Housing can contribute positively to people’s mental and physical health – but all too frequently it does not. Find out more about the links between housing and health and explore trends and inequalities in housing across different groups and types of tenures
Why housing matters for health
The condition and nature of housing can have a big impact on people’s lives, influencing their wellbeing and health. In fact, housing has a long association with efforts to improve health, such as seeking to improve sanitation and reduce overcrowding to prevent the spread of infectious disease in the 19th century.
Explore the different ways in which housing can affect health outcomes below.
Housing affordability is the extent to which a household can meet the direct and indirect costs of housing, which includes rent and mortgage repayments, council tax and utilities. Housing affordability is associated with housing security, but can also contribute directly to poorer mental health through stress and anxiety.
Affordability problems can also contribute to overcrowding as households seek to share the fixed costs of accommodation across more individuals. Affordability can also create pressure on other elements of household expenditure associated with health, such as food or social participation.
Housing quality relates to the actual physical state of a property and how suitable it is for the residents. This can encompass a wide range of potential flaws, such as lacking sufficient insulation, being damp or mouldy, or containing risks such as trip hazards. Poor housing conditions can also include overcrowding, such as when a home is not suitable for the actual number of inhabitants.
The following examples of poor housing conditions can directly affect health.
- Hazards reflect potential sources of injury or harm in households, such as the potential for trips or falls, electrical problems or fire risk. Around a third of accidents to adults happen in the home and falls are an important cause of morbidity and mortality in older adults.
- Damp in the home can affect respiratory health, which is often caused by poor ventilation and leads to the spread of mould and fungi. This can result in asthma and the proliferation of allergens and toxins. The prevalence of coughing and wheezing is also found to be higher in damp homes.
- Insufficient warmth in the home is influenced by levels of insulation, among other factors. Excess deaths have been shown to be three times higher in the coldest 25% of houses than the warmest. There is a connection between low household energy efficiency and excess winter deaths, both between the UK and other countries and between areas within the UK. Cold temperatures in the home are associated with respiratory diseases as well as higher blood pressure.
- Overcrowding is typically measured by assessing the number of people in a household against a bedroom standard of how many rooms they need. Overcrowding can place strain on family relationships, reduce privacy and limit the space for children to study or play. There is some evidence of it affecting self-rated health and respiratory conditions, as well as psychological distress.
Some studies have evaluated how improvements in housing conditions affect health. A study in Wales that matched data on housing interventions to hospital utilisation found that bringing homes up to national housing standards resulted in considerable reductions in emergency hospital admissions for cardiorespiratory conditions and injuries. Interventions addressing inadequate warmth were considered the most effective in improving health in a meta-study, particularly when they were focused on those groups with pre-existing conditions.
Housing security is the degree to which people feel certainty in remaining in their home: the continuity and constancy to life that a secure home can bring can be protective of health. This relates strongly to housing affordability, and the ability of a household to afford mortgage or rent payments. In extreme situations, housing insecurity can manifest in homelessness or rough sleeping, which can result in even more severe health consequences.
One study in the UK found that mortgage repossessions were associated with a decline in mental health, but evictions were not, possibly because insecurity was already ‘priced in’ for renters. Other UK research finds arrears, housing payment problems and imminent eviction/repossession to have a considerable cost to psychological wellbeing, with the effects being larger for homeowners who have made larger financial and emotional investments in their home than more mobile renters. US research has also found that cost-related moves and housing arrears are related to anxiety and depression.
Another study found the importance of housing tenure and housing type (houses versus flats) to health using biomarker data, with private renters found to have poorer health than home owners with a mortgage. In terms of housing type, the study reported that living in flats or terraced houses was associated with worse health than detached homes. This could be due to residents having less control or autonomy over their home, and potentially less access to green space. Housing tenure matters because private renters in the UK have less legal protection for eviction than social renters or mortgage holders, and the end of private sector tenancies are associated with homelessness applications.
Homelessness refers to people who lack stable accommodation of their own, and includes situations when people are still in shelter, such as squatting or staying with friends, as well as those sleeping rough. Sleeping rough is particularly associated with greatly elevated levels of early mortality.
Homelessness can interact with health in multiple ways: some health problems contribute to homelessness, others are caused by homelessness. Homelessness can also complicate the treatment of health problems and be associated with worse health outcomes.
Overall, the experience of homelessness harms mental health, and shelter when available may be overcrowded and poor quality, which can also harm health directly.
The coronavirus (COVID-19) pandemic has had a far-reaching impact across society. As well as the direct and indirect health impacts from the pandemic itself, the economic and social consequences from policy measures to control the disease can also have an impact on mental and physical health. This is particularly true of housing: since March 2020, a significant proportion of the population has spent substantially more time at home. Here we summarise how housing has affected the UK population’s experience of the COVID-19 pandemic.
Overcrowding and the spread of COVID-19
In the past, public health improvement efforts often focused on the role of overcrowding in spreading infectious disease. These concerns have resurfaced in the UK, with research pointing to the possible role of household overcrowding in contributing to the spread of COVID-19. For example, areas with the highest levels of overcrowding were associated with higher intensive care unit admissions for COVID-19. Analysis using data from the UK Biobank found that overcrowding was associated with an increased chance of a positive COVID-19 test. Areas with a greater concentration of multigenerational households were also associated with increased COVID-19 cases in the early stages of the pandemic. Given the importance of transmission within households, more people in a household increases the infection risk and potentially makes self-isolation with symptoms more difficult.
Spending more time at home
The measures associated with controlling the pandemic – such as the national lockdowns in 2020 and into 2021, and including the regional restrictions on social activities and attending workplaces – have meant that people are spending considerably more time at home. The restrictions have led to increases in loneliness and reported mental ill-health.
A survey by the National Housing Federation found that 31% of adults reported health problems due to the condition of, or lack of space in their home during lockdown. In particular, younger adults have reported insufficient access to indoor and outdoor space. Also, existing risks to health from housing conditions, such as damp and mould, may have more of an effect if people are exposed to them for longer periods of time.
Housing affordability and security
Economic activity and employment have been hit by the pandemic and its associated restrictions. Despite substantial government support, many households have experienced reduced incomes for an extended period time and can expect a further income hit with unemployment set to rise in 2021. Given the financial impact of pandemic restrictions, the government initially introduced a ban on evictions to help increase security for private renters. This has since been changed to a longer notice period and non-enforcement by bailiffs of court orders. However, rent arrears have accumulated, with research suggesting that up to 700,000 social and private renters were behind with their rent by October 2020. Being behind with rent can contribute to worse mental health, and an increased risk of homelessness, and the health risks this brings. However, rent arrears have accumulated, with research suggesting that up to 700,000 social and private renters were behind with their rent by October 2020. Being behind with rent can contribute to worse mental health, with an increased risk of homelessness and its associated health risks.