Housing and health: a time for action

The connection between housing—its quality, or security or affordability—and the health and wellbeing of people is well evidenced, but often underrepresented in the day-to-day governance of our cities and regions. The reasons for this underestimation are, to some extent, understandable, because the ways in which housing affects health are multiple, highly individualised, and interrelated. As the papers in this Special Issue show, despite international agreement on the fundamental requirement of shelter to enable people to have productive and healthy lives, housing is not a simple lever that can be pulled to improve or protect people’s health.

This collection of papers captures an important time in the evolution of housing research, a time when the role of housing was as far from providing simple shelter, as it has ever been. Though the special issue was planned well before the pandemic, these papers were written largely from home offices in lockdown—from kitchen tables, and temporary desks in bedrooms and shared spaces. Regardless of the nation they were written in, this background context infuses the whole collection with a powerful new take on the role of housing in people’s lives and their health. Housing is portrayed as a protector, a key source of harm and risk, a powerful but invisible buffer, a place of stability, and a generator of health inequalities. As we reflect on this collection of papers in 2023, house prices, renter rights and household aspirations are gradually returning to their pre-pandemic trajectories. But arguably, the way people and governments regard housing has been changed forever—largely for the better.

Dweik and Woodhall-Melnik’s (2022) systematic review, looks across a large literature to identify robust evidence on the impact of publicly subsidised housing on mental health. They find, despite the apparent ubiquity of social housing’s role in protecting tenants’ health, that there is a surprising sparsity of robust evidence of impact. Further, that what evidence there is, is shown to be highly dependent on the specifics of the housing programme, assistance measure, and neighbourhood being assessed. The authors note the pressing need, especially in the context of the economic uncertainty of the COVID-19 pandemic, for policies that can improve the outcomes and experiences of economically marginalised populations, such as those housed in social and public housing. For this, new, directed work to provide rigorous evidence needs to occur.

Gurney’s (2021), ‘Dangerous Liaisons’, uses a systematic literature mapping to provide us with a fresh consideration of the relationship between housing, health, and social inequality. This paper proposes a new interpretation of the three-way interplay between social inequality, housing, and health. It introduces harm-from-home to the housing and health conversation. Gurney’s use of the social harm lens leads us to reflect on the ‘trifecta’ of health, housing and social inequalities in a different way—a way that does not overstate the potential benefits of housing, and instead focusses our attention on the potential for harm. Reflecting on this potential for harm during the widespread COVID-19 lockdowns, home is shown to be a place where harms can be ‘stored and amplified’ (p. 20).

Oswald et al. (2022) focus on the well-being of renters during the COVID-19 pandemic in Australia. Using survey and ethnographic diary data, they explore renter experiences of worry, anxiety, loneliness and isolation during the early months of the pandemic. They highlight the role of housing uncertainty and precarity, and the form and quality of the living environment as key drivers of these mental health effects. Their work suggests lessons, which are echoed across this collection of papers, for improving the housing experience in a post-COVID world—improving access to green spaces, and widening the flexibility of our housing infrastructure to enable adaptability of function for work, social relationships, and living.

Bower et al. (2021) also describe the role of housing in either protecting or negatively impacting mental health during the COVID-19 pandemic in Australia. The paper conceptualises housing in its full multidimensional form - as experienced and perceived by the people living within. Unsurprisingly, people residing in poor-quality, unsuitable, insecure, or unaffordable housing were disproportionately affected by poor mental health during COVID-19. But perhaps the paper’s most compelling findings came from the deeper qualitative component, which makes explicit the very unique ways in which COVID-19 altered the peoples housing and health relationship.

Horne et al. (2021) examine the impact of Covid-19 on inequalities in housing, using ideas of exposure, sensitivity, and capability. In this very distinct context, the paper explores the effects of lockdowns on jobs, mobility, home configuration, energy use, food practices, relationships, and social, mental and physical health, and the ways in which these effects were moderated by pre-existing inequalities in housing and health. It highlights the differential impact of Covid-19 on households’ financial or social resources, their ability to generate and exercise agency and power, and the marginalisation of private renters in some parts of our cities.

Martino and Bentley (2021) examine housing’s protective role during the pandemic. The paper is set in the context of a rapid increase in the reporting of domestic abuse, and an associated spike in the demand for crisis accommodation. Their paper explores the multiple overlapping and interconnected risks associated with family violence crisis accommodation, and frames a ‘riskscape’ as a way to capture the tensions between values and pragmatics in providing housing, and make them more visible. Their case study makes visible the ‘thickness’ and location of barriers to providing effective healthy housing responses.

In a climate of reductions in housing services expenditure in England, Alexiou et al. (2021) examine whether municipal authorities experienced more adverse trends in drug and alcohol mortality. The paper is a valuable quantitative demonstration of the health and wellbeing benefit of investment in public housing. Their ecological study linked local authority level data on housing services expenditure to deaths from drug and alcohol abuse over an extended (five year) period. In their paper, they establish a relationship between declines in housing spending, and drug or alcohol mortality. Usefully for policy, the paper provides a monetary anchor for the effects they observe, finding for example, that a £10 per person decrease in Local Authority housing services spending was associated with an increase in mortality due to drug misuse of 0.37 deaths per 100,000.

Finally, the paper by Jaques et al. (2023) documents an important case study of bringing housing and health systems together - South Western Sydney’s Health and Housing Partnership. In, perhaps a rare example of a well-developed collaboration, the authors reflect on the development of the partnership, its value, the challenges, and the lessons for similar intersectoral collaborations with healthy housing aims. The paper is particularly useful in its honest reflection on the inherent difficulty of bringing housing policy and health policy together, and though it highlights the learning, skills and knowledge created, it also acknowledges the limited influence they were able to have upon institutional agendas.

Reflecting on this collection of papers, the links between housing and health are clearly demonstrated—for people, for policy and for budgets. Societies and their governments make trade-offs everyday across policy priorities, but the health risk from housing is an ‘avoidable’ (Clair & Baker, 2022) choice. This collection shines a light on the potential for inequities to be manifested in, and amplified by, housing. It reminds us of the pragmatic challenges of bringing housing and health policy together, but also of the benefits of doing so. Taken together, the papers reinforce the degree to which housing affects health in a myriad of intertwined ways. Housing is a long established and central determinant of health. The COVID-19 pandemic features as a backdrop to many of these papers, but it is just a backdrop. For housing researchers, the pandemic has been valuable in focussing public and policy attention on the role of housing in driving health. Housing became everyone’s health concern, we generated new evidence, and tried policy interventions that had never been attempted before. The challenge for researchers now is to capitalise on this.

Emma Baker
Australian Centre for Housing Research, University of Adelaide, Adelaide, Australia
[email protected] http://orcid.org/0000-0002-9390-0491
Rebecca Bentley
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australiahttp://orcid.org/0000-0003-3334-7353

Disclosure statement

No potential conflict of interest was reported by the author(s).