This is guest blogpost by Dr. Nathan Bray. Nathan is a Health Economist at Bangor University’s Centre for Health Economics and Medicines Evaluation and a Health and Care Research Wales fellow. Nathan holds a PhD in Health Economics from Bangor University. His research focuses on applying methods of economic evaluation to public health interventions and technologies to support people with disabilities.You can contact him on Twitter: @DrNathanBray
There is a real need to improve housing in the UK: a fifth of homes in England fail to meet the government’s Decent Homes Standard, furthermore it is estimated that 16% of private rented homes and 12% of housing association homes still have no form of central heating. In 2014/15 over 44,000 more deaths occur during the coldest months of the year (December to March) compared to the rest of the year. This was the highest figure for over 15 years. Chronic illnesses, such as respiratory disease, are exacerbated by cold and damp homes and contribute to the large number of avoidable excess winter deaths.
In our research we examined whether warmer social housing can improve population health and subsequently reduce use of healthcare services. Using an historical cohort study design, we analysed the costs and outcomes associated with retrofitting social housing with new combi boilers and double glazed windows. Over 470 social housing tenants from nearly 230 households in Sunderland (UK) were surveyed both before and 12 months after installation of their new boilers and windows, at no cost to the tenants. The cohort proved to be highly socioeconomically deprived; the vast majority of households had an income of less than £15,000 per year, well below the national average of £28,200. Recruitment was staggered to counter any effect of seasonality. On average the cost of completing the housing improvements was £3725 per household.
After the housing improvements had been installed, six month household health service use costs reduced by £95 per home, equating to a 16% reduction in household NHS costs. On average a 69% reduction in hospital outpatient appointments was observed per household, as well as a 46% reduction in accident and emergency attendance and a 10% reduction in GP visits. For this cohort of 228 homes alone we estimate that the NHS saved over £20,000 in six months after completion of the housing improvements. It was also found that the health status of main tenants significantly increased by almost 8% and financial satisfaction increased by 7%. Additionally, small non-significant improvements to main tenant happiness, life satisfaction, anxiety and well-being were also found.
After the home improvements were completed most households were able to heat all rooms in the home, where previously most households left one room unheated due to energy costs. Furthermore, over a third of households were no longer spending 10% or more of their income on energy bills, a key indication of reduced fuel poverty.
In conclusion the results show that retrofitting of new energy efficient combi boilers and double-glazed windows has a positive impact on the health status, health service use, and fuel poverty risk of social housing tenants. More needs to be done to ensure that everyone in the UK lives in a ‘healthy’ home which is warm and free from damp.
*for a free to read version of this paper, click here!