Evidence update

The drastic increases in energy bills are forcing everyone from politicians to housing providers to think about the efficiency of our housing stock. It doesn’t make for pretty reading: our stock is old, much hasn’t been insulated to modern standards, and gas boilers are still being fitted to new homes.

The links between the state of our housing stock and the health of the people who live in those homes are also in the spotlight. In this issue Annika Hjelmskog from the University of Glasgow calls for retrofit energy and insulation programmes targeted at those with the lowest incomes – who are likely to be living in poor quality housing, especially in the private rented sector.

And staying with Glasgow, large scale populationbased research traces the multiple health disadvantage for people who are homeless and who also experience prison, drug addiction or psychosis. The risk of an early death is far greater among these groups than in the general population.

Turning to the related issue of climate change, California has seen huge damage from wildfires in recent years. Now research identifies house building in the areas of greatest fire risk as a key problem. The new construction both increases the risk that people will ignite fires, and also makes it more difficult to achieve the natural low-intensity fire that has historically reduced the risk of out-of-control spread.

Part of California’s problem is the pressure to create more housing that would be affordable. This is also the case in Italy. Here, researchers found that social housing funded in part by government did not always achieve the results intended. The housing should offer ‘affordable’ rents at below market rates but in practice the housing in some areas cost more than market levels.

In Taiwan, housing pressures also led to a big increase in the creation of social housing. The island’s programme is only a decade old, and interesting initiatives are underway to increase the community building and tenant participation aspects of the new housing schemes. Researchers looked at how lessons from Japan and the USA can be brought to bear in facilitating local initiatives.

And finally, we have our regular roundup of newly published research by HQN Associate Emma Lindley.

Janis Bright Editor, Evidence

Housing retrofit is an essential public health intervention, writes Annika Hjelmskog from the University of Glasgow. We cannot meet our climate change targets without decarbonising our housing stock, and the CCC has repeatedly identified large gaps in existing policy efforts. This urgent priority creates an opportunity to reduce the health harms associated with fuel poverty and inefficient housing.

These health harms are not felt equally, however, and the impacts of spiralling energy costs will be felt disproportionately by both those who live in poorly-insulated housing, as well as those with low incomes. As we witness a perfect storm of injustice for poor households, these intersecting crises create an opportunity for policymakers to address health inequalities, energy poverty and climate breakdown through holistic retrofit action in the right places.

We have good evidence on what causes health inequalities. To reduce them, we need to focus on the unequal social conditions that drive unequal health outcomes, with an emphasis of support for people who are most disadvantaged. This ‘proportionate universalism’ means resourcing and delivering universal services at a scale and intensity proportionate to the degree of need.

Our existing efforts are falling short, and much retrofit assistance is only on offer to the owners of homes (owner-occupiers and landlords). Yet the largely unregulated private rented sector (particularly at the lower end) is home to the highest proportion of fuel poor households. Social landlords/registered providers have been able to apply for retrofit funding, but this has typically been on a competitive basis (such as the Sustainable Warmth competition, now closed).

Other attempts to boost or accelerate energy efficiency measures in homes have been either extremely short lived or scrapped before they could achieve their goals. Installation of insulation in lofts and cavity walls has plummeted since 2012, when grant support for households via the Green Deal was scrapped under Prime Minister David Cameron. Similarly, the Green Homes Grant scheme in England was only open 2020-2021 and was described as a “slam dunk fail”.

The short-term, reactive response to entrenched issues is the antithesis to a public health approach, which would argue that prevention is better than cure. As with recent ‘sticking plaster’ responses to the rising energy prices, offering one-off emergency vouchers or loans can deal with neither the root causes of the issue (neoliberal energy markets, poverty and inequality) nor the long-term problems that make these worse (historically poor housing quality, old housing stock).

Actions needed

For housing retrofit to take a health equity approach, it needs to be implemented with the following principles in mind:

• Proportionate universality: benefits of retrofit need to be available to everyone, but with targeted additional support to those who need it the most. Support should not be allocated competitively, which creates winners and losers

• Ease of access: a unified service/single point of contact is needed to reduce the fragmentation of services and the amount of effort and agency required. Our current system requires time, energy and different forms of capital, which disadvantages particular groups

• Empowerment: delivery is needed at all levels, and local authorities and community organisations are essential players in this, but they need national support to enable and equip (including with finance) them to fulfil their role

• Affordability: current measures don’t support households living in the private rented sector, even those on low incomes, whose landlords aren’t prepared to make a significant contribution to the costs of the improvements. Better use of means testing and progressive funding, combined with universal obligations for property owners to meet insulation standards could address some of this gap

• Holistic/joined-up thinking: this policy issue needs to be understood in terms of the wider system it sits within – it won’t be enough to simply retrofit the homes of those who can afford it, and we could lose the opportunity of creating co-benefits (such as the green, sustainable, good quality jobs needed for a Just Transition) that are also vital components for ‘levelling up’ health.

We need to insulate as many homes as possible, quickly – but huge escalations in fuel poor households (and more to come in October) makes it essential to target this activity at the households with the lowest incomes and least efficient homes first. Through housing retrofit we can improve the wellbeing of our population while stopping our depletion of nature’s resources, if we just take care to embed justice for both public and planetary health.

The grim links between poor health and homelessness are brought into the spotlight once again, in a study from Glasgow.

Researchers writing in The Lancet tracked the links between an early death and people experiencing homelessness, drug addiction, prison and psychosis. Gathering data from more than half a million Glasgow residents over a five-year span, they found that premature death was much more likely among people experiencing both homelessness and several of the other indicators than those who experienced only one. And experiencing any of the indicators was also more likely to lead to premature death than among people who experience none.

The most significant finding was that most of the causes of premature death were either preventable or treatable. In other words, many of the deaths could be avoided with timely and appropriate interventions.

Of the population studied, 2.4% made a homelessness application, 1.4% received opiate substitute therapy, 2% either went to prison or had a court report in the absence of prison, and under 1% were recorded as experiencing psychosis.

The study found that people who experienced homelessness alone (not any of the other indicators) accounted for almost 2% of the Glasgow population yet had a 2·4 times greater risk of premature death than those who didn’t. The combination of homelessness, opioid dependence and involvement in the justice system was particularly high risk for early mortality.

The authors say the findings could help identify groups particularly at risk. They also call for more attention on preventing and treating non-communicable illnesses among these groups. Current policy tends to focus on communicable diseases.

The authors suggest that current public health and health care provision is “failing to benefit many of those with the experiences of interest, creating unjust inequalities in risk of death”.

They add: “These findings suggest the need for wideranging policy and service efforts across the population to prevent these experiences and mitigate associated poor health outcomes.”

Premature mortality in people affected by cooccurring homelessness, justice involvement, opioid dependence, and psychosis: a retrospective cohort study using linked administrative data Emily J Tweed, Alastair H Leyland, David Morrison, S Vittal Katikireddi https://bit.ly/3pnUJoc

How can the need for new homes be met in areas that are at risk of wildfire? That’s the question posed by researchers from California, USA, which has seen devastating fires in recent years.

California is increasingly experiencing extreme weather, including wildfires – and the pace at which the wildfires have ignited has dramatically risen in the last two decades. Since 2017 alone, several thousand homes have been lost to wildfires and dozens of residents have been killed. In addition, the smoke from the fires is causing widespread air pollution.

While climate change is undoubtedly contributing to the increased wildfire incidence, researchers have also identified building in the ‘wildland-urban interface’ (WUI) as a critical factor. These are areas of high fire risk, and once homes have been built there it also makes it more difficult to generate low-intensity fire that’s historically a means of avoiding catastrophic wildfire.

The researchers looked at the use of the California Environmental Quality Act (CEQA), by which local authorities can mitigate developments in high fire risk areas having carried out risk assessment. In theory local authorities have considerable power to limit development but in practice they’re under pressure because of severe housing shortages and lack of affordability.

Using risk assessment

The researchers studied three counties in California that have approved new developments in high or very high fire hazard areas. They found that in San Diego before 2018 the CEQA was little used in decisions on WUI development and that most development was in these areas. More recently it’s been implemented in somewhat reducing development in those areas. By contrast, only a small percentage of Los Angeles development was allowed in high hazard areas.

Interviewees in the study pointed to developers’ preference for sprawl, as building on former agricultural land was cheaper and more attractive to them.

More recently San Diego has somewhat reduced development in higher risk areas – but two thirds of all new units were still in these areas. Nevertheless, the schemes did undergo more stringent environmental review via the CEQA.

The researchers found that generally the fire risk assessment looked at schemes individually, not landscape-wide. Thus, the focus was on making the buildings and surroundings more resilient. Similarly, the fire protection plan tended to focus on whether the building was safer, had sprinklers, etc, and whether residents could evacuate easily.

There was little or no consideration of whether a development would increase the risk of fire in the area, the researchers said.

Several legal cases are underway alleging inadequate review via CEQA and challenging particular housing developments. The researchers suggest that a way forward to meet housing demand without increasing fire risk will be to concentrate on infill building on already developed land. They speculate that state government will have to intervene more in the planning and development process, and that regional planning and analysis for fire hazard will be needed.

Building to Burn? Permitting Exurban Housing Development in High Fire Hazard Zones Eric Biber & Moira O’Neill https://bit.ly/3C5swdi

A study from Italy has questioned how the country’s affordable rents policy is working in practice.

Italy part-funds construction of new affordable housing for people on lower incomes. This housing is termed ‘social housing’ although it isn’t intended for people in the greatest need and poverty. Instead it’s created for people in an intermediate situation who can afford modest rents but not full market prices.

The rent for the affordable housing is set relative to a benchmark in each locality. The benchmark rent is agreed between national landlords and tenants’ associations in a process promoted by local authorities and regulated by government. They decide what is an acceptable benchmark rent within each of a number of zones for each city. Type and condition of the housing is taken into account. The rents should therefore reflect local conditions. Landlords who agree to set their rents according to the benchmark receive tax breaks. However, not all providers are part of the system.

The researchers noted that the great majority of social housing schemes and most of the funding has gone to northern and central Italy, with few schemes in the south. They chose two examples: Milan in the more prosperous north, and Bari in the economically disadvantaged south.

They found that in Bari the systems worked as planned and affordable rents remained relatively low. In contrast, ‘affordable’ rents in Milan often ended up being higher than market rents. The Milan schemes therefore were “failing to meet the primary goal of the law” to create affordable homes.

The researchers conclude: “The use of the agreed rents as benchmark rents for social housing causes inefficiencies and spatial inequalities.”

Social Housing and Affordable Rent: The Effectiveness of Legal Thresholds of Rents in Two Italian Metropolitan Cities Grazia Napoli, Maria Rosa Trovato and Simona Barbaro https://bit.ly/3PtcSvp

A fascinating study from Taiwan considers the island’s very new social housing policies, and how community building can be enhanced.

Researchers outline the approach to Taiwan’s social housing, almost all of which has been built in the last decade. The programme is government-driven, with local authorities doing the construction and contracting the management to outside firms. Though influenced by social housing in the Netherlands, the approach is ‘hardware’ first, they say – the focus is on getting the housing built and the tenants living there.

But more recently there has been a ‘flurry’ of experimentation with a more placeshaping-led approach, where residents are encouraged to become active and participate in the management of their housing.

The local community-driven ideas stemmed from a longstanding approach in Japan, and also from community activism mainly by ethnic minority groups in the USA. A Youth Innovation in Social Housing (YISH) programme was chosen as the vehicle to promote the new approaches.

Throughout, the idea was to foster actions that promote social inclusion. This stands in contrast to the more widespread ‘conditionality’ approach where residents are given responsibilities as a condition of being allocated a home. Here, YISH residents were chosen for the new housing on the basis of their proposals for community projects.

Three types of stakeholders were recruited to support the community placeshaping initiative. The first were initiators, who chose potential YISH teams and worked to develop the landlord and tenant relationship. This began at the planning stage of developments.

Next came the facilitators – planning specialists who worked with potential residents to decide how the YISH initiative would function locally and carry through the development plans. And, finally, there were the placemakers – actually residents whose role was to set up and encourage interest-based clubs, special services for vulnerable or older people, social media channels and so on, in line with the proposals they had made. The aim was for residents to take an active role in shaping their neighbourhood and what happened in it.

The researchers conclude that a placeshaping approach can strongly mitigate the potential problems of a fast-paced social housing construction programme that’s ‘hardware led’. The new approach promotes social inclusion and can help to overcome the stigma associated with social housing, they find.

Beyond Conditionality: Community Placemaking in Taiwanese Social Housing Management Hsinko Cinco Yu, Tsai-Hung Lin & Marcin Dabrowski https://bit.ly/3dmhZjt

Evidence newsletter editor: Dr Janis Bright

www.hqnetwork.co.uk

Email: evidence@hqnetwork.co.uk

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