Health and Housing

Investigating the Links Between Health And Housing

Introduction
One of the long term aims of SBHA is to realign all its policies and practices so that they have a positive impact on tenants' health and contribute towards reducing health inequalities amongst disadvantaged groups in west London. This thinking runs parallel with recent developments in public policy nationally where it is now widely recognised that housing and other social and environmental factors are major determinants of health and that, in order to reduce inequalities and social exclusion, these issues must be addressed.

SBHA's refurbishment programme provides an opportunity for making the link between housing and health and for starting to build an evidence base of health impacts on which policies can be based to ensure effective targeting of resources. As a result, in 1998 SBHA successfully applied for funding from the Housing Corporation's Innovation and Good Practice Grant and from the London Borough of Hammersmith and Fulham to develop a research project which starts to do just this.

The project began in April 1999 and data collection was completed in September 2002. Interim reports of the early findings were published in 2000 and 2001 and the full report is currently being finalised.

The project has been managed by a public health specialist seconded from the Department of Health and the overall direction and progress of the work was overseen by a steering group which was established at an early stage. The steering group is comprised of representatives from SBHA, the London Borough of Hammersmith and Fulham, Regenasis (the organisation responsible for local Single Regeneration Budget work), the Housing Corporation, local general practice and the London School of Hygiene and Tropical Medicine. Prior to the recent NHS restructuring, Ealing, Hammersmith and Hounslow Health Authority was also represented.

Objectives
The objectives of the work were

• to investigate the impact of refurbished, new and reallocated housing on health and well being, how other influences on health interact with housing and whether proven health savings can be produced as a result of providing refurbished, new or reallocated housing;
  
• to establish which components of housing most affect health and, as a result, how resources can best be targeted to improve tenants' health;
  
• to develop exemplars of good practice for housing associations, in partnership with other agencies, to improve their tenants' health and to assess the effect this will have on housing association, local authority and other budgets; and
  
• to examine ways in which best practice can be developed to use improvements in housing and health to improve tenant involvement and the quality of housing management.

Methodology
This study is unique in that it explores the influence of housing and related factors on health before and after housing refurbishments have taken place, follows up the tenants over a period of time, has a "control" group for comparative purposes; and includes relatively large numbers.

The methodology used for the study was outlined in our first annual report, published in May 2000. A major part of the work comprised a questionnaire survey to collect data on tenants' self-perceived health status and their views on how their housing affects their health. Two groups of tenants were - those whose homes were being renovated or who were being reallocated to new housing and those whose housing situation was unlikely to change within the period of the study. For the first group - "refurbishment and reallocation tenants" or "cases" - the questionnaires were completed after the decision was taken to refurbish their home or to allocate new housing to them, after the change had taken place and subsequently at six monthly intervals. The second group - "baseline tenants" or "controls" - first completed questionnaires either in the summer of 1999 or during 2001 and were followed up on a six monthly basis. This collection of "before" and "after" data means that responses can be compared and changes over time can be tracked.

The questionnaire survey was in two parts:

• a detailed questionnaire including questions on
  • housing
  • the local environment
  • crime and fear of crime
  • neighbours
  • other influences on health
  • health and well being, including health service uptake
  • lifestyles
  • the future
• a shorter questionnaire on self perceived health status

The interviews were initially carried out by existing SBHA staff but as time went on it was necessary to employ dedicated interviewers. For this purpose, we trained and employed local people from the long term unemployment register. Most of these people have subsequently gone on to other employment within the organisation or as interviewers on other projects.

Tenant details, drawn from SBHA's existing records, were also recorded.

Early findings
Interim reports of the early findings of the work were published in 2000 and 2001 and the full report is currently being finalised. So far, the analysis suggests the following:

• The health status of tenants in both the reinvestment and reallocation group and the control group is similar at the start of the study.
  
• Similar proportions in both groups have aids and adaptations in their homes but the previously unmet need for aids and adaptations is largely met in the cases after housing refurbishment whilst there is a growing need in the control group.
  
• There is a striking improvement in satisfaction with housing in the first, second and third follow ups amongst the cases whilst there is increasing dissatisfaction amongst the controls.
  
• This also holds true for other areas such as satisfaction with the general area, crime and the fear of crime, the perceived friendliness of neighbours and feelings of belonging to the community.
  
• Both groups of tenants show rising awareness of the influence of wider health determinants on their health throughout the study. This is particularly marked amongst the cases in relation to neighbours and belonging to the local community.
  
• There is a very clear improvement in self-perceived health status amongst the cases at the first and second follow up but this levels off at the third follow up whilst amongst the control group there are constant levels or even a decline.
  
• Problems with mobility and self care decrease in the cases in the year or so after refurbishment or reallocation as do reported problems with pain and discomfort.
  
• There is also a dramatic decrease in levels of anxiety and depression at first amongst the cases and optimism for the future also increases at first but then levels off.
  
• The use of health services shows a constant and dramatic fall in the cases whilst the opposite is true in the controls.

These patterns suggest that improving housing leads to a marked improvement in health status but there are some indications that this improvement may not be fully sustained over time. Generally, however, the overall level of health status is improved in conjunction with housing improvements even if there does not continue to be a rising trend.

Our data are currently being reviewed by an independent epidemiologist prior to the finalisation of the report which, it is envisaged, will be available by the end of March 2003.

Other health related research

As a result of our health and housing work we have also recently started to expand the range of research being undertaken. Recent work includes a study of the literature relating to mobile populations and needs assessment surveys for New Deal for Communities programmes.

Further information

For further information about our health and housing study or about our wider health research programme, please see the following publications:

Measuring health and social outcomes in mobile populations: a research review
Well being survey and needs appraisal
Community Health Needs Assessment
Health and Housing Uncovered

Alternatively, contact:

Ruth Barnes
Health Research Project Manager
Shepherds Bush Housing Association
1 Essex Place Square
London W4 5UJ

Tel. 020 8996 4203