"Housing policies & Health inequalities" by Fernando Díaz, in the framework of the final conference of the European research project SOPHIE. 29th September 2015, Brussels

1. Housing
Policies
&
Health
Inequali3es
1
Fernando
Díaz
Alpuente
“The
impact
on
health
and
equity
of
social
and
economic
policies”,
Brussels,
29.9.2015

2. SOPHIE
Housing
policies
team
Agència
de
Salut
Pública
de
Barcelona:
Carme
Borrell,
Lluís
Camprubí,
Andrés
Peralta,
Hugo
Vázquez,
Davide
Malmusi,
Ana
Novoa,
Jordi
Amat,
Laia
Palència,
Marc
Marí-­‐Dell’Olmo,
Julia
Ward,
Roshanak
Mehdipanah,
Maica
Rodríguez-­‐Sanz
Càritas
Diocesana
de
Barcelona:
Fernando
Díaz,
Carme
Trilla,
Mercè
Darnell,
Tere
Bermudez
Universitat
Pompeu
Fabra:
Jordi
Bosch

3. Why
housing?
Improvements
of
housing
condi[ons
are
considered
a
major
factor
behind
advances
in
popula[on
health
in
the
early
1900s.
Housing,
the
“wobbly
pillar”
of
the
welfare
state
–
also
in
health
inequali[es
research.
Literature
mainly
from
UK,
New
Zealand…
much
less
in
Spain
where
it
has
been
an
increasingly
pressing
social
issue,
both
before
and
acer
the
burst
of
the
housing
bubble

4. What
we
did?
Overview
Literature
reviews
and
conceptual
framework
on
housing
policies,
housing
condi[ons
and
health
inequali[es
Focus
on
fuel
poverty
1.
Associa[on
of
fuel-­‐poverty-­‐related
housing
condi[ons
and
health
status
in
European
welfare
regimes
2.
Natural
experiment
on
thermal
insula[on
and
winter
mortality
in
social
housing
3.
Realist
synthesis
on
energy
retrofihng
and
health
equity
4.
Resistance
to
austerity
on
UK
fuel
poverty
policies
Focus
on
people
with
severe
problems
of
access
to
housing
1.
Caritas
BCN
users:
follow-­‐up
survey
on
rehousing
2.
“Mortgage
affected
plakorm”:
online
survey

5. Conceptual
framework
Adapted
from
Ana
Novoa
et
al.
Impact
of
the
crisis
on
the
rela[onship
between
housing
and
health.
Policies
for
good
prac[ce
to
reduce
inequali[es
in
health
related
to
housing
condi[ons.
Gac
Sanit.
2014
Jun;28
Suppl
1:44-­‐50.

6. Focus
on
fuel
poverty

7. Fuel
poverty:
Cross-­‐country
EU-­‐SILC
2012.
Popula[on
in
the
two
lower
income
quin[les
Poor
housing
condi[ons
related
with
fuel
poverty
are
more
frequent
in
Southern
(52%)
and
Transi[on
(48%)
welfare
regimes,
and
less
in
Liberal
(29%),
Con[nental
(28%)
and
Social-­‐Democra[c
(24%)
regimes
.
In
all
welfare
regimes,
the
higher
the
number
of
poor
housing
condi[ons,
the
higher
the
risk
of
poor
self-­‐
rated
health.
Jordi
Bosch
et
al.
Associa[on
between
fuel
poverty
and
self-­‐reported
health
status
among
low-­‐income
popula[on
in
Europe.
Forthcoming.

8. Fuel
poverty:
Cross-­‐country
More
Excess
Winter
Deaths
in
countries
where
more
people
report
living
in
an
insufficiently
warm
house
Excess
Winter
Deaths
Index
2011/12
based
on
Eurostat
monthly
mortality
data.
“Home
not
warm”:
EU-­‐
SILC
2012,
two
lower
income
quin[les.
Jordi
Bosch
et
al.
Associa[on
between
fuel
poverty
and
self-­‐reported
health
status
among
low-­‐income
popula[on
in
Europe.
Forthcoming.

9. Fuel
poverty:
Realist
synthesis
Energy
retrofiSng
and
health
equity
Social
groups
suffering
most
from
fuel
poverty
and
its
health
effects
(low
income,
renters,
elderly
people,
etc)
experience
more
barriers
for
undertaking
a
building
retrofihng.
Main
causes:
-­‐ Inability
to
afford
the
ini[al
costs.
-­‐ Lack
of
incen[ve
for
landlords
to
improve
energy
efficiency.
-­‐ Insufficient
aten[on
to
residents’
needs
or
preferences.
Lluís
Camprubí
et
al.
Façade
insula[on
retrofihng
policy
implementa[on
process
and
its
effects
on
health
equity
determinants:
a
realist
review.
Forthcoming.

10. Fuel
poverty:
insula3on
&
mortality
in
Barcelona
We
carried
out
a
[me
stra[fied
case
cross-­‐over
analysis
to
evaluate
the
impact
on
the
associa[on
between
cold
outdoor
temperatures
and
mortality
of
energy
efficiency
façade
retrofihng
of
310
poorly
insulated
social
housing
blocks
in
the
city
of
Barcelona,
occurred
between
1986
and
2012.
Women
living
in
a
non-­‐insulated
block
had
a
higher
risk
of
death
when
exposed
to
extremely
cold
temperatures
on
the
same
day
of
death
and
the
day
before.
These
associa[ons
disappeared
for
women
living
in
an
insulated
block.
Greater
impacts
were
seen
in
women
aged
70-­‐79
and
with
no
educa[on.
Risk
of
death
in
extremely
cold
days
before
(blue)
and
acer
(red)
façade
insula[on
Andrés
Peralta
et
al.
Impact
of
three
decades
of
energy
efficiency
interven[ons…
Forthcoming.

11. Focus
on
people
with
severe
problems
of
access
to
housing

12. Mortgage
Affected
PlaUorm
Self-­‐rated
health
was
poorer
in
later
steps
of
the
process,
such
as
post-­‐evic[on.
A
civil
society
self-­‐organized
movement
composed
by
people
who
cannot
afford
their
mortgage.
Online
ques[onnaire
completed
by
905
adults
belonging
to
the
Plakorm
(“PAH”)
in
Catalonia.
They
were
in
a
much
poorer
mental
health
status
than
the
general
popula[on
of
Catalonia.
Poor
mental
health
was
significantly
higher
already
in
the
period
of
non-­‐payment
compared
with
those
who
were
up-­‐to-­‐date
with
the
payment.
13%
87%
0%
20%
40%
60%
80%
100%
Catalonia
Mortgage-­‐Affected
Poor
mental
health
Hugo
Vásquez
et
al.
Foreclosures
and
health
in
Southern
Europe:
the
case
of
people
affected
by
mortgage.
Forthcoming.

13. Caritas
users
with
housing
problems
Follow-­‐up
study
of
the
impact
of
housing
condi3ons
Survey
interview
on
socioeconomic
and
housing
condi[ons,
health
of
the
respondent
and
of
one
of
her/his
children
Rehoused through Caritas
social renting programme
Not rehoused
… or with difficulties paying
rent or mortgage (Housing
Mediation Service)
Families living in
substandard housing
n=175
n=145
Follow-up survey
(1 year after)
Baseline survey
(Sept-Dec 2012)
Follow-up
n=97
n=108
n=33

14. … or with difficulties paying
rent or mortgage (Housing
Mediation Service)
Families living in
substandard housing
n=175
n=145
Much
worse
health
status
than
Barcelona
popula[on
(overall
and
manual
social
classes)
Caritas
users
with
housing
problems
Follow-­‐up
study
of
the
impact
of
housing
condi3ons
Baseline
survey
Ana
M
Novoa
et
al.
Living
and
housing
condi[ons
and
health
status
among
people
atended
by
Caritas
Barcelona
…
ENHW-­‐FEANTSA
2014;Issue
19:3-­‐6.

15. 62,2
75,0
11,5 12,1
66,9
72,6
15,2
17,4
0
20
40
60
80
100
Subst housing HMS BCN BCN SC IV and V
%
Men Women
Poor mental health
24,4
45,8
11,2 12,8
53,1
60,3
15,3
20,5
0
20
40
60
80
100
Subst housing HMS BCN BCN SC IV and V
%
Men Women
Fair/poor health status
28,9
38,9
3,6
62,3
65,8
8,5
0
20
40
60
80
100
Subst housing HMS BCN
%
Boys Girls
Poor mental health (children)
Caritas
users
with
housing
problems
Baseline
survey
Ana
M
Novoa
et
al.
ENHW-­‐FEANTSA
2014;Issue
19:3-­‐6.

16. HMS Follow-up
Rehoused
adults
experienced
more
improvements
in
housing
condi[ons,
and
similar
improvements
in
health
as
“controls”
(some
of
whom
also
move
on
their
own,
find
a
job,
increase
income…)
n=97
n=108
n=33
Caritas
users
with
housing
problems
Follow-­‐up
study
of
the
impact
of
housing
condi3ons
Follow-­‐up
survey:
What
we
found
Rehoused through Caritas
social renting programme
Not rehoused
Improvements
in
habitability,
tenure
security
and
affordability
were
associated
with
improvements
in
mental
health
Change
in
%
of
poor
mental
health
in
users
with
unaffordable
(>30%
of
income)
housing
cost
at
baseline

17. Conclusions
and
recommenda3ons
Poor
housing
condi[ons,
fuel
poverty
and
lack
of
housing
affordability
are
related
to
poor
health
outcomes.
Policies
that
improve
housing
affordability,
like
social
housing
or
housing
and
energy
allowances,
can
improve
health.
Public
policies
that
tackle
housing
instability,
fuel
poverty
and
their
consequences
are
urgently
needed
in
Southern
European
countries.
Policies
on
housing
energy
efficiency
can
reduce
the
health
consequences
of
fuel
poverty,
but
need
to
be
free
to
users,
targe[ng
the
most
affected
groups
and
adapted
to
their
needs.

18.
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