-health-guidelines/en/.

Part 2

Aspects of a dwelling

The relationship between a dwelling and the household involve four main aspects – adequacy; compatibility; affordability; and security of occupation. These are discussed below.

Adequacy

A dwelling should be properly designed, constructed, and maintained so as to provide an optimum safe and healthy environment for the occupiers. As such, it will reflect cultural, economic, climatic, geographic, and other local and regional factors. It should also take into account known and predicted extreme events that may affect the locality, such as floods, earthquakes, heat waves, and cold events.

Each element of, and facility in, a dwelling should satisfy its particular function(s) and do so without interfering with the occupation or with the functions of other elements or facilities. Such elements, modules, and facilities include:

• elements such as foundations, walls, roof, windows, doors, etc., that make up the structure and fabric of the building;
• modules such as bedrooms, living rooms, kitchens, bathrooms, etc.; and
• facilities and amenities including water supply, energy (for space and water heating, lighting, and ventilation), passive ventilation, sanitation, personal and domestic hygiene, etc.

(The functions are discussed in Part 3.)

Adequacy should also recognise the basic needs of a household, such as the need for “family life”, including space for members of the household to get together, and the need for privacy such as spaces for personal necessities (personal hygiene, etc.), and somewhere to be alone and complete personal tasks (study and homework, etc.).

Compatibility

A dwelling may be adequate in itself, but unsuitable for particular households or individuals. Examples are where a dwelling is too small for a household of a particular size, resulting in crowding and interference with family and individual life; or an apartment in a “walk-up” block that is unsuitable for a family with small children, or a household that includes an individual with restricted mobility. In such cases, while there is nothing wrong with the dwelling, it is the incompatibility that is the problem, the mismatch between the dwelling and the occupiers.

Affordability

There will be various costs associated with a dwelling and these should be within the means of the household. Unaffordable housing has been shown to be detrimental to mental health, particularly for low- to moderate-income households.¹

Where the occupying household is purchasing the dwelling, there will be the repayment of instalments for a loan (mortgage) and associated interest. Such repayment is vital to avoid foreclosure (repossession).

The dwelling may be rented, or, where the physical structure is owned, the land on which it stands, or to which it is moored, may be rented (landless owner-occupation). Payment of rent is vital to retain occupation. Where a dwelling is an apartment within a block there will be service charges towards maintenance and general services (cleaning, etc.).

Assessing affordability must also include other “living costs”, including food, clothes, furnishings, and miscellaneous costs associated with human life and contentment. There are other regular or irregular financial outgoings associated with any housing – “running costs”. For example, these can include local taxes and standing charges for services (energy, water, sewerage, etc.). Where a dwelling is rented, theoretically, an element of that rent should go towards the maintenance of the structure (although this may be through service charges). Where a dwelling is subject to a loan or mortgage, the cost of maintenance etc. will fall to the household.

Affordability is an important consideration that feeds through to other aspects. If “affordable” is defined as a percentage of “market rents”, then when inflation results in the cost of housing outstripping wage and income increases, so-called “affordable” rents become, in reality, “unaffordable”. Rent control linked to local wage levels may be a one method of ensuring affordability, but this may have other consequences.

Low-income occupiers, and those with a disability (depending on the definitions), may qualify to receive financial support towards their housing cost (usually rent) or the cost of adaptations. In effect, taxpayers are subsidising the rents paid, which means that a personal benefit is a form of subsidising housing, rather than the other option of managing the cost of housing.

Assistance towards the cost of services is less certain, and, in some cases non-payment for energy or water may result in disconnection (although, in some countries this is prohibited either completely or during certain, colder, seasons).

Security of occupation

For a household to settle and establish a home, there needs to be some certainty that the right to occupy that dwelling will continue for a reasonable period. While there will be some conditions attached, such a right to occupy should be sufficient to give peace of mind and assurance.

What amounts to a reasonable period will vary, but it should reflect the needs of the household (students, for example, may not need or want a long-term tenancy beyond the academic year, while a household with school-age children will need a right to occupy for a longer period to allow for continued attendance at the same school).²

• A study in 2018 looking at tenancies in the private sector in England with those in other jurisdictions, highlighted several differences and reported on examples of good prac...