Research and Policy
Findings
The evaluation indicated that Healthy Housing achieved positive outcomes for households and programme providers. The success of Healthy Housing depends on collaborative and flexible relationships between Housing New Zealand and the district health boards. Barriers to achieving outcomes were addressed. Healthy Housing worked with other business groups in Housing New Zealand to respond to barriers outside the control of Healthy Housing, such as, maintenance issues in that part of a house not extended or modernised, and upgrading of the grounds. Healthy Housing is a sustainable approach to achieving improved health and wellbeing for Housing New Zealand tenants.
Outcomes achieved for households
Positive changes in households included:
- more functional families
- a greater sense of self-identified physical and psychological wellbeing
- a self-identified reduction in the frequency of doctor and hospital contacts
- an increase in children's school attendance identified by families.
The evaluation showed that tenants receiving minimal interventions (insulation, ventilation and heating) often noticed an improvement in the comfort of their homes on a continuum from 'more enjoyment of the home'; to 'observed reductions in asthma and respiratory infections'. Tenants were in many cases unaware of the relationship between condensation reduction through adequate ventilation and heating, and prevention of mould. They were also unaware of the relationship between the existence of mould and respiratory conditions. The heaters commonly installed in Housing New Zealand houses are heat pumps on which householders need some instruction to use efficiently.
Tenants for whom Healthy Housing delivered greater structural change (modification, extension or transfer) gave more detailed stories about how the changes in space, communal services areas and specific modifications had created a more suitable living environment for their household.
Even after the extensions the parents are sleeping in the lounge so that their children can have their own space. In 2005 disabled twins were born and the father stopped work to help with the children and the housework. In 2007 the house was no longer big enough because of natural family growth.(For a discussion of barriers see below.)
Positive effects translated into greater social cohesion and a collective sense of belonging. The evaluation showed that householders developed a strong sense of home, and linked improved living environments with a more positive sense of self. The positive effects of Healthy Housing on recipients' wellbeing were sustained.
Case Study
A Tokelauan family of ten had their four-bedroom house extended to a seven-bedroom house in 2002. Before the extension the family experienced flu, colds and diarrhoea and high levels of stress. The children were always fighting. Since the extension the family have had fewer visits to the GP and no more cases of diarrhoea and feel this is because of the changes that were made to the house. The children are at home more, rather than just walking the streets. The parents have taken a more active role in their children's education and they are doing well in school. The family as a whole are happier and are involved more in community activities, and they feel more able to open up their home. They are always receiving compliments about how nice their house is and have a great sense of pride in their home. Family visits and functions are more frequent than before because of the large spacious living room, improved kitchen and additional bathroom.
Outcomes achieved for providers
Positive changes that Healthy Housing providers experienced included:
- increases in awareness and professional expertise
- a philosophical shift linked to playing a greater role in advocacy for, and education of, tenants
- greater job satisfaction.
Collaborative and flexible relationships
The relationship between Housing New Zealand and the district health boards showed positive changes including:
- a marked increase in the development and effectiveness of collaboration not only between Housing New Zealand and the district health boards but also between Healthy Housing and other government agencies
- links among agencies which were critical in designing housing solutions for people with disabilities such as limited mobility or morbid obesity - disability emerged in the evaluation as a common challenge for many households
- continued commitment to the programme and its principle of intersectoral collaboration.
The evaluation concluded that Healthy Housing presents opportunities for staff to be flexible in responding to tenants' needs. Healthy Housing succeeds in addressing tenants' concerns that extend beyond the walls of the house, in particular, reducing social isolation (which is corrosive of health). In addressing the breadth of connections between housing and human welfare Healthy Housing offers tenants greater control over their housing. Families therefore gain greater control over their lives.
Barriers to achieving outcomes
Obstacles to the achievement of Healthy Housing outcomes tended to be outside the control of the programme, such as recipient concerns about upkeep of grounds, maintenance and household finances. Some obstacles identified by the providers included:
- the impact on, and relationships with, neighbourhood units
- 'no shows' by tenants at assessment meetings
- the risk of recurrence of the original problem
- delays to the process of interventions as a consequence of the availability of builders and maintenance contractors.
The evaluation found that, in houses modified by Healthy Housing, space issues have arisen as children have grown older. This highlighted the changing nature of household composition and how Housing New Zealand has a challenge related to anticipating need.
Programme sustainability
The evaluation indicated that Healthy Housing is strong, sustainable and responsive to recipients' needs. For instance, upgrading of grounds has since become an aspect of Healthy Housing. The evaluation provided compelling evidence, from household recipients and programme providers, of Healthy Housing's ongoing positive impacts on housing-related diseases, conditions, and wellbeing. The evaluation found that some participants no longer make specific reference to Healthy Housing. The invisibility of the programme was seen as a strength of a mature intervention. It appeared to some that Healthy Housing was simply what Housing New Zealand did as a responsible landlord. Results showed that a number of Housing New Zealand's regional offices were incorporating aspects of Healthy Housing into their services, highlighting the programme's success.
