Bilston in the heart of the Black Country; my hometown, is typical of the quintessential working-class town facing decay and decadence following deindustrialisation. Yet, Bilston was also the amphitheatre for a radical social experiment in 1945; the eminent Viennese philosopher, Otto Neurath, was deployed by the radical socialist council on a pursuit of happiness: “to make Bilston happy”[i]. The premise was simple: happiness, therefore health, is generated at home.

Today, the situation is staggeringly similar to that of 1945. The parallels between World War II and the COVID-19 pandemic are echoed continuously by our politicians. And we find ourselves in a state of economic disruption and the subsequent “building back better”. Another inescapable parallel is the housing crisis. The contemporary housing crisis is fuelled by the mass selling of social housing, demand-side policies with the lowest level of peacetime housebuilding since the 1920s, and a property market driven by cheap credit. Take; for example, in 2002, the median house price was £104,000 whilst the median annual income was £20,596: a steady 1:5 ration between median house price and medial annual income. However, by 2020, the medial house price has soared to £234,000 whilst the medial annual income is just £31,580: a ratio of 1:8[ii]. Amongst young people aged 25-39, 43% are living in the private rental sector, 68% of the time due to a lack of suitable alternative[iii]. The housing crisis is responsible for a nomadic neoliberal lifestyle for a generation of young people trapped in the private rental sector.

Just like it was recognised to be in Bilston of 1945, the housing crisis today continues to be a public health menace. The home takes a multidimensional role in our lives: a venue for contact with the most prominent members of one’s social network; and for most of society, perceived as a representation of major financial and person investment. The home is a key social determinant of health. For too many young people, the pernicious housing market denies them health and wellbeing: with 1 in 5 reporting housing issues to be negatively affecting their mental health[iv]. The harmful effect of poor-quality housing also extends to physical health. With research linking respiratory issues, physical pain, and headaches to poor-quality housing. And, with 1 in 3 houses in the private rental sector failing to meet the criteria for adequate housing under the Government’s ‘Decent Homes Standard’[v], the issue is extensive. To be clear, these issues are not discussing homelessness; but rather, the poor quality and insecurity of housing in the private rental sector.

Health is made at home: good quality housing, on the other hand, improves various health parameters. A recent longitudinal study evidenced that in houses of good quality had a reduction in hospital admissions for cardiovascular, respiratory and injury emergency admissions[vi]. The costs incurred to the NHS annually by poor housing are £1.4 billion[vii]; the likely figure is higher when accounting for the indirect effects of poor housing.

Our definition of ‘health’ has been redefined. No longer is health a solitary phenomenon existing in isolation through individual choices and self-governance. The COVID-19 pandemic has reinvented the agency of health. Instead, health is now a communitarian science, with others’ actions determining our own health status. And housing ought to be at the centre of this new reconstruction of health. Without the ability to self-isolate, COVID-19 will spread incessantly through communities, especially with 7.6 million households in England having major housing problems relating to overcrowding, affordability, or poor-quality housing[viii]. In a post-pandemic future of “building back better”, quality health-generating homes make sense for society-wide health. The cost of housing improvements may be partially offset by the reduction in hospital admissions. Poor quality housing has been shown to be reduce school attendance and knock back educational achievement[ix]; contrastingly, good-quality homes can improve labour market chances and improve health literacy, and to narrowing inequalities in the future[x]. This is health on a society-wide scale.

During this process of rebuilding, perhaps it’s worth noting the lessons of Otto Neurath’s Bilston project: “we are like sailors who must rebuild their ship on the open sea, never able to dismantle it in dry-dock and to reconstruct it there out of the best materials”.

Jatinder Hayre is a medical student and researcher with an interest in health inequalities and the social determinants of health. He is active in The Fabian Society and Socialist Health Association. In addition to this, he is a campaigner and national spokesperson for ‘Keep Our NHS Public’.

[i] http://www.usp.br/fau/iphs/lib/15IPHS-Amati_Bilston.pdf

[ii]https://www.ons.gov.uk/peoplepopulationandcommunity/housing/datasets/ratioofhousepricetoworkplacebasedearningslowerquartileandmedian 

[iii] UK private rented sector: 2018. ONS. Available at: https://www.ons.gov.uk/releases/ukprivaterentedsector2018  Accessed 1^st October 2021.

[iv] The impact of housing problems on mental health. Shelter. Available at: https://assets.ctfassets.net/6sxvmndnpn0s/59MBno13nAzVDGZeSjiJkX/3c2b8e75becb0e3f10057f696c95c284/Housing_and_mental_health_-_detailed_report.pdf

[v] Department for Communities and Local Govern- ment (DCLG). English Housing Survey Headline Report; 2012-2013.  Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/335751/EHS_Households_Report_2012-13.pdf

[vi] Rodgers SE, Bailey R, Johnson R, et al. Emergency hospital admissions associated with a non-randomised housing intervention meeting national housing quality standards: a longitudinal data linkage study. J Epidemiol Community Health. 2018;72(10):896-903. doi:10.1136/jech-2017-210370. Available at: https://jech.bmj.com/content/72/10/896

[vii] The cost of poor housing to the NHS. BRE. Available at: https://www.bre.co.uk/filelibrary/pdf/87741-Cost-of-Poor-Housing-Briefing-Paper-v3.pdf

[viii] Better housing is crucial for our health and the COVID-19 recovery. The Health Foundation. Available at: https://www.health.org.uk/publications/long-reads/better-housing-is-crucial-for-our-health-and-the-covid-19-recovery

[ix] The impact of homelessness and bad housing on children’s education. Shelter. Available at:https://assets.ctfassets.net/6sxvmndnpn0s/AZvOBS2tanDweEV0cKiiP/71a9a9d622c24680c358fb49b7c7094c/Teachers_Research_Report.pdf

[x] Beyond sticking Plasters: a whole systems approach to health and social care. Centre for Progressive Policy. Available at: https://www.progressive-policy.net/downloads/files/Beyond-sticking-plasters-CPP_181211_091637.pdf