Jill Stewart

Children, housing and health

Purpose – To consolidate and review current literature that relates childrens health to their housing and living environments.Design/methodology/approach – A range of published sources which review the relationship between children, housing and health. The sources consolidate research that applies specifically to children and their domestic situation. The paper also reviews literature around municipal tower block estates and the unique health/architecture relationship before turning to children living in temporary bed and breakfast accommodation. An overview of current public health policy that seeks to reintegrate housing and well‐being is undertaken.Findings – Decent housing lies at the heart of health for all. Generally, the picture is more positive, but action remains slow. Childrens needs must be given a higher priority in housing in future to promote physical and emotional well‐being.Research limitations/implications – It is not an exhaustive list and the sources are mainly UK publications.Practic...

Social housing in Latin America: Opportunities for affordability in a region of housing need

In advanced capitalistcountries, the term ‘social housing’ normallyrefers to social rented housing, and itsprovision can be examined within the context ofthe type of housing welfare regime that hasevolved within the country under consideration.However, in large parts of Latin America –because of minimal affordability and limitedinvestment – ‘social housing’ is very much amarginalised tenure and – apart from a smallsocial-rented sector – comprises illegalshelter in shantytowns, assisted self-buildhousing, and low-cost owner-occupation. Itwould therefore be unproductive to examinesocial housing in Latin America within thecontext of any of the welfare regimes thatprevail in the developed world.Within the region, large-scale migration intothe major urban areas created a substantial andgrowing housing deficit among the poor in thelatter half of the twentieth century. At first,there was an attempt to satisfy housing needsby the provision of social rented housing, butit was soon recognised that such accommodationwas unaffordable to the majority of the poor,while municipal governments were constrained bybudgetary considerations from increasing oreven maintaining its supply. At the same time,it was realised that informal housing could beupgraded more cost-effectively, and that forits future development the ‘legalisation’ oftenure was essential; while self-build formalhousing could be constructed through theprocess of community funding. By the 1990s,even the middle-income segment wasdisadvantaged in the housing market asunemployment and interest rates rose and realwages fell, and therefore – through theintroduction of means-tested demand-sidesubsidies – the term ‘social housing’ wasextended to the conventional owner-occupiedsector.Clearly, welfare regimes in Latin America areat a rudimentary stage in their development,although there is a tendency for governments toembrace neo-liberal housing policies. But at atime of fiscal constraint, it is a cause forconcern that macroeconomic priorities mightmake it more difficult for a large proportionof the population of the region to satisfy itshousing needs.

The environmental health practitioner: new evidence-based roles in housing, public health and well-being.

Since the Victorian public health acts, the now named environmental health practitioner (EHP) (previously public health inspector or environmental health officer) has been pivotal in providing healthier housing through a range of policy initiatives and legislative requirements. The role of the practitioner has changed substantially in the past decade, particularly as the public health and well-being agendas have brought focus to the socio-economic determinants of health, including housing, with a renewed vision of tackling the most acute health inequalities through evidence-based practice and taking a population-based approach. The now established Housing Health and Safety Rating System has enabled a far greater focus on evidence than previously. However, for many households on low incomes living in owner-occupied and privately rented housing the situation is inequitable and, for many, has negative health effects. The private-sector housing renewal budget has been discontinued and the allied housing and social care resource has been cut. As a result, EHPs and colleagues need to promote the importance of their work at every opportunity as Public Health England came into being in 2013 and public health has been transferred from the National Health Service to local authorities. This presents both opportunities and challenges in demonstrating the effectiveness of housing strategies and interventions by fine-tuning arguments for securing greater resources through joint strategic needs assessments presented to health and well-being boards.

Encouraging and enabling low‐income owner‐occupiers to maintain their homes: An exploratory study

Purpose – The purpose of this paper is to show that owner occupation has become the prevailing tenure in the UK with owners increasingly being seen as holding primary responsibility for the condition of their properties. The UK has had a long tradition of public sector enforcement and grant‐led intervention to help preserve the nations private sector housing stock. Recent housing policy changes have subsumed earlier grant legislation and provided a general provision for “assistance” to help owner‐occupiers maintain and repair their own homes. Simultaneously, the role of local authorities continues to shift from provider to enabler of service, with greater discretion and an increased role for other agencies at local level.Design/methodology/approach – This paper shows the focus group discussions that were held in South London to explore what low‐income owner‐occupiers in an ethnically‐diverse area would find helpful from the local authority in carrying out maintenance and repair works to their homes.Findi...

A review of social housing regeneration in the London Borough of Brent.

Council high-rise estates sprang up rapidly during the 1960s and 1970s, with cross-governmental support to resolve the nation’s housing crisis. It soon became apparent that many such new estates, designed by remote architects, and sometimes constructed rapidly and unsatisfactorily, did not provide the ideal living initially perceived. Many estates had early problems with architecture, construction and design. They proved an inhumane environment for many residents and there were frequent problems with communal features. Such estates were soon stigmatised and difficult to let as increasingly residual households were placed there, creating majority welfare-dependent estates. This created a downward spiral that traditional, and remote, housing management found difficult to address, and was too wide-scale to rectify financially within existing regimes. Prior to the 1980s, there were no specific government policies to tackle housing regeneration on high-rise estates. Problems became wider than traditional housing management and poor housing environments, encompassing social and economic exclusion. This paper, based on historical and contemporary literature as well as estate visits, reviews regeneration policy in three council housing estates within the London Borough of Brent. It traces successive government approaches since the 1980s from one that challenged the very status of council housing - notably at Stonebridge Park and Chalkhill, to one of partnership with the local authority - at South Kilburn. Housing policy is now concerned with more than just housing - it is about moving toward social inclusion, which requires initiative, flair, resource and commitment. It is about new accountabilities - not just numbers of bricks and mortar constructions, but about the lives, opportunities and health of those who live in an area. This fundamentally involves a partnership approach with residents at the centre of regeneration. This paper finds that sustainable estate regeneration policies are about continued improvements in both housing policy and social development.

Ageing at home? Meeting housing, health and social needs

Purpose – The purpose of this paper is to consolidate the range of issues relevant to owner occupiers who age in place and to offer an initial overview of how effective partnerships can respond to and meet the changing needs of housing, health and social care of our ageing population. Design/methodology/approach – Issues affecting older peoples changing needs are considered holistically and considered in terms of how partnerships can be enhanced to develop improved services in the future. Findings – Most owners wish to stay in their own homes for as long as possible and it can be cost-effective to do so; however, we need to look at new and innovative ways of developing and providing front-line services to enhance health and safety in the home, but also quality of life and wellbeing such as combating loneliness and isolation. However, although there are examples of evidence-based good practice, service provision is variable and there is a risk that many older home owners may miss out on services for which they may are eligible. With this in mind, it may be helpful to develop a new framework where one key practitioner holds responsibility to consolidate and coordinate the range of local services available as a package that offers a range of housing, health and social care services. Originality/value – There are currently many policy and practice gaps in older owner occupiers housing conditions and suitability to meet their changing needs. This paper has a particular starting point in housing, and how other personal or technological services can help support independence for as long as possible and adapt to the owner-occupiers changing health and social care needs as they age in place. The authors emphasise the importance of sharing evidence-based good practice partnerships.

Affordable warmth: housing strategies for older people

Purpose – The purpose of this paper is to consolidate policy, research, evidence and good practice around strategies tackling fuel poverty and affordable warmth for older people aged over 60 to support the development of more effective services for this life course stage and to tackle physical and mental health inequalities. Design/methodology/approach – The authors consolidate current policy, research, evidence and examples of good practice in exploring effective interprofessional approaches that contribute to affordable warmth for older people through “desktop analysis”. The authors support this with qualitative data from Health and Wellbeing Boards (HWBs), health inequalities and environmental health from research comprising four longitudinal case studies in the Midlands and North of England over 18 months and semi-structured interviews with members and support officers. A total of 50 interviews were undertaken and 55 hours of HWB meetings observed. Findings – There are numerous older people living in fuel poverty. The depth of fuel poverty increases with age particularly the over 75s and physical and mental ill health are affected. There are an increasing number of tools to help estimate health care costs around the cost effectiveness of interventions and there is a real need for more local evidence about what is working well, how and why. However, there is no mandatory requirement for fuel poverty strategies and more creative local strategies are required taking organisational and interprofessional relationships into account. The emphasis in integrated care provides new impetus and scope to encourage preventative services but these new partnerships need to be effective in what is a complex policy environment. There is still a long way to go in places. The challenges of ageing are numerous, complex and not fully understood and sit across multiple policy areas. Originality/value – Fuel poverty strategies tend to be delivered on a geographical or income bases rather than by life course approach and a focus on older people. We need to focus more specifically on older people, a rapidly growing population and to better understand thermal properties of our ageing housing stock and how best to intervene to protect and improve health and safety. Emerging approaches need to overcome artificial statutory and non statutory divides and move towards sustainable, evidence based affordable warmth strategies for older people to protect and improve health.

The developing role of evidence based environmental health: perceptions, experiences and understandings from the front line

There has been renewed recognition that proactive strategies and interventions can address the social determinants of health, and the environmental health profession is well placed to effect positive change in many of these determinants. This qualitative research has revealed differences in the perceptions, experiences, and understandings of evidence-based practice among public health professionals from different backgrounds across different services in health care and local government in England. The absence of a strong tradition of evidence-based practice in environmental health appears to be a disadvantage in securing funding and playing a full role, as it has become the expectation in the new public health system. This has, at times, resulted in tensions between professionals with different backgrounds and frustration on the part of environmental health practitioners, who have a tradition of responding quickly to new challenges and “getting on with the job.” There is generally a willingness to develop evidence-based practice in environmental health; however, this will take time and investment.

Personal responsibility for private sector housing renewal: Issues in health improvement

Objective To investigate current policy in respect of resourcing private sector housing renewal to promote healthy housing and communities. Design A qualitative study using focus group research investigating what low-income home owners would find helpful in carrying out maintenance and repair to their homes. Setting The focus groups were held in the area office of a South London (private sector housing) Renewal Area. Method Exploratory focus groups were held in 2003 to 2004, to represent low-income ethnically diverse home-owners within the Renewal Area. Results Respondents were open to looking at new ways of maintaining and repairing their homes, although tended to focus around their own needs rather than the works a local authority may strategically wish to see carried out in private housing sector to meet legal housing standards and promote healthy housing. Conclusion Local authorities need to be able to find new, evidence-based ways of supporting home-owners to carry out maintenance and repairs to their homes as part of a wider public health agenda.