Monday, March 30, 2015

Healthy Affordable Housing by Design


The  Royal  Institution  of  Chartered Surveyors has said this week that we are experiencing the lowest level  of housebuilding in England since the 1920's and that today's children face a lifetime of renting cramped accommodation in an increasingly unaffordable market.

Around 2.5 million children live in homes that are damp.
Around 1.5 million children live in households that cannot afford to heat their home.

Housing is not one of our most successful services compared with our European neighbours. 16th out of 34 in OECD analysis, it nevertheless ranks way above education, skills, work-life balance and wellbeing - all of them in many ways affected by quality and quantity of housing.

100 years ago many millions of people who would have died early in their lives from infectious diseases due to, or exacerbated by poor housing, sanitation, lack of food and limited access to medical care survived and flourished due to a partnership between health and planning for housing and communities. Housing was a function of the Ministry of Health.

Post 2nd world war house building was a numbers game – successfully allowing MacMillan to build over 300,000 homes in 1955.

Housing completions these days neither reach the heady numbers of the 1950s, nor do  they respond to the health and well being imperatives as they did in the 1920's.

 There is currently no effective mechanism to engage affordable housing providers in the planning and delivery of homes that are not just a roof – but afford positive benefits. There is concern in the public health realm that it is not possible to get the right houses built in the right place for the right families.

In recent decades the health priorities have become cardiovascular disease, stroke, respiratory disease and mental and physical health. November 2014 Town and Country Planning journal in a joint issue with Public Health England focuses on the  need for better understanding of both the influence of the built environment on health and the role of spatial planning in shaping places that maintain good health.

Across a range of societal factors the home environment has a massive influence on child and young adult development. As MIND, the Mental Health Charity suggest, well designed home environments need to respond to the needs of occupiers – delivering positive assistive, uplifting home environments can often be as easy as building the wrong house.

Not a cost issue but a DESIGN issue.

Research from Finland confirms  the improved development of children that can be afforded by communal space that is well designed, engaging and safe.

Affordable Housing was always intended for the most vulnerable – by enhancing life and earning chances through positive design of supportive environments the future opportunities for the less advantaged can be improved.

We are uniquely placed to influence the lives of millions of people who live in our affordable  homes...

- affording children’s perceptive capability through good environmental design,

- affording cheap warmth by high grade insulation,

- affording old age community engagement through interactive technology.

43% of adults over state pension age are disabled. Based on responses from 222 English and Wales housing authorities, the charity found that a third of councils (32%) either did not mention disability at all in their housing plan, or mentioned it only in passing.

How many homes are capable of receiving a disabled person for short term remedial care?? The Lifetime Homes standard promotes a 1 in 10 policy for new homes – but there is a massive gulf between actual accessibility and the need. The cost of bed blocking from older patients unable to return to their own home because they cannot care for themselves, but also unable to be discharged to their family's home due to lack of facilities is significant.

It is considered axiomatic by many that health and housing are linked in that poor housing results in negative health issues. But evidence suggests that housing built to address health concerns could dramatically improve health outcomes, reduce burdens of the health services and social care and not cost much, if anything, extra to build if the homes are designed right in the first place.

The space standards for UK dwellings is significantly less than that for our European neighbours. Housing Associations either have to buy land at commercial prices, or buy ready built houses also at commercial prices. 1/3 of the price of a property is taken up in profit for the land owner or developer while huge tracts of public land are classed as developable brownfield but are not being released.

Housing Associations are facing both an identity and a structural crisis. The are not delivering for the least well off, they are not working with health agencies to provide sympathetic environments in which to grow develop and retire in supportive communities, and they are now being threatened by the double threat of profit making private businesses accessing government grants and loan guarantees to build one bedroom starter homes for sale or private rent on the one hand and a promised 'right to buy' for Housing Association tenants promoted as part of a successful Conservative  Party if they win the May 7th General Election.

The strong desire of the health and wellbeing community is for lifetime homes with low energy use and cost,  high utility,   permanent low cost to access and low maintenance and service charges

A focus on affordance – what the home can do for its occupants - together with a restructuring of tenure models so that low land cost can allow lower density with higher utility could transform both the lives of social tenants but also release higher residual income to be spent in the community to support economic growth without resort to payday loans just to buy food at the end of the week. Community Land Trusts offer one route to this uprated provision.

My research will be extending and integrating the many situational aspects of affordance, drawing from human computer interaction, social psychology, design, child development and ageing amongst others to develop a framework of affordances that might allow a translation or a correspondence between required outcomes and specific characteristics of the environment. This framework will be piloted in a Health and Wellbeing context.

We need is a mechanism to relate health issues that might stem from housing deficiencies and the solutions that are possible in the housing world.

A specific case might be the need to retrofit houses with electrical sockets higher on the wall so that wheelchair users can access them – this was a solution, and it cost money to retrofit. Now with wireless technology plugs that use existing sockets that can be controlled by mobile phone or tablet, allow disabled people to live in their own home but also (given other physical factors)  during a period of recuperation in their family's home without restrictions on their use of electrical devices. No cost to the built environment, huge savings in the hospital and care  sector due to reduced bed blocking (estimated to impact 61% of days lost due to wait for discharge to nursing home or care home).

Just this month government has begun to work in this cross cutting way, recognising the value of warmth on prescription piloted in Sunderland: joint funding from health and housing leading to a reduction in unplanned admissions. This initiative builds on the Decent Homes and Affordable Warmth initiatives that have seen a major improvement in air tightness and levels of warmth at lower cost that have made significant improvements in family health.

However,  increasing air tightness creates its own problems; In a 2014 study the high prevalence of asthma in UK compared with the rest of the world was considered in relation to improved energy efficiency measures in houses. The study authors concluded that energy efficiency may increase the risk of asthma in adults residing in social housing and that a multidisciplinary approach is needed to understand the interaction between energy efficiency and fuel poverty. The risk of asthma was doubled in houses where mould was present. Tightly sealed houses with double glazing have been reported to increase the incidence of damp and mould when their SAP rating rises above 71.

Tobacco is itself a significant housing issue not only degrading the housing stock of tenants who smoke but causing a third of all household fires and resulting in a third of all domestic fire deaths resulting from cigarette smoking. Yet increasing constraints on smoking in public places and the workplace result in the domestic house becoming the last – and as we’ve seen above sadly for some the final –refuge of the smoker.

Housing designed to address health concerns can dramatically improve health outcomes and reduce burdens on health, social care and housing budgets. The annual cost of falls of people over 60 in the UK is £2billion, and at one year follow up 20% of frequent fallers are in hospital, full time care or dead. Homes designed to minimise the likelihood of falls could make a significant inroads in to this major public health focus area.

But where is the conversation being had between health and housing at this level of design solutions that impact health and housing – there is little evidence that these conversations are happening at all. One reason is that there is no common language.

And thats what my research is about …... creating a mechanism – an algebra of affordances and appropriations - that allows health professionals to describe their hopes in their language, for housing providers to express their design options in their own language and for there to be a coming together of the two  that results in the  design of houses and neighbourhoods that contribute to greatly improved well being and health with little or no direct cost.

March 27th 2015