Housing Quality and Health Outcomes Research Findings ( and the disability gap)

1. Housing Quality and Health Outcomes Research Findings(and the disability gap) By Associate Professor Nevil Pierse and Dr Esther Woodbury

2. Overview • New Zealand Housing • He KaingaOranga – Health Housing Research Programme • Disability and housing • Research to policy to real world change

3. Where we spend our time? New Zealand Travel Survey, 1997-98

4. Programme BRANZ House condition survey

5. Commissioned by Housing and Urban Development Minister Phil Twyford and released 12 February 2018, A Stocktake of New Zealand’s Housingassessed the entire housing continuum from home ownership and market renting, to state housing and homelessness, and the social cost of substandard housing. http://www.healthyhousing.org.nz/news/

6. Main findings • Homeownership at 60-yr low especially for Māori & Pasifika • house price inflation over past 5 years ~ 30% , incomes have risen by half this rate • ~50% of adults owned home in 2013 • 70% of new 150,000 households formed in past decade are tenants & strong population growth has > strong demand for private rentals • Unmeasured floating population  homelessness 2013 1 in 100, estimated 9 out 10 people turned away • Rising housing-related poverty  evictions  crowding  illness  stress  residential mobility  school performance

10. He KaingaOranga • Focus is on understanding causal relationship between housing & health • Multidisciplinary team of 28 researchers and thesis students • Range of methods (community trials, cohort studies, case-control studies, qualitative research) • Range of scales (from small in-depth studies to 5,000 people in community trials)

11. Community Engagement is Key

12. Housing, Insulation & Health Study • Community-based study of 1400 homes, 4,414 people • Insulation retrofitted • Significant increase in indoor temperature + decrease in relative humidity and energy used • Decrease in: self-rated poor health; self-reported wheezing in the last three months, children's days off school, adults’ days off work; visits to GPs; respiratory hospitalisations

13. Housing, Heating & Health Study • Community-based study of 409 homes, of children with asthma • Installed, Heat Pumps, Wood Pellet Burners & Flued Gas Heaters, in insulated homes. • Significant increase in indoor temperature + less energy used • Decrease in: self-rated poor health; self-reported wheezing in the last three months, children's days off school, visits to GPs.

14. One Child’s Data

15. Temperature • WHO recommends minimum indoor temperatures of 18-21oC • NZ Children’s bedrooms are on average 14.5oC • Insulation improves bedroom temperature by ~0.8oC • Heating improves bedroom temperature by ~0.8oC • These are averages • The worst home had -4oC in the asthmatics child bedroom while they were sleeping • 10% of insulated bedrooms had temperatures < 9oC

17. Warm Up New Zealand: Heat Smart Evaluation • $347 million four year insulation and heating retrofit programme administered by EECA • 100,000 homes in first two years • Quasi-experimental design linked administrative (NHI) and commercial datasets (QV) • He Kainga Oranga focussed on health impacts • Found household reductions in hospitalisation costs • Reductions in mortality for vulnerable individuals • Benefit: cost ratio (3.8: 1) primarily driven by health benefits, for children closer to 6:1

19. The results presented here are not official statistics. They have been created for research purposes from the Integrated Data Infrastructure (IDI), managed by Statistics New Zealand. The opinions, findings, recommendations, and conclusions expressed in herein are those of the author(s), not Statistics NZ, or any other government agency. Access to the anonymised data used in this study was provided by Statistics NZ under the security and confidentiality provisions of the Statistics Act 1975. Only people authorised by the Statistics Act 1975 are allowed to see data about a particular person, household, business, or organisation, and these results have been confidentialised to protect these groups from identification and to keep their data safe. Careful consideration has been given to the privacy, security, and confidentiality issues associated with using administrative and survey data in the IDI. Further detail can be found in the Privacy impact assessment for the Integrated Data Infrastructure available from www.stats.govt.nz.

21. Injury prevention • NZ houses are of poor quality • 500,000 medically treated falls at home per year • Observation studies suggest RR 1.23 per identifiable hazard • On average circa 3 hazards per house • ACC provides a unique point of data capture • Fix the house not the occupant • Randomised Control Trial of 850 homes

22. Home Injury Prevention Intervention • Community-based study of 950 homes, >30 years old • $500 remediation of slip trip and fall hazards • Assessment by Qualified builder • Followed for 5 years • All age groups included • 26% Reduction in slips trips and falls • 39% Reduction in preventable injuries • 15:1 Cost to benefit ratio

25. Media coverage of disability and housing

26. Disability and Housing • Housing crisis • Poor quality housing stock • Rental market • Social housing • House building • Residential and supported living

27. Housing Barriers • Physical and environmental safety and dignity in home and community • Cost and location of housing – transport, services • Discrimination in the rental market – from landlords and tenants • Need for individualised support / modifications

28. Housing Stock • 107,440 people with a physical impairment and 26,880 people with vision impairment had an unmet need for housing for a housing modification (New Zealand Disability Survey 2013) • Lifemark estimates 2% of new build housing is build to a universal design standard • Poor quality housing

29. Rental Market • Home ownership lower for disabled people • Expensive • Low quality housing (similar to private ownership) • Unequal power between landlords and tenants • Short term leases • Inability to alter properties / modify • Discrimination – desire for ‘easy’ tenants • Few rights and little knowledge about them • Little to no enforcement

30. Rental Market

31. Rental Market

32. Social Housing

33. State Housing

34. House Building • Currently slow, small scale and expensive • Little knowledge of, and no requirements for, universal design standards • Retrofitting is more expensive • UK/London model

35. Principles of Enabling Good Lives (1) • Self-determination :Disabled people are in control of their lives. • Beginning early: Invest early in families and whānau to support them; to be aspirational for their disabled child; to build community and natural supports; and to support disabled children to become independent, rather than waiting for a crisis before support is available. • Person-centred: Disabled people have supports that are tailored to their individual needs and goals, and that take a whole life approach rather than being split across programmes. • Ordinary life outcomes: Disabled people are supported to live an everyday life in everyday places; and are regarded as citizens with opportunities for learning, employment, having a home and family, and social participation - like others at similar stages of life.

36. Principles of Enabling Good Lives (2) • Mainstream first: Disabled people are supported to access mainstream services before specialist disability services. • Mana enhancing: The abilities and contributions of disabled people and their families are recognised and respected. • Easy to use: Disabled people have supports that are simple to use and flexible. • Relationship building: Supports build and strengthen relationships between disabled people, their whānau and community.

37. What could EGL mean for housing? • Residential to community living? • More modifications? Service providers? Funding? • Public provision of housing/KiwiBuild? Universal design? • Social housing / guaranteed tenancy? • Private rental market? Flatmates? Understanding/ language of disability in community?

38. Research to Policy to Real World Change • Successes of He KaingaOranga • Links with communities, community organisations, building sector • Media engagement • Political engagement

39. Disability research, policy and change • Investment in disability research – including community trials • Collaboration between disability researchers and other researchers • Collaboration between researchers, disabled people, whanau, sector and government

40. UNCRPD Monitoring Disabled Person-Led Investigation into the Housing Experiences of Disabled New Zealanders http://www.donaldbeasley.org.nz/whats-happening/news/

41. Thank you www.healthyhomes.org.nz Department of Public Health University of Otago, Wellington