Health Impacts of Social Housing: Hospitalisations in Housing New Zealand Applicants and Tenants, 2003-2008

Research Paper

Background

Housing tenure, whether a person rents or owns the house they live in, is known to have a marked effect on people’s health.  People who live in a house they own – in part or in full – have a major capital asset, which can financially and psychologically buffer them and their families throughout their lives. Those who rent, whether from a private landlord or a social housing agency, are likely to be poorer, although in some cases they may be trading off more income for less wealth [1].

There is strong evidence that people who own their own houses are in better physical health than people who rent their houses, even controlling for income [2]. It is not clear why homeownership seems better for health than renting, whether from social or private landlords. It may be that homeownership confers both psychological and material advantages upon owner occupants [3-4]. Psychologically, homeownership, rather than renting, is thought to confer greater autonomy on occupants, as well as social status [5], what economists call ‘positional goods’. Materially, houses that are owned are generally in better condition than rented accommodation.  Moreover, in general, houses are the largest capital asset owned by families and represent a measure of wealth, which can be used to generate a stream of income in addition to salary and wages.

The development of social housing was designed explicitly to counteract the generally poorer quality and greater insecurity of rental housing and racism in the private rental market [6]. Leases in social housing agencies such as HNZC have been designed to give all tenants, regardless of income, health status or ethnicity, security that approximates that given by a house title to an owner.  However, the costs and benefits are not static, in part because the housing market is such a pivotal part of the general economy and in an economic recession, homeowners, who bought in a boom, may be left with negative equity in their houses [7-8]. In this case, homeownership may be less secure than renting, particularly if the homeowner is made unemployed or becomes chronically ill.

We know from New Zealand research that housing quality is one of the contributors to health inequalities. Cold, damp, mouldy housing affects people’s health and well-being, as well as their use of health services [9-10]. In the United Kingdom, Blane and colleagues have outlined how housing conforms to the inverse care law first identified in health care [11]. Colder and windier parts of the United Kingdom have poorer housing, which is associated with reduced lung function, as well as raised diastolic and systolic blood pressure [12].
Furthermore, we know from earlier New Zealand research that the level of household crowding has a clear link to the transmission of infectious diseases [13]. Crowding is more common in low income households where people try to lower the rent per person by ‘doubling-up’ in households. At the other extreme, people in single-person households tend to have higher living costs and are more likely to suffer from fuel poverty, i.e. they spend more than 10% of their income on household energy [14]. Thus, the influences of housing on health inequalities are both direct and indirect [15].

Previous work in the United Kingdom has showed that social housing is an effective intervention to reduce inequalities in health [16]. This cohort study has been designed to evaluate the health impacts of social housing in New Zealand. It uses administrative data to monitor the effects on hospitalisation of social housing.