Health begins at home: the housing-health interface for older people

Housing issues are of fundamental importance to the health and independence of older people in Britain, but this concept is not reflected in planning for health, housing, or community care. An analysis of community care plans and public health reports reflects how little attention the majority give either to the importance of housing or to the potential of primary care as a means of information exchange between older people and planning processes. Interviews with practitioners and policy makers in four cities, combined with a review of the considerable literature on planning and joint planning in the health and social services, helped to identify the problems in achieving more integrated systems. Structural blockages as fundamental as the definitions of 'health' and 'housing', the attitude of society to manual work, the hidden nature of the problems of older people, and the failure of planning to categorize according to the level of need are identified and summarized in a chart showing how these factors are linked and self-reinforcing. The article concludes with a vision of how things might work more effectively without requiring unrealistic changes. The authors offer a challenge to planners and joint commissioners to gather different kinds of information on need; to have long-term, as well as short-term, strategies; to think broadly across categories of issue; and to be prepared to invest money in new ways. Most significantly, by redefining the role of the Director of Public Health, we identify a focal point at which the responsibility and authority for coordinating, championing, and review could lie.