“Everyone has the right to a standard of living adequate for the health and wellbeing of themselves and their family, including housing” – The Universal Declaration of Human Rights
Where we live and the conditions we live in have a direct influence on our health and wellbeing. The NHS Highland Public health team have written this blog in order to provide easy access for housing colleagues and others to some of the information and projects that public health are currently involved with.
Housing, health and health inequalities
There is an extensive literature on the relationship between housing and health. A report by the Scottish Public Health Network Foundations for well-being: reconnecting public health and housing (ScotPHN, 2017) presents a conceptual framework for understanding housing and health across the life course. It shows how the location of a dwelling, its physical characteristics and the experiences of its inhabitants influence physical, mental and social health.
A briefing Housing and Health Inequalities (NHS Health Scotland, 2016) outlines the role that good-quality housing can play in improving health and wellbeing and reducing health inequalities. This briefing highlights what housing should provide for people in Scotland in order to reduce health inequalities: everyone should have an affordable home that meets their needs and that they can afford to heat; every home should be warm, dry and energy efficient; and everyone should have a home that supports wellbeing through connections to a place and a community.
Fuel poverty is a key determinant of health and wellbeing, as summarised in a literature review on Fuel Poverty (ScotPHN, 2016). Fuel poverty particularly affects people and households on welfare benefits or low incomes, those in energy inefficient homes and those who, due to some form of vulnerability or ill-health, spend more time at home. A report Addressing fuel poverty: guidance for Directors of Public Health (ScotPHN, 2016) summarises key public health messages around fuel poverty. The NHS Highland Director of Public Health has also spoken about the impact of fuel poverty across Highland and Argyll and Bute.
The importance of housing to health and wellbeing applies across the life course. An ageing population means that accessible and adaptable homes will play an increasingly important role in maintaining independence, health, and wellbeing in later life. A report on The Impact of Population Ageing on Housing in Scotland (Scottish Government, 2010) summarises the impact of population ageing on housing including issues relating to housing stock, specialist housing, support services, and adaptations. A report Making the Connection: guide to assessing the housing-related needs of older and disabled households (Young, 2015) also provides practical guidance on assessing the housing needs of older and disabled households.
Improving housing quality can impact positively on people’s health and wellbeing, particularly if targeted at vulnerable populations, for instance, people who are homeless, gypsy/travellers, migrants, people with mental health issues and those with problem alcohol and drug use. A briefing on Health and homelessness (NHS Health Scotland, 2016) and a report Restoring the Public Health response to Homelessness in Scotland (ScotPHN, 2015) outlines key actions for a public health response to this critical issue.
Public Health Projects
Violence Against Women Partnership Safe at Home Scheme
The Violence Against Women (VAW) Partnership have worked alongside housing to develop the Safe at Home Scheme. The aim of this scheme is to prevent homelessness through early identification of those with experience of domestic abuse who wish to remain in their own homes. Security measures are put in place that support staying safe in their home. The scheme is delivered through Housing and the Police but the partnership is supported through the Violence Against Women Development and Training Manager which is hosted within NHS Highland Health Improvement Team.
Contact: Gillian Gunn – Violence Against Women Development & Training Manager; gillian.gunn@nhs.net
Highland Affordable Warmth Partners Group
NHS Highland Health Improvement team is represented on this multi-agency forum which is chaired by Highland Council Housing Department. The aim of this forum is to address fuel poverty through a range of different actions and interventions which include:
- A referral pathway to Home Energy Scotland (HES) for patients in two Sutherland community hospitals. HES work directly with individuals to provide advice and support on energy efficiency and fuel poverty. HES prepared an admission pack for patients and delivered staff training. This referral initiative was extended to East Sutherland community teams and it is intended to hold further discussions about capacity to extend it to other areas.
- Raigmore Hospital: Home Energy Scotland liaise with the hospital to have a regular stall in areas such as the outpatients waiting area; the main entrance and the staff canteen.
- HES introductory letters sent to all GP practices offering input to flu clinics in 2016 and 2017.
Contact: Margaret Brown: Policy Development Officer, Margaret.brown11@nhs.net
Understanding local needs
The Public Health Intelligence and Epidemiology teams have recently undertaken a number of pieces aimed to improve our understanding of health and social care needs in NHS Highland. These include the following:
- A literature review report on models of housing for older people living independently in the community and key messages for developing appropriate and person-centred housing for older people across the Highland region.
- Estimates of the current and future need for care for older people in Highland Health and Social Care Partnership by dependency status and by setting. This work also included a tool to predict future numbers of care home places for the population of Highland aged 65 years & over with high or medium dependency over the next 10 and 20 years.
Contact: Noelle O’Neill, Public Health Scientist, noelle.oneill@nhs.net
Ian Douglas, Senior Health Intelligence Specialist, ian.douglas@nhs.net
Case Study 4: Highland Alcohol and Drug Partnership – Housing First
The Highland Alcohol and Drug Partnership(HADP) team are working in partnership to establish a Housing First pilot in Highland (Inverness and Caithness).
Housing First provides ordinary, settled housing as a first response for people with multiple needs. This includes people who have a range of experiences including childhood and early years trauma, domestic abuse, mental ill health, addictions as well as time spent in local authority care or prison. Housing First recognises a safe, secure home is the best base for recovery and for addressing any other issues in your life.
A short life working group is working on a service redesign and will focus on people with complex needs that are difficult to engage and potentially at high risk of drug and/or alcohol related death. A couple of workshops have already been held and there are plans for another one in October.
Contact: Deborah Stewart: HADP co-ordinator: Deborah.stewart@nhs.net
Further information and sources of data
There are a number of sources of data on housing and health that provide information relevant to NHS Highland and its two Health and Social Care partnerships. Some examples are highlighted below:
- The National Records of Scotland provide estimates and projections of household composition.
- The Scottish Public Health Observatory provides information on a range of health topics, population groups and life circumstances including housing and homelessness.
- The Scottish Government produce a range of statistics on housing, health and social care, for instance, housing for older people and those with disabilities and the annual social care survey.
- Information Services Division publish data and analyses of activity within health care and social care, including an annual care home census and reports on delayed discharges.
- The Scottish Household Survey provides details of household composition, characteristics and behaviour for each local authority.
For further details contact:
Ian Douglas, Senior Health Intelligence Specialist, ian.douglas@nhs.net
Carolyn Hunter-Rowe, Senior Epidemiologist, c.hunterrowe@nhs.net
Lynda Thompson, Senior Health Improvement Specialist, lynda.thomson1@nhs.net