Housing and health: a partnership for change
Poor housing is not just a social issue—it is a major driver of ill health. It is a particular problem in south London, and that is why we, leaders of the NHS in this part of the capital, have been taking action to address it.
Cold, damp, overcrowded, or insecure homes can have devastating consequences for both physical and mental health, exacerbating long-standing health inequalities. In fact, it is estimated that poor housing costs the NHS £1.4 billion annually in England alone (Building Research Establishment, 2021), with Londoners often bearing the brunt of this crisis.
Why Housing and Health Cannot Be Separated
The evidence is stark:
- Cold homes lead to respiratory problems, cardiovascular disease, and excess winter deaths. A staggering 13% of all London households are in fuel poverty (Department for Business, Energy & Industrial Strategy, 2023), meaning they cannot afford to heat their homes adequately.
- Damp and mould are associated with asthma and other chronic respiratory illnesses. A 2023 London Tenants Federation study highlighted that 15% of private rented homes in London are deemed ‘non-decent’.
- Overcrowding not only increases the risk of infectious disease but also contributes to mental health issues like anxiety and depression. Overcrowding remains acute in London, where rates are three times higher than the national average (Trust for London, 2023).
- Housing insecurity can cause prolonged stress, affecting mental well-being and leading to poor health outcomes. London saw a 16% rise in homelessness acceptances between 2022 and 2023 (Shelter, 2023), a clear sign of the mounting crisis.
These findings align with conclusions from the Marmot Review (2020), which highlights that housing quality, affordability, and security are key drivers of health inequalities in England. Poor housing disproportionately affects low-income households, compounding social disparities and reducing life expectancy. The review found that improving housing could prevent up to 10% of hospital admissions for children with respiratory conditions.
Additionally, the Lord Darzi’s Independent Investigation of the NHS in England (2024) emphasised that addressing housing conditions is vital to improving public health and achieving sustainability in health systems. It recognised the unique challenges faced by London, where housing shortages, affordability issues, and poor-quality homes contribute to significant health burdens on the NHS and local authorities.
Given this clear link, the NHS in south east London, alongside local council leaders, GPs, third-sector organisations, and community leaders, is committed to addressing poor housing as a fundamental determinant of health.
The Power of Partnership: Our Response
This work comes a year of collaboration and listening to those most affected, as part of our South London Listens programme – in partnership with South West London ICB. Through our commitment to be an Anchor System, harnessing the power of our institutions to improve the social determinants of health, we co-developed a set of priorities with our communities that form the backbone of our Health and Housing Action Plan. These were discussed at the first meeting of the Health and Housing Coalition coordinated in partnership with the social impact charity Citizens UK on 5 December—a pioneering meeting that brought together NHS leaders, local councillors, GPs, and community leaders with lived experience from across south London. This is a new approach to tackling housing and health—and it is urgently needed.
The roundtable was part of a wider day of commitment to action. A powerful theatre performance and community-led march amplified the voices of those directly affected by poor housing, reminding us of the scale and immediacy of the challenge.
The Housing Action Plan: Three Priorities
To drive meaningful change, we have identified three key priority areas:
- Leveraging NHS land to create affordable homes. The NHS is one of the largest landowners in the country, and we recognise the potential for surplus land to be used to develop housing that meets the needs of local communities. By working with councils and housing associations, we aim to deliver homes that are affordable and accessible, supporting healthier communities, whilst ensuring that NHS hospitals are able to benefit from the strongest capital receipts to be reinvested in supporting the much needed modernisation of our NHS Estate, leading to better outcomes for local patients.
- Embedding housing advocacy within health services that support people with housing-adjacent health needs and strengthening the role of the health system in identifying housing issues. We know that housing issues are often raised in GP surgeries and hospitals, but healthcare professionals lack the tools to address them effectively. Embedding housing advocacy within healthcare settings will allow us to support patients with housing-related health concerns, connecting them with local authorities, housing providers, and support services. Strengthening our ability to identify housing issues will also improve the ways in which our healthcare professionals and NHS organisations work with local councils to raise and address health and housing needs.
- Strengthening community power to influence housing and health decisions. Real change requires the voices of those most affected to shape policy. We are committed to working alongside communities to amplify their lived experience and create solutions that reflect their realities. That’s why together with our partners in South West London Integrated Care Board we are leading these discussions through our Integrated Care Partnerships and have made this a priority for our communities.
Looking Ahead
This is only the beginning and through South London Listens, we have a strong record of listening to our communities, and taking the action that is most important to them like delivering on the London Living Wage and the Safe Surgeries initiative.
In 2025, we will launch a detailed delivery plan following further engagement with our communities and stakeholders. Our approach is built on collaboration and action—because only by working together can we tackle the root causes of health inequalities.
The link between housing and health is undeniable, but it is not insurmountable. By leveraging partnerships, resources, and community expertise, we can create healthier, more stable homes and, ultimately, healthier lives.
This work is a testament to the power of partnership—an example of what can be achieved when the NHS, councils, and communities come together with a shared purpose. Together, we can tackle poor housing and build a fairer, healthier future for all in south east London.
We welcome the Government’s new English Devolution White Paper and its opportunity help local authorities, elected mayors and the integrated care system work closer to together to tackle the deep rooted social determinants of health, and we are proud that in many ways south east London can be seen as a health and care system that is at the vanguard of this vision.