Government fails to connect dots between health and place

Last week saw the defeat in the House of Lords of an amendment to the Levelling Up and Regeneration Bill that would have promoted a healthy homes policy. The government opposed the measure, arguing that it wasn’t necessary as healthy homes are already safeguarded by existing policy. 

But the amendment’s defeat came just days after the publication of new research from the University of Bristol’s TRUUD research programme that found the very opposite is true: Housing and transport policy does not cover health impacts at all.

The defeat of the amendment, proposed by cross-bencher Lord Crisp, was by a single vote (186 to 185). It followed the withdrawal of the amendment in the Commons of an earlier and more stringent version of his amendment which would have made healthy homes standards mandatory for all new homes.

Crisp’s watered-down revision asked only for duty to consider health and wellbeing in policymaking, yet this was still opposed by the government.

The defeat of the amendment, proposed by cross-bencher Lord Crisp, was by a single vote (186 to 185)

The Town & Country Planning Association TCPA, which campaigned for Crisp’s amendment, lamented the fact that the Levelling Up and Regeneration Bill now “contains no reference to health and wellbeing, and no measures aimed at tackling health inequalities”.

What are healthy homes? The TCPA lists a number of qualities that include natural light; limits on air, noise and light pollution; providing year-round thermal comfort; having enough liveable space; being safe from fire risk; and having access to amenities and transport, including green spaces.

The report by TRUUD, a research programme within the University of Bristol’s medical school, argued that references and considerations of health are, in fact, largely absent from policy documents pertaining to the built environment despite its proven impact on health outcomes.

Its report, Urban Policies and the Creation of Healthy Urban Environments, published in the Journal of Urban Affairs on 18 October, analysed national UK policy documents pertaining to transport and housing from between May 2010 and August 2022, noting that this period covered a substantial period of urban development policy initiatives.

References and considerations of health are, in fact, largely absent from policy documents pertaining to the built environment despite its proven impact on health outcomes

It found numerous articles identifying the importance of the built environment in shaping health outcomes. In particular, these cited the presence of green space and leisure facilities as well as access to health and goods and social support. They also identified recurring factors that prevent homes being healthy, notably overcrowding, damp, poor heating and ventilation and poor noise insulation. Common results of such conditions included respiratory disease and poor mental wellbeing.

Among government housing policy over this period were a range of initiatives introduced to support the building of 300,000 homes per year across England over the next decade. But it found that these homes were likely to be of lower quality or to fail to meet standards for internal space.

It also examined transport policy, arguing that this affected health both in the impact it has on on air and noise pollution, and in the way it can create accessibility to public services and facilitate social interaction.

It found there was a hierarchy of factors used to justify both housing and transport policy, but health was never a dominant justification and very seldom a secondary justification. For example, housing policy’s primary emphasis was on “more homes in the right places” while secondary factors included a push for “beautiful homes”, boosting employment, decarbonisation and improving the natural environment. 

Concepts such as improving public health by “preventing disease, prolonging life and promoting good physical and mental health rarely featured to any substantial extent”.

The report’s findings suggest the government’s claim that healthy homes legislation is superfluous is substantially wide of the mark

The TRUUD report notes the existence of health impact assessments, which local authorities can apply to development plans to understand the possible health impacts of proposed developments. But it notes that these are not mandatory and, as result, are often not carried out.

It’s a stark demonstration of the difference between local authorities having the powers to ensure healthy housing, as cited by the communities minister, and being forced to ensure it.

The TRUUD report also notes that health impact assessments apply only to new developments. The policies don’t cover existing housing and infrastructure, even though the UK has some of the oldest housing stock in the world, with older housing more likely to be classed as “non-decent”.

And it notes that while the government-commissioned Living With Beauty report promoted the importance of good health, when it listed the partners that would be important in delivering its aims, these included the secretaries of state for transport, environment and business but not health. This kind of blind spot, says TRUUD’s report, is pretty typical.

Its findings suggest the government’s claim that healthy homes legislation is superfluous is substantially wide of the mark.

An estimate by the Building Research Establishment that over the past 30 years the cost of poor housing to the NHS alone had been £135 billion

And it’s noteworthy that in the 14 months following TRUUD’s research period, some aspects of policy have veered further away from what would be conducive to healthy homes. 

The report noted some positive moves such as those towards decarbonisation as well as low traffic neighbourhoods for improving air quality. But this has changed markedly since July’s Uxbridge by-election, where Boris Johnson’s former west London seat was unexpectedly held by the Conservatives after they based their campaign on opposing ultra-low emissions zones – an air-quality-improvement policy they had previously backed.

Sensing an electoral opportunity, prime minister Rishi Sunak subsequently doubled up, saying he was opposing the “war on motorists” and dropping support for car-reduction policies, such as low traffic neighbourhoods. This was followed in September by broader backtracking on climate policies, including scrapping energy-efficiency targets for landlords.

The amendment had been particularly targeted at new housing created through permitted development rights (PDR), which often fall short in the above qualities. This widely criticised system allows certain types of building -– notably offices and retail – to be converted into housing without having to go through the usual planning procedures.

The result has been some notoriously poor developments, criticised for lack of daylight and minimal floorspace. As the worst abuses of the system became apparent, the TCPA memorably described PDR as “creating the slums of the future”.

In 2020, writing in the Observer, Rowan Moore looked at Shield House, a PDR scheme in Harlow, Essex, where flats are not only tiny but “freezing in winter, boiling in summer, and prone to mould”. The converted office building is also in a commercial zone, “never meant for human habitation” and isolated from facilities such as shops or schools – as well as any decent public transport connections to them. It was the very antithesis of healthy housing. 

Lord Crisp, a former chief executive of the NHS, argued that apart from any other considerations, unhealthy housing ultimately cost the public purse dearly. He quoted an estimate by the Building Research Establishment that over the past 30 years the cost of poor housing to the NHS alone had been £135 billion.

In the government’s refusal to accept his proposals, there are echoes of its refusal in 2016 to accept an amendment to the Housing and Planning BIll, which would have required private landlords to make their homes “fit for human habitation”.

The government opposed this, not, they argued, because they thought homes shouldn’t be fit for human habitation but because it would amount to unnecessary regulation. Marcus Jones, who was communities minister at the time, said that local authorities already had the powers to deal with poor quality accommodation “and we expect them to use them”.

But expecting something and enforcing it are very different propositions. And this seems to also be the case with the bid to ensure healthy homes.