Home is where ... health is

He Kitenga, 2005

Raising the temperature of a house by less than one degree can have a demonstrable impact on the health of the people living in it.

Paradoxically, New Zealand has a much higher rate of hospital admissions and higher deaths in winter than countries with much colder climates. The belief is that if houses were warmer and drier, with better insulation and heating, the winter peak would disappear.

Shedding light on such links between housing and health is just part of the work carried out by He Kainga Oranga / the Housing and Health Research Programme.

The programme involves people from many different disciplines, identifying and evaluating housing and neighbourhood interventions to improve people’s health. The accent is on practical, hands-on work that can make a difference.

Associate Professor Philippa Howden- Chapman started the ball rolling. “After years spent researching and writing about health inequalities I decided I didn’t want to continue my work describing any more inequalities in health. I actually wanted to do something to change things.”

She was concerned with the impact of cold and damp in New Zealand houses, and the way that exacerbated asthma and the conditions of elderly people.

“People spend 75 per cent of their lives in their homes yet there is no official body that is responsible for the indoor environment.”

Howden-Chapman worked with colleague Professor Julian Crane. “The idea was that we would work out what the links are between housing and health, but we’d do it in as robust a way as possible so that, depending on the results, we could quantify them and therefore put a cost to the benefits. This would put us in a strong position to have our arguments considered in policy development and budget allocations.”

That is just what they did with their first big community-based trial, the Housing Insulation and Health study, and what they continue to do with the many other projects they are involved with, gaining funding from the private sector and government agencies by clearly demonstrating the potential benefits of their work.

The insulation project involved seven communities throughout New Zealand. Researchers worked with people who lived in houses that had no insulation and where there was someone in the family with respiratory problems. They carried out baseline measures, such as how many days children had off school and how much people were spending on energy bills. Almost 1,400 houses were retro-fitted with insulation. The trial had tremendous response – and results.

“A year later there were improvements across all measures – lower fuel bills, significantly fewer days in hospital, fewer days off school and work.” It’s estimated that between a third and a half of New Zealand homes are inadequately insulated. The insulation programme was extended with Budget money in the EECA Energywise Fund in 2004.

A heating study is now following a similar design, exploring the relationship between respiratory problems and the impact of sustainably heating more than one room in a house – the usual pattern in New Zealand – as well as household exposure to combustion products from home heating.

The 500 people involved in the study are taking measures of their winter indoor environment. Nitrogen dioxide levels are being monitored inside the homes, and children are being asked to breathe into puffers and take measurements twice a day. In return for their involvement, homes will be fitted with new-generation heating that is energy efficient and uses sustainable forms of energy.

About 20 researchers are involved in the He Kainga Oranga programme, based at Otago’s Wellington School of Medicine and Health Sciences, but linked to the Universities of Victoria, Massey and Auckland, and the Building Research Association of New Zealand.

Howden-Chapman and Crane work with fellow directors, Dr Michael Baker, Professor Chris Cunningham and Dr Malcolm Cunningham. Baker is leading a major project with Housing New Zealand Corporation, studying the relationship between housing and hospitalisation for infectious diseases among state house tenants. The work is prompted by such figures that show an 11-fold increase in the risk of contracting meningococcal disease for children living in overcrowded households. The study will look at the amount of time those on housing waiting lists spend in hospital, and what happens when they move into affordable housing that is more tailored to their needs and the size of their families. The programme is also working with the Victoria University School of Architecture and Design and the Wellington Tokelau Association, studying the different housing needs of cultural groups. A prototype home, specially designed with community input to cater for the needs of extended families, is to be built in Porirua.

A Healthy Housing Index is also being developed to measure the physical characteristics of houses, and will quantify their “healthiness” and safety. The resulting index will provide a practical way of measuring the “healthiness” of individual houses or entire neighbourhoods, and is likely to be used in a Statistics New Zealand Survey of Housing.

The programme’s next big project is the development of a Healthy Urban Housing Institute. “There is no reason why social housing can’t be state-of-the-art, attractive and affordable, and lead the way, not just in the suburbs but in urban environments where more and more people are going to live in the future,” says Howden-Chapman.

It’s rewarding work. “Because there are tangible results from our work and people can see the differences, it often leads to other lifestyle changes. When people feel good about their homes, they feel better about themselves.”