Living conditions and health promotion strategies

The paper assesses the empirical evidence concerning the interface between living conditions and health status provided by a number of case studies of urban regeneration in London, and Brighton and Hove. These studies were carried out in the theoretical framework provided by the Cost-effectiveness in Housing Investment programme that has been seeking since 1993 to identify and measure additional 'exported' costs to services such as health, education and policing which derive from poor living conditions. A chronological study of the 'health gain' associated with the Central Stepney Single Regeneration Budget improvement to two run-down estates indicates that a seven-fold health improvement in the rate of 'illness days' experienced has taken place over a four-year period (1996-2000). This 7:1 differential was identical to that found in the synoptic comparison of illness days, and some health and policing costs, between the Stepney area and an area of improved housing in Paddington carried out in 1996. The paper presents an exploratory attempt to list and categorise in various ways the exported costs associated with poor living conditions and offers some preliminary assessment of their measurability. Finally, a number of health promoting strategies that should be borne in mind when carrying out urban renewal programmes are discussed. It is argued that the provision of satisfactory housing is a necessary, but not sufficient, condition to promote good health. Attention must also be paid to community development, especially of 'organic' activities, the quality of services especially in relation to benefits, access to healthy food, crime reduction and, critically, the promotion of jobs and the reduction of poverty.