Housing as a social determinant of health: Evidence from the Housing through Social Enterprise study

Abstract

Housing is a key driver of public health. Existing evidence clearly demonstrates the ways in which health is damaged by homelessness and by living in poor quality housing. However, the routes from housing to health and wellbeing are wider and more complex than the negative effects of problems with housing. Housing as ‘home’ is not just a physical shelter, but also a foundation for social, psychological and cultural wellbeing. Hence, it is important to understand how houses become homes for the people that live in them and the ways in which housing organisations can affect this process. This report summarises findings from the Housing through Social Enterprise study. The project followed a group of new tenants from three different housing organisations to examine the health and wellbeing impacts of different approaches to housing provision across the social and private rented sectors. We interviewed more than 70 tenants at three points over the first year of their tenancy, to explore how they felt about their housing situation and their local neighbourhood, and to measure changes in their health and wellbeing. The key findings of this research are: • Tenants’ health and wellbeing generally improved over the first year of their tenancy, across all three housing organisations. • A strong relationship with a named member of staff, who respected them and understood their particular needs, history and situation, was important to tenants. • A good quality property was one that was efficient and free from obvious physical defects, but also well decorated, comfortable and homely. Condition on move-in day was especially important. • Tenants varied in terms of how much they wanted to improve or customise a property to their own tastes and whether they had the capacity, permission or resources to do so. • Financial challenges were particularly acute at the start of a new tenancy. Some tenants struggled to recover from this because of ongoing high or unexpected expenses, many of which were related to their properties or tenancies. • Tenants valued a sense of safety, friendliness and amenities, and having social support networks in their local area. • Tenants’ neighbourhood priorities depended on their personal circumstances, characteristics and prior experience. Ultimately, having a choice in where they would live was the most important aspect for tenants. • Many of the mechanisms linking housing to health and wellbeing operate through tenants being able to establish a sense of ‘home’ in their new tenancy. These findings raise a number of issues for debate and discussion among housing and public health professionals, as well as tenants’ organisations.