housing quality & health - hertfordshire...hertfordshire (8,607 per 100,000) and watford (7,470...

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Housing Quality & Health

First created: March 2017

Last reviewed: May 2017

Next due to be reviewed: May 2019

Version: 1.0

Contact: [email protected]

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Contents

1.0 What’s the issue? 3

2.0 Causes & risk factors 4

3.0 Scale of the issue 5

4.0 Solutions 8

5.0 Conclusions

11

References 13

Appendix A: Information for Equality Impact Assessments 14 Appendix B: Tartan Rugs 16

Appendix C: Tables 19

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1.0 What’s the issue?

There is a growing body of evidence that poor housing is associated with poor physical and mental

health, and that improvements to housing conditions can lead to positive health benefits.1,2,3,4

Improvements in housing conditions produce health benefits, while worsening housing conditions are independently associated with deterioration in health.5

Good housing plays a crucial role in supporting other determinants of good health, such as educational attainment, employment prospects and social interaction.

The Decent Homes Standard, brought in under the Blair-Brown government, sets a minimum quality standard for social housing (social housing landlords include local authorities, housing associations, arm’s length management associations, housing cooperatives and tenant management organisations). To meet the Decent Home Standard, a home must:

o meet the HHSRS minimum safety standards for housing o be in a reasonable state of repair o have reasonably modern facilities and services o have efficient heating and effective insulation6

The Housing Act 2004 introduced a set of standards for all property using the Housing Health & Safety Rating System (HHSRS). This placed the emphasis on the effects on the occupier rather than the building itself7.

In 2015, excess cold, falls on stairs and falls on the level represented the three highest costs of poor housing to the NHS (Fig 1).

Fig 1. The cost of poor housing to the NHS8

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2.0 Causes & risk factors

Research evidence linking housing quality and health pertains to: o dampness and mould; o warmth and energy efficiency; o toxins (eg lead, carbon monoxide, formaldehyde, asbestos and radon) o infestations (eg vermin and dust mites) o second-hand indoor smoke; o overcrowding; o perceived safety and security (including precarious living circumstances and/or

homelessness) o noise and green space.2

These issues are linked to a range of individual-level impacts, including neurological, cognitive, developmental, cardiovascular and behavioural conditions; respiratory symptoms; cancer; poisoning and death.2

The evidence is inconclusive in relation to the impact of internal housing conditions on mental health; however, it has been argued that living in poor housing can contribute to stress through a lack of control over living space and fuel poverty.2

The English Housing Survey Housing and Well-being Report, 2014 (Box 1) concluded that while life satisfaction and anxiety are primarily driven by personal characteristics, they are strongly associated with housing circumstances:

o The top housing factor negatively associated with both life satisfaction and anxiety was being in arrears with rent or mortgage payments.

o For life satisfaction, the second most important property-related predictor was the type of tenure, with social renters having higher levels of satisfaction. After controlling for personal and other housing factors, life satisfaction was higher for both local authority and housing association renters compared to outright owners.

o People living in semi-detached houses or (converted or purpose built) flats had lower life satisfaction than those living in terraced houses.

Poor housing circumstances present a particular risk to the health and wellbeing of: o children, and their families o people with long-term conditions o people with mental health issues o people with learning disabilities o people recovering from ill health o older people o people who spend a lot of time at home, such as carers o low income households o people who experience a number of inequalities o refugees and asylum seekers o migrant workers o children looked after** o homeless people9,10

**The definition of looked-after children (children in care) is found in the Children Act 1989.

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Worsening housing conditions are independently associated with the number of reported health problems in women especially.5

Poor quality housing is more common in the private rented sector than in other tenures and the proportion of vulnerable people (those on benefits) living in non-decent homes is greater in this sector. Nationally, the private rented sector accounted for 20% of all households in 2015-16, while the social rented sector accounted for 17%.11

Evidence shows that the greatest risks to health from poor housing quality are related to cold and damp (including moulds and fungus), which affect and exacerbate respiratory conditions.2 The prevalence of ill health appears to increase with the level of relative dampness in the household.1 Cold housing also negatively affects children’s educational attainment, emotional well-being and resilience.12

A key risk factor for experiencing health impacts from living in a cold home is being in fuel poverty – a product of household income, household energy requirements and fuel prices. Fuel poverty is measured in England using the Low Income High Costs (LIHC) indicator*. Under the LIHC indicator, a household is considered to be fuel poor if:

o they have required fuel costs that are above average (the national median level) o were they to spend that amount, they would be left with a residual income below the

official poverty line13

3.0 Scale of the issue† 3.1 Housing quality

Local housing quality data is limited in availability and quality, so it is not possible to build a reliable, comprehensive picture of housing quality across the county.

Local authorities have an obligation under the Housing Act 2004 to keep housing conditions in their area under review. This includes all tenures of housing, not just stock that may be owned by the local authority. To meet this obligation, they have typically carried out periodic surveys on the condition of a random sample of housing. Housing stock condition surveys undertaken locally by lower tier authorities cannot be reliably used to provide a Hertfordshire-wide picture, however, as the data were collected at different times using different methodologies.

Lower tier local authority data on Housing Health and Safety Rating Scheme (Box 2) inspections entered into the BRE Housing and Health Cost Calculator (HHCC) provide the best available source;

* This updated definition was introduced following the Hills Review 2012 which recommended focusing on those in greatest

need such as low-income families or older people on fixed incomes. Interventions to reduce fuel poverty, such as using funds to facilitate the installation of energy efficiency measures (eg. the Energy Company Obligation), should be directed toward these priority groups † This section highlights selected key messages from the data. See Appendices B & C for additional local figures.

https://www.gov.uk/government/publications/final-report-of-the-fuel-poverty-review

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however, only four district councils used this tool (Box 3). Data ranging from 2010-2016 in these four areas is summarised below:

o The top 5 most prevalent hazards in between 2010-2016 in order of prevalence were: Excess cold (144 hazards), Fire (102 hazards), Damp and mould (68 hazards), Electrical hazards (52 hazards) and Falling on stairs (34 hazards).

o The top 5 housing hazards that provide the largest amount of savings to the National Health

Service are Excess cold (£153,982), Fire (£24,768), Electrical hazards (£17,598), Crowding and spacing (£9,566) and Damp and mould growth (£7,347).

o The system is reliant on reports of housing quality issues being made to housing officers and

it is not known what proportion of housing quality problems go unreported.

o Only private sector homes with category 1 hazards (serious and immediate risk) were included in the data and the majority of the 555 entries were from Watford Borough Council (the only district that used the system regularly).

o These data therefore do not provide a full picture of housing quality needs and cannot be assumed to be representative of the county as a whole.

Box 1. The English Housing Survey

The English Housing Survey is a national survey of people's housing circumstances and the condition and energy efficiency of housing in England.

It was first run in 2008-09. Prior to then, the survey was run as two standalone surveys: the English House Condition Survey and the Survey of English Housing.

Commissioned by the Department for Communities and Local Government (DCLG), the EHS collects information from households on housing circumstances. It includes a household questionnaire, a physical assessment of the property and in some years, a desk-based market value assessment.

Box 2. Housing Health and Safety Rating Scheme

The Housing Health and Safety Rating System (HHSRS) is the method used by local authorities to assess housing conditions.

The Housing Act 2004 establishes the HHSRS as the current statutory assessment criterion for housing and is based on the principle that: Any residential premises should provide a safe and healthy environment for any potential occupier or visitor.

Local authorities are required to keep housing conditions in privately owned property under review and have a duty to inspect a property where they have reason to believe that it is appropriate to determine the presence of health and safety hazards.

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Box 3. BRE Housing and Health Cost Calculator

The Housing Health Cost Calculator (HHCC) is a tool which works out the costs to the NHS and society of HHSRS hazards and the savings where they have been mitigated or significantly reduced. It calculates a hazard rating score for the defects (hazards) in a dwelling and their effect on the occupiers and visitors.

The HHCC is produced by BRE, a commercial organisation, and was made available to Hertfordshire district and borough local authorities by Hertfordshire County Council from 2010-2016.

Only four district councils (Broxbourne, East Hertfordshire, Stevenage and Watford) were using the tool in 2016 and therefore the data do not provide a Hertfordshire-wide picture.

3.2 Homelessness

In 2014/15, Hertfordshire had a statistically significantly larger rate of Family Homelessness (2.1 per 1,000 households) compared to the England average (1.8 per 1,000 households).

In 2015/16, the rate of statutory homelessness – households in temporary accommodation in Hertfordshire was statistically significantly better than the England average (2.4 per 1,000 compared to 3.1 per 1,000). The districts that were statistically significantly worse than the England average in 2015/15 were Broxbourne (6.8 per 1,000) and Watford (5.6 per 1,000).

3.3 Older people living alone

In 2011, the proportion of pensioners (aged 65+) living alone in Stevenage (34.4%), Watford (32.8%) and Welwyn Hatfield (32.0%) was statistically significantly larger than the Hertfordshire average (31.0%).

3.4 Falls injuries in older people‡

In 2014/15, the Hertfordshire districts that had a statistically significantly worse rate of injuries due to falls in people aged 65+than the England average were North Hertfordshire (2,514 per 100,000) and Stevenage (2,651 per 100,000).

The rate of female injuries due to falls in women aged 80+ in Hertfordshire (6,650 per 100,000) was statistically significantly worse than the England average (6,312 per 100,000) in 2014/15. North Hertfordshire (8,607 per 100,000) and Watford (7,470 per 100,000) also had statistically significantly worse rates than the England average in 2014/15.

‡ Housing quality may contribute towards falls injuries in older people; however, this statistic should not be regarded as an

indicator of housing quality in itself.

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In 2014/15, the rate of injuries due to falls in people aged 80+ in North Hertfordshire (6,826 per 100,000) and Stevenage (7,118 per 100,000) were statistically significantly higher than the England and Hertfordshire averages.

3.5 Fuel poverty

The districts with statistically significantly higher proportions of fuel poverty than Hertfordshire (7.5%) in 2014 were: Watford (8.6%), Welwyn Hatfield (8.0%) and North Hertfordshire (8.0%).

3.6 Excess winter deaths§

In August 2014-July 2015, Hertfordshire had a statistically significantly higher excess winter death index (34.5) than the England average (27.7) for the same time period.

The Hertfordshire district with a statistically significantly higher excess winter death index than the England average (27.7) in August 2014–July 2015 was North Hertfordshire (50.5).

4.0 Solutions

4.1 What should be done?

With limited budgets available to address housing quality, there is a necessity to focus efforts over and above the fulfilment of statutory obligations (Box 2) on the most cost effective improvements to the poorest housing occupied by the most vulnerable people,8 such as targeting low SAP energy rated homes in which people are at risk of ill health (Box 4).

NICE guidance published in 2015 on tackling cold homes in order to prevent excess winter deaths included 12 recommendations:

o Develop a strategy. o Ensure there is a single point of contact health and housing referral service for people living

in cold homes. o Provide tailored solutions via the single point of contact health and housing referral service

for people living in cold homes. o Identify people at risk of ill health from living in a cold home. o Make every contact count by assessing the heating needs of people who use primary health

and home care services. o Non-health and social care workers who visit people at home should assess their heating

needs. o Discharge vulnerable people from health or social care settings to a warm home. o Train health and social care practitioners to help people whose homes may be too cold. o Train housing professionals and faith and voluntary sector workers to help people whose

homes may be too cold for their health and wellbeing.

§ Excess winter deaths statistics can be affected by fluctuations in mortality at other times of the year. Housing quality may

contribute towards excess winter mortality; however, this statistic should not be regarded as an indicator of housing quality in itself.

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o Train heating engineers, meter installers and those providing building insulation to help vulnerable people at home.

o Raise awareness among practitioners and the public about how to keep warm at home. o Ensure buildings meet ventilation and other building and trading standards.14

A report by the think tank Institute for Public Policy Research (IPPR) published in 2014 on addressing housing quality in the private rented sector (PRS) made four general recommendations:

o Better use should be made by local authorities of existing powers, such as the use of selective licensing, improvement notices, hazard awareness orders and demolition orders, to persuade private landlords to maintain their property to a good standard.

o Local authorities should establish community housing agencies as not-for-profit groups dedicated to working within the private rented sector and responsible for operating a system of landlord accreditation, tenant matching and other management services.

o Alongside these agencies, PRS support teams should be established to support vulnerable private tenants.

o Councils who already have an accreditation system in place should ensure home improvement grants and loans are available to landlords to enable them to meet Decent Homes criteria.15

Health & Wellbeing Boards have an important role in collaborating and working with other parts of local authorities, stakeholders and local organisations including CCGs and primary care in order to tackle fuel poverty and cold homes16.

NHS England, Department of Health and Public Health England have also recommended greater collaboration between housing and health given the impact housing has on prevention of hospital admissions, quicker hospital discharges, reduced readmission rates and reduced health inequalities. This includes working together to introduce:

o GPs using social prescribing to link to local authorities, voluntary and community organisations

o Improving affordable warm homes o Improving suitability and accessibility17

Box 4. SAP energy ratings

SAP stands for ‘Standard Assessment Procedure’. It is the only official, government approved system for assessing the energy rating for a new home. SAP assessors must be accredited and registered with a certification body. A SAP Rating is a way of comparing energy performance of different homes – it results in a figure between 1 and 100+.

SAP Calculations are a requirement of the Building Regulations, and are required for all newly built dwellings in the UK. A SAP Rating has been required for all new homes under Part L of the building regulations since 1995, therefore most developers will be familiar with it.

The Energy Efficiency Regulations (2015) for privately rented properties requires a minimum SAP rating of Band E from April 2018 (Band A: 92-100, Band B: 81-91, Band C: 69-80, Band D: 55-68, Band E: 39-54, Band F: 21-39, Band G 1-20)18.

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4.2 What are we doing locally?

Hertfordshire’s Health and Wellbeing Board have incorporated housing issues into their 2016-2020 strategy and specifically mention that they will seek to tackle homelessness and housing issues and their underlying causes16.

Following completion of a comprehensive internal report on housing and health by the County Council’s Public Health Service, a Hertfordshire Housing Quality Working Group was set up in 2016. The group was formed to bring together key stakeholders working in the area of housing quality across the county’s ten districts and agree a Hertfordshire Housing Quality Action Plan.

Local initiatives to improve housing quality are undertaken by both the County Council and the county’s ten district and borough councils.

County-led initiatives currently include: o ‘Safe and Well’ home visits: HCC Community Protection have developed and piloted a new

‘Safe and Well’ visiting service targeted at vulnerable older people. The visits are undertaken by the Fire Service and include the provision of advice, support and referral around home warmth, security and fire prevention. The project is planned to be rolled out countywide to around 8,000 homes per year.

o The Hertfordshire Warmer Homes Project: The Warmer Homes project will install up to 700 energy efficiency measures in low income private households across Hertfordshire – this will use Energy Company Obligation funding (Government-set fuel poverty reduction targets for energy companies) supplied by energy companies. The project will finance ‘top-up’ contributions, requested by some energy companies towards the cost of measures, to enable all householders to get the support they need. It will also fund an Assessor role to support and coordinate referrals, and link into districts and the wider health and social care system. Set to run for one year starting 1st Sept 2017, the project will be overseen by the multi-partner Housing Quality Working Group.

Work undertaken by individual district and borough local authorities includes: o responding reactively to complaints about housing quality (both private and social): inspect,

advise, provide financial assistance or enforce as appropriate; o bringing empty homes back into use; o providing energy efficiency/fuel poverty advice and incentives; o signposting to other agencies as appropriate; o providing grants for vulnerable residents; o licencing larger houses of multiple occupation (HMOs) and investigating how to find and

improve HMOs.

District and borough councils have legal powers to enforce housing conditions in the private rented sector; however, limited financial and staff resources make it more challenging to proactively identify illegal housing conditions or take on additional casework, and the grant funding available to owner-occupiers to improve their homes is limited. The majority of casework comes from complaints from tenants, with low levels of referral from other areas of the public sector.

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5.0 Conclusions 5.1 Analysis

Poor housing conditions often coexist with other forms of deprivation, for example, unemployment, poor education, ill health, and social isolation, making it difficult generally to separate, modify and assess the overall health impact of housing conditions.5

Current limitations in assessing housing quality and health needs locally include a lack of county wide data and trend analysis. This is due to the limited and inconsistent collection of relevant data at district level. A consistent approach to robust data collection across the county would enable investigation of housing quality and health needs over time and allow statistical associations between different housing hazards and health indicators to be explored. Current barriers to standardised data collection across the county include lack of staff capacity at district level and the absence of a single centralised data recording tool.

Although there are a number of different issues related to housing quality which have a direct or indirect impact on health and wellbeing, the available evidence most strongly links health outcomes with cold homes. Excess cold is also by far the most common housing hazard recorded locally, accounting for over a quarter of all of the recorded hazards in the Housing and Health Cost Calculator. (Although due to the lack of data, trend analysis is not possible across years or districts, it is notable that the majority of excess cold hazards were reported in Watford – this could reflect a genuine difference in prevalence or a difference in reporting practices/data recording.)

Box 5. Welwyn Hatfield: Health Impact Assessment – private sector housing

In 2015 Welwyn Hatfield Council commissioned BRE to understand the health impacts of poor housing.

There was an estimated 5,909 category 1 HHSRS hazards in Welwyn Hatfield private sector housing, with an estimated cost to the NHS of £1.1m each year

Mitigating these hazards would cost £12.7m but would result in estimated annual savings to the NHS of £1m

Recommendations for future initiatives include: o Comparing areas with high category 1 hazards to areas with high deprivation

to determine whether geographical targeting would be an effective approach o Having an active housing enforcement strategy for private sector landlords o Introducing initiatives that reduce falls in over 60s as a cost-effective method

for health improvement o Improving private sector energy efficiency through better advice or

grants/loans to pay for improvements o Targeting health visitors of Children’s Centres to reduce home hazards that

particularly affect children (damp, mould, flames, falling between levels)

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Tackling cold homes, particularly those occupied by people vulnerable to ill health and improving reach into the private rented sector stand out as potential early priorities in addressing housing quality to improve health.

One of the main NICE recommendations for tackling cold homes to improve health is around commissioning a local single point of contact health and housing referral service that helps people who are identified as being vulnerable to the health problems associated with a cold home to receive tailored support from identified partners (local organisations providing relevant interventions and services). The feasibility of commissioning such a service locally should be considered as part of efforts to build a more joined up housing quality and health strategy.

Challenges remain around the proactive identification of homes in poor condition (particularly housing in the private rented sector), and limited staff and financial resources. Successfully raising housing standards further in both the existing and new housing stock, however, would accrue health benefits, which the NHS and society as a whole would benefit from.8

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5.2 Recommendations

Addressing cold homes should be the primary focus of efforts to improve housing quality in Hertfordshire from a public health perspective.

Further work should be considered to implement national guidelines and recommendations relating to housing quality (particularly the NICE guidance14 and Quality Standard19 around tackling cold homes) including exploring the potential for:

o commissioning a local single point of contact health and housing referral service that helps people who are identified as being vulnerable to the health problems associated with a cold home to receive tailored support;

o the delivery of home heating and insulation interventions targeted at low SAP homes in which people are at risk of ill health;

o more effectively identifying and addressing poor quality housing in the private rented sector;

o more widespread identification of housing quality issues and appropriate signposting by

professionals across sectors, including GPs, community nurses, health visitors, home care practitioners, housing association officers, fire service, and voluntary organisations.

Joint steps should be taken by the county council and lower tier local authorities to improve understanding of local needs going forward. Key steps for consideration are:

o Adopting a common approach to the procurement of Stock Condition Surveys across the county, including a standardised methodology for sampling, data collection and reporting.

o Devising and adopting a standardised approach to collecting and recording data regarding housing quality complaints at district level.

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References

1. Wilkinson D. Poor Housing and Ill health A SUMMARY. Scottish Off. 1999.

2. Byrne E, Elliott E, Green L, Lester J. Housing and Health Evidence Review for Health Impact Assessment (HIA).;

2014.

3. Hatfield W. A Quantitative Health Impact Assessment of Private Sector Housing in Welwyn Hatfield Executive

Summary.

4. Akinwale B, Boardman B, Bone A, et al. Local action on health inequalities: Fuel poverty and cold home-

related health problems. 2014. www.gov.uk/phe. Accessed May 19, 2017.

5. Wiltshire S. A Thematic Review of Literature on the Relationship Between Housing, Neighbourhoods and

Schools. 2010:1-18.

6. Shelter. What counts as a decent home?

7. Housing Act 2004. http://www.legislation.gov.uk/ukpga/2004/34/part/1. Accessed May 31, 2017.

8. Nicol S, Roys M, Garrett H, Building Research Establishment. The cost of poor housing to the NHS - Briefing

Paper. 2015:10. https://www.bre.co.uk/healthbriefings.

9. Public Health England. Improving health through the home.

https://www.gov.uk/government/publications/improving-health-through-the-home/improving-health-

through-the-home. Published 2016. Accessed January 25, 2017.

10. National Institute for Health and Care Excellence. Equality analysis form – Preventing excess winter deaths

and morbidity.

11. Department for Communities and Local Government. English Housing Survey Headline Report, 2015-16.

London; 2017.

12. Marmot Review. The Heath Impacts of Cold Homes and Fuel Poverty. London; 2011.

13. Department for Business E& IS. Fuel poverty statistics - GOV.UK.

https://www.gov.uk/government/collections/fuel-poverty-statistics. Published 2013. Accessed May 15, 2017.

14. NICE. Excess Winter Deaths and Illness and the Health Risks Associated with Cold Homes. London; 2015.

15. IPPR. Back to Rising Damp? Addressing Housing Quality in the Private Rented Sector.; 2014.

16. Hertfordshire Health & Wellbeing Board. Hertfordshire Health and Wellbeing Strategy.; 2016.

https://www.hertfordshire.gov.uk/media-library/documents/about-the-council/partnerships/hertfordshire-

health-and-wellbeing-strategy-2016-–-2020.pdf. Accessed May 31, 2017.

17. NHS England. Quick Guide: Health and Housing. Department of Health; 2016.

http://www.nhs.uk/NHSEngland/keogh-review/Pages/quick-guides.aspx. Accessed May 31, 2017.

18. Department For Communities and Local Government. Energy Performance of Buildings Data England and

Wales. https://epc.opendatacommunities.org/. Published 2017. Accessed May 19, 2017.

19. NICE. Preventing excess winter deaths and illness associated with cold homes.

20. Building Research Establishment (BRE). How the HHCC calculates the health cost data.

https://www.housinghealthcosts.org/res/hhcc.pdf . Accessed May 19,2017

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Appendix A: Information for Equality Impact Assessments

●●● Hertfordshire JSNA

Information for Equality Impact Assessments

Housing Quality and Health

March 2017

Part A: Protected characteristics

Age

The housing circumstances present a particular risk to the health and wellbeing of older people.9

Older people (aged 65+) are more vulnerable to adverse effects from cold homes.10

Disability

The home or housing circumstances present a particular risk to the health and wellbeing of people with long-term conditions; people with mental health issues and people with learning disabilities.9

Research suggests that people with mental health conditions are at a greater risk of adverse health due to cold homes.10

Gender reassignment No specific issues identified through this needs assessment.

Marriage and civil partnership No specific issues identified through this needs assessment.

Pregnancy and maternity

Pregnant women and young children (aged under 5 years) are more at risk for negative health consequences resulting from cold homes.10

Race

The link between some minority ethnic groups and deprivation may mean that some of these groups are more likely to live in cold homes leading to excess winter deaths.10

Refugees in particular may be living in cold temporary or emergency accommodation and recent immigrants, could also be particularly vulnerable during their first few years in the UK.10

Religion or belief No specific issues identified through this needs assessment.

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Sex

Worsening housing conditions are independently associated with deterioration in health, especially the number of reported health problems in women.5

Sexual orientation No specific issues identified through this needs assessment.

Part B: Military personnel and armed forces veterans

No specific issues identified through this needs assessment.

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Appendix B: Tartan Rugs

Housing and Health Tartan Rug

Quintile: Low High

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Th

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Wa

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Period of

Data

Persons All ages 21.8 12.2 17.3 12.2 8.1 12.9 11.6 7.7 18.4 10.0 15.7 12.9 2015

Persons 0-18 yrsper

100,000216.1 131.0 - - - - - - - - - - 2014/15

Persons Not applicable % 4.8 4.1 5.4 3.4 2.7 4.8 2.9 3.4 4.1 3.7 7.0 4.9 2011

Persons Not applicable per 1000 1.8 2.1 - - - - - - - - - - 2014/15

Persons All ages per 1000 3.1 2.4 6.8 1.3 0.32 3.3 1.5 1.9 2.5 1.5 5.6 1.5 2015/16

Persons 65+ yrs % 5.2 4.9 - - - - - - - - - - 2011

All 65+ % - 31.0 30.0 31.5 30.0 30.9 31.0 29.3 34.4 30.1 32.8 32.0 2011

Female 65+ yrsper

100,0002509 2545 1902 2547 2212 2535 3126 2498 2925 2489 3023 2349 2014/15

Male 65+ yrsper

100,0001740 1706 1265 1669 1329 1731 1902 1428 2377 1957 1773 1949 2014/15

Persons 65+ yrsper

100,0002125 2126 1584 2108 1771 2133 2514 1963 2651 2223 2398 2149 2014/15

Persons 65-79 yrsper

100,0001012 969.5 740.2 1036 758.2 1011 1027 913.1 1110 1008 1228 1050 2014/15

Female 80+ yrsper

100,0006312 6650 5225 6503 5981 6342 8607 6349 7355 6666 7470 6031 2014/15

Male 80+ yrsper

100,0004391 4306 2833 3932 3433 4431 5045 3666 6881 4830 4110 4640 2014/15

Persons 80+ yrsper

100,0005351 5478 4029 5218 4707 5387 6826 5008 7118 5748 5790 5335 2014/15

Female 65+ yrsper

100,000717.6 678.6 628.3 740.3 605.7 572.7 777.1 760.2 726.6 696.3 654.4 605.1 2014/15

Male 65+ yrsper

100,000425.1 382.4 286.7 399.2 363.7 478.9 340.0 233.3 454.8 413.4 530.0 468.8 2014/15

Persons 65+ yrsper

100,000571.3 530.5 457.5 569.7 484.7 525.8 558.5 496.8 590.7 554.8 592.2 537.0 2014/15

Female 65-79 yrsper

100,000311.6 271.5 - 333.2 158.3 217.8 284.2 408.2 - 340.2 236.2 208.9 2014/15

Male 65-79 yrsper

100,000166.8 138.8 - 162.0 86.0 165.7 107.2 121.1 - 189.1 283.1 173.4 2014/15


100,000239.2 205.1 125.6 247.6 122.1 191.8 195.7 264.7 217.6 264.6 259.6 191.1 2014/15

Female 80+ yrsper

100,0001895 1859 - 1921 1903 1602 2207 1781 - 1729 1867 1754 2014/15

Male 80+ yrsper

100,0001174 1089 - 1087 1169 1387 1015 558.8 - 1064 1246 1326 2014/15

Persons 80+ yrsper

100,0001535 1474 1420 1504 1536 1494 1611 1170 1673 1396 1557 1540 2014/15

Persons All ages % 10.6 7.5 6.6 7.3 7.5 7.3 8.0 7.2 7.1 7.1 8.6 8.0 2014

Persons 65+ yrs % 96.7 99.3 - - - - - - - - - - 2011/12

Female All ages 31.6 38.9 8.5 58.4 36.0 37.7 49.4 28.1 30.1 15.4 67.1 52.4 Aug 2014 -

Jul 2015

Male All ages 23.6 29.7 26.9 11.3 10.5 33.6 52.0 40.3 28.8 43.8 26.7 29.5 Aug 2014 -

Jul 2015

Persons All ages 27.7 34.5 17.6 34.9 22.9 35.7 50.5 33.6 29.5 27.6 47.6 40.9 Aug 2014 -

Jul 2015

Female 85+ yrs 42.4 52.5 30.6 81.3 47.6 31.9 61.1 35.8 67.3 34.3 88.0 54.8 Aug 2014 -

Jul 2015

Male 85+ yrs 36.3 49.3 49.0 11.1 47.6 42.3 88.8 50.0 23.3 93.4 42.4 59.6 Aug 2014 -

Jul 2015

[email protected]

Compared to England

hertshealthevidence.org Where applicable see target

column shading

Printed:

15/02/2017

"-" Data not

available for

area

Data as of

01/09/16

Housing and Health Tartan RugHertfordshire Districts compared to England

Health & Wellbeing in Hertfordshire

Population

Public Health

Evidence & Intelligence

Injuries due to falls in people aged 65 and over

Injuries due to falls in people aged 65 and over -

aged 65-79


aged 80+


aged 80+


aged 80+

Older people living alone: % of households occupied

by a single person aged 65 or over

Pensioners living alone



Hip fractures in people aged 65 and over - aged 65-

79

Hip fractures in people aged 65 and over - aged 80+



Fuel poverty

Hip fractures in people aged 65 and over




79


79

Excess winter deaths index (single year, age 85+)

% of people aged 65+ receiving winter fuel payments

Excess winter deaths index (single year, all ages)




Deprivation score (IMD 2015)

Hospital admissions for asthma (under 19 years)

Household overcrowding: % of households

Family homelessness: rate per 1,000 households

Statutory homelessness - households in temporary

accommodation

Indicators(for definitions and data sources see

user guide/methodology documents)

Significantly Lower

Significantly Higher

Not Compared

Significantly Better

Significantly Worse

Not Significantly Different

Housing and Health Tartan Rug Quintile: Low High

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[email protected]

Compared to England


column shading

Printed:

15/02/2017

"-" Data not

available for

area

Data as of

01/09/16

Population

Public Health




Significantly Lower


Not Compared


Significantly Worse


Persons 85+ yrs 40.1 51.3 36.9 51.5 47.6 35.7 70.0 41.0 48.5 52.0 72.7 56.6 Aug 2014 -

Jul 2015Excess winter deaths index (single year, age 85+)

Housing and Health Tartan Rug

Quintile: Low High

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Period of

Data

Persons All ages 21.8 12.2 17.3 12.2 8.1 12.9 11.6 7.7 18.4 10.0 15.7 12.9 2015

Persons Not applicable % 4.8 4.1 5.4 3.4 2.7 4.8 2.9 3.4 4.1 3.7 7.0 4.9 2011

Persons All ages per 1000 3.1 2.4 6.8 1.3 0.32 3.3 1.5 1.9 2.5 1.5 5.6 1.5 2015/16

All 65+ % - 31.0 30.0 31.5 30.0 30.9 31.0 29.3 34.4 30.1 32.8 32.0 2011

Female 65+ yrsper

100,0002509 2545 1902 2547 2212 2535 3126 2498 2925 2489 3023 2349 2014/15

Male 65+ yrsper

100,0001740 1706 1265 1669 1329 1731 1902 1428 2377 1957 1773 1949 2014/15

Persons 65+ yrsper

100,0002125 2126 1584 2108 1771 2133 2514 1963 2651 2223 2398 2149 2014/15


100,0001012 969.5 740.2 1036 758.2 1011 1027 913.1 1110 1008 1228 1050 2014/15

Female 80+ yrsper

100,0006312 6650 5225 6503 5981 6342 8607 6349 7355 6666 7470 6031 2014/15

Male 80+ yrsper

100,0004391 4306 2833 3932 3433 4431 5045 3666 6881 4830 4110 4640 2014/15

Persons 80+ yrsper

100,0005351 5478 4029 5218 4707 5387 6826 5008 7118 5748 5790 5335 2014/15

Female 65+ yrsper

100,000717.6 678.6 628.3 740.3 605.7 572.7 777.1 760.2 726.6 696.3 654.4 605.1 2014/15

Male 65+ yrsper

100,000425.1 382.4 286.7 399.2 363.7 478.9 340.0 233.3 454.8 413.4 530.0 468.8 2014/15

Persons 65+ yrsper

100,000571.3 530.5 457.5 569.7 484.7 525.8 558.5 496.8 590.7 554.8 592.2 537.0 2014/15

Female 65-79 yrsper

100,000311.6 271.5 - 333.2 158.3 217.8 284.2 408.2 - 340.2 236.2 208.9 2014/15

Male 65-79 yrsper

100,000166.8 138.8 - 162.0 86.0 165.7 107.2 121.1 - 189.1 283.1 173.4 2014/15


100,000239.2 205.1 125.6 247.6 122.1 191.8 195.7 264.7 217.6 264.6 259.6 191.1 2014/15

Female 80+ yrsper

100,0001895 1859 - 1921 1903 1602 2207 1781 - 1729 1867 1754 2014/15

Male 80+ yrsper

100,0001174 1089 - 1087 1169 1387 1015 558.8 - 1064 1246 1326 2014/15

Persons 80+ yrsper

100,0001535 1474 1420 1504 1536 1494 1611 1170 1673 1396 1557 1540 2014/15

Persons All ages % 10.6 7.5 6.6 7.3 7.5 7.3 8.0 7.2 7.1 7.1 8.6 8.0 2014

Female All ages 31.6 38.9 8.5 58.4 36.0 37.7 49.4 28.1 30.1 15.4 67.1 52.4 Aug 2014 -

Jul 2015

Male All ages 23.6 29.7 26.9 11.3 10.5 33.6 52.0 40.3 28.8 43.8 26.7 29.5 Aug 2014 -

Jul 2015

Persons All ages 27.7 34.5 17.6 34.9 22.9 35.7 50.5 33.6 29.5 27.6 47.6 40.9 Aug 2014 -

Jul 2015

Female 85+ yrs 42.4 52.5 30.6 81.3 47.6 31.9 61.1 35.8 67.3 34.3 88.0 54.8 Aug 2014 -

Jul 2015

Male 85+ yrs 36.3 49.3 49.0 11.1 47.6 42.3 88.8 50.0 23.3 93.4 42.4 59.6 Aug 2014 -

Jul 2015

Persons 85+ yrs 40.1 51.3 36.9 51.5 47.6 35.7 70.0 41.0 48.5 52.0 72.7 56.6 Aug 2014 -

Jul 2015

[email protected]

Compared to Hertfordshire


column shading

Printed:

15/02/2017

"-" Data not

available for

area

Data as of

01/09/16

Housing and Health Tartan RugHertfordshire Districts compared to Hertfordshire

Health & Wellbeing in Hertfordshire

Population

Public Health



aged 80+


aged 80+







aged 65-79


aged 80+


Fuel poverty





79


79


79






Deprivation score (IMD 2015)

Household overcrowding: % of households

Statutory homelessness - households in temporary

accommodation

Pensioners living alone




Significantly Lower


Not Compared


Significantly Worse


19

Appendix C: Tables Table 1: Housing hazards identified in local BRE Housing and Health Cost Calculator data for Broxbourne, East Hertfordshire, Stevenage and Watford, 2010-2016

Type of Hazard Number of Hazards

Excess cold 144

Fire 102

Damp and mould growth 68

Electrical hazards 52

Falling on stairs etc 34

Personal hygiene, Sanitation and Drainage 33

Crowding and space 26

Food safety 20

Falling between levels 18

Falling on level surfaces etc 12

Entry by intruders 11

Structural collapse and falling elements 9

Domestic hygiene, Pests and Refuse 6

Lighting 4

Excess heat 4

Flames, hot surfaces etc 3

Collision and entrapment 3

Carbon monoxide 3

Explosions 1

Asbestos (and MMF) 1

20

Table 2: Housing hazards identified in local BRE Housing and Health Cost Calculator data for Broxbourne, East Hertfordshire, Stevenage and Watford, 2010-2016 by total savings to NHS, 2010-201620

Type of Hazard Total saving to NHS

Total savings to society

Average payback period (months)

Excess cold £153,982 £384,955 88

Fire £24,768 £61,920 64

Electrical hazards £17,598 £43,995 208

Crowding and space £9,566 £23,915 16

Damp and mould growth £7,347 £18,368 302

Falling on stairs, etc. £5,515 £13,788 25

Excess heat £4,747 £11,868 84

Food safety £3,763 £9,408 512

Personal hygiene, sanitation & drainage £3,281 £8,203 346

Structural collapse and falling elements £2,259 £5,648 66

Falling on level surfaces, etc. £2,061 £5,153 72

Falling between levels £1,859 £4,648 106

Domestic hygiene, Pests and Refuse £798 £1,995 4

Entry by intruders £318 £795 97

Lighting £291 £728 55

Explosions £285 £713 12

Carbon monoxide £137 £343 418

Collision and entrapment £59 £148 360

Flames, hot surfaces etc £50 £125 314

Asbestos (and MMF) £31 £78

housing quality & health - hertfordshire...hertfordshire (8,607 per 100,000) and watford (7,470...

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