This piece is part of a series of blog posts by members of the Inequalities in Health Alliance, highlighting the breadth of health inequalities that exist throughout society. #EverythingAffectsHealth
Health and social inequalities are bound together, with housing – often substandard – a key factor in both, writes Natasha Owusu, policy lead for England at the Chartered Society of Physiotherapy.
Black, Asian, minority ethnic and migrant communities are more likely to live in overcrowded housing and face homelessness. LGBTQI+ people can face discrimination when accessing housing or homelessness support, and 90% of wheelchair users struggle to find accessible housing in the private rental sector.
Four million homes in England are currently categorised as ‘non-decent’. That’s 16% of homes failing to meet the government’s Decent Homes Standard. It is a standard that, if met, means you will be warm and your home will be in a reasonable state of repair, with reasonably modern facilities and services.
But when these key measures are not met – your home is cold, perhaps plagued with a damp problem, or you aren’t able to care for yourself properly – it is health that suffers. Poor housing leads to an increase in respiratory disease: something that affects one in five people in England and is the third biggest cause of death according to the NHS.
Over the past 7 years, hospital admissions for lung disease have also risen three times faster than admissions more generally.
The risk of cardiovascular and nervous system diseases also increases when housing is not up to standard – something the WHO and others have long reported.
But these health impacts are not evenly spread. Those on lower incomes are more likely to be adversely affected. For example, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) are more prevalent in areas of deprivation and worse still in neighbourhoods classed as ‘left behind’, with typically very poor housing and infrastructure.
While these health impacts are avoidable for many with improved housing, we can’t escape the fact that, right now, they’re costing the NHS in England billions of pounds each year, and the need for vital rehabilitation services has never been more acute.
With each hospital admission for respiratory disease or CVD caused by poor housing, there is also a need for rehabilitation. This rehab can break the cycle of hospital admission and discharge if it is accessible, person centred and high quality. Everyone has a right to rehabilitation, but so often services are patchy, and many don’t get the support they so desperately need. For example, only 15% of people with COPD who are eligible for rehabilitation are referred for this.
What’s more, in areas of deprivation the age profile for people with CVD and COPD is younger, with many not in work. Effective rehabilitation can help those of working age stay in, or return to, work.
The case for high-quality rehabilitation can therefore be made on economic as well as health grounds. Thankfully, progress is being made. In Wales there are new commitments to prehab and rehab as part of plans to reduce NHS waiting lists. In Scotland, a ‘Once for Scotland’ community rehab approach is being proposed. These moves towards a greater focus on the importance of rehabilitation take time.
The housing sector, too, can help with the rehab journey. Improve housing and you also improve people’s ability to rehabilitate in an environment that doesn’t undo the progress being made.
Add into the mix the current cost of living crisis, and that extra knock-on onto rehabilitation need is clear. Thousands of people who are unable to afford to heat their homes properly again increases the risk of health conditions arising. Those conditions spill into a need for further care and rehabilitation to return people to better health.
We must recognise that rehabilitation can help address many of the challenges faced by the NHS and exacerbated by poor housing, but it needs the application of focus, political will and investment to turn ambitions of better rehabilitation services into reality.