Report – Housing for health, 20 years on…

A peer-reviewed paper has been published looking at 20 years of Housing for Health projects in NSW.

Titled: Prioritising Housing Maintenance to Improve Health in Indigenous Communities in NSW over 20 years

Healthabiatat has summarised some of the report below…

Housing and health agencies should collaborate more closely on social housing programs and ensure programs are adequately resourced to address safety and health issues.

The World Health Organization (WHO) recognises poor housing as one of the main social causes of ill health [1,2] and extensive evidence has demonstrated improvements in health associated with improvements in housing and living environments since the late 1800s [3–5]. While Australia is an economically developed country with a high standard of living [6–8], poor housing in Aboriginal communities continues to be linked to the compromised health status of Aboriginal Australians since early last century [9–18].

There are some widely held beliefs about social housing being poorly looked after by the tenants, so the tradespeople are required to identify and record the cause for each repair being either:
• Routine (maintenance reasonably expected in a house);
• Faulty (the item isn’t present or installed incorrectly), or
• Damage (by people, and not by ants, vermin, poor water quality or other factors outside of the residents’ control).

Based on the literature, Healthabitat developed a practical implementation of evidence-based practices that support healthy living [11,22]. These included 11 Critical Healthy Living
Priorities (CHLPs) which are reported in this analysis:
1. Power, water, and waste connected
2. Electrical safety
3. Gas safety
4. Structure and access
5. Fire safety
6. Shower working adequately
7. Facilities to wash children
8. Laundry services
9. Flush toilet working
10. All drains working
11. Facilities to store, prepare and cook food

Each CHLP is measured by assigning a set of data items from the survey. For example, for a house to enable residents to wash effectively and to maintain hygiene and health, a shower in a house requires the following minimum seven items to be functioning: hot water; cold water; hot water at a safe but effective temperature; hot and cold water taps; a shower hose and adequate drainage [9].

The HfH program has reached around 70% of houses in the NSW Aboriginal community housing sector from 1997-2017.

At SF1(Survey Fix One) …only 39% of all houses had all items in the shower working and two thirds of houses had a place to wash a small child with all hardware working (such as a bath, large basin or laundry tub with washing machine by-pass).

Figure 4 presents data on the reasons tradespeople recorded for repairing 63,648 items identified by the survey during the 20-year study period. Across NSW Aboriginal community housing, 84% of items repaired were routine maintenance issues. Faulty design or workmanship accounted for 11% of failures, with 5% of items fixed as a result of damage by the tenants

Figure 4. Percentage of items fixed under the NSW Housing for Health Program (n = 63,648) by the reason for repair from 1998–2017.

Focusing on tenancy management to reduce tenant damage will only address 5% of the issues related to house function in NSW community housing. Our results are consistent with previously published national data (2006) which showed, whilst there were slightly higher rates of tenant damage (10%), the primary cause for house function failure stemmed from a failure of maintenance regimes and quality control [9].

Figure 2. Average Percentage of houses with Critical Healthy Living Priorities fully met at Survey-Fix 1 and Survey–Fix 2 for all NSW projects 1998–2017 by 5-year intervals.

Although the average condition of houses at SF1 across all 112 HfH projects shows very little change over 20 years, (Figure 2) the 24 locations that have received a second HfH project have maintained higher house function (at the second project SF1) for most CHLPs (Figure 5), suggesting a sustainable benefit of the HfH program over time. This finding is consistent with results reported in the 10-year review which showed one community in 2003 where a third survey and fix had been undertaken 2–3 years later to gauge the sustainability of the program, house function had deteriorated slightly since SF2 (Survey Fix 2), but only 5% of the original funding was required to bring the houses back to the same

Figure 5. Percentage of houses with Critical Healthy Living Priorities fully met for NSW projects with repeat visits at First Project SF1 (n = 802) and SF2 (n = 722); and at Second Project SF1 (n = 788) and SF2 (n = 734) from 1998–2017.

For disadvantaged families where unemployment is high, the home environment is often the environment where people spend most of their time. Ensuring the homes’ ability to support health is associated with significant reduction in the rates of infectious diseases, which in turn can reduce the risk factors for many chronic diseases, such as renal and cardiac disease, both of which are overrepresented in the Aboriginal population [17,20,31]. The HfH program also helps ensure the home environment supports practices delivered by health messages through clinical and population health services. Improving health outcomes should reduce health expenditure on preventable conditions. “The cost of poor housing is borne by the health system” [32]

THE REPORT CONCLUDES – A lack of routine maintenance and faulty design or construction is overwhelmingly the key cause identified for the failure of items repaired under the program

The specification of quality health hardware in maintenance programs is likely to be a cost-effective investment in both housing and health in the long term

The program should be expanded to communities that have not yet received the program, and the program principles should be embedded into larger social housing repair and maintenance programs.

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