As the cooler weather signals a change in seasons, GPs are readying themselves for the annual onslaught of recurrent respiratory problems that are the direct result of living in cold, damp and mouldy housing.
Poor housing is causing preventable injury and illness that is estimated to cost New Zealand more than $145 million annually in accident compensation claims and hospital admissions, according to new research released this week.
These costs are “solely attributable” to homes that are cold, damp, mouldy or dangerous to live in, says researcher Dr Lynn Riggs, from the Motu Economic and Public Policy Research.
The study, which was undertaken by researchers from Otago University’s housing and health research programme He Kainga Oranga, found that such homes cause more than 35,000 nights in hospital with an associated cost of around $35 million.
That figure does not include the additional financial cost to individuals, such as the cost of time lost from work or school while patients are in hospital, or charges from GP visits and prescriptions, says Riggs.
“Nor does it include the associated costs to society more broadly.”
Dr Bryan Betty, a GP for Porirua Union and Community Health Services in Cannons Creek, East Porirua, agrees that poor housing “exacerbates” certain conditions, particularly recurrent respiratory ones like bronchiolitis, asthma and chest infections.
He generally sees a spike in patients – particularly children and elderly people – coming to him with respiratory problems in winter, and this is linked to poor housing.
“For elderly with conditions like COPD [chronic obstructive pulmonary disease] and emphysema, heart conditions and diabetes, for example, living in cold, unheated houses, is problematic.”
The new study is thought to be the first in New Zealand to estimate the combined burden of disease from multiple housing conditions: damp, cold, mould and disrepair.
Previous research done in this country has generally focused on the effect of a single housing condition on health outcomes and the associated burden of disease.
A total of 32 percent of homes in New Zealand report problems with damp or mould.
The bulk of these are rental properties and lower income households are far more likely to be affected, says Riggs.
“In the year from April 2014 to March 2015, 15 percent of owner-occupier homes were reported to be cold, compared to 35 per cent of rental homes. Three percent of owner-occupied homes were damp or mouldy compared to 12 percent of rentals.”
In addition, household crowding – which is thought to affect a staggering 10 per cent of New Zealand’s population – causes more than 3,500 nights in hospital and costs nearly $5 million per year.
Nearly 2,000 nights in hospital are due to homes being cold, with a cost of more than $2 million annually. More than one-fifth (21 per cent) of New Zealanders report their house is always or often cold.
Riggs acknowledges that it can be expensive to fix problems with housing, but stressed that not fixing them is also costly.
“Previous research has estimated broader societal costs from home falls alone at over $5 billion per year.”
Poor housing is an equity issue, says Betty, who also chairs the Tū Ora Compass Health VLCA (Very Low Cost Access) council.
The council advocates for patients and practice teams working at the front line with high-needs communities.
“Poor housing adds to the equity equation in terms of disparity; not only do certain communities that we serve have higher rates of these conditions, but if you add poor housing on top, it adds to the equity burdens.”
Riggs presented the results on Monday to coincide with the launch of new World Health Organisation (WHO) housing and health guidelines.
It came a day after the Government’s announcement that new healthy-homes standards will be introduced for rental homes.
It is hoped that the WHO guidelines will help turn around the preventable health costs identified in the research.
One of the authors of the guidelines, Philippa Howden-Chapman, of the University of Otago, says they are a “world first”.
“[They] bring together the most recent evidence to provide practical recommendations on how to improve housing conditions.”
Back in East Porirua, Betty says he has seen some recent improvements for residents, including a Housing New Zealand programme to better insulate and heat properties.
There has also, he says, been more opportunity for frontline GPs and nurses to connect to healthy housing initiatives. These see experts go in to assess patients’ houses, particularly private rentals, and look at ways to improve heating and insulation and eradicate mould and dampness.
“To be fair, things have improved over time. However we’re nowhere near to solving the problem.”
What could help?
“We need to keep the focus on this issue, number one. Number two, we really need to drive integration between the services.
“As a primary care physician in a low-decile area, the biggest problem we face on a daily basis with patients coming to see us with these problems is the difficulty with referring through and accessing other relevant services. So the whole integration and movement of people is really important.”
Thirdly, he says, housing standards must be upgraded and new housing is also needed.
“It’s being talked about, it’s being looked at, but it does need sustained substantive investment to really move this on.”
Problems such as housing, social, equity and disability issues tend to concentrate in certain areas, and this places a “real burden” on the primary care centres and general practice centres in these communities.
Such centres, he says, require “an absolute funding review to provide the adequate wrap-round services that are needed for these populations because, at the moment, we are grossly under-funded”.