KNOW-PH Evidence Map - KNOW-PH version

Housing and Public Health

What's the evidence?

Produced in collaboration with Nifty Fox. Suggested citation: Marshall, F. Langley, J. Tattersall, A. & Such, E. (2025) Housing and Public Health Knowledge Hex. KNOW-PH.

Housing Standards

Fuel Poverty

Wellbeing

Housing and Public Health

What's the evidence?

Supported Tenancies

Downsizing

Housing Insecurity

Produced in collaboration with Nifty Fox. Suggested citation: Marshall, F. Langley, J. Tattersall, A. & Such, E. (2025) Housing and Public Health Knowledge Hex. KNOW-PH.

Housing Standards

Meet Jeff. He is 62 and lives in a council flat in Swansea. He loves to walk and play with his grandkids Lila and Eden. But recently he’s struggled with a chest infection that just doesn’t seem to go away. It’s kept him off work, and he’s had to go to the hospital a few times, it’s been that bad. He put it down to a change in the weather. But let’s look closer. He doesn’t have double glazing in his council flat and he always feels cold as the insulation is poor. At night he just can’t get warm and sees his breath sometimes too! Could improving his housing standard get Jeff back to work and back to the park with Lila and Eden?

Research evidence

Outcomes

Return to the board

Fuel Poverty

Meet Nisha and Sunny. They are enjoying their well-deserved retirement together! Their family home has served them well bringing up 3 kids. But now they are getting older, they are noticing the creaks and cracks in their beloved home. It gets so cold at night; you can see condensation on the windows and it really doesn’t help with Nisha’s COPD. She coughs a lot at night and feels more breathless than normal during the day. How can she enjoy her well-earned rest in a freezer? Don’t get them started on the increase in energy prices too! They’re pensioners – ‘we’re not made of money’ they think. The government has offered direct fuel payments to help with the costs. Sunny can’t help but think though: ‘Isn’t this money just papering over the problem? The real issue is that our house can’t hold the heat, that’s driving up our bill.’ How can Nisha and Sunny be supported to keep their home warm in winter?

Research evidence

Outcomes

Return to the board

Downsizing

Meet Pat. She recently celebrated her 67th birthday, and has lived in her council house for the last 30 years. She brought up her sons Dave and Mark here, nursed her husband Bill here until he passed away, and has a great network of friends locally to help her through tough times. But the house now feels big and empty. It is a lot to manage. She loves it here, but the council have offered her a rehousing programme to find her somewhere smaller. It would be easier for her to clean and the bills would be lower she thinks, but she’d be giving up her home, her community. Sadly, the options she’s presented with aren’t suitable . All the flats have just one bedroom and they are miles away. What happens when Dave, Mark and her grandkids want to visit? What if the new landlord is a nightmare? Pat is worried.

Research evidence

Outcomes

Return to the board

Housing Insecurity

Meet Kai. He is 14 and football mad! He loves playing with his school friends and watching Sheffield United on the TV with his Dad. But, Dad can’t always afford the bills for their flat. They’ve had to move a few times, even living with Kai’s uncle for a while where he didn’t have a room and had to sleep on the sofa. It was really far away from his school and his friends, and he had to move to a new school. He found it hard to make new friends and felt sad a lot of the time. Kicking a ball against a wall instead of with his mates was no fun. Not being able to sleep in a busy house made it harder to concentrate at school too. How could reducing housing insecurity help Kai?

Research evidence

Outcomes

Return to the board

Supported Tenancies

Meet Rowan. They are 28 and have struggled with their mental health for as long as they can remember. Things at home weren’t great, and Rowan didn’t get the support they needed when diagnosed with bi-polar when they were 17. Now Rowan doesn’t live at home and has found a safe place to live in supported housing. Before that - when Rowan was having a tough patch - they didn’t look after themselves well and sometimes people they thought they could trust took advantage of them. They have lived in residential care before but felt like they didn’t have that much independence. Living in supported housing has helped Rowan do the things they love like starting a book club and working towards becoming a massage therapist. They really feel like they are getting somewhere in their life after so much uncertainty. How do we best support people living in Rowan's circumstances?

Research evidence

Outcomes

Return to the board

Housing and Wellbeing

Meet Chuks. Chuks is 42, lives in the countryside and works for the bank in the nearest town. He’s pretty money conscious and keeps an eye on how much things cost him and his family. His kids’ dream of going to Disneyland starts with saving the pennies! He is worried about things like rising fuel bills. He decided to see what help he could get to make his home more energy efficient. He found a local scheme where he could get his housing insulation and gas supply improved to help with rising costs. It made a difference, saving £76 a month! Which of course, is now going towards the kids’ dream holiday.

Research evidence

Outcomes

Return to the board

Research Evidence

Rehousing programmes for older social housing tenants in Hackney, London.Published 2022 Findings:

• Downsizing could help to use social housing more efficiently. But downsizing is challenging to implement. This is because decisions to downsize are often emotionally charged and difficult to achieve.

Rehousing programmes struggle due to:

• Not enough suitable housing stock; mismatch with tenants’ preferences
• Tenants’ reluctance to give up (a) spare room(s), and their long-term home

• Tenants’ wish to stay close to neighbours/support networks & familiar facilities/services
• Feeling daunted by the upheaval and move to a new landlord
• Worries about higher rent & bills.

Link to research in full

Research Evidence

The Health Impacts of Structural Energy Performance Investments in Wales: An Evaluation of the Arbed Programme Published 2016 Findings:

• Improving home energy efficiency saw improvements in well-being and psychosocial outcomes. But there was no evidence of changes in physical health.

• Typical energy-efficiency measures included external wall insulation (with mechanical ventilation), new windows and doors, heating system upgrades, and the connection of off-gas communities to the gas mains network.
• It did find that wall insulation and links to mains gas (previously oil) as the most effective intervention leading to sustained indoor temperature increases and lowering use of fuel.

Link to research in full

Research Evidence

Exploring the impact of housing insecurity on the health and well-being of children and young people: a systematic review Published 2023 Findings:

• Children’s health, education and well-being are significantly impacted by housing insecurity.

• This can lead to anxiety/stress, trouble eating and sleeping, wetting the bed and health problems, such as asthma, due to poor living conditions.

• Some things can help to protect children experiencing housing insecurity, including friendship and support, staying at the same school, and support from parents.

• The problems of housing insecurity may be made worse by life circumstances, including domestic violence, being a migrant/refugee/asylum seeker and a forced relocation.

Limitations Most studies included parents/ professionals, with few seeking the views of the children and young people themselves.

Link to research in full

Health Outcomes

For Rowan: Staying in supported housing is good for them. There is no benefit in moving them to residential care. For public health and health services:

• Identifying the best type of supported accommodation for the individual could help guide judgements on what is most appropriate and help use NHS and local authority resources most efficiently whilst providing a high standard of care.

• People living in supported housing had most independence and similar quality of life outcomes to those in residential care.

• Outcomes for floating outreach are inconclusive. This means that whilst floating outreach interventions are the cheapest to provide, they may or may not be the best option for people to remain in the community as independent living.

Research Evidence

There are two significant ways Councils can help:

1. Improving housing quality & energy efficiencyRetrofitting houses to improve energy efficiency and renewing heating systems can improve warmth and reduce energy costs. Thurrock Council, for example, partnered with public health and other public services to develop the Well Homes Project which removed health hazards, especially cold hazards.
2. Reducing energy costsCouncil-organised collective switching (energy supplier) schemes can reduce energy bills (example Switch Together, Save Together, Merseyside). Councils can also help people maximise their income, such as in the case of the Welsh Child Poverty Income Maximisation Action Plan (IMAP) intervention which improved low income people’s access to the benefits they were entitled to. But, direct fuel payments don’t significantly reduce the incidence of cold related deaths and diseases among older people.For more see:

Armstrong and colleagues (2018)

Centre for Ageing Better (2021)

Cetnre for Ageing Better (2025)

Research Evidence

Quality and Effectiveness of Supported Tenancies for people with mental health problems (QEST) Published 2019 Findings:

• People with mental health issues experienced high levels of self-neglect and exploitation.
• People living in supported housing had most independence and similar quality of life outcomes to those in residential care (not including secure units)
• Outcomes for floating outreach (i.e. professionals visiting those in the community) are inconclusive.

• All three types of supported accommodation (residential, supported and outreach) are needed to help people in their recovery. Methods other than trials are needed to compare services.

Limitation: A feasibility study for a trial that did not find clear evidence on the most effective model(s) of mental health supported accommodation.

Link to research in full

Health Outcomes

For Jeff:

• Upgraded flat improves health and wellbeing. And reduces likelihood he will experience a related hospital admission.

For health services:

• Reduced emergency admissions.
• Reducing demand and cost savings to the NHS.
• For over 60 year-olds over 10 years: 39% less emergency admissions.
• Of these: 57% reduction in respiratory admissions
• Other decreases: falls, burns, heart conditions

For public health: The study authors suggest that better standards of housing will improve wider health, social and educational outcomes, and narrow inequalities in the long term.

Health Outcomes

For Kai:

• Kai needs a secure and stable place to live with his Dad if he is to stay well.

For public health, children’s services and housing teams in councils:

• Housing insecurity impacts on health, education and social work resources.

• Housing insecurity affects children maintaining social life, schooling, health, finance and family wellbeing.

• Poor quality housing has a direct impact on children's health especially if they have chronic health conditions.

• This may be compounded by domestic violence, migrant status, forced relocations.

Health Outcomes

For Chuks:

• The benefits of the subsidised scheme are not only reductions in costs. There could be improvements in feelings of wellbeing.

For public health and housing teams in the Council:

• Upgrades to housing bring improvements in sense of health & wellbeing that could reduce the burden on NHS mental health services.
• The study did not, however, find explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.
• Considerations for rural areas might include support for switching to mains gas from oil.

Health Outcomes

For Nisha and Sunny:

• A more energy efficient home means that Nisha and Sunny would be able to have their grand kids over more often, knowing that they’ll be warm and comfortable.
• Nisha will be able to sleep better and night and function better in the day as her COPD won’t flare up as much.

For health services:

• Improving housing energy efficiency reduces deaths and illnesses and so the impact on the NHS.
• Cold-related deaths impacted by increased fuel costs (leads to reduction on fuel use and lower home temperatures), seasonal temperature, and persistent lower outdoor temperatures.
• Cold-related illness affected by housing quality so upgrades in windows, insulation and boilers make a difference.

For public health:

• Little evidence that cold winter payments make a difference to health outcomes. This suggests that the mode of payment delivery, and frugal attitudes towards fuel use among elderly may be more influential.
• More work needed to explore fuel consumption and decision-making.

Health Outcomes

For Pat:

• If Pat downsizes, she might see reduced heating costs, less time/effort spent cleaning, and a maybe more modern home.
• But there are also negative impacts - she needs to build new local networks, create a new emotional attachment to the house and the neighbourhood.
• Do downsizing/rehousing programs need to offer clear calculations of cost savings for individuals and neighbourhood welcome/integration activities?

For public health and housing teams in councils:

• Downsizing is very difficult to achieve as individual motivations do not align with rehousing initiatives.
• As a result, rehousing programmes might not be the best use of social housing resources for the long-term.

More work needs to be done to enable downsizing in the local community to ensure ongoing attachments and social support.

Research Evidence

Health impact and economic value of meetinghousing quality standards. 10 year comparative study in Wales, published in 2018. Findings:

• Headline finding: council properties meeting national housing quality standards through multiple home improvements were associated with reduced emergency hospital admissions.
• Provision of adequate housing is likely to have an impact on wider social, health and educational outcomes.
• Upgrading included: electrical (rewiring, alarms), heating, wall insulation, new windows and doors, garden pathways, kitchen and bathrooms, and loft insulation.
• For tenants over 60, the strongest intervention associated with fewer admissions was electrical system upgrades (smoke detectors, carbon monoxide detectors, security lights, kitchen and bathroom extractor fans, and internal rewiring)
• Across all ages, the strongest interventions associated with fewer admissions were new windows and doors, wall insulation, garden pathways and electrical upgrades.

Click here to read the research in full