TED X Sydney 2013 – Housing for Health


The idea of “eliminating poverty” is a great goal, no one here could disagree – what worries me is that politicians with money and charismatic rock stars make the words sound so, so easy.

I don’t have a bucket of money, a policy to release or a guitar but I do have an idea…. its called Housing for Health.
Housing for Health projects work with poor people, fixing the places where they live, to improve their health.


For 28 years this tough, grinding and uncharismatic work has been done by literally thousands of people
Collectively, the work has proven that focussed design can improve health and reduce poverty.

This story begins in in 1985, when an aboriginal man called Yami Lester, was the boss of an aboriginal controlled health service in Central Australia.
He saw that 80% of the illnesses walking into clinics in the region every day were, developing world, infectious disease caused by a poor living environment. This work was started by local need not policy or money.

In Alice Springs he got together a group of people, a medical doctor, environmental health guy, his hand picked local aboriginal team. ….and an inexperienced, city based architect more familiar with the wealth of Sydney than the health of central Australia. No prizes for guessing the weakest link.
He told us was no money and we were to report back in 6 months with a plan to answer his one line brief was Uwankara Palyanku Kanyintjaku or “a strategy for well being” or more roughly translated “to stop people getting sick”.

The doctor spent 6 months developing the health targets – called the nine healthy living practices.
I was less than impressed when I first saw just a few words written on a sheet of paper …surely big ideas needed bigger words and more of them!
What I didn’t see was the 1000s of pages of local, national and international health research had been distilled into the nine health goals.


Each one puts people and their health into the centre and describes whats needed, in this case, to have The ability to wash people, particularly children, once a day. … the highest priority.

Now a personal question – how many of you could have washed this morning using a shower?
OK so most of us in this famous house could have had a wash this morning!

Now I’d like you all to pick one house from this small Indigenous community in northern Australia… I want you to remember the position of the one you picked ….as you’ll be living there for a while. OK, lets see if the shower is working in your chosen house.


A green tick…means you and your kids can have a shower tonight
A red cross means your shower is not working …looking around I reckon you’re all too old to worry too much about washing – I include the 20 year olds … by old I mean older than 5 years of age.
You all might smell after a few days but for kids 0-5, washing prevents the repeated skin, eye, ear and respiratory infections that lead to permanent health damage and reduce hearing, lung capacity and impair eyesight.
Even minor skin infections for kids will increase the risk of kidney / renal failure at age 40. So, for any child, these ticks and crosses matter.

Your chances of a working shower in this small community match the results for 7,800 showers tested in Housing for Health projects around Australia. In those NOT so famous houses, lived in by 50,000 Indigenous Australians, only 35% had a working shower.
So how do you get a green tick …. what’s the shower test?
For a shower to get the green tick your shower has to have:
– hot and cold water
– both taps and a shower rose working and
– a drain to remove the wastewater.
If any of those don’t work the shower fails. The test is not about a well designed or delightful shower …just that it functions. And only 35% of houses nationally could pass this test.

If you were shocked by the lack of showers working,
Then imagine, only 10% of the same houses were electrically safe 


and only 58% had a working toilet. Imagine living in your house with all your relatives for 6 months no shower / toilet and the electrical dangers.


Housing for Health is about improving houses not measuring failure.
We make change, rather than reports. On the first day of every project, we take tools, tonnes of materials and train local people to be employed on the project so that the families visited by teams on the first day of a project will have a slightly better house that evening.  The fix work continues for 6-12 months and then we test the houses again to ensure we have not just spent money BUT that house function has improved.

With a total average budget of around $7,500 a house we can:
– get 86% of showers working
– make 77% of houses electrically safe
and have toilets working in 90% of houses.


to cover all 9 healthy living practices, we test, check and then improve over 250 items in every house. We don’t achieve perfect scores – I hope we’ve improved your chosen house.

So why are these houses in such poor condition?
In the last 12 years we have fixed over 200,000 items in houses.
– 70%, and the bulk of the work, is due to a lack of routine maintenance
– 21% of the works fixed things built poorly, upside down / back to front and
– and counter to all you have ever heard about why Indigenous housing fails only 9% of the repair work was to fix damage by tenants 


The people living in the houses are not the problem, in fact we argue they are an essential part of the solution
In 2010, over three quarters of the Australian Housing for Health team were local Indigenous people.
These 831 people were testing and fixing houses, doing computer work or helping trades.


Keeping the focus on health has guided the work. A very poor pun because the eye in the slide has trachoma, a bacterium that leads to blindness, it is thought of as a developing world bug.
But in Australia, in this small central desert community in the late 1990s, that the bug was damaging the eyes of 95% of the school age kids.
So what was done?
Eye doctors who were treating the illness wanted help to improve the living environment to reduce the impact of the trachoma bug
To flush the bugs out of eyes, we made sure all the houses had working showers and added face washing facilities at the school.
Next the medicos knew that dust scrapes the eye and means the trachoma bug gets in quicker.
So we needed the Dr of Dust …yes …the specialist who regularly works at mining sites to reduce dust for workers health.
Dr Dust worked out that local wind driven dust occurred within a metre of the ground. One design idea was for local teams to construct earth mounds near houses, to reduce the amount of wind driven dust getting to people – we used dirt to stop dust.
Dr Dust monitored dust levels to show how well the mounds worked… and they did!
Concurrently we wanted to reduce the prevalence of the bug. For this we enlisted the Dr of Flies, yes a forensic entomologist who worked out which local fly carried the bug, …He provided fly traps and taught the local school kids how to regularly trap, kill and send him the flies.
When he found the bug in the fly’s gut …he would send a pack of dung beetles to eat the wild camel dung that was the fly’s food source. With less dung the flies died and trachoma bug was reduced.

Within 12 months there was a major decline in trachoma and eye health improved.

All these small apparently insignificant changes do improve health.
The Health Department in NSW, assessed the health impact of 10 years of Housing for Health projects in 71 communities by comparing rates of hospital admissions to similar communities not receiving the program.
The results showed a 40% reduction in hospital admissions for environment related illnesses.
For the 9,000 people in the houses improved health meant a better chance of – educational achievement, higher income, avoiding gaol and reduced poverty.

The same ideas linking health and living place work in very different settings.
Nepal for example

We were invited to help a small rural village of 600 people that had no toilets and poor health.
We made no grand promises, but offered simply to design and build 2 toilets for 2 families with the help of the village and a local Nepali partner.


Working on the design for the first toilet, a lunch break with the family meant battling the dense smoke of the enclosed house. The green firewood used for cooking produced choking smoke and is a leading cause of respiratory illness in the region.
So the design problem grew and involved more than toilets, and the design solution had to grow.
… by combining human toilet waste and animal waste in a biogas tank it is possible to produce 3-4 hours of free, smokeless cooking fuel each day. From 2 toilets, many have been built

This small project has not eliminated poverty …. a few million more toilets needed …. but as we sit here today there are over 100 toilets being used by over a 1000 people …..and they all have names
Yami Lama… a young kid has less gut infection,
Kanji Maya…..a mother is cooking with biogas and breathing less smoke so her respiratory health is improving,
Surya …..whose family use the treated waste from the biogas plant to fertilise crops and this means more food and greater family income
….and Bishnu’s ……the team leader ….realises as well as toilets we have built a strong team …they finished the first village and are now employed to train teams who are building more toilets in the next two villages.

Poor people are not the problem.
Poor living environments, housing and the bugs that harm people are the problem.
The common link between all the work is not skin colour, geography or religion its … poverty.


Nelson Mandela has said

 “Like slavery and apartheid, poverty is not natural. It is man-made and it can be overcome and eradicated by the actions of human beings”.

The Housing for Health program has shown how the actions of thousands of ordinary ‘human beings’ doing extraordinary work – has improved health and reduced poverty.

The Crowd

This talk was delivered at TED X Sydney in May 2013 by Paul Pholeros, Healthabitat Director. In June of the same year it was selected to be posted on the main US TED site giving international exposure to the ideas of Housing for Health.