Since May, the Health Foundation has been tracking emerging evidence on the impact of the coronavirus (COVID-19) pandemic on health and health inequalities. This evidence has highlighted the many ways in which different groups are being affected unequally by the virus and the measures to control its spread.
There is clear evidence that our housing is an important determinant of our health. It’s important for our health and wellbeing that our homes provide for our needs, make us feel safe and allow us to stay connected to our community. But our homes can also expose us to dangerous substances, accident hazards and infection risks. And experiencing housing insecurity – including unaffordability, short and unstable tenancies, and overcrowding – can also have a negative impact on our health.
The impact of housing on our health is likely to have been greater than ever over the period of lockdown, with government guidance to stay at home with very limited exceptions, and a significant number of people experiencing greater financial difficulties. Here, we look at evidence from recent months about the role housing has played in the unequal impacts of the pandemic and how the crisis may influence health inequalities linked to housing in years to come.
The unequal impact of COVID-19 due to housing conditions
The pandemic has already had unequal consequences for people’s health based on their housing. Research published by the National Housing Federation, carried out in June 2020, indicated that 31% of adults in the UK had experienced mental or physical health problems linked to the lack of space in their home or its condition during lockdown. It also found that an estimated 3.7 million people were living in overcrowded homes over this period including 1.6 million children, which are record levels. People who reported a lack of space at home during lockdown were more likely to report experiencing depression and lack of sleep.
A direct mechanism through which housing has contributed to the unequal impact of COVID-19 has been infection risk. When living in an overcrowded space, self-isolating becomes much more difficult. In May, analysis of ONS data by Inside Housing found a correlation between the level of overcrowding in councils in England and Wales and their COVID-19 death rate. Of all the councils in England and Wales, Newham in east London had both the highest COVID-19 death rate and greatest proportion of homes classed as overcrowded (25.2%). There could of course be many reasons for this association, with overcrowding being an indicator of a more socioeconomically deprived area, and it’s important to consider other contributing factors.
The Runnymede Trust has released a report on the factors that have contributed to the increased risk of COVID-19 for people from black and minority ethnic communities. Among other factors, this found that black and minority ethnic households are more likely than white British households to be multi-generational, have more occupants, and to be overcrowded. The report also found that 38% of people from black and minority ethnic households live with someone who is particularly vulnerable to COVID-19, compared to 31% of white British people. The report pointed to racial and socioeconomic inequalities as the cause of these housing circumstances and recommended that government invest in affordable housing, particularly larger social housing, so that fewer lower income households have to experience overcrowding.
- Recent Health Foundation analysis found that people in lower income households are more likely experience overcrowding and to live in overcrowded conditions with someone older than age 75, or who has an existing health condition, than those on higher incomes.
- ONS analysis shows that during the lockdown period, people of all minority ethnic backgrounds in England were less likely to have a garden than those of white ethnicity, even after accounting for the influence of age, region, urban or rural settings, socioeconomic factors and having children. People of black ethnicity were the least likely of all ethnic groups to have access to a garden.
- New Policy Institute modelling found that the proportion of those aged older than 70 in a local authority area, who lived with someone of working age, was a significant contributory factor to the variation in COVID-19 cases across local authorities in England in April 2020.
The unequal impacts of measures to control the virus
The measures taken to control the spread of the virus are likely to have unequal indirect consequences for health through their impact on people's housing circumstances.
Early in the crisis, the governments in each UK nation took measures to house people who were experiencing rough sleeping. By May 2020, the government’s survey data showed that 14,610 people in England had been housed under this initiative. Between 13 April and 28 June 2020, data from the Welsh government showed that in Wales 407 people who had been sleeping rough, and 1,859 others experiencing housing insecurity, had been moved into emergency accommodation.
Despite these initiatives, statistics from the Greater London Authority show a 33% increase in the number of people sleeping on the streets in London between April and June 2020, compared with the same period in 2019. 63% of the people outreach workers identified as rough sleeping were doing so for the first time.
An interim report from the social housing provider Riverside, evaluating emergency accommodation provision in Manchester during the lockdown, found that people who had been housed under the scheme had overwhelmingly positive feedback about its impact on their health. They reported better wellbeing, nutrition, and mental health and said they felt safer and more positive about their future. They also reported positive impacts on drug dependency conditions with improved access to addiction support.
On housing insecurity
The government has also taken several steps to reduce housing insecurity during the peak of the COVID-19 crisis, as highlighted in our recent long read Learning from Lockdown. However, some groups are still facing increased housing insecurity as a result of the pandemic’s economic implications, and polling by the debt charity Step Change indicated that by May 2020, around 590,000 people in the UK had fallen behind on their housing payments. This will become a critical issue as the Government’s ban on evictions ends on 23 August.
- A survey by the Resolution Foundation, also carried out in May, found that one third of new benefit claimants were behind on their housing payments. Overall, one in eight private renters and one in six social renters had reported falling into housing cost arrears since the beginning of the crisis.
- In June 2020, polling carried out for Shelter indicated that around 227,000 adult private renters in the UK had fallen behind on housing payments since the start of the pandemic and that 31% of adult private renters were feeling more depressed and anxious about their housing situation. Shelter also found that 458,000 parents who are private renters were more worried that their family would become homeless as a result of the crisis.
This evidence indicates the impact of the pandemic on housing insecurity is being felt hardest by those who are renters, particularly those who rent from private landlords. Worryingly, Health Foundation analysis has found that people working in sectors that were shut down during the lockdown (including hospitality and leisure facilities) are more likely than other workers to be private renters. Until stability returns to these sectors, the people who work within them and rent their homes from private landlords are likely to face significant housing insecurity.
On the supply of quality housing
Before the pandemic began, the UK already had a crisis in the supply of housing, with a deficit of 1.2 million homes. A July 2020 report by the Affordable Housing Commission found that the pandemic has worsened this situation, with a particularly hard impact on social and affordable homes. Research by Shelter and Savills has indicated that around 84,000 homes that would have been built in the UK in 2020 will not be as a result of the pandemic, with a drop of 30% in social rent homes built compared with the previous year, to just 4,300. To put this in context, there are around a million households on social housing waiting lists in England alone.
In response, government has announced an extension to a scheme that supports local councils in England to construct affordable homes. However, there will still be delays in the construction of new homes due to the pandemic. Concerns have been expressed however over plans to relax permitted development rights. And it is vitally important the homes constructed under this scheme are of good quality, so that their eventual occupants will have what they need to live healthy lives.
Emerging evidence indicates that stark differences in housing conditions may have already contributed to the unequal impact that the pandemic is having on different groups in the UK. Though we are no longer in a nationwide lockdown, COVID-19 continues to pose a very real risk to people’s health. Government efforts to control any further spread of the virus must take all possible risk factors into account, including the impact of housing conditions.
The pandemic also continues to pose a threat to the UK economy, with long-term consequences for health and health inequalities. Emerging evidence on the impact of the pandemic on people’s housing circumstances indicates that private renters could benefit from targeted support. Without this, people who have been forced into (or to remain in) housing insecurity and poor-quality homes as a result of the pandemic will face further damaging consequences for their health. In this way, the pandemic could drive unacceptable health inequalities in the future between people who are experiencing different housing circumstances now.
Isabel Abbs is Policy Support Officer at the Health Foundation.