Good Housing Leads To Good Health - Chartered Institute Of .
Good Housing Leads To Good HealthA toolkit for environmental health practitionersSeptember 2008
AcknowledgementsGood Housing Leads To Good Health: Atoolkit for environmental health practitionersis published by the Chartered Institute ofEnvironmental Health (CIEH), ChadwickCourt, 15 Hatfields, London SE1 8DJ, UK.Tel: 44 (0)20 7928 6006.Website: www.cieh.orgThe toolkit provides the methodology andcase studies to help environmental healthpractitioners indicate the links betweenprivate sector housing and public health.The CIEH would like to express its gratitudeto Viv Mason at the Building ResearchEstablishment, who was commissioned toproduce the report, and to all members ofthe steering group.Steering group membersDr Stephen BattersbyConsultant, CIEH PresidentJohn BrysonConsultant, CIEH TrusteeAndrea BuseSouthampton City CouncilAndrew GriffithsCIEH Acting Director of PolicyRobin KennedyDover District CouncilViv MasonBuilding Research EstablishmentPaul MishkinLondon Borough of Islington
Contents1.01.11.2IntroductionWhy is a toolkit necessary?Using this toolkit0404052.0Wider health determinants073.03.13.23.33.4The mechanismsHealth Impact Assessment (HIA)Local Area Agreements (LAAs)Departmental Strategic Objectives (DSOs)Home Improvement Agenciesand handyperson schemes080809109.09.19.24.05.0Quantitative methodologyto show health impactUsing the Housing Health andSafety Rating System (HHSRS)20Health@Home: Warrington BoroughCouncil20Safe and Warm Housing ImprovementProject: Merseyside Health Action Zone219.3Health through Warmth: Walsall Council 239.4The impact of housing on health:Stockport Metropolitan Borough Council 269.5Health Impact Assessment: North WestLeicestershire’s Private Sector RenewalStrategy279.6Leeds Landlord Accreditation Scheme:Leeds City Council28Pimhole Clearance Area: BuryMetropolitan Borough Council29Health Housing Service: NottinghamEnergy Partnership31Broadening Choices for Older People(BCOP): A handyperson service inBirmingham321112149.76.06.16.2Cost comparisonOther costsSummarising hazards, health and cost7.0Health Impact Assessment– Questionnaires17171718Useful websites199.89.98.0Case studies – Measuring healthimpact to show qualitative effectsof intervention9.10Entry by Intruders – Demonstrating thetrue local picture: Bristol City Council339.11Overcrowding: Islington Borough Council 3510.010.1AppendicesAppendix 1: Evidence linking housingand healthAppendix 2: Showing links with costsAppendix 3: The strategic context10.210.338384142
1.0 IntroductionThe number of people living in Decent Homeshas been recognised as being not just of benefitto the occupiers but also to the wider communityand to societyThe Building Research Establishment (BRE)Housing Centre was commissioned by theChartered Institute of Environmental Health(CIEH) to produce a toolkit to help CIEHmembers and housing managers topromote the role of private sector housingand its wider contribution to public health.The number of people living in DecentHomes has been recognised as being notjust of benefit to the occupiers but also tothe wider community and to society.Homes play the most important role inproviding occupiers with opportunities andcontribute to the World HealthOrganization’s (WHO) definition of healthas: “a complete state of physical, mentaland social well being”.The toolkit provides methodology and casestudies to help indicate the links betweenprivate sector housing and public health ata local level.There have been a number of studiesspecifically linking health and housing,together with the costs generated by poorhousing. A summary of some of these isincluded by way of background informationin Appendix 1.Research has been carried out to establishlinks between housing and public health ata local level. This involved: Researching web-based information Using in-house data where available Contacting local authorities to find evidenceof best practice and examples of locallinks between public health and housing Examining the use of local evidencewithin the Housing Health and SafetyRating System (HHSRS) Researching local health impact projectsbased around housing Carrying out interviews with third parties Reproducing relevant case studies Producing a sample tool designed tocollect local dataThe Government has allocated additionalfunds to Primary Care Trusts (PCTs) topromote public health, much of which hasrecently been shown to have been usedwithin other health budgets1.Cross discipline targets have beenintroduced by the Government whichrequire partnership working, such as LocalArea Agreements (LAAs). These agreementsprovide private sector housing sections aunique chance to grasp the opportunity toshow elected councillors and partnerorganisations how private sector housingcan make a real difference to public health.The resulting package provides evidence ofcurrent good practice and details of how togather information locally to influencestrategy and Local Area Agreements (LAAs).The project has been undertaken withguidance from a steering group.1.104Why is a toolkit necessary?The first few years of the 21st century hasseen a plethora of information, targets andnew legislation concerning private sectorhousing. Much of it is aimed at encouraginglocal authorities to meet the Government’stargets and aspirations.The CIEH Commission on Housing Renewaland Public Health2 recommends thatgovernment should consider housing renewalas a public health intervention as a specifictheme for future Beacon Council awards.1 Report of Association ofDirectors of Public Health,October 20072 Commission on HousingRenewal and Public Health:Final Report, CIEH 2007Good Housing Leads To Good Health: A toolkit for environmental health practitionersThe aim of this toolkit is to show how linksbetween homes and health can be madeand showing, where possible, the costbenefit of some specifically linked housingand health issues. Providing evidence ofcost benefit is important where resources
for improvement or enforcement action arelacking. Cost benefit is a complex issue andadditional information discussing this isprovided in Appendix 2.Local authorities are being charged withdrawing up LAAs. The information gainedby using this methodology can be linkedwith wider local priorities, maximising theimpact of improved private sector housing.Reducing health inequalities is a key targetfor government and councils. The existinglinks to Local Strategic Partnerships (LSPs),Audit Commission Key Lines of Enquiry(KLOE) and Best Value Indicators (BVIs) isprovided in Appendix 3.Private sector housing is in danger of beinglost in the Government’s new agenda ofsocial housing and new build. 85 percent ofdwellings are in the private sector and thereis an important role of advocacy for thissector within a local authorities’ strategy.The Housing Regulatory Reform (HousingAssistance England and Wales) Order 2002,commonly called the RRO, introduced anew concept in dealing with private sectorhousing.The legislation and associated guidance(Housing Renewal Guidance 6/2002) gavelocal authorities freedom to draw up theirown policies.In many councils this has reduced the levelof action in the private sector. Officers needto work harder to bring increased resourcesinto the sector to push private sectorhousing back up the agenda and reducethe widening gap between social andprivate sector housing.1.2Using this toolkitThis evidence based toolkit utilises HealthImpact Assessments (HIAs) to show theimpact of housing intervention measureson wider health benefits.What is required is a method of measuringand showing the value of private sectorhousing intervention to health, society andquality of life. This same method can also beused to show the effect of not intervening(for example the loss of independent living).The evidence is there and this toolkit aimsto help you find it. Firstly find a baseline,and work out the most effective and costefficient methods of improving homes tosell the approach as Local Area Agreement(LAA) targets. This kit is only a starting point.Step 1: Use the Housing Health andSafety Rating System (HHSRS) CostsCalculator available to download fromthe CIEH website www.cieh.org/library/Knowledge/Housing/HHSRS cost calculator.xlsThis will provide a baseline of likely numbersof incidences within local authority areas,together with the health costs and cost ofmitigating the hazard.This figure can be used as evidence of thecost and subsequently compared to thecost of improvement works.Local statistics from census data and webbased statistics can be transposed to showa cost benefit or to compare it with theexpected national average.Step 2: Additional informationUse the web links on page 19 to provideadditional information at local authority orregional level. In many cases information isprovided in graph or chart format and canGood Housing Leads To Good Health: A toolkit for environmental health practitioners05
Step 6: Documented evidencebe easily copied into reports. The healthprofile is particularly useful.Publicity, photographs and videos ofsuccess help to show the importance ofimproved homes. Projects to demonstratethis can have an important impact,especially on disassociated audiences3,bringing the issue of health inequalities toan audience who may not be listening.Step 3: Carry out a Health ImpactAssessment (HIA)HIAs are particularly valuable in bringingtogether professionals from differentdisciplines and will increasingly need toinclude community safety officers or similar.These can be used to measure the effect, orlikely effect, of enforcement action,proactive policy or proposed policy changes.Step 7: Keeping aheadNew targets and Departmental StrategicObjectives (DSOs) have now beenannounced by the Government. Furtherguidance is expected when these objectiveshave bedded in and good practice can becopied. It will be necessary to thinkholistically to show other partners the trueimpact of housing interventions. Goodpractice is often publicised. Review annually.Once the initial picture and figures havebeen built up the process will become easier.Using questionnaires are a useful start inhealth impact assessment. A list of possiblequestions is included on page 18.A number of examples of HIAs are includedas case studies, starting on page 20.Working with a Primary Care Trust (PCT) ispreferable to ensure easy access tovulnerable households.Voluntary organisations, such as AgeConcern or home improvement agenciescan be enlisted to help. Data can also bedownloaded from Regional HealthObservatories.Step 4: Involve elected membersElected members will have excellent localknowledge of their wards and may also sitas board members on other organisations,for example the PCT or Age Concern.Step 5: Local prioritiesLink the information and key issues to LAAtargets. Planned proactive work, such asadditional licensing planned to deal withovercrowding, grants to target bed blockingor working with other agencies on areaenforcement, should all link with otheragencies priorities.063 Measuring Impact:Improving the health andwellbeing of people inmid-life and beyond,National Institute Healthand Clinical Excellence 2005Good Housing Leads To Good Health: A toolkit for environmental health practitioners
2.0 Wider health determinantsThe importance of an increase in Decent Homesis linked to improved communities, reducing crime,improving employment opportunities andeducational achievementQuantifiable evidence of the health benefitsassociated with improved housing aredifficult to show, however the importanceof an increase in Decent Homes is linked toimproved communities, reducing crime,improving employment opportunities andeducational achievement4.We also need to ask how much is the costinvolved for example in moving an item ofdumped furniture or removing graffiti?Evidence from Neighbourhood RenewalAssessments (NRA) over a number of yearsshow these issues, usually included as partof the environmental assessment, areimportant to householders.These links can also be expanded to coveranti-social behaviour and vandalism.Furthermore, stress is an health issue withinmany of the hazard profiles and is linked tobullying, truancy, under performance atschool, unemployment or absence at work,etc. Many of these issues bring with themcosts of their own.Table 1Health Impact Assessments can provide astructured approach to this.The links between public health and holSuicideLonelinessand stressLack oblemsLack ofmoneyPneumoniaheart attacksDangerousstairsAccess toburglarsXcoldOvercrowdingTriphazardsDamp &mouldLack oldsAsthmaDeathBurglariesAbsencefrom altargets C02DepressionCrime disordercostsGraffitiVandalismEnvironmentalclean up costs4 ODPM 2002Good Housing Leads To Good Health: A toolkit for environmental health practitioners07
3.0 The mechanismsHealth impact can be used to help assess the effectsof improving homes (or not improving them) and tomeasure in a definable way the health determinants3.1Health Impact Assessment (HIA)Health impact can be used to help assessthe effects of improving homes (or notimproving them) and to measure in adefinable way the health determinants.contributing to improvements andreductions in health inequalities.HIAs contribute to ensuring ownership of apolicy, cross-departmental working andpartnership development by involving thecommunity and professionals.Within local authorities HIAs can be used todetermine the health impact of privatesector housing policy, bringing it into themain stream or what could be part of aLocal Area Agreement (LAAs). They can beparticularly effective in linking enforcementactivity with health. The diagram below7depicts the WHO definition of health and isincluded as it is used as the basis for HIAs.The assessment looks at health determinantsas a wider contribution to quality of life andsociety rather than just health costs. A HealthImpact Assessment [HIA] is “a combinationof procedures, methods and tools by whicha policy, program or project may be judgedas to its potential effects on the health of apopulation and the distribution of thoseeffects within the population”5.At the local level an HIA has a potentialcontribution to make to many areas ofactivity and can provide a valuable tool tosupport the work of Local StrategicPartnerships (LSP) to demonstrate and6 tosupport evidence based decision-making;Table 23.2Local Area Agreements (LAAs)Local Area Agreements (LAAs) took theplace of Best Value Indicators (BVIs) fromApril 2008.Health determinants: Key areas influencing health5 WHO European Centre forHealth Policy, GothenburgConsensus 19996 Mason V, A HolisticApproach to Housing,Environmental HealthJournal, November 20037 Scott-Samuel A, Birley Mand Arden K, The MersysideGuidelines for HealthImpact Assessment,Liverpool: MerseysideHealth Impact AssessmentSteering Group 199808Good Housing Leads To Good Health: A toolkit for environmental health practitionersDahlgren and Whitehead, 1991
Local authorities as the lead partner havebeen asked to draw up LAAs in consultationwith statutory and non-statutoryorganisations operating within their area.The aim of the agreements is to link keytargets. Private sector housing generally haslinks to many areas through the knownwider influence of Decent Homes. Theproblem within private sector housing is toaccurately show this link.LAAs were introduced by the Department ofCommunities and Local Government (DCLG)in the Strong and prosperous communitiesWhite Paper. The Government has developeda set of 198 national indicators from whichthe authority will be able to select up to35 negotiated targets, reflecting the mostimportant needs of the local community.Community and Environmental HealthManager at Daventry District Council MikeArnold said:“If services are not recognised as contributingto LAA targets then they will have a lowerpriority and this may affect funding”9.The priorities have to be negotiated withthe government office for the region andtargets set. There is an additional set of18 statutory targets. The aims of theagreements are divided into four parts:During future comprehensive areaassessments (replacing comprehensiveperformance assessments) judgements willbe made on outcomes and funds will follow.Evidence will be required to show theimportance of housing as opposed to otherservices competing for funds. Children and young people Safer and stronger communities Healthier communities and older people Economic development and enterpriseAs a comparison the table below providesevidence of the numbers of home accidentsagainst those caused at work or on theroads10. The importance of housingmessage needs to be brought to theattention of those allocating resources.Many councils are already involved inpreparing LAAs8. All councils were requiredto have these in place by March 2008 tostart work on 1 June 2008.Table 38 Office of the DeputyPrime Minister, The RewardElement of Local AreaAgreements: Negotiationof Stretched Targets,November 20059 Mike Arnold, Communityand Environmental HealthManager at Daventry DC, AVoice for Local People PublicHealth LAAs, EnvironmentalHealth Practitioner,September 2007, vol. 115/09Comparison between causes of deaths and injuries in United Kingdom and FrancePer yearUnited KingdomFranceKilled personsInjured personsKilled personsInjured personsAt work3801,500,0007001,150,000On the road3600317,0007600170,000In the home41002,700,00090003,000,00010 WHO Europe 2005Good Housing Leads To Good Health: A toolkit for environmental health practitioners09
3.3Recent guidance for DCLG has indicatedthat resources available to make morehomes decent will be favoured in localpartnerships.11 12New Local Area Agreements (LAAs) willhelp to embed housing at the heart of thearea’s priorities. They will also providefurther leverage over local authorities’housing delivery and renewed focus onareas of particular importance.Future targets are likely to require someform of measurement set by the LAA froma baseline14. The Audit Commission has saidthat they intend to concentrate onmeasuring outcome as opposed to localauthority delivery. Their intention is not tobe bound by the targets set by the LAA.Appendix 3 gives details of where and howprivate sector homes fit into the AuditCommission Key lines of Enquiry (KLOE).But with the move to outcome based DSOsand NIs, within homes there will be agreater place for data based on specificHHSRS hazards. Below are a few examplesrelating hazards with national indicators(NI) and outcome based DepartmentalStrategic objectives (DSO) or Public ServiceAgreements (PSA), which are not directlyrelated to measuring conditions in a home.The Audit Commission have been chargedwith introducing the Comprehensive AreaAssessment (CAA)13, to take the place of theComprehensive Performance Assessment(CPA). This is intended to be risk based andwill focus on the LAA targets.The CAA framework is still emerging but therisk based approach will concentrate onhow policy and practice affects theneighbourhood and community. CAA riskassessments will focus on outputs.11 reCommunity/fs/enAvailable p?id 79712 PSA Delivery Agreement20: Increase long termhousing supply andaffordability, HMGovernment, October 200713 Strong and ProsperousCommunities – the LocalGovernment White Paper,Cm 6939-I, Department ofCommunities and LocalGovernment, October 200610Departmental Strategic Objectives (DSOs)New National Indicators (NI) andDepartmental Strategic Objectives (DSOs)have been announced. LAAs will have toselect the most appropriate NIs for theirarea.PSA 12: Improve the healthand wellbeing of childrenand young peopleAn example where private sector housingmay b
Chartered Institute of Environmental Health (CIEH) to produce a toolkit to help CIEH members and housing managers to promote the role of private sector housing and its wider contribution to public health. The toolkit provides methodology and case studies to help indicate the links between private sector housing and public health at a local level.
Crisis response system recognize roles in housing advocacy and rapid connection to permanent housing. Strong referral linkages between crisis response system and permanent housing. Unified, streamlined, and user-friendly process for applying for rapid re-housing, permanent supportive housing and/or other housing interventions.
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