Hardship and housing

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CIBSE Journal

Households hit hardest by the cost of living crisis are those most likely to live in unhealthy homes. UCL’s Professor Anna Mavrogianni considers the relationship between the built environment and health inequalities.

There is an increasing recognition of the role the built environment plays in people’s health and wellbeing. A wide range of health determinants are contingent on the quality of the built environment, including neighbourhood conditions, green infrastructure, and outdoor and indoor environmental quality. 

It is expected that health inequalities will be exacerbated by the ongoing cost of living crisis. Due to a hike in energy prices, a reduction in disposable income and low thermal efficiency levels of the housing stock, almost a quarter of UK households are now facing fuel poverty, with large families, lone parents and pensioner couples being most affected. 

Many people in deprived population groups are having to choose between eating or heating their homes. Beyond the impacts of rising fuel costs on health and wellbeing, there are also interactions between building energy efficiency and building services, financial choices, occupant behaviour, IAQ, and comfort. 

One example is the increase in mould risk due to reduced heating. English Housing Survey assessments say that damp and mould risk is almost four times higher for the poorer quintile group compared to the wealthiest group.

Another example is the emerging trend of switching to solid fuel heating. The rapid rise in domestic burning of solid fuels, such as wood, for heating, can deteriorate both outdoor and indoor air quality.

Currently, there is lack of financial mechanisms to support the installation of energy efficiency measures. According to a recent letter by the Climate Change Committee, the number of government installations of energy efficiency measures fell from 2.3 million a decade ago to fewer than 100,000 in 2021.

While it is imperative that we decarbonise our building stock, single focus policies can potentially lead to unintended consequences, if other aspects of building performance are neglected. 

As our buildings become more thermally insulated and airtight in the path towards net zero, ‘unintended ventilation’ air exchange paths will be diminished. Unless energy efficiency interventions are combined with sufficient means of controlled ventilation, this could lead to air pollutants and heat trapped indoors. 

A recent BMJ paper called for empirical longitudinal data to be collected in energy efficient buildings, to quantify the effects of low carbon measures on health and inequalities. 

The effects of outdoor air pollution are not equally distributed: it is estimated, for example, that 46% of the most deprived London areas experience NO2 concentrations above the recommended EU limits; thresholds are exceeded in only 2% of the least deprived areas.

Although the distribution of indoor air quality exposures across building types and socioeconomic groups was less understood until recently, recent research studies have demonstrated that households of low socioeconomic status are exposed to higher levels of indoor air pollutants on average. 

This may be the result of overcrowding or solid fuel cooking resulting in increased particulate matter, or the use of lower quality consumer products that may emit volatile organic compounds. Lower income households may also live in lower quality housing where ventilation systems, such as extract fans, are not regularly repaired. 

This summer, the UK experienced an unprecedented 40oC heatwave. The deadly hot spell caused more than 20,000 excess deaths across Europe. 

The effects of extreme heat can hit the most vulnerable the hardest. Older people and individuals suffering from ill health are generally found to be most at risk, but social isolation and low income can also limit one’s capacity to identify a hazard and reduce exposure. 

Poorer households may have lower thermal adaptive capacity as they may have limited access to cool spaces and be less able to afford to modify their surroundings through retrofit or use of air conditioning. 

The potential of natural ventilative cooling may be less in lower income neighbourhoods, where concerns about crime, noise and traffic-related air pollution may hinder window opening. Although fuel poverty research and policy generally refer to winter, summer fuel poverty may soon become a significant issue too. A recent CCC-commissioned report by Arup found that the cost of implementing passive cooling measures in existing homes is appreciable. 

Successfully integrating health, wellbeing and equity with net zero goals and building safety is critical towards achieving a healthy and sustainable built environment for all.

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