Poor housing and neighbourhood deprivation lie behind persistent health inequalities

A new report highlights how illness and lost years of life are strongly correlated to poor and overcrowded housing, high levels of fuel poverty, and poor air quality in the centres of our cities and towns, and costs the NHS £1.4bn every year.

Amanda Tomlinson is Chief Executive of Black Country Housing Group

Amanda Tomlinson is Chief Executive of Black Country Housing Group

27 February 2018

At a recent lecture supported by Black Country Housing Group (BCHG), Professor Sir Michael Marmot provided comprehensive evidence for the existence and persistence of health inequalities in the UK, and their underlying causes.

Sir Michael, a global expert on the social determinants of health, demonstrated how inequality and poverty are strong drivers of inequities in health, with a social gradient between the top and bottom of the income spectrum. The higher on the scale people are, the better health they enjoy, including longer life expectancy. Socio-economic status is the closest guide to how long we live.

The lecture was accompanied by a new report by the Human City Institute, The Power of Place: Health Inequalities, Housing and Community in the West Midlands Conurbation (PDF), which maps key health, housing and neighbourhood data in BCHG’s home region. The report draws on Marmot’s social determinants research, but focusses on the effects of poor and overcrowded housing, and neighbourhood deprivation, in perpetuating health inequalities.

The report concludes that illness and lost years of life are strongly correlated to concentrations of poor and overcrowded housing, high levels of fuel poverty, and poor air quality in the centres of our cities and towns. Non-decent housing in deprived communities causes poorer health and shorter lives and, according to the Building Research Establishment, costs the NHS £1.4bn every year.

People living in the most deprived areas of the West Midlands conurbation die, on average, around a decade before those living in the most affluent neighbourhoods. They also report higher levels of ill health. Neighbourhood-based poverty, compounded by poor housing, deprives residents, many of whom are social tenants, of years of good health and wellbeing.

It’s no coincidence that we use the word ‘poorly’ as a commonplace for ‘ill’. Being poor kills; it shortens life, heightens morbidity, threatens wellbeing and lowers quality of life. Where we are born is still the major indicator of how we do in life and how healthy we are. ‘Place’ is very important in determining our health and wellbeing. And at the centre of ‘place’ is housing.

The West Midlands, like most other regions across England, has its share of housing problems, including rising homelessness and rough sleeping, and an increasing use of temporary accommodation. There are also clusters of non-decent housing in all tenures, but especially in the lower end of the private rented sector, and in the most deprived neighbourhoods.

Housing associations have a long history, going back to their foundation more than a century ago, of confronting neighbourhood deprivation and inadequate housing. They have also invested significant resources in their communities over time, often in initiatives to directly improve health and wellbeing, and others that have indirect effects, such as those that boost employment and training opportunities, or that provide community credit, or that tackle community safety issues.

In our region, housing associations, local councils, the West Midlands Combined Authority and the community sector are working together to tackle homelessness and housing need. Andy Street, the WMCA Mayor, has established the Homelessness Taskforce, headed by homelessness charity St Basils, a member of the West Midlands Housing Association Partnership, alongside BCHG.

At BCHG we have years of experience in community investment to alleviate some of the root causes of health inequalities related to housing and deprived communities. Our efforts create more than £7 annually for every £1 invested.

But what is urgently needed is a rethink of national policies to improve the health of all communities. We must acknowledge how health inequalities are constructed and persist, with solutions going beyond health provision alone, such as tackling rough sleeping, homelessness, poor and overcrowded housing, and neighbourhood deprivation. Growing disparities in income and wealth also need action.

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