Large-scale literature reviews (Ambrose et al., 1996) and specific studies appear to have confirmed that poor housing and poor health have a close relationship and that improving housing conditions has a positive effect (Green, 1997; Collins, 1999; Wilkinson, 1999). However, establishing a causal link remains challenging, in part because of the large number of variables to account for. It may also be the case that the health-led nature of previous research has not fully appreciated the complexities of some of the housing inputs.
Earlier research (Revie, 1998) suggests that, although Scotland does not experience higher levels of fuel poverty than other parts of the UK (one-third of households), the temperature is generally lower and the quality of housing stock is inferior. This may mean that Scottish households are at greater risk of negative health outcomes, but existing data are not robust enough to conclusively prove this.
Key research Question
Whether using an interdisciplinary approach could provide the necessary expertise to provide a more robust assessment of the multiple factors connecting fuel poverty, housing and health that affect households in Scotland and, if possible, estimate the likely costs to the NHS.
Summary of activity
The study looked at a sample of patients attending GP clinics in a deprived area near Glasgow (Paisley). A health questionnaire was completed by 440 patients awaiting consultation after periods of cold weather (Phase I). A subset of 135 households were identified as living in damp or cold properties, of which 95 agreed to complete a more detailed questionnaire and 72 agreed to receive an energy audit (Phase II). Participation was voluntary in both phases, and health data were self-reported. Interviews with GPs at participating clinics and also local council officials concerned with energy advice and housing collected insights into health and housing for comparison with the data emerging from the study.
Phase I – The rate of attendance at GP clinics was double the Scottish average. Four-fifths of respondents had an income of less than £150 per week, and 40% of those reporting damp, mould or draughts attended over ten times per year. Those with central heating were far less likely to attend the GP clinics on multiple occasions. Overall, the additional cost to the NHS was estimated at over £263 per person per year.
Phase II – Income levels in the subset of households were similarly low, with two-thirds of respondents on less than £150 per week and under a third in employment. However, over half paid for electricity through schemes known to pose an increased risk of fuel poverty/debt such as prepayment meters, and a similar level did not achieve affordable warmth. The overwhelming majority lived in social housing (77%).
Phase II – Over half of respondents reported health problems with known connections to damp. There was a clear association between living in damp housing and poor health among children, with much higher levels of asthma in the sample (one in four households) in comparison with the UK average, but this was not observed in cold and/or draughty housing. Some 60% of the sample stated that either they or a member of their household had visited their GP ten or more times in the last year.