For more than a century, poor housing has been recognised as a threat to health.
Though issues of overcrowding and poor sanitary conditions have receded, suitable accommodation is now widely recognised as the keystone for improved health and wellbeing, social inclusion and access to wider services.
As councils retain substantial responsibilities for housing, there is strong evidence that their actions can significantly contribute to the improved health of residents.
More than one million children visit A&E every year due to accidents in the home, making it the commonest cause of death in children over the age of one.
Large numbers of older people and those with serious disabilities also live in homes that pose a risk of falls, or are not otherwise adapted to their needs. Falls cost the NHS £2bn per year.
But many domestic accidents can be prevented by raising awareness and by making simple and cheap improvements in the home environment.
The National Institute of Health and Care Excellence and the Royal Society for the Prevention of Accidents have produced guidance showing how the installation of safety equipment such as gates, window restrictors and bath mats can significantly reduce accidents. This is especially the case when they are targeted at high risk groups such as households with young children or those living in rented or overcrowded conditions.
Meeting NICE guidelines would cost the average local authority about £40,000, but if it prevented just 10% of injuries it would save more than twice this amount in lower NHS, ambulance, police and fire and rescue costs.
Cold housing is another killer, raising the risk of cardiovascular disease and stroke. Every winter about 25,000 more people, mainly older people, die in the UK than during the summer months.
Cold homes also increase morbidity, can affect mental health and reduce school attendance. About 2.5 million homes have poor energy efficiency and pose serious health risks.
Councils again have an important role to play in tackling energy efficiency and fuel poverty issues. For example, they have a direct role in reducing the problems of cold in their own housing stock and through using their enforcement powers where homes present excess cold hazards.
They can also encourage others by providing advice on how to save energy, home energy audits and campaigns designed to change behaviour.
Many local authorities are bringing communities together to improve bargaining power with energy suppliers through “collective switching” and community heat and power schemes, which can lead to significantly lower fuel bills.
Housing improvements have been shown to produce significant cost savings too. Birmingham City Council’s health impact assessment of its main housing improvement programmes showed a return of £24m per year for an investment of £12m, the quickest wins coming from reducing cold homes and the prevention of falls.
David Buck, senior fellow for public health and inequalities, the King’s Fund
Invest in housing to improve health and reduce costs