Geoff Fougere

Improving health and energy efficiency through community-based housing interventions

ObjectivesHouses designed for one climate and cultural group may not be appropriate for other places and people. Our aim is to find cost-effective ways to improve the characteristics of older homes, ill-fitted for New Zealand’s climate, in order to improve the occupants’ health.MethodWe have carried out two community randomised trials, in partnership with local communities, which have focused on retrofitted insulation and more effective heating and have two other studies under way, one which focuses on electricity vouchers and the other on housing hazard remediation.ResultsThe Housing, Insulation and Health Study showed that insulating 1,350 houses, built before insulation was required, improved the occupants’ health and well being as well as household energy efficiency. In the Housing, Heating and Health Study we investigated the impact of installing more effective heating in insulated houses for 409 households, where there was a child with doctor-diagnosed asthma. Again, the study showed significant results in the intervention group; indoor temperatures increased and levels of NO2 were halved. Children reported less poor health, lower levels of asthma symptoms and sleep disturbances by wheeze and dry cough. Children also had fewer days off school.ConclusionImproving the energy efficiency of older housing leads to health improvements and energy efficiency improvements. Multidisciplinary studies of housing interventions can create compelling evidence to support policies for sustainable housing developments which improve health.

Death by disconnection: the missing public health voice in newspaper coverage of a fuel poverty-related death

Determinants of population health such as fuel poverty (inability to afford adequate household temperatures) are difficult to highlight in the media. In this paper we analyse newspaper reports of the death of a Pacific migrant, Mrs Muliaga, who could not afford her electricity bill, and reflect on using individual cases to highlight the importance of the social determinants of health, such as fuel poverty. We undertook a thematic analysis of 368 articles published in major New Zealand newspapers. Four key themes were identified: personal tragedy, conflicting evidence, institutionalised racism, and responsibility. The on-going focus on the medical status of Mrs Muliaga continued the media trend of highlighting personal behaviours as the root cause of health problems in New Zealand, and justified a medically focused policy response. We argue that public health advocates should consider using media advocacy to make fuel poverty a priority on the policy agenda.

A wicked problem: early childhood safety in the dynamic, interactive environment of home

Young children being injured at home is a perennial problem. When parents of young children and family workers discussed what influenced parents’ perceptions and responses to child injury risk at home, both “upstream” and “downstream” causal factors were identified. Among the former, complex and interactive facets of society and contemporary living emerged as potentially critical features. The “wicked problems” model arose from the need to find resolutions for complex problems in multidimensional environments and it proved a useful analogy for child injury. Designing dynamic strategies to provide resolutions to childhood injury, may address our over-dependence on ‘tame solutions’ that only deal with physical cause-and-effect relationships and which cannot address the complex interactive contexts in which young children are often injured.

Renting in New Zealand: perspectives from tenant advocates

ABSTRACT Currently, around a third of New Zealand’s households, and half its population live in rental accommodation. The proportion of tenant households is growing. Tenant advocates, who are a first port of call for tenants experiencing difficulties in their housing situation, can provide unique insight into the experience of renting in New Zealand. This article presents key themes generated from semi-structured interviews with tenant advocates. Tenants are confronted with issues of poor housing quality, insecure housing, high rents relative to income, lack of autonomy, and difficulty asserting their legislative rights. These aspects of renting in New Zealand are likely to have adverse effects on health. Tenant advocates play an important role in supporting tenants to better housing. Their knowledge of the relationship between a landlord and tenant, particularly in times of trouble, means they can provide unique perspectives on policy solutions.

The Application of Hirschman’s Exit-voice Framework to Housing Studies: A Review and Some Ways Forward

Abstract Albert Hirschman’s 1970 work Exit, Voice and Loyalty, which considers the interaction of responses to dissatisfaction with an organization, product or country, has been drawn on by social scientists to look at concepts as diverse as health care provision, marital relationships, shareholder activism and strike activity. This paper reviews ways that the exit–voice framework has been drawn on to discuss issues related to housing: first, homeowners’ responses to neighbourhood decline and homeless people’s response to policing of their space; second, council tenants’ response to opportunities to buy their council home or to become involved in participation schemes; and third, private tenants’ responses to dissatisfaction in their homes. We suggest that this work could be extended through closer attention to the interaction of different types of exit and voice. Finally, we suggest that the exit–voice framework could be used to give insight into the development and influence of tenant collective voice in different types of housing systems.

Child home safety: are we tackling a wicked problem with tame solutions?

Unintentional injury to young children often occurs at home. Common causes have been identified and a few interventions proven, but many injuries still occur that appear predictable and preventable. The home is a complex, interactive environment that operates within a dynamic social setting. Child home safety, therefore, could be considered a wicked problem, a concept described in the 1970s by Rittel and Webber. Wicked does not denote an unethical problem, but one that exists in complex ecological systems in which social, cultural, economic and political factors operate concurrently. Solving such problems by using tame solutions that address simple causes and their effects is not effective. The ongoing lack of success in reducing some child home injury at least, suggests that an analysis using a wicked problem approach offers an alternative lens that may help find resolutions. In a qualitative study that explored child home injury, the subject was examined in light of the wicked problem model. Using data obtained from in-depth interviews with health professionals, community family workers and parents of young children, opinions and experiences regarding what influenced keeping children safe were analysed and the wicked problem framework applied. This presentation examines a few of the issues that emerged as being potentially critical to keeping children safe at home, for example, parental fatigue and being time poor. Implications for developing and delivering effective health promotion programmes to reduce child home injury are discussed.