Evidence shows that decent housing is an important social and environmental determinant of health  [1] These determinants lie outside of the health sector [2]. Nevertheless, neither health professionals nor health policymakers are able to tackle health inequalities in the housing sector without the support and cooperation of their colleagues in the fields of housing. This made the case for a joint seminar between the European Public Health Alliance, the Federation of public, cooperative and social housing and the European Parliament Urban Intergroup.

- The Agenda of the event is available here.

MEP Karima Delli, vice-president of the EP Urban intergroup who hosted the event, deplored the fact that the link between housing and health is all too often overlooked at a European level. She highlighted that EU member states are seeking to reform their welfare states under serious budget constraints, acknowledging that a more nuanced awareness of the intricacies between health and housing is necessary to promote more efficient spending in social and care services.

- Karima Delli is the rapporteur of the EP own initiative report on Social housing in the European Union

CECODHAS Vice-President Özgür Öner stated that “investment in social infrastructures today will relieve public budgets for health and social assistance in the longer run”.

EPHA Secretary General Monika Kosińska said that “improving housing for workers was one of public health’s first areas at its birth. We need to rethink these synergies to ensure that we enjoy good quality public housing to reduce the impact of poverty and build healthy populations and communities.“

Measuring the housing component of health inequalities in Europe Matthias Braubach, Technical Officer of WHO Europe Environment and Health, coordinator of the WHO report on environmental health inequalities in Europe detailed the many housing-related environmental disadvantages that impact on people’s health: lack of flush toilets, shower or bath, damp dwellings, excessive exposure to noise, difficulty in accessing recreational or green areas and thermal discomfort. [3]

Furthermore, high housing costs have indirect negative health outcomes as it dangerously limits families spending for other basic needs. According to a 2011 report [4], inadequate housing accounts for around 100 000 deaths per year in the WHO European region.

In all cases, poor households are more exposed to these disadvantages but depending on the issue and the countries, it can be a more widespread problem (notably in new member states). Also worth underlining is the fact that housing-related inequalities are accumulative and clustered. This means that population groups that combine socio-economic characteristics such as being low income, single parent families and/or large families have increased the chances to be exposed to housing-related environmental disadvantages and that they are often affected by several types of inequalities at the same time.
- the presentation of Matthias Braubach: Environmental Health Inequalities in Europe – Health and Housing implications.

Carlotta Balestra, policy analyst in the Directorate of Statistics of the OECD, introduced the results of an analysis by the OECD exploring the determinants of housing and neighbourhood satisfaction among a series of micro-data?. She noted that people who assess their health status as good, are much more likely to assess their housing situation as satisfactory.

There are great discrepancies across EU countries as regards child-injury risks, pointed out Morag MacKay from Childsafety Europe, who highlighted shortages in prevention policies concerning home safety of children.
- the presentation of Morag MacKay: Analysis of national policies to address injuries in the built environment of the home

Investing in human capital: housing is more than just a roof!

With the presentation of the OECD Better Life Initiative, Carlotta Balestra stressed the importance of thebeyond-GDP approach and she proposed to shift from “treasuring what you measure - the GDP - to measuring what you treasure”. The index compiles eleven indicators of human well-being including housing and health and safety. Ms Balestra insisted that housing is not only about sheltering from bad weather: quality housing increases people’s self-esteem and social capital. Having access to decent housing is at the basis of human dignity. She finally underlined that well-being is sustainable over time because it builds up human, natural, economic and social capital that feeds into tomorrow’s well-being.
- the presentation of Carlotta Balestra: OECD findings on health inequalities and housing

Efficient spending: invest in social infrastructure today to save money tomorrow

This vision is likely to be endorsed by the up-coming Social Investment Package of the European Commission, suggested Fritz von Nordheim, from DG Employment and Social Affairs. Europe needs to put an end to the destruction of human capital triggered by today’s soaring unemployment levels. More emphasis should be put on social investment because the quality of our labour force depends on the support we provide to people throughout their life. M. von Nordheim also recalled that the earlier you invest in somebody’s life, the higher the returns in terms of reduction of inequalities and increases in their capacities.

Drawing from the example of social housing in Northern Ireland, Joe Frey, Head of Research at the Northern Ireland Housing Executive, explained that if investment in energy efficiency of buildings had failed to take place in the past years, fuel poverty would have gone up by 50%. He also presented the results of a study undertaken by the Building Research Establishment: investments of nearly € 600 million to reduce category 1 hazards in the housing stock in the UK would cut down health expenditure by € 40 million per annum and thus have a payback period of 13 years.
- the presentation of Joe Frey: Health benefits of investing in housing and impact on health expenditure/ Fuel poverty and health impacts

Capitalizing on synergies to improve service coverage and social integration

Dr Chris Handy, CEO of the Accord Group, advocated for a renewed partnership between social housing providers and healthcare services. The Accord Housing Group endeavours to open up new horizons with initiatives such as Direct Health, where Accord Group acquired an independent healthcare company in order to increase home care and residential support provided to tenants.
- the presentation of Dr Chris Handy: Cooperation between social housing organisations and health services providers

Undertaking combined health-housing action proves very efficient when it comes to targeting marginalised communities. Deyan Kolev, from the NGO Amalipe pointed to some de-segregating projects for the Roma in Bulgaria that involved integrated approaches - notably with housing and health dimensions - with support from EU funds. According to Kolev, these are pilot models that should be implemented on a national basis.
- the presentation of Deyan Kolev: Social housing sector inclusive towards marginalized communities

Natalia Rogaczewska from the BL housing association explained how a Danish non-profit housing organization trains voluntary tenants to become Health Ambassadors and run seminars among tenants to promote healthy eating regimes and lifestyle.
- the presentation of Natalia Rogaczewska: Educating tenants for a healthy lifestyle

Finally, Dr Pascale Estecahandy, National Technical Coordinator of the "Un chez soi d’abord" programme, submitted encouraging results from a French experimental programme for reintegration of homeless people based on the “housing first” model.
- the presentation of Dr Pascale Estecahandy: Social housing sector, homeless population and health outcomes

Recommendations for further action:

  • Rethink the relationship between end users and service providers According to Claire Roumet changes come from the ground. The policies that work are the ones that take people and make them act. Therefore public services should not be a place where people go but public services should connect with each other and reach out to the people.
  • Reconsider social spending as an investment for future human capital. The crisis is too often used as a false excuse to mitigate what can be done in particular for marginalised groups like Roma people, in the opinion of Michel Verschraegen from DG Justice. Member states need to continue to spend on social issues and budgetary adjustments should be implemented after consulting with relevant stakeholders so as not to put social services in jeopardy.
  • Combine general and targeted action to improve living conditions for all. More efforts can be made to ensure affordable and quality housing for all as well as to reduce fuel poverty. Measures to increase energy efficiency of buildings will be vital in the context of rising energy prices and decreasing disposable income. Although this has been identified as a fundamental investment effort, inadequate ventilation has important negative health outcomes and should not be disregarded.
  • Continue research and collect more data in order to better identify the most vulnerable groups.Both WHO and OECD plan to collect and harmonize more data about housing conditions and affordability. In the field of fuel poverty, trying to define vulnerable energy consumers needs to go further than the income element, contended Kyriakos Gialoglou, from DG Health and Consumers. Vulnerability has to do with situations that potentially concern everybody. A report from the Vulnerable Consumers Working Group is expected by the end of 2013.
    - the presentation of Kyriakos Gialoglou: Actions against energy vulnerability & towards delivering warmer & healthier homes for European consumers
  • Integrating approaches and better coordination of initiatives were two points that were repeatedly called for by speakers, notably when it comes to initiatives funded by the EU. Andor Urmos from DG Regional and Urban Policy warned that for the next period 2014-2020, the EC will be expecting more consistency between national policies and the operational programmes.
    - the presentation of Wladyslaw Piskorz (presented by Andor Urmos): Inclusive Growth, Urban and Territorial, Development
  • Addressing homelessness by making accessible advice centres, as well as counselling and rehabilitation programmes Homelesses is the extreme form of deprivation of housing. By presenting the different element of the Social Investment Package, Fritz von Nordheim from DG EMPL highlighted the importance of investing in social infrastructure, as well.

Open discussion with the participations of MEPs.

At the end of the event, a roundtable discussion was held by the active participation of several MEPs (Alejandro Cercas (Spain, S&D) MEP and shadow rapporteur of the EP report on social housing, Jean Lambert MEP (UK, Greens/EFA), Françoise Castex MEP (France, S&D) during which participants discussed the following issues:

- Could and should the EU do more for a quality housing sector supporting health equity? What could be done, when, by whom and to what end?

- What do we need to make it happen? Research, funds, collaboration, political will, social movement, leadership?

- How can the European elections 2014 help change the paradigm of social investment?

The main messages of MEPs are quoted in the EPHA-CECODHAS Housing Europe Joint press statement "Fighting an uneven battle - without tackling poor housing, the race against social exclusion risks stumbling", which is available on request.

- on EPHA website
- on CECODHAS Housing Europe website

Related EPHA articles

- [Seminar] Tackling Health Inequalities through Investing in Housing
- Energy and Health: How are these Policies Connected? Why should we Tackle Energy Poverty?
- European Urban Health Conference - Amsterdam, September 12th-14th 2012
- The Impact of the Economic Downturn and Policy Changes on Health Inequalities - the example of London
- Poverty is Not a Crime! - European campaign against the criminalisation of homelessness and poverty kicks off in Brussels
- Most EU Member States Fail to Ensure the Right to Housing - FEANTSA Press Release


[1] Social and environmental determinants of health are the conditions in which people are born, grow up in, live, work and age. They have impacts on the opportunities people have to have healthy lives; affect the chances of developing illness and suffering injury; and also impact on people’s life expectancy.

[2] WHO Commission on Social Determinants of Health (2008) Closing the gap in a generation: Health equity through an action on the social determinants of health. Final Report. Geneva: World Health Organisation

[3] Findings from the WHO report Environmental Health Inequalities in Europe, 2012.

[4] WHO report Environmental burden of disease associated with inadequate housing. Methods for quantifying health impacts of selected housing risks in the WHO European Region, 2011.

Last modified on February 5 2013.