Why the housing crisis is also a public health emergency

In our latest blog, Emma Doyle, Organisational Lead for Housing and Homelessness at Public Health Scotland, discusses the current lack of affordable housing and it's impact on the  levels of people experiencing homelessness in Scotland.

What does home mean to you? To me, it’s safety, security, familiarity. It’s not just a roof over my head, important as that is, but so many other things that are fundamental to my wellbeing. When we talk about homelessness, we are talking about the absence of those things. In the most extreme cases we are also talking about sleeping on the streets or on someone’s floor or sofa but, in Scotland, we have a definition of homelessness that recognises that living in a place that doesn’t provide security or safety is also ‘homelessness’.

Too many people in Scotland are living without this housing security. Amidst rising rents and mortgages, and a shortage of available properties in both the private and social rented sectors, several local authorities have declared housing emergencies. The number of people experiencing homelessness continues to rise, and people are being left in temporary accommodation, including unsuitable accommodation, for far too long.

Why is this a public health problem?

Being homeless is bad for your health. Physical and/or mental ill-health can be both a cause and a consequence of homelessness. Many homeless people have co-occurring mental ill-health and substance use needs and have experienced significant trauma in their lives. People who sleep rough have catastrophically poor health outcomes, are more likely to experience health conditions associated with old age in mid-life, and to die before they are 50.

But even if they don’t end up on the streets, people who have been homeless experience significantly worse health than those in the most deprived communities who have not experienced homelessness, and they are likely to use health services more. Research in Scotland found that, as of 2015, at least 8% of the population of Scotland had experienced homelessness at some point in their lives, so the associated poor health impacts affect a sizeable minority of the population.

What can we do about it?

There is a lot that can be done to support people experiencing homelessness but, ultimately, we need to stop it from happening in the first place. The answer to this is providing more homes, and particularly more homes for social rent, provided by local authorities and housing associations. These social homes provide that all-important security and long-term stability, which removes the stress and uncertainty about losing your home that can contribute to poor health. Social homes are also more affordable than private sector homes, so they help to alleviate poverty, which also leads to better health.

At the moment almost one in twenty people in Scotland are on a waiting list for a social home, there are 30,000 homeless households and nearly 10,000 children are growing up in temporary accommodation. Scottish Government’s Housing to 2040 strategy commits to delivering 110,000 affordable homes, with at least 70% for social rent, by 2032. To meet this target, 38,500 social homes would need to be delivered by 2026; this is not on track and the number of new houses being completed or started fell in 2023. Accelerating this programme needs to be a priority. In the 1950s and 1960s enough social homes were being built, and this can be done again.

While the increasing costs of construction and ever-tightening public sector budgets are undoubtedly a barrier, providing temporary accommodation is also incredibly costly. In addition, investment in social housing is also an investment in one of the key building blocks of health, which will save money in the future. Previous research commissioned by PHS and partners found that investment in the social housing sector generates economic and social benefits for Scotland and its people, including reducing poverty and homelessness, improving health, and creating jobs. It showed that increasing affordable housing supply levels has many social benefits which can help to address inequality.

Strong protections are also needed for those who are at risk of homelessness or housing insecurity to keep the homes they already have. That’s why PHS welcomes the introduction of the new Housing Bill, which aims to strengthen tenants’ rights and limit the rent increases that can drive people into poverty. People also need adequate support to understand and realise their housing rights. Keeping people in their homes is protective of health. Homelessness is not inevitable, it can be avoided, and doing so should be seen as a public health priority.

Photo provided by the Centre for Homelessness Impact