Research reveals how housing improvements can lead to health benefits

Warmer homes can improve the health of social housing tenants and reduce NHS service use according to health economists at Bangor University.

Working with Gentoo housing association and Nottingham City Homes, Health Economists at the University’s Centre for Health Economics & Medicines Evaluation (CHEME) evaluated the costs and outcomes associated with social housing improvements and found a link between warmer homes and improved health for social housing tenants and reduced NHS service use.

The results, published in the International Journal of Public Health, showed that retrofitting new energy efficient combi boilers and double-glazed windows has a positive impact on the health status, health service use, and fuel poverty risk of social housing tenants.

Bangor University’s Professor Rhiannon Tudor Edwards and Dr Nathan Bray provided Health Economics support from the University’s Centre for Health Economics and Medicines Evaluation to the Warm Homes for Health Project.

Professor Edwards said: “A year after receiving housing improvements from Gentoo, tenants reported improved health status, less use of outpatient and emergency NHS services, that they could heat an extra room in their home and that they felt more secure financially with respect to fuel bills”.

Dr Bray added: “This was a group of tenants with considerable ill health and financial deprivation, who experienced a number of significant benefits after receiving housing modifications to improve the warmth of their homes.”

Professor Edwards added:

“More needs to be done to ensure that everyone in the UK lives in a ‘healthy’ home which is warm and free from damp. This research could influence healthcare commissioners, councils and housing associations to work together to improve health through better housing.”

“There is a real need to improve housing in the UK: it is estimated that almost 44,000 more deaths occur during the coldest months of the year compared to the rest of the year. Chronic illnesses, such as respiratory disease, are exacerbated by cold and damp homes and contribute to these avoidable excess winter deaths.”

Using an historical cohort study design the costs and outcomes of retrofitting social housing improvements were examined. Over 470 social housing tenants from nearly 230 households in Sunderland were surveyed both before and 12 months after installation of new boilers and double glazed windows by Gentoo, at no cost to the tenants. The cohort proved to be highly socioeconomically deprived; the vast majority of households had an income of less than £15,000 per year. Recruitment was staggered to counter any effect of seasonality. On average the cost of completing the housing improvements was £3725 per household.

After the housing improvements had been installed, six month household health service use costs reduced by £95 per home, equating to a 16% reduction in household NHS costs. On average a 69% reduction in hospital outpatient appointments was observed per household, as well as a 46% reduction in accident and emergency attendance and a 10% reduction in GP visits. For this cohort of 228 homes alone it is estimated that the NHS saved over £20,000 in six months after completion of the housing improvements. It was also found that the health status of main tenants significantly increased by almost 8% and financial satisfaction increased by 7%. Additionally, small non-significant improvements to main tenant happiness, life satisfaction, anxiety and well-being were also found.

After the home improvements were completed most households were able to heat all rooms in the home, where previously most households left one room unheated due to energy costs. Furthermore, over a third of households were no longer spending 10% or more of their income on energy bills, a key indication of reduced fuel poverty.

Health and Care Research Wales have funded PhD student Eira Winrow (CHEME, Bangor University) to further investigate the impact of housing on health and NHS expenditure.

Publication date: 5 October 2017