Physical and mental health outcomes following housing improvements: evidence from the GoWell study

Abstract

BackgroundExisting research points towards physical and mental health gains from housing improvements, but findings are inconsistent and often not statistically significant. The detailed characteristics and variability of housing improvement works are problematic and studies are often small, not experimental, with short follow-up times.MethodsA quasi-experimental design was used to assess the impact on physical health and mental health (using SF-12v2 Physical and Mental health component summary scales) of four types of housing improvement works—central heating, ‘Secured By Design’ front doors, fabric works, kitchens and bathrooms—both singly and in pairwise combinations. A longitudinal sample of 1933 residents from 15 deprived communities in Glasgow, UK was constructed from surveys carried out in 2006, 2008 and 2011. Sociodemographic characteristics and changes in employment status were taken into account.ResultsFabric works had positive associations with physical health (+2.09, 95% CI 0.13 to 4.04) and mental health (+1.84, 95% CI 0.04 to 3.65) in 1–2 years. Kitchens and bathrooms had a positive association with mental health in 1–2 years (+2.58, 95% CI 0.79 to 4.36). Central heating had a negative association with physical health (−2.21, 95% CI −3.74 to −0.68). New front doors had a positive association with mental health in <1 year (+5.89, 95% CI 0.65 to 11.14) and when provided alongside kitchens and bathrooms (+4.25, 95% CI 1.71 to 6.80). Gaining employment had strong associations with physical health (+7.14, 95% CI 4.72 to 9.55) as well as mental health (+5.50, 95% CI 3.27 to 7.73).ConclusionsFabric works may provide insulation benefits and visual amenity benefits to residents. Front doors may provide important security benefits in deprived communities. Economic regeneration is important alongside property-led regeneration.

Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study

“…[20][21][22] However, some housing policy has been implemented despite evidence from housing interventions suggesting small or unclear health effects. 23 Countries in temperate regions with fewer energy-efficient homes, including the UK, Greece, Portugal and Ireland, have more excess winter deaths, indicating that variations in winter mortality are caused by differences in indoor temperatures, health-care spending and socioeconomic circumstances. 24 Direct health impacts of cold housing and fuel poverty are thought to cause 33% and 40% of respiratory and cardiovascular diseases, respectively.…”

“…23 A systematic review of the effects of improvements to housing found some evidence of health benefits following changes to thermal conditions, particularly when these interventions were targeted towards those with chronic respiratory conditions. 26,27 Evidence of health improvements not specifically targeted at vulnerable groups were less clear; authors noted that impacts measured for everyone in a housing improvement area may conceal health improvements for vulnerable population subgroups.…”

“…Although limited to a 5-year follow-up for 1011 participants, the authors found positive associations with mental health (kitchens and bathrooms, and front doors) and physical health (fabric works), and a negative effect on physical health following the installation of central heating. 23 Our study did not rely on self-report survey data and we have captured health service utilisation (as a proxy of health outcomes) for everyone who lived in an intervention home, even if it was for as little as 60 days, thereby limiting the possibility of a sampling bias.…”

“…There were positive associations with mental health (kitchens and bathrooms, front doors) and physical health (fabric works) but a negative effect on physical health following the installation of central heating. 23 Three waves of cross-sectional surveys had 1011 participants contributing to all waves to constitute a 5-year longitudinal data set. 23 The authors were unable to randomise the allocation or to a waiting list but used the waiting list as a control.…”

“…23 Three waves of cross-sectional surveys had 1011 participants contributing to all waves to constitute a 5-year longitudinal data set. 23 The authors were unable to randomise the allocation or to a waiting list but used the waiting list as a control. The use of survey data directly from participants introduces bias and restricts follow-up duration.…”