Calls to increase government investment in social housing in London to keep children out of temporary accommodation
An inadequate level of social housing across London is affecting children’s physical and mental health, and could permanently hinder their development, according to the latest Marmot Review from the UCL Institute of Health Equity (IHE).
The IHE’s Evidence Review on Housing, Health Inequalities in London, is a rapid evidence review involving literature searches for evidence of interventions to address housing and health issues in the capital. Ithighlights that there are over 75,000 children under 18, who are homeless and living in temporary accommodation in in London. That’s because of the severe shortage of good quality and affordable housing in London, particularly social housing, which forces many people to live in unsafe, insecure or unaffordable homes.
Professor Sir Michael Marmot, Director, UCL Institute of Health Equity commented: “This is an unacceptable state-of-affairs as it blights children’s future permanently. Our homes provide the living environment that dictates our future health. We know that living in cold, damp and mouldy homes leads to lung damage in children and impairs their development.
“Children are less likely to be able to do their homework if their home is cold and overcrowded, leading to them falling behind at school. Long term that is more likely to lead to low-income, unstable work and not being able to make ends meet. Educational achievement is a key predictor of long-term health and longevity, and health inequalities.”
The latest Marmot review, produced for the Greater London Authority (GLA), is calling on the government to accelerate, rapidly, the increase in the supply of good quality social housing, which offers long-term security at an affordable cost. The series of recommendations includes ensuring no household with children is placed in single-room or bed and breakfast accommodation, with a goal that no children are placed in temporary accommodation for more than a specific and limited period of time.
The Mayor of London, Sadiq Khan, said: “I welcome the findings of this important report, which highlights how more government investment in social housing is vital to improving health and addressing health inequalities.
It is unacceptable that a child’s background and postcode has such a major impact on their overall health. London has the potential to become one of the world’s healthiest major cities but if we are to achieve this ambition, we must start by reducing some of the massive inequalities that exist in the capital.
“Since I became Mayor, we have delivered record-breaking affordable homebuilding. This includes starting work on more new council homes last year than at any time since the 1970s. But the government must now help us to do even more by rapidly increasing investment in good quality social housing that meets the scale of demand in our city.”
Why London is hit the hardest
The past decade has seen major events affect Londoners’ experiences of their homes. These include the COVID-19 pandemic, which brought about significant changes in lifestyles and housing requirements, and highlighted overcrowding. The Grenfell tower tragedy also exposed a previously hidden phenomenon of unsafe cladding and building materials, whilst the war in Ukraine and cost-of-living crisis now risk driving many more households into fuel poverty and making it more difficult for tenants to cover their rent.
People from minority ethnic backgrounds on average experience worse housing conditions, and greater housing insecurity and need than White Londoners.
Housing impacts health through three established pathways: quality, security and affordability. Underlying all three however, there are fundamental challenges related to the shortage of good quality and affordable housing in London.
Sir Michael explained: “Until there is a major step-change in levels of investment in social housing many people living in the Capital will remain at risk of sub-standard and insecure accommodation. The situation will only change if there is a move towards valuing our homes as a vital infrastructure for public health and wellbeing.”
In the post-war years good quality homes were understood to be an essential need for health and wellbeing of the population, and public investment was prioritised despite high national debt. In the 1970s, local authorities in London alone were building over 20,000 new homes every year. Since the first sale of council homes through the Right to Buy scheme in the 1980s, only one in five of the homes sold have been replaced with council housing.
Sir Michael added: “As London enters a period of the highest inflation seen in a generation there is a real risk of widening housing-related health inequalities: this includes a particular risk of growing rates of fuel poverty, higher costs of maintenance and repairs, and greater risk of arrears and eviction leading to rising homelessness, especially for people living in the private rental sector.”
In addition, neighbourhoods and the surrounding environment play a critical role in people’s experiences of home and in how they interact with the surrounding area. It can affect how much time people spend in their homes and how they use their homes if safe and appealing outside spaces or local destinations do not exist. For example, children may spend more time indoors rather than playing outside, with implications for physical activity, social development and mental health.
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An overarching recommendation of this review is that the GLA and local authorities in London must continue to use their expertise and experience to advocate for national government action to provide secure, good quality homes for all. The Government should adopt a medium- to long-term aim to rapidly accelerate an increase in the supply of social housing, available at an affordable rent, that is good quality, suitable for a range of needs, and offers long-term security of tenure.
The Problem, examples
The Solution, examples
· Many more households are likely to be living in cold homes, with increased damp and mould, as household energy bills continue to rise into 2023: although London has lower rates of fuel poverty than average for England, it has much higher rates of after housing cost poverty, which leaves people with less disposable income to afford the rising cost of living.
· London has the highest rates of overcrowding in England.
· London typically experiences the highest temperatures in England during summer, including during heatwaves. Many homes are not adapted to extreme heat and this will become an increasingly significant determinant of health inequalities as summers become hotter over the course of this century.
· London has higher rents and house-prices than average for England.
· The majority of children who are homeless and living in temporary accommodation in England are in London.
· London has the highest rates of poverty after housing costs are taken into account in England, and children are significantly more likely to grow up in after housing cost poverty than average for England.
· London has the largest shortage of health and social care workers in England, and this is in part driven by the shortage of affordable housing for key workers.
Quality: Local authorities in London, supported by the GLA, and adequate national funding, should:
· Continue to seek to raise standards of temporary accommodation to ensure that no child is placed in single-room or bed and breakfast accommodation, with a goal that no children be placed in temporary accommodation for more than a specific and limited period of time.
· Implement and evaluate interventions to address overcrowding in the social and private rented sectors that include both facilitating moves and supporting people to live in their existing homes through modifications and psychosocial support.
· The Government should resource local authorities, the Dept for Work and Pensions and other delivery partners to deliver a range of interventions - financial, advisory and practical - to support households facing difficulties with energy and repair bills.
· Local authorities in London should work closely to reduce competition and increase collaboration in the commissioning of temporary accommodation.
· Local authorities should apply the core principles of Housing First.
· Local authorities in London should maintain and increase provision of debt and financial advice to tenants facing eviction for rent arrears.
· The GLA and local authorities should engage with proposals outlined in the Levelling up and Regeneration Bill
· The Government should increase local housing allowance in line with local rents and inflation, at a minimum returning it to pre- April 2011 levels, when housing allowance was set at 50% of average rents. The definition of affordable housing used to determine prices for sale and rent should be universally agreed to become a function of local incomes rather than of average local house values and rents.
The UCL Institute of Health Equityis confident enough to conclude that we have the evidence on what needs to be done to advance health equity, as laid out in our 2010 Marmot Review. The recommendations in Reducing Health Inequalities in Luton: A Marmot Town are structured according to the ‘Marmot Principles’.
The first Marmot Review, published in 2010, introduced six of these principles, which are broad policy objectives aimed at reducing health inequalities by improving the conditions of everyday life and reducing socioeconomic inequalities. Two further principles have since been added to make more explicit and add focus to the key considerations of discrimination and sustainability, which are essential to equity.
The UCL Institute of Health Equity works in local partnerships nationally and globally to influence the delivery of interventions to ensure they incorporate action on health, social and economic inequalities. Organisations with which the IHE works include business, city authorities, voluntary sector, local government and healthcare services.
In the UK the evidence on what needs to be done to advance health equity has been overlooked by central government. From 2010, the rate of increase in life expectancy slowed markedly; health inequalities increased, linked to deprivation and region; and life expectancy for the poorest people outside London declined.
This worsening health picture is related to policies of austerity and regressive cuts to spending during that period. The IHE produced Build Back Fairer: The COVID-19 Marmot Review in December 2020, which includes national for government, business, the health and care system, and the voluntary and community sector. Build Back Fairer in Greater Manchester published June 2021, builds on the 2020 review.
In April this year IHE published its first review for the role of business in reducing health inequalities: The Marmot Review for Industry. Building on this review the IHE, in partnership with Legal and General, will launch the Health Equity Network this autumn. The aim of the network is to support action on health equity through partnerships across the UK by sharing experience between the partnerships and building momentum on health equity as the primary goal of place-based working.
IHE continues to work closely with other cities and regions, including Coventry, for which a city evaluation was produced in 2020. We have begun programmes of work with Cheshire and Merseyside, Cumbria and Lancashire and other local authorities in England. In May 2021 IHE published a commentary report on UK ethnicity and mortality statistics in relation to the COVID-19 pandemic.
Internationally IHE has responded to COVID-19 with:
· Build Back Fairer: Achieving Health Equity in the Eastern Mediterranean Region - The WHO EMRO Commission on the Social Determinants of Health, published on 31 March 2021
· Hong Kong, with the first report in a series from our collaboration with the Chinese University of Hong Kong's Institute of health Equity: Build Back Fairer: Reducing Socioeconomic Inequalities in Health in Hong Kong published 16 November 2021
· Evidence Brief: COVID-19, the social determinants of health and health equity, which discusses the disproportionate impacts that the COVID-19 pandemic is having on more disadvantaged population groups, with a focus on how it is widening health inequities.
The IHE’s Director, Sir Michael Marmot, is Professor of Epidemiology at UCL and Past President of the British and World Medical Association. He is the author of The Health Gap: the challenge of an unequal world (Bloomsbury: 2015) and Status Syndrome: how your place on the social gradient directly affects your health (Bloomsbury: 2004). Professor Marmot holds the Harvard Lown Professorship for 2014-2017 and is the recipient of the Prince Mahidol Award for Public Health 2015. He has been awarded honorary doctorates from 18 universities. In 2021 Professor Marmot received BMJ's Outstanding Contribution to Health award. Professor Marmot has led research groups on health inequalities for over 40 years.