Ensuring an adequate supply of appropriate, affordable housing for the growing and changing populations of Hackney and the City is a key priority in both local authority areas.  In the recent Hackney: a place for everyone (HAPFE) consultation, housing was the top concern of Hackney residents when asked what has got worse in the local area over the last five years. 4 Affordable housing also remains a very significant priority for the City of London.

Housing affects health in a number of important ways and, to illustrate this, this section is broadly themed around four overarching housing-related ‘drivers’ of health and wellbeing as described below.

  • Housing conditions: risk factors that affect the health and wellbeing of people living in particular housing stock, which may be ‘physical’ (such as damp and mould, disrepair, cold or overcrowded homes) or ‘social’ (such as isolation and sense of place).
  • Affordability and availability: issues relating to residents’ ability to access adequate housing at a cost that reflects their circumstances. Housing costs (e.g. rent or mortgage payments) are strongly linked to housing availability and the extent to which supply is sufficient to meet demand.
  • Housing tenure: the differences in housing circumstances, housing-related support and health-related outcomes experienced by residents of social housing, private rented accommodation and owner-occupied homes.
  • Homelessness: homelessness is essentially the effect of a lack of affordable accommodation, but is a significant cause of health harms and inequity in its own right (see Box 1 for definition of homelessness, as well as other definitions used in this section).

Box 1: Definitions of key terms used in this section

Affordable rent – rent levels set by housing associations that can be up to 80% of the local market rate. Most council providers of social housing still charge ‘social rents’, set with reference to a national ‘target rents’ formula, and typically around 40% of the local market rate in the area.

Decent Homes Standard – a national measure of housing conditions, which requires homes to meet four criteria:

  1. free of serious ‘category 1’ HHSRS hazards (see below)
  2. in a reasonable state of repair
  3. has reasonably modern facilities and services
  4. provides a reasonable degree of thermal comfort.

Excess winter deaths – the seasonal increase in average mortality rates during the winter months.

Fuel poverty – households living on a lower income in a home that cannot be kept warm at reasonable cost.

Homelessness – lack of a place to live that is supportive, affordable, decent and secure. Rough sleepers are the most visible homeless population, but the vast majority of homeless people live in hostels, squats, bed and breakfasts or in temporary and insecure conditions with friends and family. 5 In England, Scotland and Wales, only ‘statutory homeless’ people are a mandatory priority for social housing – i.e. those who are eligible for public funds, have a connection to the local area and can prove they are ‘unintentionally homeless’.

Houses in multiple occupation (HMO) – typically, properties rented by at least three people who are not from the same family or household, but who share facilities such as a bathroom or kitchen. Another type of HMO is a house or block converted into smaller self-contained units for rent.B

Housing Health and Safety Rating System (HHSRS) – a method of risk assessing the health and safety hazards in a home. 6

Local Housing Allowance – a calculation used to work out Housing Benefit for tenants who rent privately. How much tenants receive is usually based on where they live, their household size, and their income.

Overcrowding – the situation in which more people are living within a single dwelling than there is space for, so that movement is restricted, privacy curbed, hygiene limited, rest and sleep difficult. This is commonly measured by the ‘bedroom standard’, where the number of bedrooms is allocated to each household in accordance with its age/sex/marital status composition and the relationship of the members to one another (definition of statutory overcrowding uses the ‘room standard’, which is deemed to be too strict and rarely used).

Private Rented Sector (PRS) – housing that is owned by a private individual, company or organisation, and rented to tenants. Other housing arrangements include social renting (from a council or housing association) and owner-occupying

Temporary accommodation – interim housing used to support residents while their homelessness application is being investigated or where they are awaiting suitable permanent housing.

Tenure – the legal status under which people have the right to occupy their accommodation. The most common forms of tenure are home ownership (including homes owned outright and with a mortgage) and renting (including social rented housing and private rented accommodation).

Box 2: Government housing and welfare reforms

The measures below are being brought forward as part of the Housing and Planning Act 2016. There are concerns that they will increase affordability pressures and further reduce the availability of social housing.

  • Extending the Right to Buy to housing association tenants
    • A number of government pilots are currently underway, and a further pilot was announced in the Autumn Statement in 2016. The government’s intention is that the scheme will be funded from the sale of higher value council homes and other assets (see below).
  • Forced sale of council housing (higher value local authority assets)
    • Powers granted to the Secretary of State to collect a levy from councils who own housing and other stock. It is understood that the levy will be comprised of receipts from the sale of higher value council homes (as they become vacant), as well as receipts from other disposals.
  • Tenancy reform
    • The government has changed the succession entitlement for household members and removed the right to a lifetime tenancy for council tenants (except where a household has to move as a direct result of a housing regeneration scheme).

Welfare reform

In addition to these reforms, changes to the welfare system are ongoing that place further pressure on household incomes. These include:

  • the lowering of the benefit cap to £23,000 for families and £15,410 for single people, implemented in November 2016
  • the removal of Housing Benefit for under 21 year olds, from April 2017.

For more detail on welfare reform and associated health and wellbeing impacts see the ‘Living standards’ section of this JSNA chapter.

Social care and supported housing

The Care Act (which received Royal Assent on 14 May 2014) consolidates the framework of social care law and creates new responsibilities for councils.  The Act creates a new focus on preventing and delaying the need for care and support, rather than only intervening at crisis point. It also provides a framework to support integration and cooperation with the aim of joining up services.

Key aspects of the Act related to housing include the provision of suitable accommodation as an integral component of care and support. Housing is also fundamental to the general duty to promote wellbeing and a focus on prevention that promotes independence. Housing is defined clearly within the Care Act as a health related service.



  1. A full HMO definition, including how they are licensed, is available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/15652/HMO_Lic_landlords_guide.pdf (PDF document)
  2. A full HMO definition, including how they are licensed, is available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/15652/HMO_Lic_landlords_guide.pdf (PDF document)


  1. Hackney Council, “Hackney: a place for everyone (HAPFE) report,” 2016 (forthcoming)
  2. Crisis, “What is Homelessness,” 2005.
  3. Department for Communities and Local Government, “‘Housing health and safety rating system (HHSRS): guidance for landlords and property-related professionals’,” 26 May 2006
  4. Hackney Council, “Hackney: a place for everyone (HAPFE) report,” 2016 (forthcoming)
  5. Crisis, “What is Homelessness,” 2005.
  6. Department for Communities and Local Government, “‘Housing health and safety rating system (HHSRS): guidance for landlords and property-related professionals’,” 26 May 2006