Creating healthy homes fit for future generations

The link between poor housing conditions and poor health outcomes is well established globally. In England, the Nuisances Removal and Disease Prevention Act 1846 is attributed with starting the process of defining unfit living accommodation by setting out procedures for the removal of ‘nuisances’ to curb cholera spread. Further public health acts followed in 1848, 1872 and 1875 to establish sanitary authorities and required new housing to have proper drainage and running water. Housing is an important component of the 2030 Agenda for Sustainable Development and an essential driver for achieving many of the Sustainable Development Goals (SDGs) (United Nations, 2015). Adequate and affordable housing leads to benefits in health, education and economic opportunities. The process of housing improvement is often a ladder out of poverty for vulnerable families. These changes benefit the larger community, reducing inequality and building resilience against economic and natural disasters.

Everyone has the right to a warm, secure and decent home and to be treated with dignity and fairness. Yet, as of 2024, the stark reality is that there is a global crisis of inadequate housing, considered a multifactorial epidemic, impacted by population growth and migration, rapid urbanization, economic restructuring, natural disasters and wars. In England, a high-income country, many people are living in a home with damp and mould, putting their health at risk – highlighted in England when 2-year-old Awaab Ishak died from a severe respiratory infection caused by prolonged exposure to damp and mould in his home. Estimates of the number of homes in England alone with damp and mould range from 4% to 27% of homes, or 962,000 to 6.5 million households. The UK’s housing crisis reflects decades of failure to take the long-term action required to ensure the nation’s housing stock is affordable, high quality and secure. Almost a fifth (19%) of families now live in the private rented sector, of which 36% are families with children. The long-awaited Renters (Reform) Bill presents an opportunity to begin to ensure tenancy conditions support healthy homes.

Housing conditions can impact physical and mental health in various ways. The independent Marmot Review (2010) (Health Equity in England: The Marmot Review 10 Years on, n.d.) stated that housing is a ‘social determinant of health’, meaning it can affect physical and mental health inequalities throughout life. The Marmot Review 10 Years On – Health Equity in England recorded an expansion in research on the relationship between poor housing and health. The impact of poor housing goes wider than the actual inhabitants as conditions incubated in unhealthy housing may spread, with costs ultimately borne by health and social care services. The Building Research Establishment (Bregroup.com, n.d.) estimates the cost to the NHS of treating those affected by poor housing as £1.4bn per year. The most costly issue to the NHS relates to excess cold. Across all tenures, there are still 3.7 million households in England classed as ‘non-decent’, causing avoidable ill health and inequalities.

The Decent Homes Standard was set almost two decades ago and is currently being reviewed by the Department for Levelling Up, Housing and Communities. The review has the challenge of updating the criteria to ensure it meets modern standards and protects against future risks and harms to the public’s health. However, housing issues linked to poor health do not affect the population equally. Lower-income and vulnerable households are more likely to live in non-decent, overcrowded properties and are more likely to experience a higher housing cost burden, all of which negatively affect health. Those households facing multiple housing problems are mostly in social and private rented homes. These two types of tenure are the only ones to experience all three problems of non-decent, overcrowded and unaffordable housing (Moving to Healthy Homes, n.d).

The current government aspires to reduce non-decent housing by 50% by 2030. It has now brought forward plans to apply the Decent Homes Standard to the private rented sector in the Renters (Reform) Bill. Private housing is largely unregulated. The new Renters (Reform) Bill aims to address this; however, it currently does not apply Awaab’s Law to the private rented sector which would force faster action to fix housing quality problems in that sector. It proposes creating the first national register of landlords via a new national property portal. This will assist councils with the enforcement of standards and should allow renters to check whether a property meets basic requirements.

In England today, we are in an enforced time warp with last century’s standards and a continuation of historic affordability and insecurity issues. These housing problems affect health, widen inequalities and lead to avoidable tragedies. These impacts also create preventable costs to the health and care system through avoidable illness and lengthy hospital admissions. These outdated standards are becoming more transparent as more contemporary challenges emerge that are multiple crises converging in time and place such as climate change, COVID-19 pandemic and the cost-of-living crisis that further exacerbate existing health inequalities across and within population groups.

A redoubling of political priority and efforts on better housing standards can help reduce the risk to health of poor quality housing; however, such measures on their own will not be enough to enable healthy homes. There is a need for supportive national policy mechanisms to ensure standards are met, enforcement and consistent improvements across all types of housing tenure. Given the scale of investment needed, homeowners and landlords will require support to upgrade properties. Tax incentives, subsidised green loans, ‘warm rents’ and increased ‘decent housing benefit’ rates to pay for improved quality could all be considered.

National policymakers should galvanise all stakeholders in this rebuilding effort, including creating the environment for an updated set of housing standards for the next few decades. Committing to improving the Decent Homes Standard and applying it to the private rented sector as part of the Renters (Reform) Bill are key initial steps in the path ahead. Without concerted action to create healthy homes fit for future generations, we risk not only our health but also the economic prosperity and future sustainability of our health and care services within the context of a rapidly ageing population. Failure to act will not only cost countless lives but place in jeopardy our prospects of an economic revival and hopes of levelling up communities across the UK.