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23/144 Healthy homes

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Published: 07 November 2023

Version: 1.0 October 2023

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Research question(s)

  • What are the health and health inequality impacts of interventions affecting the physical quality of UK housing?

Housing is an important determinant of health. There is extensive evidence to show that good quality housing protects individual health and supports communities to be healthy and resilient. As well as the physical and mental health benefits for individuals, families, and communities, good quality housing has the potential to bring wider societal benefits such as:

  • savings in energy and carbon emissions
  • a reduction in the use of emergency services and health and social care service costs
  • increased social capital
  • local job opportunities

Contrastingly, poor quality housing can have a negative impact on physical and mental health, causing or exacerbating conditions such as respiratory disease, depression and anxiety.

The UK has the oldest and most inefficient housing stock in Europe. Over 4 million homes do not meet basic standards of decency, with the majority of these homes in the private rented and owner occupied sectors. Work carried out by The Health Foundation has found that one third of households had at least one major housing problem relating to either:

  • poor quality
  • overcrowding
  • affordability

Older people and children are at particular risk from homes with damp and mould. In 2023, the Regulator of Social Housing found that a substantial number of homes in this sector (approximately up to 6% of four million homes) have damp and mould problems. A report by the Housing Ombudsman urged landlords to take responsibility for damp and mouldy homes rather than shifting the blame onto the lifestyles of tenants and their families. A 30 year cost-benefit analysis by the Building Research Establishment highlights the potential health impact of ignoring poor quality homes.

Evidence shows that there are inequalities in exposure to indoor air pollution and people living in constrained socio-economic circumstances are at greater risk of exposure. The CMO’s 2022 annual report highlights the need for more research on indoor air pollution.

Rising fuel and energy costs have drawn attention to the link between cold homes and health. Addressing energy inefficiencies in the home has the potential to:

  • improve health
  • reduce health inequalities
  • mitigate climate change risks

However, the cost of living crisis could be causing delays in improvements as net zero retrofit costs become unmanageable for home owners, including landlords. Where retrofitting occurs, it may exacerbate health inequalities, and potentially lead to unintended consequences. Local authorities can sometimes face barriers delivering net zero, including fragmented funding models.

The Public Health Research (PHR) Programme is interested in applications to evaluate the effectiveness of strategies to reduce the negative health impacts of poor quality housing. This call is intended to cover the evaluation of interventions to improve the physical features of homes. Researchers who are considering submitting an application evaluating a housing intervention not covered by this brief, should apply through the PHR researcher-led workstream.

The PHR Programme is predominantly interested in the evaluation of interventions operating at a population or sub-population level rather than at an individual level, which should address health inequalities and the wider determinants of health. We recognise that interventions are likely to impact different (sub)populations in different ways, and encourage researchers to explore such inequalities of impact in their study design.

Of particular importance to the PHR Programme is an understanding of inequalities in the impact of interventions on people from ethnic minority backgrounds in the UK. Evaluations of interventions seeking to reduce health inequalities experienced by people from ethnic minority backgrounds are also of specific interest.

This call recognises that housing interventions impacting health can act at a variety of levels, and in different ways. For example, interventions might:

  • target different phases of development (e.g., housing design or provision)
  • operate at various scales (e.g., individual homes, communal spaces, neighbourhoods)
  • have different areas of focus (e.g., address environmental, social, economic, or governance issues)
  • target specific population groups

Taking this into account, research areas of interest could include but are not limited to the following topics. 

Physical quality

Research on the health impacts of interventions in the private and social rented sector to improve housing quality such as:

  • interventions impacting on:
    • damp
    • mould
    • ventilation
    • noise
    • privacy
    • safety
    • access to light.
  • interventions to increase access to or improve housing-related services such as maintenance and repairs
  • interventions to support or expand access to outside, green or blue spaces
  • interventions to enhance a sense of home
  • research on the health impacts of policies that encourage or support home owners to improve the quality and/or energy efficiency of their homes
  • evaluations of the unintended consequences of improvements made to the physical quality of homes, for example, financial costs being passed on to tenants

Climate change, air quality and temperature

This includes:

  • studies focused on the health impacts of housing interventions aimed at achieving net zero
  • research on the health impacts of climate change-related interventions targeted at poor quality housing/populations in greatest need
  • evaluations of housing interventions that aim to impact on temperature-related ill-health and mortality rates such as:
    • insulation interventions that are targeted at people across the spectrum of fuel poverty
    • interventions to improve winter energy efficiency
    • interventions focused on mitigating the impact of extreme heat events
  • evaluations of interventions which impact indoor air pollution, including domestic gas usage
  • research on Department for Levelling Up, Housing and Communities (DLUHC) climate change, net zero and housing priorities that are within remit for the PHR Programme

Population and neighbourhood

This includes:

  • research on neighbourhood-level interventions aimed at empowering communities in the resolution of housing quality issues with landlords
  • evaluations of neighbourhood and housing designs which impact on the demographic mix of a community, for example, lifetime homes and co-housing initiatives
  • research that focuses on the mental health impacts of poor quality housing
  • research that focuses on under researched population groups and/or groups where the literature identifies that more research is needed, such as:
    • older people
    • people with health conditions or impairments
    • people who need homes which are accessible for their individual circumstances
    • people living on low incomes
    • LGBTQ+ people
    • people with no recourse to public funds
  • evaluations focused on the quality of housing in high density neighbourhoods

The PHR Programme recognises that this call is broad and expects researchers to be targeted in their research. As part of their application, and with relevance to their own study, researchers need to clearly identify the gaps in the existing evidence base and how their study could improve decision making.

Study designs

A range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of outcomes, and target population group, as well as the rationale for their methodological approach. Researchers will need to specify how outcomes will be measured in the short, medium and long term. The PHR Programme typically requires primary outcomes to be direct health outcomes. However, for this commissioned call, we will accept proxy measures for health, for example, a decrease in indoor air pollution. Such outcome measures need to be appropriately defined and the link to health must be clearly justified.

Providing value to the economy and community

Understanding the value of public health interventions - whether the outcomes justify their use of resources - is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.

Researchers are strongly encouraged to ensure that there is involvement from people with lived experience and other relevant key stakeholders in the design of the intervention and the evaluation. Researchers can do this by involving them as costed members of the research team. Researchers are encouraged to explain how they will share their findings with local and regional governments, social housing providers, special interest, private sector rental and third sector housing organisations, community audiences and other relevant stakeholders.

Further information

For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information.