Substandard South Auckland housing: findings from a healthy homes initiative temperature study

ABSTRACT

There is strong evidence demonstrating cold housing prevalence in Aotearoa New Zealand. Whānau (families) were recruited from a healthy homes programme based in South Auckland. Forty whānau consented to participate in a temperature-based study that assessed the ability of homes to protect against outdoor temperatures. In this observational study, temperature sensors measured night-time indoor temperature every 15 min from May 2020 to October 2020. Whānau were provided with healthy homes education and practical suggestions to help make homes warmer and dryer. Notably, each device (and house) spent 85% or more of the time below the World Health Organization Housing and Health Guidelines recommended minimum indoor temperature of 20°C for vulnerable groups. The lower standard of 18°C for more general populations referenced in the Healthy Homes Standards was not met over 60% of the time. Over a quarter of the time temperatures measured inside homes were below 12°C. If Māori and Pacific whānau continue to live in substandard housing due to residential inequities, they will continue to experience inequitable health outcomes related to cold housing. Solutions include the anticipated Residential Tenancies (Healthy Homes Standards) Regulations, supports for tenants and support with housing-related costs.

KEYWORDS:

• Healthy homes
• health
• equity
• indoor temperature
• housing

Introduction

Substandard housing is a major issue affecting health in Aotearoa New Zealand (Bennett et al. 2016; Rangiwhetu et al. 2018; Chisholm et al. 2019; Pierse et al. 2020). In particular, the indoor temperature of a home can have a significant impact on the health of those that live within it (Ormandy and Ezratty 2012). The World Health Organisation (WHO) recommends that the optimal indoor housing temperature range is between 18°C and 24°C for general populations, with a minimum indoor temperature of 20°C for more vulnerable groups (e.g. children and older adults) (Ormandy and Ezratty 2012). Temperatures below 18°C are associated with poor health outcomes including decreases in lung function, with functional risk increasing with each degree colder a home is (Ormandy and Ezratty 2012; Pierse et al. 2013). Indoor temperatures of 16°C or less are associated with diminished resistance to respiratory diseases and poorer asthma outcomes (Pierse et al. 2013). Whānau (families) in Aotearoa NZ spend on average 70% of their time at home indoors, with the most vulnerable populations (low-income families, young children and older adults) spending around 90% of their time inside (Rangiwhetu et al. 2018). Due to the enduring impacts of colonisation (Bécares et al. 2013), residential segregation (Grbic et al. 2010) and systemic racism (Norris and Nandedkar 2020), Māori and Pacific whānau make up the majority of low-income households in Aotearoa NZ and therefore are at most risk of living in poor quality housing subject to low indoor temperatures (Marriott and Sim 2015).

Te Tiriti o Waitangi (The Treaty of Waitangi) was meant to ratify sovereignty and autonomy for Māori when British people colonised the country, however in the years following the signing of Te Tiriti o Waitangi, Māori rights were impeded in many ways (I Anderson et al. 2006). Te Tiriti o Waitangi is one of the founding documents for Aotearoa NZ and is the agreement between Māori and the British Crown to allow for partnership between Māori and the Crown and to allow British citizens to live in Aotearoa NZ as citizens (M. Baker and Levy 2013). British colonisation led to the re-distribution of resources and land that were held by Māori to European settlers through land purchases and confiscation as well as legislation and warfare (I Anderson et al. 2006). In the years following, with urbanisation and devaluation of cultural traditions, Māori have been pushed out of traditional areas and lands into urban areas, where discrimination and racism have segregated families into low socioeconomic areas (Norris and Nandedkar 2020). Pacific families have similarly been impacted by discrimination and the ongoing and complex renegotiation of cultural traditions in Aotearoa NZ (Grbic et al. 2010).

Through urbanisation and labour shortages in low wage industries, Māori and Pacific whānau have been pushed to areas within cities with low rates of home ownership, poor infrastructure and discrimination (Bécares et al. 2013). Residential segregation is not only due to colonisation, but ongoing systemic land re-distribution and confiscation through government policy (Bécares et al. 2013). Income inequality perpetuated by structural racism and government policy adds strain when whānau attempt to secure healthy housing (Norris and Nandedkar 2020). These inequities have resulted in Māori and Pacific whānau being pushed to live in more deprived areas in housing that is shown to be cold, resulting in disproportionate exposure to housing-related ill health.

Multiple Aotearoa NZ studies show that low indoor temperatures have an impact on the respiratory health of children in Aotearoa NZ (Butler et al. 2003; Pierse et al. 2013, 2020; Oliver et al. 2018; Rangiwhetu et al. 2018). This is especially true for Māori and Pacific children, who have disproportionately worse childhood respiratory health and hospitalisation with preventable respiratory illnesses (Telfar Barnard et al. 2020). Damp, mouldy and cold housing is linked to an increase in transmission of Group A Streptococcus, which if left untreated and allowed to persist increases the likelihood of rheumatic fever and in turn rheumatic heart disease (Oliver et al. 2018). Housing is the most important risk factor for rheumatic fever in Aotearoa NZ (MG Baker et al. 2022). Transmission of Group A Streptococcus is likely to occur more often in cold housing due to a number of factors including overcrowding (A Anderson and Spray 2020). Overcrowding occurs for various reasons, including in cold homes where whānau make the most of warmth in certain spaces (functional overcrowding), crowding into those spaces and sharing air and in doing so, spreading germs (Jansen 2016).

In 2013 the Ministry of Health Aotearoa NZ established the Healthy Homes Initiative (HHI) in response to increasing national rates of rheumatic fever and the risk that overcrowding adds to its prevalence (Ministry of Health New Zealand 2021). AWHI, previously known as Auckland Wide Housing Initiative, is one of many Healthy Homes Initiatives across 10 District Health Board areas in Aotearoa NZ (Ministry of Health New Zealand 2021). The HHIs work to support whānau to live in warmer, dryer, healthier homes (Ministry of Health New Zealand 2021). They achieve this by working with a variety of agencies including not for profits and charitable organisations, for example Habitat for Humanity, to implement interventions needed to make the home healthy, including initiatives such as insulation and heat pump installation.

HHIs were initially targeted in areas with high incidence of rheumatic fever and where low-income families were living in overcrowded homes (Ministry of Health New Zealand 2021). Later, the programme expanded in breadth to include supporting warm, dry and healthy housing for pregnant people, low-income families with children aged between 0 and 5 years, and families with children also between 0 and 5 years for whom at least two of the social investment risk factors apply (e.g. long-term beneficiary and caregiver with corrections history) (Ministry of Health New Zealand 2021). HHIs work with diverse whānau who reside across different housing tenure and quality.

AWHI currently supports low-income whānau from four referral groups: (1) housing indicator conditions: children with respiratory conditions aged 0–14 months; (2) rheumatic fever prevention: children or another member of the household with rheumatic fever, or children with 3 or more recurrent group A Streptococcus throat infections; (3) social indicators: children aged 0–5 years with at least two of the social investment risk factors; and (4) hapū māmā/pēpi (pregnant women and new-born babies): this group also includes children up to 5 years of age. The quality of housing in Aotearoa NZ is correlated with tenure. Generally, privately rented housing and public housing are of worse quality than owner-occupied housing, including having lower rates of insulation and heating in living areas (Johnson et al. 2018). Differences in interventions and supports for warm and dry homes can be attributed to the lack of policy regulations in the private rental market in Aotearoa NZ (Pierse et al. 2020). To help reduce the impact of poor housing quality on health, the Aotearoa NZ Government legislated the Healthy Homes Standards (Residential Tenancies (Healthy Homes Standards) Regulations 2019) to define a minimum standard of housing across the country. Before the Healthy Home Standards Regulations, there was little to no regulation requiring private landlords to supply warm, dry and healthy homes to whānau who rented from them (Pierse et al. 2020).

AWHI is based within the National Hauora Coalition – a Māori led Primary Care Organisation. Each HHI in Aotearoa NZ operates in different geographic regions as governed by historical district health board boundaries. AWHI works with whānau in Counties Manukau, South Auckland. Compared to other historical district health board populations in Aotearoa NZ, Counties Manukau has the largest Pacific and second largest Māori population, and the region more broadly has high levels of hardship and deprivation (Lees et al. 2021). In this region, Māori and Pacific peoples are overrepresented in the most deprived sections of the population, with over 50% of the Māori population and over 70% of the Pacific population in New Zealand Index of Deprivation 2018 deciles 9 and 10 (representing those with the most socioeconomic hardship) (Lees et al. 2021).

AWHI undertook a research project from July 2019 to January 2021 to assess the night-time temperatures in the homes of AWHI-referred whānau. Temperature sensors were used to measure temperature in a bedroom and the living room of each participating home to determine the relative risk to health. This study is the first of its kind in the Counties Manukau Auckland area looking at the thermal envelope of housing predominantly occupied by Māori and Pacific whānau, with a focus on private rentals and public housing.

Materials and methods:

Recruitment

This project was part of the AWHI Healthy Housing Initiative funded by the New Zealand Ministry of Health from July 2019 to January 2021. Participants for the study were defined as the child or adult referred to the AWHI programme, and ethnicity data collected was that of the referred person. The term whānau is used throughout the paper to describe the participants as a household rather than an individual.

Eligible whānau who were newly referred to the AWHI programme between May 2019 and October 2019 were considered for recruitment in this study. 50 out of the 1,129 whānau who were referred to AWHI in the recruitment period were asked by phone if they would like someone to talk to them about this project. If whānau were interested in taking part, a home visit was scheduled to explain how the sensors work before they were installed. Written consent was then obtained from 40 whānau agreeing to take part in the project. Whānau were given a koha (acknowledgement) of $50 by way of a supermarket voucher for their participation.

A scope of review application was submitted to Aotearoa NZ's Health and Disability Ethics Committees (HDEC) to assess whether an ethics submission was required to undertake the project. HDEC provided a letter stating that an initial review indicated no submission was required as the project did not fall in the scope of HDEC review.

Study sample

Convenience sampling was used for housing in the study, though heterogeneous purposive sampling was also applied to ensure 50% of homes were Kāinga Ora (public housing, formerly known as Housing New Zealand) and 50% were private housing (privately rented or owner-occupied homes) (Etikan et al. 2016). This sampling represented the different types of tenure included under the AWHI programme. We did not stratify sampling based on ethnicity or referral pathway.

Data collection

Temperature sensor nodes (supplied by Monkeytronics) were chosen for the research because of their small size and inconspicuous appearance. Each home had two temperature sensor nodes installed; one in the living room of the home and the other in one bedroom. These locations were chosen as they are the areas where whānau spend most of their time at home in the evenings. They were installed away from windows and exterior doors on walls at approximately 1.2 metres above floor level using 3M removable tape to ensure no damage to the property, to prevent ground temperature influencing the reading, and to help mitigate the risk of tampering by small children. These were installed at the first home visit by the project team, which started in October 2019.

The indoor temperature was recorded in Celsius every 15 min at each sensor location during day and night-time, and matching outdoor temperatures were taken from the nearest weather station reporting to the National Institute of Water and Atmosphere (NIWA) database at similar time intervals. The accuracy of the temperature measurements is specified as +/−0.3°C, from 0°C to 65°C with a repeatability of 0.06°C and a resolution of 0.015°C. The long-term drift (maximum acceptable change in value over time due to aging of the sensor and environmental factors) of the sensor is less than 0.03°C per year. Before transmission of data from the device to the cloud, the readings were rounded to the nearest 0.1°C.

Data analysis

Of the original 80 installed devices across 40 homes, 11 devices were excluded, resulting in 69 devices with data for the analysis period from 01 May 2020 to 01 October 2020. Exclusions occurred for many reasons, six devices included participants who withdrew from the study due to relocation or no longer wanting to participate, and the other five were from homes located in low-network areas where data could not be captured adequately, or as a result of device damage. Due to COVID-19 restrictions at the time of the project, replacement devices were unable to be installed for any damaged devices. This resulted in some homes where only one device was reporting data over the reporting period, either in the bedroom or the living room.

The reporting period included the coldest months in the year (May to October) and was the period during which the Aotearoa NZ Government provided a Winter Energy Payment to low-income families for increased energy use in the households (Ministry of Social Development 2021). The data was restricted to ‘night-time’ and collected between 20.00 and 06.00 h. These evening/early morning measures were selected as it was assumed that they were the times of day that most people would be at home. These indoor temperatures were then compared to outside temperatures to measure the home’s ability to protect against cold (Pierse et al. 2013).

Private rentals and homes owners were combined and together analysed as private housing. This was done as all whānau referred to AWHI (including those living in private rentals or who are homeowners) are below the same income threshold and follow a similar process through the programme. The key focus for the analysis was to compare indoor temperatures in private housing (rentals and owners) to public housing. A simple linear regression model was undertaken for each sensor with the recorded indoor temperature as the outcome and outdoor temperature as the predictor (Alexopoulos 2010). The β coefficient for each sensor was then recorded and tabled to provide an estimated measure of how well the housing was protecting against the outdoor cold. The β coefficient estimates the degree of change in the outcome variable (indoor temperature) for every single unit of change in the predictor variable (outdoor temperature) (Alexopoulos 2010). The interpretation of the β coefficient for this study is that for every 1-degree change of outdoor temperature, the indoor temperature will change by the β coefficient value (Alexopoulos 2010).

Results

Whānau from 40 homes participated in the study, of which 21 resided in private rentals or were homeowners and 19 resided in public housing. However, only 18 private housing and 15 public housing homes were included in the final analysis. At the time of recruitment and temperature sensor installation, whānau were also given healthy homes education which included practical suggestions including, but not limited to; opening curtains during the day to let the sun warm the home, closing curtains before night-time to keep the heat in, opening windows for approximately 15 min each morning to let fresh air in, and turning on extractor fans when cooking or showering to let moisture out.

Demographics of the whānau who participated are shown in Table 1. Most participants were of Pacific (45%) or Māori (27%) ethnicity (self-reported) totalling 72% of total participants. Five participants (15%) did not provide their ethnicity, noted as ‘Not Stated’ in demographic data (as per HISO 10001:2017 Ethnicity Data Protocols from the Ministry of Health). No participants identified as NZ European, Aotearoa NZ's majority ethnicity. Most households were referred to AWHI through the rheumatic fever prevention group (45%) or the housing indicator conditions group (33%). There were slightly more private housing (rentals and homeowners) (n = 18) homes included compared to public housing/Kāinga Ora homes (n = 15). In private housing, more sensors were included from the living room (n = 17) than in the bedroom (n = 15), however the same number of sensors (n = 13) were included from both the living room and bedroom of public housing after exclusions.

Table 1. Demographic data per whānau/household.

	Household occupants	Private Housing* (n = 18) N (%)	Public Housing^ (n = 15) N (%)	Total (n = 33) N (%)
Ethnicity	Māori	6 (33%)	3 (20%)	9 (27%)
	Pacific	6 (40%)	9 (60%)	15 (45%)
	Other	4 (22%)	–	4 (12%)
	Not Stated	2 (11%)	3 (20%)	5 (15%)
Referral Group	Rheumatic fever prevention	8 (44%)	7 (47%)	15 (45%)
	Social indicators	3 (17%)	1 (7%)	4 (12%)
	Hapu māma/pēpi	1 (6%)	2 (13%)	3 (9%)
	Housing indicator conditions	6 (33%)	5 (33%)	11 (33%)
Housing Type	Private Rental	10 (56%)	–	10 (30%)
	Private Homeowner	8 (44%)	–	8 (24%)
	Public Housing	–	15 (100%)	15 (45%)
Room Type^^	Living	17 (53%)	13 (50%)	30 (52%)
	Bedroom	15 (47%)	13 (50%)	28 (48%)

*Private housing includes both private rentals and homeowners.

^Public housing refers to Kāinga Ora (previously known as Housing New Zealand) managed homes.

^^Room type count does not correspond with total n (33), as there were multiple sensors in each home.

Sensor data revealed that all the homes in this study were at temperatures below 20°C for 85% of the time and below 18°C over 60% of the time (shown in Table 2). Furthermore, all devices in this study recorded temperatures below 12°C over 25% of the time, with temperatures dropping below 10°C less than 5% of the time for each area and housing type. Overall, bedrooms in private housing reported colder temperatures than living rooms. In public housing, the opposite was seen with the living room sensors consistently reporting colder temperatures than bedrooms.

Table 2. Percentage time spend in below the selected thresholds between 20.00 and 06.00 h.

		<20°C	<18°C	<12°C	<10°C
Private Housing (Rental or Homeowner)	Living	83.1%	59.8%	26.2%	1.0%
	Bedroom	87.7%	59.3%	26.9%	2.2%
Public Housing (Kāinga Ora)	Living	87.4%	64.7%	32.1%	3.6%
	Bedroom	87.2%	63.7%	27.4%	1.6%
All Devices	Living	85.0%	61.9%	28.8%	2.1%
	Bedroom	87.5%	61.3%	27.1%	1.9%

Overall, indoor temperature dropped by more than one degree for each drop in outdoor temperature across all devices, this was significant with a p-value of <0.0001. For each degree Celsius change in outdoor temperature, the indoor temperature followed by 1.46 (95% Confidence Interval 1.05 to 1.87) degrees. This is shown in Table 3.

Table 3. Relationship between indoor-outdoor temperature by housing type.

Housing type	Average Temperature (°C) inside	Average Temperature (°C) outside	β Coefficient (95% CI)
Private Housing (Rental or Homeowner)	16.8	10.5	1.49 (0.87–2.11)
Public Housing (Kāinga Ora)	16.6	10.5	1.43 (0.81–2.05)
All Devices	16.7	10.5	1.46 (1.05–1.87)

Discussion

This study highlights the inequity and poor quality of housing in Aotearoa NZ. The majority of whānau recruited for this study were of either Māori and/or Pacific ethnicity and all homes were exposed to temperatures below a healthy limit. Māori and Pacific whānau are disproportionately represented in the most deprived sections of South Auckland and in this study, which is representative of the whānau who AWHI support more broadly (Lees et al. 2021). The housing infrastructure in these most deprived areas is deficient in insulation, heating and other healthy homes interventions, supporting other findings which show that Māori and Pacific whānau over the years have been pushed to live in cold housing in more deprived areas resulting in disproportionate exposure to housing-related health risk factors (M Baker et al. 2010; Howden-Chapman et al. 2012). Māori and Pacific whānau are more likely to live in private rentals and public housing than non-Māori and non-Pacific whānau (Stats NZ 2016). A report by Baker, Zhang and Howden-Chapman in 2010 highlights the overrepresentation of Māori and Pacific whānau in public housing (M. Baker et al. 2010). 44% of tenants of public housing are Māori which is three times higher than the proportion of Māori in the total Aotearoa NZ population, and 26% are Pacific, four times higher than in the total Aotearoa NZ population (M Baker et al. 2010; Bennett et al. 2016; Stats NZ 2016; Pierse et al. 2020; Goodyear et al. 2021). Since 1986, the proportion of Māori and Pacific whānau living in private rentals increased more than for the total Aotearoa NZ population, an 88% increase for Māori and 59% for Pacific, compared to 43% for the total population (Stats NZ 2016). These trends highlight that Māori and Pacific whānau are more likely to be living in either private rentals or public housing rather than owning their own home, and are therefore more likely to be living in housing of poorer quality than owner-occupied homes (Bennett et al. 2016; Stats NZ 2016; Pierse et al. 2020; Goodyear et al. 2021).

Despite Government efforts to improve housing quality and population health through initiatives such as AWHI and HHIs more broadly, this study shows little difference between indoor and outdoor temperatures. The data reported in Table 2 shows that the homes in this study were exposed to temperatures below 20°C more than 85% of the time. This is below the WHO Housing and Health guidelines (World Health Organization 2018) that recommend a minimum indoor temperature of 20°C for vulnerable individuals (including children and older adults). Considering that the referral pathways for whānau into AWHI include children with respiratory conditions, children or another member of the household with rheumatic fever, and pregnant women and new-born babies, most of the families that are supported by AWHI would be considered vulnerable by the WHO standards and should be living in temperatures which are above 20°C. Additionally, the homes included were exposed to temperatures below 18°C more than 60% of time over the research period, which is the minimum temperature recommended in the Aotearoa NZ Healthy Homes Standards as per WHO guidelines (Ormandy and Ezratty 2012). These findings correlate with research done by Rangiwhetu et al., where indoor temperatures of publicly owned homes in an urban setting (Wellington city) were also found to be below the WHO recommended temperature (18°C) 87% of the time (Rangiwhetu et al. 2018). Over a quarter of time measured in this study was spent in temperatures below 12°C, which has been found to cause a short-term decrease in lung function for Aotearoa NZ children (Pierse et al. 2013). Outcomes from this study are also consistent with findings from other Aotearoa NZ housing research showing that the housing stock across Aotearoa NZ is cold and failing to meet recommendations for healthy housing (Bennett et al. 2016; Rangiwhetu et al. 2018). These findings correspond with research (Pierse et al. 2013) which found that the average bedroom and living room temperatures, around 14°C and 16°C respectively, were below WHO recommendations. Housing that allows for cold temperatures to persist affects the health outcomes of whānau living in the home as it increases exposure to allergens and promotes crowding and therefore disease transmission, increasing the likelihood of respiratory infections overall (Telfar Barnard et al. 2020).

In particular, this study showed that the indoor temperature decreased more than one degree Celsius for each one degree drop in outdoor temperature (as per Table 3), showing that these homes do not adequately protect against the cold. In private rentals, for every one degree drop in outdoor temperature the indoor temperature dropped by 1.49°C (as per Table 3). In public housing, for every one degree drop in outdoor temperature the indoor temperature dropped by 1.43°C (see Table 3). These findings are of particular concern in the winter months, where hospitalisations associated with housing are higher (Howden-Chapman et al. 2012). Increased hospitalisations are observed where whānau are living in older dwellings, in areas with more rental housing and in substandard housing conditions (Howden-Chapman et al. 2012). Cold, damp housing can increase mould, which in turn can cause respiratory symptoms (Howden-Chapman et al. 2012; Gillespie-Bennett et al. 2013). Viruses and bacteria are more likely to survive for longer periods of time in colder temperatures, leaving vulnerable individuals such as young children more susceptible to respiratory conditions (Howden-Chapman et al. 2012; Gillespie-Bennett et al. 2013). The cost of these housing-related diseases is estimated at over $141 million (Riggs et al. 2021). Specifically, housing indicator conditions including rheumatic fever and respiratory conditions such as bronchiolitis, are frequently observed through the AWHI programme in children living in cold housing in the Counties Manukau Area, and most participants in this study (78%) were referred to the AWHI programme with a respiratory health concern. This indicates that the cold temperatures of the homes are likely impacting the health outcomes of these whānau.

Noting that a key determinant for many illnesses across the country is housing quality, Aotearoa NZ has set standards for homes in the Residential Tenancies (Healthy Homes Standards) Regulations 2019. However, the Healthy Housing Standards have not reached compliance phase at this stage. Support needs to include whānau level support with tenant rights, regulation and enforcement of housing standards for rentals and public housing, support with rising housing costs, incentives for long-term tenancies and support for home ownership, as well as support at a more systemic level, with pro-equity tools, redesign of communities and consents, and indigenous ways of doing (Johnson et al. 2018). The disparity and inequities in housing across Aotearoa NZ continue to stem from the colonisation of Aotearoa NZ including land confiscations and urbanisation which have led to Māori whānau living in private rentals and public housing. Support may look at creation of housing projects utilising Māori design to support communal living, allowing for multi-generational living and flexible homes which can expand or contract to accommodate changing family size and dynamics. This could allow for multi-generational wealth creation through home ownership and shared housing costs across whānau, as well as facilitating collective social dynamics (Howden-Chapman and Wilson 1999). These traditional methods of design are just one way housing could be structured to impact the health of the home and its occupants. Repeated housing projects across Aotearoa NZ show the value in design for culture and flexible living conditions to meet the needs of whānau (Ware 2013). Many wānanga (meetings/forums) have highlighted community-driven solutions including the idea that houses are not just thermal comfort measures but places with memories and emotions which meet spiritual needs (Boulton et al. 2022). Homes are more than mere physical structures, but homes are too often only spoken of in a physical sense in the literature on housing health. Newly built homes need to meet the emotional, spatial and thermal needs of whānau as well as meet building standards to ensure homes are fit for purpose, hence the recognition of the need to utilise indigenous designs.

We also recognise that solutions are not easily actioned outside of research when political (local and national), economic and health policies are at odds with each other (Larcombe et al. 2020). Government and health leaders acknowledge the link between cold housing and poor health outcomes, but little regulation has been implemented to date through policy. The government continues to offer support through subsidies, funds and healthy housing initiatives but homes are still deficient (Howden-Chapman et al. 2012). Pre-existing and older homes are exempt from many of the policies that have been implemented to encourage warmer housing, including the 1996 standard for insulation, and retrofitting is not working for whānau at this stage (Kelly et al. 2013). Consistent political, economic and research efforts at a national and local level will impact and support housing health in the long term, but only if all these groups are in alignment.

While there have been considerable efforts to improve housing quality and population health through government initiatives such as AWHI, this study has shown no home heating improvements for the population at large. Targeted support like the HHIs in areas where Māori and Pacific families reside and where there are also notable health outcomes that are linked to poor housing could be a key solution when implemented alongside other regulations. Whānau are likely to be supported further by the Residential Tenancies (Healthy Homes Standards) Regulations 2019, however at the time of this study, the Healthy Housing Standards had not reached compliance phase (Tenancy Services 2022). Private rental properties have until 01 July 2025 to be compliant with the standards, while public rental properties have until 01 July 2024 (Tenancy Services 2022). Further research needs to be done after these compliance dates for both private and public housing to determine the impact of recommended interventions from the Healthy Homes Standards. This study was unable to look at how healthy homes interventions such as insulation present in the home impacted the temperature or ability to protect against the cold. It was also unable to analyse other factors contributing to temperature in the home, such as energy affordability. These limitations should be considered in future research along with the complexity of how these factors contribute to the health of a home.

Both solutions to housing and solutions for whānau will be needed to counteract the long-term inequities seen across Aotearoa NZ for Māori and Pacific whānau. Housing targeted solutions created through central government like HHIs (including AWHI) and stricter standards and regulations are a key action to encourage more healthy and warm homes (Howden-Chapman et al. 2017). These improvements need to be supported by developers and those in the housing industry, who can bring healthier housing from planning into construction (Howden-Chapman et al. 2017). Local government can then offer support for warmer and healthier homes through infrastructure provision, utility management and enforcement of standards (Howden-Chapman et al. 2017). The health and education sectors can continue to support the assessment and communication of health risks associated with housing in order to support whānau education and behaviour change. Action is needed at the public and private levels and at national and regional levels to support healthier homes, and whānau cannot be expected to do it alone.

Disclosure statement

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

Data availability statement

Research data are not shared.

Additional information

Funding

This project was funded $40,000.00 by the New Zealand Ministry of Health.