Housing and Health

by admin on June 14, 2011

When you think of health you typically think of things like diet and exercise and doctors and drugs. But there’s another key component that often gets overlooked in being able to live a healthy life. If the house you live in is a downtrodden, or  bad neighborhood, or the house itself is crummy and in a crappy neighborhood and surrounded by derelict buildings, trash-strewn streets graffiti, it’s hard enough just to survive without fretting about living a balanced healthy lifestyle.

Take San Francisco for instance. There are some neighborhoods that have almost no grocery stores. If you want to buy fresh produce you have to travel several miles to a supermarket. If you don’t have a car that means a long bus ride, or two buses. Try carrying home a week’s worth of groceries for a family on the bus. Not much fun. So housing, the kind you have, the location, the surrounding community, all play a role in how healthy you are.

While most of us may not think about things like this, our friend Colin Wiles, a community housing consultant in England does… so we wanted to share his latest blog with you.  It may give you something to think about and realise (that’s the English spelling of the word) that health is a hugely complex issue.

Health and Housing – where is the joined up thinking?

Colin Wiles

Published by Colin Wiles on Tuesday, June 14th, 2011 

So the proposed National Health Service (NHS – the English health care system) reforms are being watered down, but the principle of GP commissioning remains (General Practitioner – their name for a family doctor), albeit with other professionals now included on local panels.

Professor Field’s report emphasises the importance of prevention rather than cure, but where does housing feature in the health debate? Nineteenth century reformers, from Chadwick onwards understood that bad housing conditions led to bad health outcomes. In the nineteenth century and throughout much of the twentieth century the emphasis was on improving housing conditions and sanitation as a route to better health. But in recent decades there has been a decline in interest in this link, perhaps because the most intractable health problems have been solved. But inequalities in health still remain, and many of these are linked to poor housing.

The British Medical Association estimates that multiple housing deprivation poses a health risk that is on the same scale as smoking and, on average, greater than the dangers of excessive alcohol intake. Numerous government commissions and reports have called for joined up working between health and housing bodies, but the reality on the ground, from my own experience, is that health and housing professionals rarely take a strategic view of these issues.

A few years ago I was responsible for building a scheme in the community for elderly patients with mental health problems. Some of them came from the local “asylum”; in fact one poor chap had been incarcerated there for 40 years. Within a year all of the residents were showing huge improvements in their mental health and they were all able to live more or less independent lives. The scheme was expensive, about £1.5 million (approx. $2.5m) in capital costs and £250,000 (around $410,000)  in annual running costs, but how do you set that against the savings to the NHS resulting from the improved mental and physical health of these patients?

Is there an actuarial office somewhere, like Charles Dickens’ Circumlocution Office, totting up the costs and savings of such schemes and arriving at a final tally? I don’t think so. This is why the health and wellbeing boards that are proposed for each local authority area are such a positive development.

Why shouldn’t GP commissioners decide that some of their budget should be diverted from hospital provision and spent on decent housing for people with mental health problems, or for recovering alcoholics, or improving bad housing where multiple health problems exist?

Prevention rather than cure. Indeed, what about combining the budgets of the HCA and the NHS so that we take an all-embracing view of health and housing? Some joined up thinking in this area is long overdue.

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