The document discusses the link between housing conditions, health, and ethnicity in the UK. Some key points: - Minority ethnic groups experience worse housing conditions like hazards and excess cold more than white households. This contributes to higher rates of fuel poverty. - Fixing housing conditions for ethnic minorities could save costs for the healthcare system and improve health outcomes. - Conditions like sickle cell disease are exacerbated by cold homes, disproportionately impacting some ethnic groups. - As trends show greater numbers of ethnic minorities in private renting and poorer housing, these disparities may persist or worsen without interventions targeted at improving housing for these communities.

1. Housing and health: working in partnership
Jabeer Butt, OBE
Deputy Chief Executive
10th May 2017

2. Introduction
• Explore what we know about black and minority ethnic
communities experience of cold homes and fuel poverty;
• Explore the link with health and wellbeing;
• Reflect on the implications for policy and practice; and
• Argue for a universal approach with targeted interventions

3. About the Race Equality Foundation
The Race Equality Foundation promotes race equality in social support
(what families and friends do for each other) and public services (what
'workers‘ do with people who need support). We do this by:
• exploring what is known about discrimination and disadvantage;
• developing evidenced-based better practice to promote equality; and
• disseminating better practice through educational activities, conferences,
written material and websites.
We were established in 1987 and became an independent charity in 1995. We
have offices in London, Leeds and Manchester.
We are a member of the Health and Wellbeing Alliance, which has replaced the
Department of Health Strategic Partner Programme. We are also a member of
the Engage London consortium, which is supporting voluntary and community
organisations in London to improve support for children and families.
We are a founding member of the BME VCS Coalition which has recently been
renamed Coalition for Race Equality.

4. Evidence
• Explosion of national data sets since 1991 that record ethnicity, and more
recently faith
• Growth of comparative analysis (within and between ethnic groups) as well as trends
• Persistence of ‘one dimensional’ analysis. But more sophisticated analysis taking
account of socio-economic characteristics taking place. However, some minorities
within minorities often still missing, such as black and minority ethnic LGBT people
• Other limitations also persist. Variation of how minority and majority groups are
recorded in data make it difficult to compare results from different data sets.
Changes between one iteration and the next has raised problems too.
• This presentation draws on three Better Hosing briefing papers published by the Race
Equality Foundation and available on our website www.better-housing.org.uk.
• Helen Garrett; Justine Piddington; Simon Nicol (2014) The housing conditions of minority ethnic
households in England, Better Housing Briefing Paper 25
• Megan McFarlane (2014) Ethnicity, health and the private rented sector, Better Housing Briefing
Paper 25
• Nigel de Noronha (2015) Ethnic disadvantage in the housing market: Evidence from the 2011 census,
Better Housing Briefing Paper 26

5. 47%
28%
45%
41%
36%
39%
27%
33%
31%
21%
12%
19%
30%
15%
18%
16%
18%
16%
5%
36%
45%
38%
42%
36%
41%
48%
48%
45%
48%
59%
49%
39%
55%
46%
33%
33%
30%
24%
15%
24%
14%
14%
24%
16%
21%
16%
19%
26%
24%
26%
25%
24%
28%
37%
33%
35%
40%
2%
2%
3%
3%
3%
3%
3%
4%
4%
5%
5%
5%
6%
6%
8%
14%
16%
19%
31%
Mixed White/African
African
Mixed White/Asian
Mixed White/Caribbean
Other Black
Other Mixed
Arab
Bangladeshi
Pakistani
Other Asian
Chinese
Other
Gypsy or Irish Traveller
Other White
Indian
Caribbean
England and Wales
White British
White Irish
Under 15 15-39 40-64 65 or older
Age composition of all ethnic groups, 2011
Source: CODE, 2013

6. Variation in housing tenure between ethnic groups 2011
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
White Other
Arab
Other Asian
Chinese
Mixed Other
Any Other Ethnic Group
Mixed White and African
Black African
Mixed White and Asian
Mixed White and Caribbean
Black Other
White Gypsy or Irish Traveller
Indian
Pakistani
Bangladeshi
White Irish
White British
Black Caribbean
Private Rented Social Rented Owned
Finney and Harris (2013) How has the rise in private renting disproportionately affected some ethnic groups? CODE

7. Variation in housing tenure between ethnic groups, for
young adults aged 25-34
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
White Other
Arab
Chinese
Other Asian
White Irish
Mixed Other
Any Other Ethnic Group
Indian
Mixed White and African
Mixed White and Asian
African
Black Other
White British
Mixed White and Caribbean
White Gypsy or Irish Traveller
Pakistani
Bangladehi
Caribbean
Private Rented Social Rented Owned
Finney and Harris (2013) How has the rise in private renting disproportionately affected some ethnic groups? CODE

8. Change in the age breakdown of black and minority ethnic
over the age of 55 according to the 1991 and 2011 Censuses
Black and minority ethnic people
aged 55 and over from 1991 Census
Black and minority ethnic people
aged 55 and over from 2011 Census
66%
55 to 64
years old
25%
65 to 74
years old
9%
75 and older
n = 282,799
52%
55 to 64
years old
29%
65 to 74
years old
19%
75 and older
n=860,892

9. Caribbean, 37,804
African, 6,757
Indian, 44,450
Pakistani, 19,439
Bangladeshi, 5,737
Chinese, 7,754
Other, 40,951
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
Caribbean African Indian Pakistani Bangladeshi Chinese Other
1991
2001
2011
Black and minority ethnic people 75 years and older,
1991 to 2011
Source:Simpson,2013

10. 0.0 5.0 10.0 15.0 20.0 25.0
Bangladeshi
Pakistani
Indian
Other Asian
Chinese
Other White
African
Any other ethnic group
White and Asian
Other Mixed
Arab
Gypsy or Irish Traveller
White British
White and Black African
White and Black Caribbean
Other Black
Caribbean
Irish
16 %
Percentage of the population aged 16 and over living alone
by ethnic group, 2011

11. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0
Chinese or Other
Black
Asian
Mixed
White
Percentage
60–74
75–84
85 and over
Older people living alone according to 2001 Census
Men Women
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0
Chinese or Other
Black
Asian
Mixed
White
Percentage
60–74
75–84
85 and over
Source: Focus on
older people, 2005

12. 12
27 27
23
35
27
29 29
33
36
24
16 14
18
821
15
12
16
14
16 13
18
10
8
WHITE INDIAN CHINESE OR OTHER
ETHNIC GROUP
BLACK OR BLACK
BRITISH
PAKISTANI &
BANGLADESHI
INCOMEQUINTILES
Top
Fourth
Third
Second
Bottom
Quintile distribution of income for pensioners by
ethnic group, 2010/11

13. Mean weekly rents, London and outside London,
2008-09 to 2014-15
0
50
100
150
200
250
300
2008-09 2014-15
£perweek
private rents social rents
0
50
100
150
200
250
300
private rents social rents
2008-09 2014-15

14. Odds ratio of black and minority ethnic groups experiencing
housing deprivation
0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00
Black Caribbean
Indian
White British***
Other
Pakistani
Mixed*
White Irish*
Black other
Chinese***
White other***
Arab***
Asian other***
Bangladeshi***
Black African***
White Gypsy or Irish traveller***
Noronha (2015) Ethnic disadvantage in the housing market: Evidence from the 2011 census, Race Equality Foundation

15. Odds ratios of black and minority ethnic households with
dependent children experiencing housing deprivation
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0
White Irish
Chinese
White British
White other
Black Caribbean
Indian
Mixed
Other
Asian other
Black other
White gypsy or Irish traveller
Arab
Black African
Pakistani
Bangladeshi
Noronha (2015) Ethnic disadvantage in the housing market: Evidence from the 2011 census, Race Equality Foundation

16. 0 1 2 3 4 5 6 7 8 9
White British
Black Caribbean
White Irish
White gypsy or Irish traveller
Mixed
Bangladeshi
Pakistani
Black other
Indian
Other
Chinese
Black African
Asian other
Arab
White other
Odds ratios of black and minority ethnic households who
migrated to England and Wales since 2000 experiencing
housing deprivation compared to the population
Noronha (2015) Ethnic disadvantage in the housing market: Evidence from the 2011 census, Race Equality Foundation

17. Cold homes, fuel poverty and ethnicity
Garrett, Piddington and Nicol (2014) conclude, from their analysis of the 2010
English Housing Survey, that:
• In 2010, there were around 2.2 million households from minority ethnic
backgrounds in England. Around 327,000 (15%) minority ethnic households lived
in a home with at least one Category 1 HHSRS hazard.
• 18% of minority ethnic private sector households lived with a serious health and
safety hazard compared with 8% of those who lived in the public sector.
• In 2010, some 4% (around 78,000) of minority ethnic households lived in a home
with a Category 1 excess cold compared with 6% of white households.
• The Hills definition of fuel poverty takes account of housing costs and the depth
of fuel poverty or the ‘fuel poverty gap’ (the difference between a household’s
required fuel costs and what these costs would need to be for them not to be in
fuel poverty). Under this definition, 16% (around 370,000) of minority ethnic
households were in fuel poverty compared with 10% of white households.

18. Garrett, Piddington and Nicol (2014) cost and benefit
analysis of fixing housing conditions for ethnic minorities
Garrett, Piddington, Nicol (2014) The housing conditions of minority ethnic households in England, Race Equality Foundation

19. National Energy Action (NEA) analysis of
EHS 2012
Fuel poverty in England by ethnic group (EHS,
2012)
*Sorted by FP%
Number of
households in FP
% of households in
FP*
Pakistani or Bangladeshi 117,446 29.1%
Other Asian 42,805 20.9%
Chinese 12,395 16.3%
Indian 69,486 15.0%
Mixed 32,005 13.3%
Other 28,336 11.4%
Black 74,030 10.6%
White 1,906,076 9.7%
All households 2,282,579 10.4%
National Energy Action (2015) Personal communication

20. Boiler on prescription
• Trial of scheme between a housing association and two
CCGs in the North East.
• 1800-home Green Deal pilot scheme to establish the
effectiveness of such a scheme in the social housing sector.
• Benefits
 28% reduction in GP appointments
 33% reduction in outpatient appointments
 Up to 35.6% reduction in gas consumption per month
 Up to £29.91 saving on gas bill per month
 Generally an increase between 2 and 7 SAP points however a
maximum increase of 47 points (moving the property from EPC
G to EPC D)
 Up to a 42% increase in living room temperature
 Up to 14% increase in bedroom temperature

21. Sickle Cell Disease and cold homes
• Sickle Cell Disease (SCD) mainly affects Black and minority ethnic people, and
particularly African Caribbean people in the UK.
• Link between cold housing and sickle cell disease crises – severe painful episodes
that can last a week and result in hospital admission and put people at higher risk
of infection (Chavez, 2015).
• Need to keep homes warmer than average for SCD sufferers, leading to higher
spending on heating and impact on fuel poverty (Chavez, 2015).
• Islington Council’s Seasonal Health Intervention Network (SHINE) is a single point
referral system offering advice and support to Islington residents. Over 200
organisations refer clients into the team who then make contact and assess the
client for around 30 possible interventions helping people with health, energy
efficiency, general housing quality, income, and social isolation. December 2010
and April 2015, SHINE received over 8,700 referrals.
• Focus on those in fuel poverty and vulnerable people: aged over 75, those with
respiratory or cardiovascular diseases, children under 5 in low income families,
those with dementia or severe mental illness, those with autoimmune disease
and those with haemoglobinopathies (thalassaemia, sickle cell disease)

22. Conclusions
• Some variation between black and minority ethnic groups, but still
greater risk of poor/er housing
• If present trends in housing tenure continue, then the greater presence in poorer
housing will persist or grow
• Compounded by similar or significant risk of poorer health and wellbeing for
black and minority ethnic communities
• Costs of poor housing are already being paid by individuals, their families and
communities are paying, but also being faced by services such as the NHS,
therefore inaction is not a cost free option.
• Clear need to improve housing stock for all, but interventions must also target
black and minority ethnic communities and/or demonstrate impact

23. Person-centred housing and BME dementia
• Social housing providers are working to improve
services for black and minority ethnic people with
dementia (Age UK, 2016).
• Engagement with tenants is crucial. Tailored services
such as culturally familiar and appropriate
environments, activities and language support have
been developed by housing associations to meet
these needs.
• However, none have yet fully integrated the three
strands of housing, dementia care and cultural or
ethnicity related needs and preferences, nor the
impacts of racism and disadvantage (Age UK, 2016).

24. Find out more
www.raceequalityfoundation.org.uk
www.better-health.org.uk
www.better-housing.org.uk