Welcome!
Housing improvements for
health and associated socio-
economic outcomes: What’s
the Evidence?
You will be placed ...
What’s the evidence?
Thomson, H., Thomas, S., Sellstrom, E., and
Petticrew, M. (2013). Housing improvements
for health and...
Housekeeping
Use Q&A to post comments/questions
during the webinar
•‘Send’ questions to All (not privately to
‘Host’)
Conn...
Welcome!
Housing improvements for
health and associated socio-
economic outcomes: What’s
the Evidence?
You will be placed ...
The Health Evidence Team
Maureen Dobbins
Scientific Director
Tel: 905 525-9140 ext 22481
E-mail: dobbinsm@mcmaster.ca
Lori...
What is www.healthevidence.org?
Evidence
Decision Making
inform
Why use www.healthevidence.org?
1. Saves you time
2. Relevant & current evidence
3. Transparent process
4. Supports for EI...
A Model for Evidence-Informed
Decision Making
Source: National Collaborating Centre for Methods and Tools. (revised 2012)....
Stages in the process of
Evidence-Informed Public Health
9
Review
Thomson, H., Thomas, S., Sellstrom, E., and Petticrew,
M. (2013). Housing improvements for health and
associate soc...
Importance of this Review
• Large volume of evidence reporting an association
between poor housing and poor health
• Poor ...
Who has heard of a PICO(S)
question before?
1. Yes
2. No
Searchable Questions Think “PICOS”
1. Population (situation)
2. Intervention (exposure)
3. Comparison (other group)
4. Out...
Review Focus: Thomson (2013)
P All populations from any region of the world and from
both industrialized and non-industria...
Review Focus: Thomson (2013)
O Primary Outcomes: direct measure of health or mental
and physical illness, general measures...
Senior Investigator Scientist (MRC/CSO Social and Public Health
Sciences Unit), University of Glasgow, Glasgow United King...
What do we know about the health
impacts of housing improvement?
A synthesis of research evidence
Presented May 20, 2014
H...
Systematic review of health impacts of housing
improvement
Review question
• What are the health & socio-economic impacts ...
Systematic review: housing improvements for
health
• Broad approach
– Look at all available evaluations- not just randomis...
What we found
59,248 records screened
336 full-text articles assessed for
eligibility
Best available evidence included in ...
Randomised controlled trials of housing improvement
Assess health of residents still waiting to move
BEFORE & AFTER (Contr...
Problems with controlled studies: selecting a
control group for comparison
INTERVENTION GROUP similar to CONTROL GROUP
Ind...
Controlled Before & After studies
(Prospective controlled studies, controlled cohort studies)
ALSO assess health of simila...
Before & After studies
(Prospective uncontrolled studies, uncontrolled study)
Assess health BEFORE AND AFTER house move
• ...
Problems of Before & After studies
• Not able to control for other important changes
which might influence health- do not ...
What we found:
Warmth & energy efficiency improvements
• Best available evidence (11 studies)
– 5 randomised controlled tr...
Warmth & energy efficiency improvements
• Mixed reports across studies
– Some improvements in mental health, respiratory
h...
Warmth & energy efficiency improvements: other
impacts
• Reduced time off work/school due to illness
• Increased usable sp...
Housing led neighbourhood renewal
• Best available UK evidence (n=6)
─ 6 controlled before/after studies
• Unclear impacts...
Comparing warmth only with programmes
of housing-led regeneration
• Studies of warmth improvements more likely to be targe...
Why the small impact on health?
• Evaluations only assess short term impacts
– Health impacts may be seen years after even...
What about impacts on proxy
measures of health?
?
Examine immediate impacts on socio-economic
determinants of health to sh...
Pathways from housing improvement to
health improvement
• Examine impacts on socio-economic determinants of
health
– Proxi...
Logic model mapping reported qualitative and quantitative
impacts/pathways following warmth and energy efficiency
improvem...
Summary of short term impacts of housing
improvement
• Housing improvement is likely to affect:
– Domestic space & design ...
Conclusions of systematic review:
health impacts
• Improvements in warmth can lead to health improvements, but
cannot be a...
Conclusion
• Housing improvement is likely to affect:
– Domestic space & design appropriate to needs
– Thermal comfort
– H...
A Model for Evidence-Informed
Decision Making
Source: National Collaborating Centre for Methods and Tools. (revised 2012)....
Did you find the information presented today
helpful?
Yes
No
Poll Question
Was this information new to you?
Yes
No
Poll Question
Questions?
Contact Us
info@healthevidence.org
For a copy of the presentation please visit:
http://www.healthevidence.org/webinars.asp...
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Housing improvements for health and associated socio-economic outcomes: What's the evidence

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Health Evidence hosted a 90 minute webinar that focused on changes in any health and associate socioeconomic outcomes following housing improvements. Key messages and implications for practice were presented on Tuesday May 20, 2013 at 11:30 am EDT.
This webinar focused on interpreting the evidence in the following review:
Thomson, H., Thomas, S., Sellstrom, E., and Petticrew, M (2013). Housing improvements for health and associate socioeconomic outcomes (Review). Cochrane Database of Systematic Reviews, 2013(2): Art. No:CD008657
Hilary Thomson, the review author, lead the webinar.

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Housing improvements for health and associated socio-economic outcomes: What's the evidence

  1. 1. Welcome! Housing improvements for health and associated socio- economic outcomes: What’s the Evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  2. 2. What’s the evidence? Thomson, H., Thomas, S., Sellstrom, E., and Petticrew, M. (2013). Housing improvements for health and associate socioeconomic outcomes (Review).Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No:CD008657.DOI:10.1002/14651858.CD00865 7.pub2. http://www.healthevidence.org/view- article.aspx?a=23638
  3. 3. Housekeeping Use Q&A to post comments/questions during the webinar •‘Send’ questions to All (not privately to ‘Host’) Connection issues •Recommend using a wired Internet connection (vs. wireless), to help prevent connection challenges WebEx 24/7 help line: 1-866-229-3239 Q&A Participant Side Panel inWebEx
  4. 4. Welcome! Housing improvements for health and associated socio- economic outcomes: What’s the Evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  5. 5. The Health Evidence Team Maureen Dobbins Scientific Director Tel: 905 525-9140 ext 22481 E-mail: dobbinsm@mcmaster.ca Lori Greco Knowledge Broker Robyn Traynor Research Coordinator Heather Husson Manager Yaso Gowrinathan Project Coordinator Arnav Agarwal Research Assistant Stephanie Workentine Research Assistant Matt Edmonds Research Assistant
  6. 6. What is www.healthevidence.org? Evidence Decision Making inform
  7. 7. Why use www.healthevidence.org? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  8. 8. A Model for Evidence-Informed Decision Making Source: National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision- Making in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf
  9. 9. Stages in the process of Evidence-Informed Public Health 9
  10. 10. Review Thomson, H., Thomas, S., Sellstrom, E., and Petticrew, M. (2013). Housing improvements for health and associate socioeconomic outcomes (Review).Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No:CD008657.DOI:10.1002/14651858.CD008657.pub2.
  11. 11. Importance of this Review • Large volume of evidence reporting an association between poor housing and poor health • Poor housing has significant health impacts, increasing incidence of illnesses (i.e., heart disease and stroke) and premature death
  12. 12. Who has heard of a PICO(S) question before? 1. Yes 2. No
  13. 13. Searchable Questions Think “PICOS” 1. Population (situation) 2. Intervention (exposure) 3. Comparison (other group) 4. Outcomes 5. Setting
  14. 14. Review Focus: Thomson (2013) P All populations from any region of the world and from both industrialized and non-industrialized countries I All physical house types which are static (that is not caravans or house boats) C No intervention/no comparison
  15. 15. Review Focus: Thomson (2013) O Primary Outcomes: direct measure of health or mental and physical illness, general measures of self-reported wellbeing, and quality of life measures (health service use was not included in health outcomes). Secondary Outcomes: additional social and socio-economic outcomes (i.e. fuel costs, household income, measures of social contract, social exclusion, education, employment, time off work) Quality Rating: 10 (strong)
  16. 16. Senior Investigator Scientist (MRC/CSO Social and Public Health Sciences Unit), University of Glasgow, Glasgow United Kingdom Hilary Thomson
  17. 17. What do we know about the health impacts of housing improvement? A synthesis of research evidence Presented May 20, 2014 Hilary Thomson MRC/CSO Social & Public Health Sciences Unit, University of Glasgow This work is supported by the Chief Scientist Office, Scottish Government and the Medical Research Council
  18. 18. Systematic review of health impacts of housing improvement Review question • What are the health & socio-economic impacts of housing improvement? • Published as Cochrane & Campbell review (February 2013) Thomson H, Thomas S, Sellstrom E, Petticrew M. Housing improvements for health and associated socio-economic outcomes. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008657. DOI: 10.1002/14651858.CD008657.pub2. http://doi.wiley.com/10.1002/14651858.CD008657.pub2
  19. 19. Systematic review: housing improvements for health • Broad approach – Look at all available evaluations- not just randomised trials » Controlled studies & uncontrolled studies – Incorporate qualitative studies – Include all health & socio-economic outcomes • Systematic review of housing improvement – Searched globally (39 databases) – Grouped according to broad intervention type » Warmth & energy efficiency (post 1985) » Housing-led neighbourhood renewal (post 1995) » Basic housing in Low & Middle Income Countries » Historical studies of rehousing from slums (pre 1960) – Conclusions prioritised better quality evidence
  20. 20. What we found 59,248 records screened 336 full-text articles assessed for eligibility Best available evidence included in synthesis Quantitative n=19 • Warmth & energy efficiency n=11 • Rehousing/neighbourhood renewal n=6 • Rehousing from slums n=1 • Provision of basic housing needs=1 Qualitative n=9 • Warmth & energy efficiency n=5 • Rehousing/neighbourhood renewal n=4
  21. 21. Randomised controlled trials of housing improvement Assess health of residents still waiting to move BEFORE & AFTER (Control group) Intervention group Compare BEFORE & AFTER house move (Intervention group) 1 year 1 year • Control group move house after 1st year and enter intervention group • Equal levels of eligibility for the intervention 1 year
  22. 22. Problems with controlled studies: selecting a control group for comparison INTERVENTION GROUP similar to CONTROL GROUP Individual factors (age & sex) Individual factors (age & sex) Individual deprivation (income, Individual deprivation (income, employment, education) employment, education) Housing type/quality Housing type/quality Neighbourhood deprivation Neighbourhood deprivation • Residents in control group should be similar to residents in intervention group – EXCEPT for the house move/improvement • Often not able to match for ELIGIBILITY for the intervention: area or individuals offered the intervention are often selected due to greater need
  23. 23. Controlled Before & After studies (Prospective controlled studies, controlled cohort studies) ALSO assess health of similar residents who do not move BEFORE & AFTER (Control group) 1 year Assess health BEFORE & AFTER house move (Intervention group) 1 year
  24. 24. Before & After studies (Prospective uncontrolled studies, uncontrolled study) Assess health BEFORE AND AFTER house move • Assess change in (impact on) health outcome 1 year after house move » at same time of year as before measures 1 year
  25. 25. Problems of Before & After studies • Not able to control for other important changes which might influence health- do not know if health would have changed anyway • Health may change due to » changes neighbourhood » changes to income & state benefits » changes in local services, amenities, transport, opportunities » changes to individual circumstances (employment, family changes, other ill health)
  26. 26. What we found: Warmth & energy efficiency improvements • Best available evidence (11 studies) – 5 randomised controlled trials (RCTs) – 5 controlled before/after studies – 1 uncontrolled before/after studies • Included – loft/cavity wall insulation, double glazing, central heating, lagging, flued heaters, energy advice…
  27. 27. Warmth & energy efficiency improvements • Mixed reports across studies – Some improvements in mental health, respiratory health, and general health – Greatest improvement in RCTs in New Zealand » Among those with respiratory illness – Least improvement in UK studies » General population • Warmth improvements can lead to health improvements – especially when targeted at individuals with inadequate warmth & chronic respiratory disease
  28. 28. Warmth & energy efficiency improvements: other impacts • Reduced time off work/school due to illness • Increased usable space at home – Improved household relationships – Increased entertaining at home • Increased control over home environment • Reduced fuel costs (sometimes) • Increased rent costs- protected by welfare • Mechanisms for later health impacts?
  29. 29. Housing led neighbourhood renewal • Best available UK evidence (n=6) ─ 6 controlled before/after studies • Unclear impacts across different health measures ─ Little indication of improved health No changes statistically significant ─ Impacts reported in qualitative data similar to those in warmth studies »...but didn’t lead to health impacts- WHY?
  30. 30. Comparing warmth only with programmes of housing-led regeneration • Studies of warmth improvements more likely to be targeted according to individual need – Studies which targeted those with poor health and living in poor housing reported greatest health impact » Comparing New Zealand & UK studies – Greater potential to benefit across whole sample • Housing led regeneration- area based need – Wider range of intervention type – Additional neighbourhood change/relocation – More potential for disruption related to improvement – Not targeted according to individual need » Less consistent potential to benefit across whole sample » Those who benefit most are hidden by the mean improvement in health
  31. 31. Why the small impact on health? • Evaluations only assess short term impacts – Health impacts may be seen years after event • Delivery of tangible improvements in housing conditions was rarely confirmed in studies – Was new heating system used by residents? – Were baseline conditions affecting health? • Complex interaction of influences on housing & health – Historical study of rehousing from slums: increased mortality following rehousing explained by increased rents and inability to buy food • Housing improvements only one factor in link between poverty & poor health – Link between housing & health perhaps not as strong as assumed – Is addressing one factor likely to lead to break link between poverty & health?
  32. 32. What about impacts on proxy measures of health? ? Examine immediate impacts on socio-economic determinants of health to shed light on pathways to longer term health impacts
  33. 33. Pathways from housing improvement to health improvement • Examine impacts on socio-economic determinants of health – Proxies for health impacts: » may be detectable in the short timescale of evaluation » point to potential for future health impacts – Mediating factors: » explain absence of or small health impacts observed » Identify ways of maximising potential for health benefits in future
  34. 34. Logic model mapping reported qualitative and quantitative impacts/pathways following warmth and energy efficiency improvements, and rehousing/retrofitting
  35. 35. Summary of short term impacts of housing improvement • Housing improvement is likely to affect: – Domestic space & design appropriate to needs – Thermal comfort – Housing costs – Attitudes to home- satisfaction & control over living environment • These may act as mechanisms through which housing improvement might lead (or may not) to longer term improvements in health or wellbeing
  36. 36. Conclusions of systematic review: health impacts • Improvements in warmth can lead to health improvements, but cannot be assumed – Improvements seen in New Zealand RCTs – But less conclusive in UK studies – No evidence of harmful effects • Greatest potential for health improvement is where improvements targeted at those with inadequate warmth and with chronic respiratory disease • Unclear health impacts reported in studies of housing led- neighbourhood renewal – No evidence of harmful effects
  37. 37. Conclusion • Housing improvement is likely to affect: – Domestic space & design appropriate to needs – Thermal comfort – Housing costs – Attitudes to home- satisfaction & control over living environment • These changes have the potential to lead to longer term health impacts • Health housing investment should aim to provide affordable thermal comfort in housing of appropriate size & design to meet household needs
  38. 38. A Model for Evidence-Informed Decision Making Source: National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision- Making in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf
  39. 39. Did you find the information presented today helpful? Yes No Poll Question
  40. 40. Was this information new to you? Yes No Poll Question
  41. 41. Questions?
  42. 42. Contact Us info@healthevidence.org For a copy of the presentation please visit: http://www.healthevidence.org/webinars.aspx Login with your Health Evidence username and password or register if you aren’t a member yet.

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