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Open Access 01-12-2017 | Research article

Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey

Authors: Wouter Poortinga, Nikki Jones, Simon Lannon, Huw Jenkins

Published in: BMC Public Health | Issue 1/2017

Abstract

Background

While existing research indicates that housing improvements are associated with health improvements, less is known about the wider social and health benefits of meeting national housing standards, as well as those of their specific constituent measures. This study evaluates the impacts of a managed housing upgrade programme through a repeated cross-sectional survey design.

Methods

A five-wave repeated cross-sectional survey was conducted over a seven-year period from 2009 to 2016 (n = 2075; n = 2219; n = 2015; n = 1991; and n = 1709, respectively). The study followed a managed upgrade programme designed to meet a national social housing standard over an extended period. The data were analysed from a multilevel perspective to take account of the time-dependent nature of the observations and differences in socio-demographic composition.

Results

The installation of the majority of individual housing measures (new windows and doors; boilers; kitchens; bathrooms; electrics; loft insulation; and cavity/external wall insulation) were associated with improvements in several social (housing suitability, satisfaction, and quality; thermal comfort and household finances) and health (mental, respiratory and general health) outcomes; and analyses showed relationships between the number of measures installed and the total amount invested on the one hand and the social and health outcomes on the other. There were however a few exceptions. Most notably, the installation of cavity wall insulation was associated with poorer health outcomes, and did not lead to better social outcomes. Also, no association was found between the number of measures installed and respiratory health.

Conclusions

The study suggests that substantial housing investments through a managed upgrade programme may result in better social and health outcomes, and that the size of the improvements are proportionate to the number of measures installed and amount invested. However, there may be risks associated with specific measures; and more attention is needed for mechanical ventilation when upgrading energy efficiency of houses through fabric work. In addition to providing new evidence regarding the wider social and health outcomes, the study provides an analytical approach to evaluate upgrade programmes that are delivered over multiple years.

Available only for authorised users

The Standard Assessment Procedure (SAP), developed by the Building Research Establishment, is the UK Government’s recommended method system for measuring the energy rating of residential dwellings [42]. The Welsh Housing Quality Standard requires a minimum rating of 65 out of 100.

LSOAs is part of a geographical hierarchy used to report official small-area statistics in Wales and England.

The windows and doors were double glazed and had safety features complying with Secured By Design (http://www.securedbydesign.com).

Both kitchens and bathrooms need to be up-to-date with appropriate design, layout and state of repair for their safe use.

The electrics element involved rewiring (where necessary), the installation of power sockets, Carbon Monoxide and Smoke detectors, security lighting, and extractor fans in kitchens and bathrooms.

The insulation measures were selected to achieve a minimum SAP (Standard Assessment Procedure for Energy Rating of Dwellings 2005) rating of 65 out of 100. External wall or cavity wall insulation were installed depending on the building type. External wall insulation was companied by mechanical ventilation, while cavity wall insulation was not.

Data were collected in the following periods: Survey 1: 23 February to 20 March 2009; Survey 2: 14 February to 2 April 2011; Survey 3: 13 February to 31 March 2012; Survey 4: 1 February to 23 March 2014 and Survey 5: 15 February to 5 April 2016.

Response rates for the five surveys were as follows (excluding non-traditional properties):

Survey	Year	Type	Contacted	Achieved sample	Response rate
1	2009	Face-to-face	553	319	55%
		Postal	8237	1769	21%
2	2011	Face-to-face	2088	976	47%
		Postal	6180	1246	20%
3	2012	Face-to-face	2117	1034	49%
		Postal	6017	1008	17%
4	2014	Face-to-face	1989	1021	58%
		Postal	6039	972	16%
5	2016	Face-to-face	1769	906	51%
		Postal	5920	807	14%

New windows and doors: £3500; boilers: £5752; kitchens: £3298; bathrooms: £2349; electrics (re-wiring): £3159; loft insulation: £225; cavity-wall insulation: £1000; and external wall insulation: £9000.

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Title: Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey
Authors: Wouter Poortinga
Nikki Jones
Simon Lannon
Huw Jenkins
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-017-4928-x

At a glance: The STEP trials

Springer Medicine

Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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