Housing to 2040: equalities position statement

Housing to 2040 and health

We recognise that housing and health outcomes are inextricably linked. Whilst undertaking a full Health Inequalities Impact Assessment (HIIA)[i] is not a legal requirement, we have engaged with Public Health Scotland to ensure that health and health inequalities dimensions are considered as part of the development of the Housing to 2040 route map and to provide important evidence to support ongoing policy development. This section sets out key sources of evidence which describe the fundamental relationship between housing, health and wellbeing.

The right to an adequate standard of housing is inextricably linked to the right to the highest attainable standard of health.[ii] The right to health is a shared and inclusive right and good quality, sustainable housing is key to fulfilling this shared right for individuals, families and communities. Scotland is facing considerable health and wellbeing challenges including our relatively poor life expectancy, health inequalities, the impact of COVID-19 and climate change.[iii] It is clear that the current COVID-19 pandemic has underlined, more than ever, the importance of warm, safe and affordable housing in protecting and improving health.

Public Health Priorities for Scotland[iv], jointly published by the Scottish Government and COSLA in 2018, places good quality, accessible and affordable housing as one of the key factors for progressing these priorities. The Housing to 2040 route map recognises that good affordable homes in positive neighbourhoods lead to reduced poverty and inequality, better health outcomes, improved educational attainment and more cohesive communities. It sets out actions that will benefit people’s health and wellbeing, through improving access to affordable housing choices, tackling homelessness, driving up housing quality, supporting independent living and enabling the creation of quality greenspace. As the route map is taken forward, these considerations will continue to inform and shape our work.

7.1      The pathways of influence on health

Estimates vary, but it is widely accepted that health is largely shaped by factors beyond access to health care.[v] Housing, employment, education and income all influence health.[vi]

There is a wealth of evidence that demonstrates the association between homelessness, poor housing conditions, overcrowding and insecure tenure with significantly negative impacts on health and wellbeing.[vii],[viii],[ix] The indirect impacts of housing on health and wellbeing are more complex.[x] For example, high housing costs can reduce household’s access to other health-promoting factors such as nutritious food or leisure activities and the availability of affordable housing in a particular area can constrain or facilitate access to good work.[xi]

Poor housing conditions and overcrowding have made it harder for people to shield and self-isolate during the COVID-19 pandemic, whilst people living in larger homes with access to the outdoors have been able to adapt to living, working, learning and playing at home more easily.[xii],[xiii]

The following pathways set out how housing can affect health and how good quality housing can be a preventative measure for poor health outcomes.

7.1.1   Living conditions

There is a longstanding body of evidence describing the link between cold and damp homes with higher mortality rates and cold-related ill health, particularly for vulnerable groups.[xiv] Low income households are more likely to be impacted with a number of causal factors such as stress and anxiety due to worrying about bills/debt, choices being made between heating and eating, and behaviour such as only heating part of a home, leading to stress and isolation.[xv],[xvi] Cold-related mortality is likely to remain the largest weather-related driver of mortality in Scotland into the 2050s without further action to reduce fuel poverty.[xvii]

Overcrowding can reduce privacy, limit space for children and can cause stress and anxiety.[xviii] There is also evidence that shows overcrowding increases the spread of respiratory conditions[xix] and increased risk of childhood infection and asthma.[xx]

The design of homes including size and accessibility is important for our health and wellbeing too. For example, space for wheelchairs, design to enable adaptability and space to play, work and learn all contribute to improved health and wellbeing. The need for specialist and adapted housing will increase as Scotland’s population ages and people are living independently or looked after for longer at home.[xxi] Increasing use of technology and digital service delivery is also important.[xxii] Direct impacts on health can also be through exposure to hazards such as toxins in paints, unsafe electrical fittings and allergens.[xxiii]

7.1.2   Household costs, income and economics

For the majority of people in Scotland, housing costs are a major factor in determining not only the degree of control over where they live and the quality of the home that they can afford, but also the amount of money that they have available to support their health and wellbeing after paying for housing costs. Housing costs are influenced by a complex range of factors such as rent and mortgage costs, fuel costs, location, household size and household composition.[xxiv]

Income, welfare reform, unemployment and precarious employment all contribute to people struggling to find affordable, secure housing to meet their needs.[xxv] Income and poverty are key determinants of health and policies that affect income have the potential to influence housing security, healthy life expectancy and health inequalities in Scotland.[xxvi]  Models of financial inclusion, often provided by social landlords, can facilitate access to appropriate financial services or products through income maximisation, money and debt advice and service provision around banking, insurance and affordable credit.[xxvii],[xxviii]

7.1.3   Housing satisfaction

Choice and control of our housing options can have a significant influence on health and wellbeing. Housing Options[xxix] as an approach has long been adopted in Scotland, based on principles of early intervention and preventing homelessness. Principles of the right to housing, value based support and choice are key to ensuring sustainable housing solutions.[xxx]

The social, psychological and cultural value of housing is well recognised with tenure, security, empowerment and social capital associated with a sense of stability and satisfaction.[xxxi],[xxxii] Conversely, private rented sector tenants are more likely to be at risk of eviction[xxxiii], to experience high housing costs and live in poorer conditions.[xxxiv] Frequent house moves are associated with poorer health outcomes, particularly for those who rent.[xxxv]

The Living Home Standard[xxxvi], developed by Shelter Scotland, builds on public research which identified key themes of affordability, decent conditions, space, stability and neighbourhoods as being the attributes that makes housing acceptable.  Satisfaction with housing in Scotland is generally high (90% reporting ‘very’ or ‘fairly’ satisfied) however people living in the most deprived areas of Scotland experience lower levels of housing satisfaction (84%).[xxxvii]

7.2      Housing to 2040 and its contribution to Health outcomes

Specific elements of the route map which will make a significant contribution towards health outcomes include:

• A continued focus on delivery of affordable homes
• Work to improve the quality of affordable homes with provision for outdoor space and space for home work and learning
• Bespoke pathways to prevent homelessness and address it when it does occur
• Work to improve affordability and choices in the rented sector
• A new tenure-neutral Housing Standard
• A new Scottish Accessible Homes Standard
• Work to improve the adaptations system
• Work at national and local levels to embed a person centred approach, that aligns housing support with social care services, so people have choices and flexibility to live independently
• Investment in energy efficiency

In addition to the above, the National Planning Framework 4 (NPF4) will support access to blue and green space through adopting an infrastructure-first approach to neighbourhood planning.