Homes, health, and COVID-19: how poor housing adds to the hardship of the coronavirus crisis
This blog article was written for the Ask the Expert series, a partnership between the SMF and UK Research and Innovation, which brings academic research to bear on policymaking.
Housing is an important social determinant of health. COVID-19, and the actions taken to mitigate its spread, highlight the central role of the home in people’s lives. With the country in lockdown people must stay in their homes with very limited exceptions. These unprecedented restrictions mean that people are being forced to think about their homes in new ways, highlighting inequalities in housing and repercussions for health.
Homelessness and housing insecurity
Most obviously, staying at home is not an option if you do not have a home [i]. Homelessness has increased dramatically in recent years [ii]. Homeless people have poorer existing health [iii] and lack the basic facilities that would enable them to reduce their risk to COVID-19 by isolating or washing their hands regularly. The closure of public services will particularly affect this group, as libraries for example often host outreach and support activities.
Facilities available to homeless people are also problematic in terms of dealing with the virus. Homeless shelters are a high-risk environment due to the close proximity of residents and shared facilities. Many homeless people are housed in accommodation intended to be used as a short-term last resort, such as B&Bs, where they have no access to cooking facilities, exacerbating difficulties in accessing food. With the latest government restrictions many hotels which provide emergency accommodation for homeless people have been shutting, often with no clear alternative for these displaced people [iv].
The economic impact of COVID-19 raises serious concerns about an escalation of homelessness. The ending of a private tenancy is the leading cause of homelessness [v] and key workers at risk of contracting the virus because of their employment have found themselves facing eviction because of fears that they will spread the virus to landlords [vi]. COVID-19 has led to sudden and severe reductions in incomes for many, particularly the self- and precariously employed. This is likely to lead to housing payment arrears, which have been linked to reduced health, particularly for renters (in the UK), and can lead to eviction or foreclosure [vii]. While mortgage-holders were given a 3-month mortgage holiday, provisions to protect renters in England from eviction during the COVID-19 crisis were initially disappointing [viii] though those measures have been improved and now suspend eviction processes for 3 months [ix]. In the face of a looming economic crisis, there is still scope for further intervention here, however. For example there are plans in Scotland to enforce a 6-month ban on evictions in the private rented sector, providing renters with greater security.
The inequalities of “Stay Home”
Even among those that do have homes, the lockdown experience will vary dramatically. A recent study found that private renters have higher levels of C-reactive protein (CRP) in their blood than those living in other tenures [x]. CRP is a biomarker [xi] associated with stress and infection, with higher levels indicating that private renters have poorer health. This will likely be due in part to the poor housing security in this tenure, as discussed above. Conversely those living in detached homes (rather than flats, semi-detached homes, or terraces) had better health as measured in terms of CRP levels. The increased time spent in homes under the lockdown will potentially exacerbate these effects. There are a number of reasons for the link between housing and CRP that are related to the COVID-19 pandemic.
Larger, more spacious homes allow for a separate working space (if working from home), space for exercise, space for solitude, and greater storage space for food and essential supplies (given that the government requires shopping for essentials “as infrequently as possible” [xii]). Private rented homes in England are on average 28% smaller than owner-occupied homes [xiii], and it is likely that the greater space and likelihood of having a garden afforded by detached homes in part explains the finding of lower CRP for people living in detached houses.
For those in poor-quality housing, the lockdown means more time exposed to cold, damp and other hazardous conditions with consequences for both physical and mental health. Housing conditions are typically poorest for Britain’s 5.5 million private rented sector households [xiv]. In England, 25% of privately rented homes fail to meet the decent homes standard, compared to 13% of social rented homes and 19% of owner-occupied homes. Some 670,000 privately rented houses have a Category 1 Hazard, a hazard that is deemed a serious and immediate risk to health [xv]. Similarly, inaction on dangerous cladding following the tragedies at Grenfell Tower and previous fires means that many people, around 600,000 in all, are having to self-isolate in homes that they know are unsafe and vulnerable to fire [xvi].
Many private renters live in shared housing to reduce costs, in part because of housing benefit rules. In 2012 the Coalition government expanded the Shared Accommodation Rate age range from 25 to 35, meaning that housing benefit recipients under the age of 36 would only be entitled to financial support to rent a room in a shared home, and not a home of their own. Those living in shared housing face difficulties in successfully self-isolating, while also experiencing reduced privacy and more difficult conditions for working from home. Some positive news for private renters however is that accommodation previously listed on short-term letting websites such as Airbnb are returning to long-term let as tourism reduces [xvii], potentially putting downward pressure on rents.
Children are an often-forgotten group when it comes to discussions around housing, perhaps given their perceived detachment from housing issues. However, housing is central to children’s health and well-being [xviii]. A previous SMF blog [xix] has highlighted the risk of school closures widening educational inequalities, in part because of housing inequalities. Homes are children’s new learning environments, and not all children will live in homes where they have the space, privacy, and quiet to do schoolwork. Many will now be spending more time in poor-quality homes, exposed to the health risks these cause, with parents trying to meet housing costs at a time of significant financial uncertainty, which is linked to changes in parental behaviours and strained familial relationships [xx].
It is worth remembering that the challenges brought on by COVID-19 are being faced by many people in addition to existing housing challenges. Disabled people face significant challenges finding suitable housing in the current housing market [xxi]. Racism persists, limiting the housing options of people from ethnic minorities [xxii], and racist incidents associated with COVID-19 have also been reported [xxiii]. People in receipt of social security have increasingly found it difficult to find private [xxiv] and social landlords [xxv] that will rent to them, as well as experiencing affordability, quality, and security issues. COVID-19 is exacerbating the challenges faced by many people navigating the housing market. The lockdown will also confine people to homes where they experience abuse, and there are concerns, with increasing supporting evidence, that domestic abuse will increase during the lockdown [xxvi], particularly affecting women and children [xxvii].
What policymakers need to think about in the long term
Policy responses to the COVID-19 pandemic have thus far been necessarily short-term. While short-term help is clearly needed, COVID-19 provides an opportunity to rethink the direction of our social policies over the longer-term. COVID-19 has demonstrated that problematic gaps in the social safety net can quickly become catastrophic when the system comes under pressure. The following are longer-term recommendations that can ensure a more robust housing safety net.
Expand social housing so that last resort and temporary measures are no longer regularly used for housing homeless households. This should take the form of rented, rather than shared ownership, homes at social rents linked to incomes rather than ‘affordable’ rents linked to the housing market. Social housing provides higher quality, more secure, and more affordable housing for renters than the private sector, protecting renters from the negative health impacts of these problems. Increased social housing also has the potential to reduce government expenditure on housing benefit (calculated using the Local Housing Allowance) and alleviate pressure on the private rented sector, giving renters more choice in where they live.
Raise the Local Housing Allowance. The recent increase is welcome but should go further: to at least the median local area rent (the level at which it was previously set) with no delay in payment from the time of a claim, reducing the risk of housing arrears. Remove the Bedroom Tax/Spare-Room Subsidy and Shared Accommodation Rate. Reassure landlords that administrative errors or delays will not leave them out of pocket, reducing the challenge faced by recipients in finding landlords willing to let to them. Return Support for Mortgage Interest to a payment rather than a loan for owner-occupiers.
Protect and improve housing quality and space standards. This will mean rethinking approaches to tackling perceived problems with housing supply shortages, such as permitted developments which allow the conversion of properties to residential use without planning permission and have led to “rabbit-hutch homes”[xxviii], some without windows[xxix].
Adequately fund Local Authorities so that they can enforce rules designed to protect private renters from poor quality accommodation and unfair treatment, as well as maintain social rented homes for which they are responsible. Support Local Authority landlord licensing schemes[xxx].
The views expressed here are those of the author. The SMF’s Ask the Expert series is kindly sponsored by UKRI.
[vi] https://www.independent.co.uk/news/uk/home-news/coronavirus-nhs-paramedic-evictions-whatsapp-south-west-ambulance-service-a9417021.html https://www.theguardian.com/world/2020/mar/27/probation-officer-faces-eviction-landlord-coronavirus-fears
[xv] “for a dwelling to be considered ‘decent’ it must:
– meet the statutory minimum standard for housing under the HHSRS. Homes with a Category 1 hazard under the HHSRS are considered non-decent
– be in a reasonable state of repair
– have reasonably modern facilities and services
– provide a reasonable degree of thermal comfort” see https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/817408/EHS_2017_Stock_Condition_Report.pdf