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Are you interested in social housing quality and its effects on the tenants’ life? Our summary today works with the article titled Housing as a social determinant of health and wellbeing: developing an empirically-informed realist theoretical framework from 2020 by Steve Rolfe, Lisa Garnham, Jon Godwin, Isobel Anderson, Pete Seaman, and Cam Donaldson, published in the BMC Public Health, which is part of Springer Nature. Since we are investigating the future of cities, I thought it would be interesting to see how urban social housing quality influences human wellbeing and health, which will be discussed in detail with the next interviewee, Chris Maher in episode 96. This article presents a theoretical framework to understand the less tangible aspects of housing experience on health and wellbeing.

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Welcome to today’s What is The Future For Cities podcast and its Research episode; my name is Fanni, and today I will introduce a research paper by summarising it. The episode really is just a short summary of the original paper, and, in case it is interesting enough, I would encourage everyone to check out the whole paper. Stay tuned until because I will give you the 3 most important things and some questions which would be interesting to discuss.

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Housing is often cited as an important social signal of health, because lack of housing, or poor quality of housing can negatively affect health and wellbeing. However, these connections are incredibly complex, so many are neither fully conceptualised nor empirically understood. This paper aims to develop an empirically-informed theoretical framework to highlight some of the possible causalities between less tangible aspects of the housing experience and health and wellbeing for low-income households in rented accommodations. The research works with the subjective experience of housing from the low-income renters’ perspective.

The causal relationships between tangible physical housing defects and poor health outcomes are widely accepted, since there are clear evidence of negative physical and mental health effects of toxins, mould, cold temperatures, overcrowding and safety. The literature has less information on the less tangible aspects of the housing experience. The home, as a theoretical and empirical starting point, is seen a secure base from which people can develop confidence in self and social identity. Research also suggests that the subjective experience of housing and housing services can be important in creating a sense of home and underpinning security. Previous research in the psychosocial benefits of a home suggest that aspects of control, autonomy, status and empowerment are related to measures of wellbeing.

Examining health and wellbeing impacts of housing beyond bricks and mortar is particularly important in the context of declining rates of home ownership and increasing rates in renting across the globe after the global financial crisis in 2007-8. Aside from the obvious relevance of tenure security for this growing group of tenants, the role of landlords and housing organisation may be especially important in terms of constraints that are put on the tenants and reducing their agency in generating their own sense of home. This paper wants to test and refine four hypotheses relating to: the relationships between tenants and their housing providers, tenants’ experience of property and quality, affordability and aspects of neighbourhood and social support.

This study treats the entire housing experience as the cause resulting in health and wellbeing impacts. It seeks to understand the mechanisms through which that subjective experience generates impacts, the different contexts in which those mechanisms operate and impacts vary and why. To produce the results, the authors worked with three different housing organisations which operate across the social and private rented sectors but have similar low-income tenants. Low-income households are most likely to be at risk from poor health and wellbeing and most likely to experience poor housing. They therefore represent the portion of the population for whom it is more important to understand the relationship between housing and health and wellbeing.

In their analysis, the authors concluded that the health and wellbeing of the participants does appear to be affected by the change in subjective housing experience resulting from a move into a new tenancy. Where their new housing experience is positive, they are likely to describe improvements in health and wellbeing that are sustained or even increased over the first year. There seems to be a statistically significant relation between the subjective housing experience and heath and wellbeing outcomes.

The positive tenancy experience from the housing provider can be an important determinant of health and wellbeing. Importantly, this relationship seems to be near universal which suggests that a positive renting experience, underpinned by a high-quality service may be important for all tenants. When tenants feel they are being treated well by their housing organisation and that their overall experience is better than previous situations, it is plausible that this will help to underpin their sense of control, autonomy and safety, which positive impacts their wellbeing. Interestingly, this undermines the hypothesis that ownership is important, because these findings suggest that aspects of the tenancy experience may be more important than the legal status of tenancy itself.

Proper quality also seems to be an important determinant of health and wellbeing. The existing evidence base suggests that the negative aspects, such as mould and toxins, and their impacts on health and wellbeing are more prevalent. However, the results show that other aspect of the property quality beyond the basic fabric of the building are important. Naturally, tenants’ previous experiences and expectations vary and those are influencing the results. Furthermore, these results present that quality of service and property, the first two hypotheses, are strongly related in tenants’ real-world experiences.

Affordability, for the participants, was less related to health and wellbeing. This can be due to the fact that the rentals were all in set rates, therefore, the prices were affordable for low-income tenants. However, financial aspects do indeed impact wellbeing. The authors suggested further investigation into which aspects would be impacted by any changes in finances, but they said that there is a strong connection.

The fourth hypothesis about the importance of neighbourhood and support networks was confirmed for the health and wellbeing of tenants. The needs, however, vary across the different groups and need further investigation. While the experience of good service from a housing provider may be important for all tenants to gain health and wellbeing benefits, other aspects of the housing experience and its connection to a sense of home, such as the connection between the dwelling and personal relationships may be more varied between individuals.

The basic human need for a home that provides more than simply shelter from the elements underpins the need to understand the relationships between housing and health and wellbeing, going beyond the traditional obvious problems of the house being damp and cold. Positive tenancy experience is shaped at least partly by relationships with the housing provider – influencing health and wellbeing for all tenants across backgrounds and characteristics. Housing quality seems to be important for some tenants and this is likely to be influenced by previous housing experiences and expectations. Neighbourhood quality and social support in the area may impact health and wellbeing but that varies across the different groups. Affordability for this participant group was not an influencing factor because of the nature of social housing with set rates. These aspects help examine and potentially improve practice within housing organisations and housing policy, highlighting the ways in which aspects of housing service can operate as public health intervention in the lives of tenants.

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What was the most interesting part for you? What questions did arise for you? Do you have any follow up question? Let me know on Twitter at WTF4Cities or on the wtf4cities.com website where the transcripts and show notes are available! Additionally, I will highly appreciate if you consider subscribing to the podcast or on the website. I hope this was an interesting paper for you as well, and thanks for tuning in!

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Finally, as the most important things, I would like to highlight 3 aspects:

1. Social housing and renting can impact tenants’ health and wellbeing so how we do it must be properly set up to create the best outcomes.
2. Quality renting service and quality housing influence the tenants’ experiences in a positive way, improving health and wellbeing.
3. Investigating and improving these aspects can even operate as public health intervention and prevention in the lives of tenants.

Additionally, it would be great to talk about the following questions:

1. Why is it so hard to create quality social housing experiences? Is it only because the market dictates the developments or are there other obstacles?
2. What do you think? Is the positive tenancy experience more important than home ownership?
3. What are the impacts you think can influence your housing experiences for the better? Are you conscious about how housing impacts your health and wellbeing?

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