HEALTH & HOUSING
Poor Health and poor housing are inextricably linked. Critically evaluate this statement in relation to both 19th and 21st century housing
Most researchers would agree that during the 19th Century housing and health were inextricably linked. However in the 21st Century the ‘causal link' between health and housing is debated by researchers and clarity is sought by policymakers. Whilst the development of legislation and social policy initiatives in Britain have eradicated the main problems faced by those living in sub-standard housing in the 19th Century, the reduction in inequalities in housing continue to be a key policy objective for the present day government.
During the 19th Century the prospect of work in the newly formed manufacturing towns and cities attracted migrant workers from Ireland and Scotland and local workers from the rural communities. Therefore, the population in these urbanised areas rapidly expanded. However, insufficient housing supply and lack of amenities soon led to severe health problems that affected both the rich and the poor (Lund, 2008)
The housing around the factories was of a poor standard, being damp and having no water supply or sanitation. Up to 100 houses shared a ‘toilet' (a hole in the corner of a yard) (Life in Manchester in the 19th Century). The poor living conditions were further exacerbated by the pollution from factories which, due to lack of personal transport, were based, out of necessity, in close proximity to the factories.
As the supply of housing depleted, households were forced to set up homes in previously unused spaces such as cellars and attics. When there were no more spaces, landlords embarked on building cheap, private-enterprise housing (Fraser, 2003). With demand for housing outstripping supply, landlords could charge a premium rate. This resulted in extreme overcrowding as families could ill-afford the escalated rents, resulting in up to twelve people sharing one room (Life in Manchester in the 19th Century)
Sub-standard housing was not the only problem facing the poor. The working conditions were appalling, with shifts regularly lasting 14 hours, sometimes longer, for a low wage. The plight of the working classes was highlighted by writers such as Charles Dickens and Freidrick Engles. In his book ‘The Condition of the working-class in England in 1844,' Engels describes the housing conditions for the working classes -
“Every great city has one or more slums, where the working-class is crowded together. True poverty often dwells in hidden alleys close to the palaces of the rich..... These slums are pretty equally arranged in all the great towns of England, the worst houses in the worst quarters of the towns; usually one or two-storied cottages in long rows, perhaps with cellars used as dwellings, almost always irregularly built..... The streets are generally unpaved, rough, dirty, filled with vegetable and animal refuse, without sewers or gutters, but supplied with foul, stagnant pools instead......” (Engles, 2005 pg 26)
These houses, deficient of ventilation, clean water supply, drainage, sewage system or rubbish removal were the perfect breeding ground for diseases i.e. cholera and smallpox (Chalkin, C, 2001). With no health provision the life expectancy for the poor in these urbanised areas was low and infant mortality high. However, government intervention did not come swiftly. This could be said to be typical of the ‘laissez-faire' approach of the Victorian era.
It was an accumulation of events that led to legislative changes to improve public health. This was initiated by Edwin Chadwick in his 1842 Report, ‘The Sanitary Conditions of the Labouring Population.' Using data from the 1837 Civil Registration of births, marriages and deaths, Chadwick was able to establish a link between appalling living conditions and ill health. However, this was not the sole factor for state intervention. The government faced criticism when high incidences of cholera not only brought death to the poor but also to the rich. Additionally, there was an economic concern from the upper class factory owners. Not only were productive workers being lost to disease but their dependents were left with no option but to become reliant on the limited Poor Law funds (Fraser, D 2003). Therefore, Chadwick argued, it was more cost effective to construct a sewage and water supply system rather than lose productive workers to disease and put an additional strain on the poor law funds.
Over the past two centuries legislation has developed following the recognition that poor housing is a primary agent for ill-health (Forrester, 1998). Today, poor housing is defined as a dwelling that is cold, damp, overcrowded, or badly designed and built (National Housing Federation, 1999). The basic standards introduced in the 19th Century to alleviate lack of sanitation; contaminated water supplies and gross overcrowding have expanded into a wide range of legislation around public health, planning, nuisance removal and housing. Of particular note is the Decent Home Standard which requires all social rented homes to be wind and weather tight, warm and have modern facilities. In 2007 it was estimated that 7.7 million homes were non-decent, equating to 35% of the housing stock (CLG, 2008). Expanding on these standards is the Fitness Standard which replaced the Decent Home Standard in 2006. The Fitness Standard provides a far more robust requirement for housing. According to this standard, homes should: be free from disrepair; be structurally stable; be free from dampness; have adequate lighting, heating and ventilation; have adequate piped supply of water; have an effective system for drainage of foul, waste and surface water; have a suitably located WC for exclusive use of the occupants; have a bath or shower and wash-hand basin with hot and cold water; have satisfactory facilities for the preparation and cooking of food including a sink with hot and cold water. (Office of the Deputy Prime Minister, 2004)
The Decent Home Standard is specific to the social rented sector, whereas the Fitness Standard is applicable to social and private rented sector. Both policies could significantly improve housing standards within the rented sector if appropriately applied and administered by local authorities. However, there is lack of provision for owner occupiers, who through ill health, age or other socio-economic reasons, struggle to maintain their home. The significant stresses caused by such factors were highlighted by the Department of Health in their report, Saving Lives: Our Healthier Nation (1999) as being a major health issue. With owner occupation being the largest housing tenure in Britain today at 71%, compared to the end of the 19th Century when 10% (Office for National Statistics) of the population lived in private rented accommodation (Harriott, 2004). Additional financial incentive schemes, such as grant funding, are needed to ensure that all housing within the UK is of a decent standard, not just those in the rented sector.
As a result of legislation, current day housing standards have vastly improved compared to the slums occupied by the poor in 19th Century. Nonetheless some issues (although less severe) still exist. For example, slum dwelling found in the 19th Century, has been replaced with ‘sink estates' (social rented housing with high levels of economic and social deprivation). Other issues include overcrowding, ventilation and social stigma.
Shelter (a charity that works to alleviate the distress caused by homelessness and bad housing) have carried out extensive research on the affects poor housing has on children's physical and mental health as well as the impact on their education and opportunities in adulthood. In their reports, ‘Chance of a lifetime' (Harker, 2006) and ‘Against the Odds,' (Rice, 2006) Shelter reveal horrifying statistics on the number of children affected by poor housing in the 21st Century.
Shelter estimates that more than one million children live in poor housing. Consequently, compared to other children, they are twice as likely to leave school without any GCSE's; twice as likely not to attend school; twice as likely to have be excluded from school; three times as likely to feel unhappy about their family; more likely to run away from home; twice as likely to suffer from persistent bullying and more likely to attend Accident & Emergency in any given year (Shelter, 2006)
The research on how housing impacts on health is not conclusive. The link between housing and health was further explored by Martin, Platt, & Hunt (1987) in North Edinburgh. Residents were asked to assess the damp levels in their homes together with their perceived health problems. In conjunction with this, environmental health officers carried out their own inspections to assess damp levels in each home. The study found no clear evidence to support the premise that damp housing has a detrimental effect on the physical health of adults. These findings support a study conducted by Barton (2007) which measured the health benefits of residents living on a council estate in South Devon following upgraded home improvement works consisting of central heating, ventilation, rewiring, insulation and re-roofing. The programme lasted 2 years but the study found no difference in health between intervention and control houses. These studies conflict with a longitudinal study by Hopton and Hunt SM, (1996) which found that installation of central heating into homes on a Glasgow housing estate did not improve health but did prevent further deterioration.
There have been a number of epidemiological studies and reports addressing the implications of damp housing. The Black Report (DHSS, 1980) and the Acheson Report (1998) both reported a significant relationship between the incidence of dampness and poor health. Damp housing poses a threat to health through the effects of house dust mites and moulds which can create allergic reactions with repeated exposure. In particular children are most at risk, developing conditions such as asthma and being prone to aches, pains, nausea, diarrhoea and headaches. In adults the affects are more likely to cause aching joints, nausea and poor mental health (Ormandy & Burridge, 1993). These findings, in relation to children, are further supported by the British Medical Association (BMA) in their report ‘Housing and Health' (2003). The Courts would seem to recognise the link between poor housing and respiratory diseases by way of their awards for damages in disrepair cases for aggravating the symptoms of asthma and other diseases (Lowry, 1991)
However, health is not just a ‘physical' condition. According to the World Health Organisation's definition “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity” (World Health Organisation). Most research on health and housing has concentrated on the physical impacts of poor housing rather than the impact on the occupant's mental and social well-being. The affects of poor housing on mental health was an area researched by Thompson et al (2002). This highlighted that there were measurable mental health gains by improving housing conditions. Other housing related factors, such as design and layout, can impact on health. Ineichan (1993) argues that living in high rise flats can result in occupants feeling socially isolated having reduced privacy and being more prone to crime. All of these factors can cause stressful living conditions.
The British Medical Association has written a number of articles on the impacts of housing on health. They claim that the “provision of a reasonable standard of accommodation for all will have health benefits for the most disadvantaged of society” (British Medical Association, 2003 pg 2)
Measuring the impact of improved housing on health has proved difficult because it is tied to other complex socio-economic factors such as income, occupation and educational attainment. Thomson (2001) expands on this point. He found it difficult to measure the affect of housing improvements on health because poor housing conditions often exist alongside other forms of deprivation. In essence, housing interventions rarely occur in isolation. This hypothesis is mirrored by (Wilkinson, 1999) which argues that because people in poor housing suffer so many other deprivations, an assessment of any one risk factor is difficult because the direction of cause and effect is often unclear.
Unsatisfactory housing exports additional costs onto other service sectors, for example, the health service because of the association between poor housing and increased instances of ill-health. A further example is education, because children living in cold damp homes cannot learn as effectively. The potential for savings in other service areas mean that there is a growing government interest in how investment in housing can reduce public sector spending.
The squalid living conditions caused through industrialisation and urbanisation in the 19th Century brought ill health to the population as a whole. This, together with economic concerns, was the main driver for state intervention. The passing of the 1848 Public Health Act was a major stepping stone for the Laissez-Faire Victorian government. Whilst these changes were positive and did improve mortality, there was little focus on the other inequalities faced by the poor such as low wages, inadequate access to health care and social stigma. However, despite a raft of legislation, the poor still exist within the capitalist society of today. Whilst the poor may not suffer the same fate as those living in the 19th Century, they experience relative poverty, being unable to participate fully, in economic terms, in the society in which they live. This group have other similar shared experiences. They are likely to live in sub-standard housing, be reliant on state benefits or a low wage and be susceptible to overcrowding. Housing standards in the social rented sector have improved through recent government policies, for example, Decent Home Standard and the HHSRS Fitness Standard but more intervention is required for owner-occupiers and the private-rented sector.
Today the link between health and housing remains a key objective area for government policy. In particular the link and its affect on children are highlighted by Shelter. There is evidence supportive of the fact that children's health and future attainment can be improved by quality of housing. The research is less clear on the specific outcomes improved housing has on the physical health of adults due to other socio-economic factors. Nevertheless research indicates that improved housing can stop further exacerbation of physical ill-health although the evidence is unclear on whether it can actually improve health.
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