scope:

Introduction

There is a long-established, recognised relationship between poor housing and poor health. In Victorian England, diseases such as tuberculosis, cholera and typhus were known to be associated with unsanitary, cold, damp and overcrowded housing and this led to various public health and housing acts designed to improve housing conditions. The problems of disease associated with 'slum' living have now largely been eradicated in developed countries like England, but there remains a significant number of health and safety hazards in the home. This is compounded by the fact that England has one of the oldest housing stocks in the developed world and one of the lowest rates of housing replacement.

Many studies have investigated the relationship between housing and health but, because of the number of intervening variables, it has been difficult to demonstrate clear and measurable cause and effect relationships. Nevertheless, there is a large and growing body of evidence linking systematically adverse health effects with poor housing conditions. These conditions include dampness, the effects of living in a cold home, household accidents, noise, insecurity, overcrowding and fire safety.

BRE has been involved in the development of the Housing Health and Safety Rating System (HHSRS) since its inception; from 2006 it became the minimum standard of housing in England. The HHSRS produces scores for dwellings based on the statistical risk of 29 health and safety hazards, particularly focusing on the risk to vulnerable people.

Through the English House Condition Survey (EHCS), and its successor the English Housing Survey (EHS), which now measures the presence of HHSRS hazards in the home, we are able to quantify the prevalence of poor housing and also the cost of remedial action. However, until this research project we have not had the ability to link this information to medical and social costs to estimate the 'cost to society' of poor housing conditions. This report updates all the figures used in the 2010 publications^{[1, 9]}, allowing comparisons to be made using 2011 prices. It also introduces for the first time a comparison of hazards in terms of health impacts to QALYs.

Our previous reports suggested that the annual cost to the NHS of treating HHSRS Category 1 hazards accounted for a maximum of 40% of the total cost to society. However, this was based on the limited information that was available at the time, and it was thought that improvements to the assessment could be made to improve this estimate. For minor injuries the cost to society may have been overestimated where the cost to the NHS might be most, if not all, of the cost to society; whereas for more serious injuries, it is likely that this estimate seriously underestimated the true cost to society.

In order to establish a better estimate of the total cost to society of these hazards, a literature review of similar cost-benefit analyses has been carried out. From the review, the best available numbers are used to weight the COPH model, and hence to determine the overall cost to society of poor housing. This revised number is used to determine the proportion of the cost represented by the cost to the NHS at each of the harm levels and overall.

The final aspect considered in this report is the cost of treatment burden to the NHS associated with all sub-standard housing. The risk of harm is likely to be smaller for these dwellings than for housing with Category 1 hazards present, and the cost of remedial action to bring them up to the desired standard, in many cases, is likely to be prohibitive. However, an understanding of this extra burden on the NHS may highlight the contribution less significant hazards play in affecting health and safety in dwellings across the housing stock. It also helps to justify the case for building housing to a better standard in the first place.