Housing as an instrument of health care

Housing is a key instrument of health care. This was recognized long ago when the Victorians introduced public health measures to tackle unhealthy city slums. The links between housing and health have since been forgotten by some people, as general housing standards have improved and housing has developed as a separate area of public policy. This paper attempts to show that in the late twentieth century housing is still a fundamental factor in determining health. A number of policy issues now point to the need to rebuild the links between housing and health: evidence of persistent inequalities in health, a recognition that those with the poorest health still live in the worst housing, and the new care in the community policy which demands closer working relationships between agencies. The current political and economic climate does not encourage or foster links between services. The government's approach to health focuses on personal behaviour rather than environmental factors as determinants of health, there is a rift between entrenched professional interest groups which provides no incentive for cooperation, and there is a lack of research which demonstrates clear financial and service benefits from coordinating housing and health planning and provision. However, a renewed concern for public health is becoming more prominent (which recognizes the fundamental links between environment and health). This paper argues that housing is a key factor in individual, and hence public health, and should therefore play a more central role in this debate. The challenge now is to gain wider recognition of the essential policy and financial links between housing and health-care services. This involves clearly identifying exactly what aspects of housing are important for health and in what way, including housing issues in health and public health concerns at all levels, and suggesting priorities for policy makers. It must be demonstrated that expenditure on housing is still an effective way of achieving improvements in health. Housing is an enduring instrument of health care.