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Homes on the map

4th September 2009

The publication of the Rogers Review in March 2007 was a shock to EHPs and housing professionals. Westminster Council chief Peter Rogers, tasked with reducing 60 or so environmental health policy areas to five core national priorities, concluded that housing should not be in the top five priorities for local government.

Excluding housing seemed unbelievable. Even Rogers was surprised. He told EHP at the time: “I came with a reconceived idea that housing regulation would feature very heavily and, quite simply, the evidence is not there to support it.”

This lack of evidence did not come as such a shock to some academics. A year before the Rogers Review the University of Greenwich published research showing housing interventions to be fragmented, with little reliance on evidence. It revealed that an inconsistent use of evidence was leading to a patchwork response to poor private sector housing. The report concluded that it would take some time before housing officerswould once again effectively influence the public
health agenda.

The Rogers Review was a wake-up call. Since 2007 there has been an increased focus on showing links between housing and health, culminating in the launch this month of a private sector housing evidence base (PSHEB) at the CIEH Best of the Best conference.

Developed in partnership with the University of Greenwich, the database will provide a single gateway to published research, documents and media relevant to EHPs and their colleagues. Its primary purpose will be to save practitioners
time sourcing literature on, for example, fuel poverty or potential resources.

As a profession we understand how poor housing impacts on health in terms of where people live and by defining their environment and community. Poor housing affects the quality of life, life expectancy and opportunities to work, study, and access leisure, sport and cultural activities. Housing is critical to economic regeneration, improving educational
achievements, reducing health inequalities and achieving community cohesion.

We also know that the privately rented and owner occupied sector accounts for about 80 per cent of UK housing, but contains some of the worst living environments. Conditions are acute in some HMOs and for lower income group home owners. In England 34 per cent of owneroccupied homes and 45 per cent of private rented homes fail the decent homes standard. Worse, 30 per cent of private rented homes and 22 per cent of owner-occupied homes contain a serious (category 1) health and safety hazard. (English house condition survey 2007).

The private sector presents a challenge for EHPs. Government favours “personal responsibility” for the sector by cutting capital expenditure and granting new freedoms for local housing authorities (LHAs) to invest in improvements based on local need. The introduction of the housing health and safety rating system and HMO licensing has radically changed the way that housing officers work.

People in the private housing sector often have complex objectives and needs. Many landlords, for example, are well meaning amateurs while others are downright criminal. Tenants often do not know their rights or are reluctant to exercise them for fear of eviction or rent rises. Homeowners may lack funds to repair and improve their homes or be reluctant to spend during the recession due to job insecurity. Loans and remortgages are hard to come by.

While front-line EHPs recognise that high levels of poor housing affects health, this is not always apparent to budget holders, elected members or senior council officers. They need evidence to be persuaded to release more resources. While there is no shortage of research linking housing and health, evidence of longer term, cost-effective, sustainable solutions are scarce, particularly in published work relating to private sector housing interventions.

One explanation for the shortage is that research is often on its academic merit rather than its practical use. This has led to gaps in the literature – particularly for EHPs. A recent shift in focus towards demonstrating the effectiveness of interventions will lead to new evidence looking at socio-economic factors, with a greater emphasis on prevention and cost-effective interventions at the point at which health is determined.

The role of EHPs is to improve and protect health, address health inequalities and place emphasis on social inclusion and community through a greater reliance on evidence-based practice. Public health partnerships between primary care trusts, LHAs and other health agencies have become the norm, and processes such as health needs assessments, health impact assessments and joint strategic needs assessments are becoming increasingly important.

The joint University of Greenwich/CIEH evidence base will aim to contain more quantitative and qualitative data about what is working, how and why. It will be contemporary, valid and reliable, consolidating research and good practice. It will also contain peer-reviewed research, case studies and funded initiatives to help influence policy, gain credibility and access further resources.

A second priority will be to make unpublished literature available. Reports, local projects, Powerpoint presentations, and dissertations can also be included on the evidence base. Examples could be an abstract to an MSc dissertation about
tenants’ rights to repairs, a local authority study into coastal bed and breakfast establishments or an evaluation of a home improvement agency in service delivery.

Developing and managing the site will initially be an enormous task and will need to be carried out in several stages. In the first instance, the PSHEB will be an online portal accessed via the CIEH website for published literature relating to private sector housing and health. The initial publications cited will have been sourced through an online academic literature review and by collating other existing known sources. Once established, colleagues will be asked to notify the site editor if they know of any other published sources which can be uploaded or linked.

The next stage will be to collate unpublished literature to see if it can be published on its own or with other submitted papers. The editor will then sift through the new literature and publishing ideas and try to find a suitable publishing outlet. At this stage, it may be possible to put colleagues in touch and possibly pool budgets to commission an academic to carry out some research, or even to be paid to write up work on similar initiatives across the country.

Users will be asked to evaluate the site and suggest improvements. In the longer term it is hoped to set up a discussion forum and photo and video library, which will be increasingly user-led.

Jill Stewart is senior housing lecturer at the Universityof Greenwich. Thanks to Kevin Thompson

Unique opportunity to publish

The University of Greenwich aims to help EH Ps who want to get work published.

Please send your work or a synopsis of publishing ideas of no more than 100 words by the end of November to give us an idea of what subject areas are of interest and put colleagues in contact with each other.

Please submit without obligation to: psheb@greenwich.ac.uk

Areas of initial interest include:

  • Housing and health partnerships and processes
  • HMO s
  • Grants and regulatory reform
  • Lessons learnt from difficult areas and individuals
  • Tenants and owner occupiers empowerment etc
  • How the Housing Act 004 helped with HHSRS and HMO licensing
  • Miscellaneous areas such as: geography and health, migrant housing, overcrowding, fuel poverty and energy efficiency, home safety, empty homes and area regeneration.

Information online

The type of information that will initially be hosted or linked will include readily accessible online publications
such as:

  • The BRE /CIEH toolkit Good housing leads to good health, which contains a range of tools for demonstrating links between housing interventions and improved health.
  • Housing – Fire safety (Lacors). A risk-based guidance on fire safety provisions in existing housing.
  • Tackling overcrowding (Lacors). Regulation of crowding and space inresidential premises.
  • Research and good practice papers eg how local authorities have addressed “personal responsibility” in private sector housing through a range of innovative activities involving local communities in shared initiatives; or how HHSRS has been used at local level to address issues like fuel poverty; and lay perceptions of housing, health and community in coastal towns.

Other sources will include recommended books that are not online, but nevertheless useful reference sources. One such example is the forthcoming edited textbook, Professional practice in public health, which contains several chapters by EHPs, including one on the challenges for health and community in the private housing sector. This refers to a range of initiatives in partnership workingto deal with HMO s and area action, including on empty homes.