Introduction

There are some very obvious wide differences in housing. This chapter largely deals with conditions in the UK, particularly in England, because of the availability of data and the policy changes that have occurred. However, the principles and discussions can be applied elsewhere in the UK. There are differences in housing archetypes – detached, semi-detached, terraced, maisonettes and flats, and houses in multiple occupation; and differences in housing age, which for the purposes of this chapter reflect major changes to the building control requirements – pre-1920, 1920-45, 1946-79, post-1979. There are differences of location – urban, rural, north of England, south of England; differences in tenure – freehold, leasehold, commonhold, private sector tenancies, public sector tenancies, and licences; and differences in access to housing – financial resources and qualifying status (need and vulnerability).

Some of these differences may reflect or influence inequalities: the most obvious are the value of the dwelling as an asset, the security of tenure and the socioeconomic status of the occupants. Some differences may have a direct or indirect impact on health: housing type and age, tenure and condition. This chapter concentrates on the potential effect of housing conditions on health, and on how other factors influence the impact on health that may lead to inequalities, including policies and actions following the recommendations made by the Acheson Inquiry (Acheson, 1998). These recommendations included improving the quality of housing and, specifically, actions to address fuel poverty, accidental (unintentional) home injuries, fire safety and fear of crime.

It is now accepted that housing conditions affect health, and, particularly, that unsatisfactory conditions can have a negative impact on health. However, while the evidence base is considerable and growing, and a strong association between housing and health outcomes has been well established, there are major methodological challenges in trying to unravel the potential impact of individual and combinations of housing conditions from other environmental, social and economic factors. What is also clear is that the more vulnerable members of society are more likely to be exposed to the worst and most healththreatening conditions.

The chapter begins with a discussion of definitions of housing and of health, and follows with evidence on the relationship between housing conditions and health, especially that which supports the contention that it is the most vulnerable sectors of society that are most at risk.