Housing research: cold rooms have high health costs

October 2015 Vol 15 (5)

Housing researcher NEVIL PIERSE talks to Nursing Review about getting the hard statistics and evidence to back healthy housing initiatives.

Nevil PierseKiwi kids’ health is suffering as too much of our rental housing is “too damned cold, old and mouldy”, as housing researcher Dr Nevil Pierse bluntly sums up the situation.

The statistician is part of the University of Otago’s He Kainga Oranga/housing and health research team that this year received a $5 million Health Research Council grant to further its ongoing research into improving New Zealand’s housing stock for the “sake of our children’s health” see more in ‘Warrant of Fitness’ sidebar p.8).

One of the six new studies funded involves Pierse following the work of Wellington housing nurses Shirley Pierce and Tineke Snow to see what impact their intervention service, which draws on the team’s research, makes to housing-related health conditions in children.

Pierse says in recent years around 4,400 Wellington children were hospitalised because of conditions potentially attributable to housing – or just over a quarter of the children hospitalised.

He says Pierce and Snow’s nursing service is innovative as, rather than children who are hospitalised for housing-related conditions just being sent back to the same environments, the pair assess the homes and try to resolve issues so the children don’t end up in hospital again.

Warmer in the freezer

The story of one asthmatic boy in Bluff involved in another of Pierse’s research projects, provides a stark example of how housing impacts on health. “He was sleeping in a room that we measured as being down to minus 4 degrees Celsius at its coldest. This boy would have been warmer in his freezer than in his bedroom.”

Not surprisingly, this boy had four hospitalisations for asthma in the winter. The following winter, after his house was insulated and adequately heated, he had no hospitalisations.

That study, led by Pierse, involved looking at the temperature of children’s bedrooms and the impact on their lung function. It found that when a child’s bedroom temperature dropped to less than 12 degrees Celsius for even around an hour, the resulting decrease in lung function was still detectable two weeks later. Pierse says room temperatures that low are not uncommon in Wellington or Christchurch if a bedroom isn’t heated during winter.

“It would be cheaper for the Government to ensure that low-income families can heat their children’s bedrooms rather than paying for the health consequences afterwards because the health consequences last for a lifetime – and they are rapid and substantial.”

New Zealand has amongst the highest rates of asthma in the world and Pierse says that can probably be linked in part to our damp, cold and mouldy housing.

He says every asthma hospitalisation is estimated to cost a district health board about $2,500 and a further financial burden of at least $350 to the family through lost work time and extra costs. “And these are the poorest families paying for this – they really can’t afford these costs.”

Studying nursing intervention

One answer is targeted interventions like those provided by Snow and Pierce’s healthy housing nursing service. The health outcomes of the pair’s client cohort are being followed by Pierse for five years and will be compared with a control group of “equally sick” children hospitalised for potentially housing-related conditions, including skin conditions. He hypothesises though that the nursing intervention will impact most on respiratory conditions as skin conditions are more related to overcrowding, which is more difficult to resolve than making houses warmer and drier.

Having nurses lead a housing intervention makes sense to Pierse. “Nurses are very practically minded people and there are a lot of practical answers to these [housing] problems.

“And I think people do respond very well to well-trained nurses.” Nurses can explain the health consequences to families on taking practical steps, from wiping down condensation to giving up smoking, and can also explain the health consequences to landlords and other agencies when they write letters in support of tenants or make referrals on housing-related issues.

Pierse says it would also be helpful for nurses and others working in the public health field if there was more regulatory clout to enforce basic housing standards.

More regulatory clout

In the United Kingdom it has been calculated that having minimum building standards saves them more than £7 billion in health costs, says Pierse.

New Zealand taxpayers are paying for the increased health costs resulting from poor housing and the Government is also spending $1.3 billion on accommodation supplements a year, including low-income families living in cold, damp and mouldy rental stock.

For Pierse the statistician it makes economic sense for the government to enforce minimum standards for rental housing it subsidises or a rental Warrant of Fitness (see sidebar p.8). He says while there is some nervousness about heating and safety requirements, in general most landlords want good habitable housing of a good standard. “Nobody wants to be a slum landlord.”

Also, having set minimum standards for rental housing would empower nurses and other public health professionals to ensure a house is brought up to standard, particularly if a tenant had been hospitalised for housing-related reasons. The World Health Organisation recommends children’s bedrooms never go below 20 degrees and even with insulation and heating we struggle to get many Kiwi houses above 16 degrees, says Pierse.

At present the whole burden of  that old and cold housing is falling on the health system argues Pierse. “It is the health system that is fixing up the kids and sending them back out (to the same houses that often caused the problem).”

Compulsory insulation and ‘WOF’ for housing

Healthy housing advocates would like to see some form of warrant of fitness (WOF) introduced to ensure minimum health and safety standards for New Zealand’s rental housing.

The government is yet to be convinced but this winter announced it has reformed the Residential Tenancies Act so that from July next year all social housing must have retrofitted ceiling and underfloor insulation and from 2019 all other rental housing will require insulation. Smoke alarms will also be required in all tenanted properties from July 2016.

Housing Minister Nick Smith said at the time the changes would make houses warmer, drier and safer and were a more pragmatic and efficient way of improving housing standards than a housing warrant of fitness. “Such a scheme [WOF] would cost $100 million a year and $225 per house for inspections alone, and these costs would be passed on to tenants in rent.”

In June the Health Research Council awarded a $5 million Health Research Council grant to the University of Otago’s He Kainga Oranga/housing and health research team to further its ongoing research, including trialling a rental warrant of fitness prescribing minimum standards for existing properties. Lead researcher Professor Philippa Howden-Chapman said rental housing was on average of lower quality than social housing or owner-occupier housing and just under half of children in households below the poverty line lived in private rental dwellings.

The study aims to establish the effect of implementing a rental WOF on tenant health, particularly children’s health, and to determine the effect of a rental WOF on housing supply and affordability. (Earlier research by the team on the health impacts of insulation prompted the government’s Warm Up New Zealand scheme that lead to retrofitting insulation in state housing stock and subsidising or funding nearly 280,000 more homes being insulated.)

An initial draft rental WOF – developed by the He Kainga Oranga team with the New Zealand Green Building Council and in collaboration with ACC and five of the country’s largest local bodies – has been pretested and is being refined.

This WOF has 31 health and safety criteria including: ceiling and underfloor insulation; no cracks or holes in roof or cladding; opening bedroom and living area windows (with latch); curtains in the lounge and bedrooms; fixed, effective and safe heating in the living areas; an operational toilet; and a functional bath or shower.

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