Introduction

A hundred years ago, when infectious diseases were the principal threat to life expectancy, housing was at the center of public health initiatives in the UK and in other now-highincome countries. Links between poor housing and poor health have continued, despite decades of improvements in average housing conditions and substantial public investment. While the UK has relatively good-quality housing by international standards, polluted air shortens 40,000 lives and costs the National Health Service (NHS) £20bn annually, and housing health and safety risks cost the NHS £1.4bn a year (Nicol et al, 2016). In 2017–18 deaths were 49,000 higher in winter than summer, partly due to cold housing (Office for National Statistics (ONS), 2018). Eight hundred people died sleeping rough in England and Wales in 2019, at a mean age of 46 (ONS, 2020c). Reductions in housing allowances in 2012 caused about 26,000 extra cases of medium-term mental health conditions (Reeves et al, 2016).

Across the world, COVID-19 has returned housing to the forefront of public health. In both high-income nations and those with many crowded informal settlements, it is feared that shared accommodation, overcrowding, and large households have made self-isolation difficult or impossible. Overcrowding and housing insecurity have been associated with higher national cases in high-and medium-income countries (Shadmi et al, 2020; Brown et al, Chapter Ten; Xavier, Chapter Seven). Housing has also been central to lockdown experiences and to potential lockdown harms –to education, physical and mental health, working life, relationships, disposable income, and housing security. Home can be a place of harm as well as a refuge (Gurney, 2020). A politician from Newham, an area of London which in May 2020 had the highest COVID-19 death rate in the UK as well as amongst the worst overcrowding, declared, ‘This is a housing disease’ (Barker and Heath, 2020).

This chapter examines evidence from the UK to assess whether COVID-19 and lockdown harms are ‘housing diseases’. While the UK has relatively good-quality housing, it has relatively high-income inequality, and a minority have poor-quality or very unaffordable homes. Over the 2000s and 2010s, the housing safety net has been weakened, with reduced eligibility and generosity of rent allowances, and less social housing. In addition, the UK has had among the highest COVID-19 death rates in the world (Johns Hopkins Coronavirus Resource Centre, 2021).