The Healthy Homes Initiative (HHI) is a unique programme, celebrated for being an outstanding public service delivering positive outcomes for New Zealand.
A paper has recently been published by Nevil Pierse and other colleagues about what one HHI does – Well Homes in Wellington. People can be referred to Well Homes when they have a number of risk factors – basically, when it’s thought that some of their health problems could be avoided if their housing was in better condition. If the household wants, they’ll be visited by someone who will inspect their home, give them advice on how to get it warmer, dryer and safer, provide them with things they might need (provided by charities), such as firewood, curtains, or bedding, and refer them on to receive other things: insulation, or help with budgeting or health issues or welfare assistance or public housing, for examples.
The researchers found that Well Homes clients had urgent needs for better housing. 88% reported mould on the walls of bedrooms or living, and only 23% felt they could heat their home to a comfortable level. 25% were assessed to require beds in the house, and 43% had insufficient bedding. 84% needed heating, and 82% were identified as having a problem with draughts in the house.
These issues – the product of poor regulation and insufficient incomes – are the type of problems present when people discharged from hospital for respiratory issues return home.
In almost all the cases, households received an intervention that could contribute to improving the house’s condition – such as a heater, or bedding or a means to remove mould. More substantial interventions were harder to achieve. Our qualitative work on Well Homes found that one of the challenges with the programme was working with landlords who were unwilling to invest in making their tenants’ homes better. This is reflected in the findings of this paper: insulation was installed in fewer than 40% of the clients living in private rentals whose homes needed insulation.
This problem will be helped by the regulations for rental housing under the Healthy Homes Guarantee Act, however, as is the case with previous standards, to a large extent these rely on tenants reporting landlords’ infractions – when we know that this is a frightening prospect for tenants afraid of endangering their tenancies in a tight rental market.
Well Homes targets households that needs better housing, and engages with them directly, offering immediate and practical interventions that make a difference to a house and to the people living there. However, it’s just one piece of the puzzle: as the paper states, “interventions like Well Homes are compromised by a poorly regulated market driven
housing system, which fails to protect and support vulnerable populations” .
Ongoing work by the team will assess the health outcomes that result from participation in HHIs.
Pierse, N., White, M., Ombler, J., Davis, C., Chisholm, E., Baker, M., & Howden-Chapman, P. (2020). Well Homes Initiative: A home-based intervention to address housing-related ill health. Health Education & Behavior, 47(6), 836-844. doi: 10.1177/1090198120911612
The MOH position (at Oct 2019) on HHIs was “Initial evaluation evidence points to significant improvements in health outcomes for the families/whānau involved” (without stating what that initial evaluation evidence was). Will be interested in the ongoing research.
Kia ora Bruce – Thanks for reading! Check out the first evaluation below. Best wishes, Elinor
Pierse N, White M and Riggs L. 2019. Healthy Homes Initiative Outcomes Evaluation Service: Initial analysis of health outcomes (Interim Report). Wellington: Ministry of Health. https://www.health.govt.nz/publication/healthy-homes-initiative-outcomes-evaluation-service-initial-analysis-health-outcomes-interim-report