We've known about the link between poor housing and health for 150 years. So why is the government still so unwilling to tackle the problem of overcrowding in Britain's homes?
When Treasury adviser Derek Wanless published his report on improving the nation's health last week, he called for more emphasis on the prevention of illness, focusing on poor diet, lack of exercise and alcohol abuse. Housing barely got a mention.

The omission troubled doctors, MPs and housing professionals. Andy Love, MP for Edmonton in north London and one of the "gang of four" MPs pressing the government for a change in the overcrowding law, says: "Here's the government trumpeting a high-profile report into public health on the one hand while with the other it is presiding over a failure of housing policy to tackle overcrowding – one of the major contributory factors to poor health in the first place."

Wanless' report, Securing Good Health for the Whole Population, says a lot about how people live but precious little about where they live. This flies in the face of evidence that poor and overcrowded housing result in a multitude of social ills of precisely the type that the government hopes to overcome.

The British Medical Association sees an unequivocal link between overcrowded housing and poor health – such as that experienced by Dee Pinder and her four children, pictured above in their Tower Hamlets flat. In Housing and Health: Building for the Future, published last May, the BMA concluded: "The health of some of the most vulnerable groups in society is being adversely affected by living in damp, cold, overcrowded homes, often in socially excluded areas."

The report said low-quality and overcrowded housing was responsible for a range of illnesses: heart disease, strokes, stomach cancer, respiratory problems, asthma, infectious diseases, mental health problems and depression. And it found a correlation between higher adult mortality and childhood overcrowding.

A 10-year study undertaken by the University of East Anglia and published in 1998 produced even more explicit findings in relation to TB. It concluded: "A strong association was found between all TB mortality groups and overcrowding at the household level."

The Association of London Government has recently added to this evidence. It shows that in all 33 London boroughs – which between them account for a third of England's overcrowded households – the greater the overcrowding, the greater the incidence of TB. According to the World Health Organisation and the Public Health Laboratory Service, east Londoners are more likely to contract TB than people living in Azerbaijan or Armenia.

The council with the greatest TB problem is Newham. More than one in 10 residents live in overcrowded housing and it has a TB rate of 101 per 100,000 people – the UK average is 11. Chris Wood, director of housing at Newham, says overcrowded accommodation is one of the contributing factors.

Wood points out that if a TB sufferer is living in statutorily overcrowded housing, the council will prioritise that person for rehousing. He also cites a recent programme of urban renewal targeted on the areas of greatest deprivation in the borough. "Housing conditions, health and educational achievement are all linked. There should be a better standard for monitoring overcrowding so that we know the extent of what is going on. This would place greater pressure on councils but that's what we're here for."

Here’s the government trumpeting a report into public health on the one hand while with the other it is presiding over a failure of housing policy to tackle overcrowding 

Andy Love, MP

Although the link between poor housing and poor health has been known for more than 150 years – it was first highlighted by social campaigner Edwin Chadwick in 1842 – research specifically linking overcrowding to ill health is thin on the ground. Even so, there is no shortage of anecdotal evidence. Love says many of his constituents give him "chapter and verse" on what they see as the reasons for their asthma or TB. One constituent – who lives with her husband and four children in a two-bedroom flat – writes: "[I believe ] tuberculosis will … begin to extend throughout those of us who live in conditions ideal for its persistence … if families are left to suffer in conditions of overcrowding."

In another letter a local GP says: "Overcrowding and poverty are linked with poor emotional and physical health … The sort of problems we see include: behavioural disturbances in children related to the inability to play or have their own private space; parents who are unable to achieve any private space or time resulting in additional stress; a feeling of low self-esteem and frustration about not being able to supply basic needs for the family or parental relationship … if anyone has a chronic disease such as asthma, diabetes, or skin conditions that require active medication, this is doubly difficult in a crowded environment."

The ODPM – at the request of housing minister Keith Hill – is presently gathering all the available evidence on the extent of overcrowding and its impact. The aim is to allow Hill to make an informed decision on how best to tackle the problem.

Yet the issue has been excluded from the housing bill going through parliament. As reported last week, the government is reluctant to overburden councils already struggling to rehouse all families living in temporary accommodation by the end of this month (HT 27 February, page 19). The ODPM's research is due to be completed shortly and although it will show that about 500,000 households live in overcrowded conditions – that is, more than one person per bedroom – and that overcrowding rose sharply between the censuses of 1991 and 2001, urgent action to tackle the problem is unlikely.

Love points out that this reluctance will compromise "one of the government's top three priorities – child poverty".

One of the government's key tests of child poverty is whether there are enough bedrooms for every child over 10 of different sex to have his or her own room.

According to charities and MPs that are campaigning for a change in the overcrowding law, this simply is not good enough. They say children should have their own space from the age of five, otherwise they are living in cramped conditions that adversely affect their development.

Love strikes a sobering note: "If the government is serious about reducing child poverty, action has to be taken to deal with the nation's poor quality and overcrowded housing. I'd like to be proven wrong but I just can't see there being the necessary increase in housing spending to achieve this."

‘We are squashed up like rats’

“I’ll take you on the grand tour – it’ll be the shortest one you’ve ever had,” says Dee Pinder (above). We are standing at the top of the carpetless stairs in her two-bedroom, ninth-floor flat in Tower Hamlets, east London. The view is spectacular – the Millennium Dome, Canary Wharf – the interior is not. Her four children are at school so we are able to walk around the cramped flat. “If they were here,” Pinder explains in the children’s tiny bedroom, “we wouldn’t be able to move as we can’t all fit into the room at one time.” The 38-year-old has lived there since 1994, and has four children – Makeeba aged 10, Zak, nine, Danny, seven and Curtis, five. All the children have health complaints – the three eldest have asthma and the youngest suffers from epilepsy – illnesses that have worsened as they have grown older. Pinder is convinced that the cramped conditions are to blame. Yet under the 1935 overcrowding standard, her flat is deemed big enough for five adults. Children under 10 count for only half a person, so the Pinder family adds up to 3.5 people. Even before the children’s father moved out in 1999, the flat was deemed large enough. “The fact that the council says we are not overcrowded is really out of order,” she says. Pinder has been on Tower Hamlets’ housing waiting list for five years, despite the deterioration in her family’s health. “Damp has been appearing in their room over the past four months so they won’t be getting any better soon,” says Pinder. “We are squashed up like rats – just walking around is a nightmare as you’re constantly bumping into each other.” There is no respite from the overcrowding and nowhere for the children to play – the park nearby has been closed for two years. “If the children want to go in the park they have to climb over the railings or some of them have kicked the bricks out to get through.” A spokeswoman for Tower Hamlets – the country’s most cramped borough with 12.5% of its households overcrowded – says it has 2960 tenants awaiting transfer who are classed as overcrowded or lacking one or more bedrooms. “We have introduced a knock-through programme whereby smaller adjacent dwellings are knocked through to create larger homes. “We also award additional rehousing priority to adult sons and daughters of extremely overcrowded tenants … and we work closely with our association partners to ensure that large, family-sized homes are provided on new developments.” She added that health considerations were taken into account when families were assessed for transfer to bigger homes. The borough employs three health workers to undertake these assessments. Pinder knows exactly what she wants from the council: “It has to make sure that bigger homes are built in the area that we could move to. My life would be so much less stressful if we had more space and the kids’ health would be better – it’s as simple as that.”

Source

Housing Today