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02_RebeccaBentley - The health benefits of secure housing: examining the evidence

  1. The health benefits of secure housing: examining the evidence Professor Rebecca Bentley Centre of Research Excellence in Healthy Housing 1
  2. Overview 1. What is housing security? 2. What do we know about its effects on health? – Directly – In the context of housing systems? – In the context of intergenerational inequalities in housing? – In the context of climate change adaptation of housing systems? 3. Based on this evidence, I will reframe: – The benefits to health, health care expenditure and productivity of addressing insecurity in the housing system – using an example of energy poverty and cold housing. – The role of housing security as an apex determinant of health. – The potential for developing an internationally comparable indicators of housing system health. 4. Draw conclusions 3
  3. Housing insecurity 4 Adelle Mansour et al. J Epidemiol Community Health 2022;76:833-838 The guarantee that occupants can reside in their homes without fear of forced eviction, harassment and other threats. Precarious housing
  4. Housing Insecurity and Health (Direct effects) 5 Injury hazards Indoor air quality Overcrowding Indoor temperature Noise Security Injury Cancer Mental health Umbrella: related to wellbeing Respiratory illness Infectious disease Universal access Toxic material Cardiovascular disease –– Evidence has not been mapped specifically in WHO HHGL (prior evidence links these pathways). Weak [ – – – ] to strong [ ––– ] evidence. Diagram based on WHO 2018 healthy housing priorities included in the WHO Healthy Housing Guidelines literature synthesis. Mould & damp Health outcomes Home environments
  5. Housing Insecurity and Health (Direct) Housing Affordability Stress negatively effects mental health and wellbeing - between 1 and 2 points on a 100-point mental health measure (Bentley et al 2011) - Particularly so for people in the rental sector (Mason et al 2013) and people who are insecurely employed (Bentley et al 2016). 6 Bentley, R., Baker, E., Mason, K., Subramanian, S.V. and Kavanagh, A.M., 2011. Association between housing affordability and mental health: a longitudinal analysis of a nationally representative household survey in Australia. American journal of epidemiology, 174(7), pp.753-760. Mason, K.E., Baker, E., Blakely, T. and Bentley, R.J., 2013. Housing affordability and mental health: does the relationship differ for renters and home purchasers?. Social science & medicine, 94, pp.91-97. Bentley, R., Baker, E., LaMontagne, A., King, T., Mason, K. and Kavanagh, A., 2016. Does employment security modify the effect of housing affordability on mental health?. SSM-population health, 2, pp.778-783. Av MH=48 Av MH=50
  6. Why does housing affordability stress have a negative mental health effect? 7 Financial hardship Housing quality and condition Housing location Poor health and disability Energy poverty Compromise on Suitability
  7. Housing Insecurity and Health (& the housing system) Does renting negatively impact on health? • In and of itself, NO • Largely explained by the composition of people in rental. • BUT – where there is instability or insecurity we do see a causal effect. Can renters and owners have the same health? • YES 8
  8. Through direct and indirect effects, security is one of the causes of the causes…. Housing security (affordability, suitability and location) shape home environments which shape health. 9 Figure1. Prevalenceof chronichealth problemsby beingable toafford to heat home
  9. Share of young adults age 25-29 living with their parents Housing Insecurity and Health (& intergenerational inequalities) Source: Adapted from Landgeist using Eurostat data from 2020 United Kingdom The Netherlands Germany Australia 25% 16% 18% 29% Source: Estimate From HILDA, 2019 18% 55% Spain
  10. Housing Insecurity and Health (& intergenerational inequalities) 11
  11. Housing Insecurity and Health (& climate change) Housing insecurity at the time of experiencing the natural disasters impacts on the length of time it takes to recover. 12
  12. Reframing Housing Security – quantifying the benefits of better security Based on the WHO Healthy Housing Guidelines (2018) literature synthesis
  13. Δ cold housing Δ blood pressure Δ ischaemic heat disease incidence Δ stroke incidence Δ asthma severity, children Δ depression annual period prevalence Δ health expenditure Δ population income Δ chronic kidney disease incidence Δ hypertensive heart disease incidence Δ atrial fibrillation incidence Δ COPD severity Δ asthma severity, adult Δ LRTI annual period prevalence Δ anxiety annual period prevalence Δ asthma and COPD incidence rate = Strong evidence = Moderate evidence = Weak evidence Sum Δ morbidity rates, mortality rates, health expenditure rates, and income earning rates Δ all cause morbidity Δ all cause mortality Δ health adjusted life years (HALYs) Δ health inequalities Mishra,, S, Wilson, T, Andrabi, H, Ait Ouakrim, D, Li A, Singh A, Akpan E, Bentley R, BlakelyT. The health gains and cost savings of eradicating cold housing in Australia (Under review)
  14. 0 10000 20000 30000 40000 50000 60000 70000 Ischaemic hearth disease incidence Stroke incidence Chronic kidney disease incidence Hypertensive heart disease incidence Atrial fibrillation incidence Depression prevalence Anxiety prevalence Asthma severity COPD severity LRTI event rate Hypertension-related disease Mental health Respiratory HALYs gained 20 years Lifetime Health gains ≈6 times greater amongst most deprived $5.8B (range 2.5 to 13.1) increase in income earnings 2021-40 $1.16B (range 0.5 to 2.6) in health care savings 2021-40 Mishra,, S, Wilson, T, Andrabi, H, Ait Ouakrim, D, Li A, Singh A, Akpan E, Bentley R, BlakelyT. The health gains and cost savings of eradicating cold housing in Australia (Under review) We can conclude that the contribution of eradicating cold housing to better health through improved mental health is likely large. • Health gain of 202,000 (range 113,000 to 373,000) HALYs
  15. 0,00 5,00 10,00 15,00 20,00 Smoke-free generation Tight limits on sodium in bread Taxing alcoholic beverages Eradication of indoor cold Statin for adults (5%-9% CVD risk next 5 yrs) Mandatory Tick food labelling program ACE inhibitor for adults (5%-9% CVD risk next 5 yrs) Beta-blocker for adults (5%-9% CVD risk next 5 yrs) Community heart health program Lifestyle program for adults HALYs gained (log scale) over the remaining lifetime of the population, per 1000 people, 3% annual discount rate Mishra,, S, Wilson, T, Andrabi, H, Ait Ouakrim, D, Li A, Singh A, Akpan E, Bentley R, BlakelyT. The health gains and cost savings of eradicating cold housing in Australia (Under review)
  16. Interventions to reduce energy poverty, and other housing interventions, are cost-effective: - We could spend up to $7.6 billion* to eradicate cold housing and still be cost effective. - If we add in other gains, like productivity gains, energy and environmental savings, we would be prepared to spend $7.6 billion ++. Cost-effectiveness insights * Given lifetime discounted health expenditure savings of $1.3 billion, and 89,600 discounted life time HALY gains, as society we would spend up to 1.3 + $70k*89600 = $7.6 billion to eradicate cold housing and still be cost effective (valuing a HALY at GDP per capita) – just on health outcomes alone
  17. Contextual drivers Housing Systems Healthy Housing Indicators Home environments Cardiovascular, respiratory, mental health, injury Reframing housing security – Apex determinant 18 Affordability •Cost of renting •Cost of purchasing •Cost of maintenance •Cost of utilities Security •Housing supply/demand •Social housing availability •Informal settlements Suitability •Housing size and condition •Accessible housing Location •Green space •Access to transport •Access to jobs
  18. Reframing Housing Security Useful internationally comparable indicator of housing system health ASPIRATIONAL By Socio-Economic Position: Age-cohort patterns of housing occupancy by tenure Social housing (% stock) relative to need Housing affordability (%HAS) in rental and owner-occupied sectors Distance to jobs and transport for affordable housing developments 19 AVAILABLE Indoor air quality (from global burden of disease measures) Number of informal settlements (monitored as part of the Sustainable Development Goals).
  19. Conclusions Housing security is an apex determinant of how people are housed. Security of tenure is a critical characteristic of healthy housing in the rental sector. Improving security, at the population level is potentially a cost-effective prevention strategy for health. With the rise of intergenerational inequalities and the threat of our changing climate – its importance has increased as a prevention and mitigation strategy. Recommend developing internationally comparably indicators of the health of our housing systems that we can use to generate and evaluate policy. 20
  20. Thank you Professor Rebecca Bentley Director, NHMRC Centre of Research Excellence in Healthy Housing Melbourne School of Population and Global Health T: +61 3 8344 0639