Neighbourhood renewal and health: evidence from a local case study

Abstract

This article presents findings from a before-and-after study of the effects of neighbourhood renewal on residents’ health. Survey data were analysed using multivariate logistic regression. Before the renewal programme, damp and draughts had significant independent effects on respiratory health problems. Draughts and perceived community safety were associated with mental health problems. Children's mental health was associated with parental mental health. Following the renewal work, improvements occurred in both adults’ and children's mental health, and smoking declined sharply. Respiratory health did not improve and there was no change in use of health services. Neighbourhood renewal in deprived areas can have an important role in improving community health.

Introduction

By the end of the 1960s, it was widely considered that the most unhealthy housing in Britain had been removed from the housing stock (Byrne et al., 1986; Conway, 1995). For much of the 1970s and 1980s the link between housing and health was not a policy issue. However, despite general improvements in certain indicators of physical housing conditions, evidence that this link was not broken accumulated following publication of the Black Report, which put housing back on the public health agenda (Townsend and Davidson, 1982). Where this evidence has influenced housing policy and practice the response has been more selective than the ‘clean sweep’ slum clearance of the past. The Chartered Institute of Housing, for example, advocates a number of specific measures targeted on suspected health-damaging defects such as lack of insulation and poor security (Chartered Institute of Housing, 1998).

There is now a substantial body of evidence pointing to a link between poor quality housing conditions and health problems (Acheson, 1998; Ineichen, 1993; Marsh et al., 1999). This evidence largely comes from cross-sectional surveys using self-reported measures of health status and housing conditions and consists of statistical associations between various housing variables and both mental and physical health problems. Self-reporting has been found to be reliable, although careful attention needs to be given to questionnaire design (Hopton and Hunt, 1996; Jenkinson, 1994). Physical health problems found to be associated with poor housing are mainly infections, respiratory diseases and chronic illness. Housing-related mental health problems include depression and anxiety, symptoms of which can be grouped together under the generic term ‘psychological distress’ (Halpern, 1995). Both physical health problems and psychological distress have been found to be related to overcrowding, damp, mould, indoor pollutants, infestations, cold and homelessness. Mental health problems have in addition been linked with living in unpopular housing areas and high rise flats (Halpern, 1995; Hopton and Hunt, 1996).

Establishing that poor housing conditions are a cause of ill-health rather than simply associated with ill-health is difficult because of the confounding effects of other variables such as household type, age, income and smoking. This issue can be tackled using appropriate designs and statistical techniques, and preferably longitudinal data so that changes in housing conditions can be linked to the health status of the same individuals over time. In one of the few longitudinal studies so far undertaken, Marsh et al. (1999) investigated the effects of housing deprivation on health. They created a housing deprivation index that drew on a range of housing variables from the UK National Child Development Study, including physical characteristics, location, satisfaction, past homelessness and independent assessments of housing difficulties. Housing deprivation substantially increased the likelihood of disability and severe ill-health across the life-course of individuals sampled in the study. The strongest effects arose from multiple housing deprivation, equivalent to the influence of smoking and greater than excessive alcohol consumption in terms of effects on health status.

Although this evidence strongly suggests that improving housing conditions should achieve a health gain for local residents, there are still few studies that have sought to measure health gain arising from housing renewal. In particular, relatively little is known about the scale or type of changes in health status that can result from physical improvements, or whether savings in expenditure on health care follow. This article seeks to add further evidence about these issues at a time when urban regeneration in the UK is high up the political agenda (Department of the Environment, Transport and the Regions, 2000).