We focus on four complex health issues more prevalent in urban areas
With the Social Progress Imperative, we've developed the first neighbourhood level, health-focused social progress index of its kind.
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If we want to improve health outcomes, it is essential that we understand people’s homes.
Our work focuses on improving the health of the population in Lambeth and Southwark. We know that housing is a social determinant of health and where people live can affect their physical and mental health. Therefore, if we want to improve health outcomes, it is essential that we understand people’s homes.
In Lambeth and Southwark, we see how housing plays out in an urban environment. The type of housing residents live in differs significantly from the rest of England: they are more likely to live in a flat, apartment or maisonette, more likely to live in social housing and more likely to live in an overcrowded home. The proportion of residents living in privately rented homes has also risen rapidly in the past decade.
We used Census 2021 data to answer questions relating to the type of accommodation people live in, whether they own their accommodation, and how housing intersects with other characteristics including health.
Census 2021 told us that there are 265,500 households living in Lambeth & Southwark. There was no change between 2011 to 2021 in the proportions of households living in different types of accommodation. In Lambeth and Southwark over 75% of households live in flats, maisonettes or apartments, while in England the same proportion lives in a whole house or bungalow.
While there are properties of varying quality across different types of homes, the pandemic truly highlighted the impact of the type of home you live in and how that can impact your health and quality of life. People living in houses and maisonettes tended to have more of the extra space and outdoor space that made working from and staying at home more manageable. While the full impact of the pandemic is still being evaluated, the health impact of living in a small, potentially crowded space for long periods cannot be underestimated.
The neighbourhoods in the north of the boroughs have a higher proportion of households living in flats, maisonettes, or apartments; many above 90%. Only the neighbourhoods of Streatham Vale (85%), Herne Hill and Dulwich Park (72%), and East Dulwich (57%) have over 50% of households living in a whole house or bungalow.
According to Census 2021, more than one in three households in Lambeth and Southwark live in social rented accommodation, a proportion over twice that of England. 35% of households in Lambeth and 31% in Southwark own the accommodation they live in, compared to 63% in England. While around half of the accommodation owned in England is owned without a mortgage, in Lambeth and Southwark this proportion goes down to one-third.
In 2021, there were 79,835 households living in private rented accommodation in Lambeth & Southwark, an increase of 13,200 (20%) since 2011. There was also an increase in the number of households owned outright (13%), and little difference in mortgage ownership (1% increase) and social rented numbers (1% decrease).
The neighbourhood with the highest proportion of households in social rented accommodation as of 2021 is Peckham North West with almost two thirds, while Butler’s Wharf & Queen’s Walk has the highest proportion of households in private rented (61%) and Herne Hill & Dulwich Park the highest proportion of households owned outright (35%).
A total of 30,193 households in Lambeth and Southwark had fewer bedrooms than required and therefore are considered overcrowded. This accounts for 12% of households in Southwark and 11% in Lambeth, compared to 4% in England.
Overcrowding in Lambeth and Southwark is a bigger problem in the social rented sector, where almost one in every five households live in homes with fewer bedrooms than required, compared to only 10% in privately rented households, and 4% in owned households.
Census 2021 asked people to report on their general health status – overall, 14% of residents in Lambeth & Southwark reported that they are not in good health, compared to 18% of residents in England. People living in social rented accommodation in Lambeth and Southwark experience poorer health than people living in other tenure types. 22% of people living in social housing reported being not in good health. The proportion of people in poor health is higher in social housing than other housing tenures across all age groups, more notably so as age increases.
In Lambeth and Southwark, a total of 64,989 households have dependent children. 50% of them live in social rented accommodation, compared to 26% in London and 20% in England.
A stable, secure, decent, affordable home is a foundation for health. If we have a right to good health, then housing is an issue of health equity. Housing is a fundamental human right and one of the underlying key capabilities, which Amartya Sen argues, is required for opportunities to be harnessed (Sen 1985).
The stark reality is that in London and other cities around the world, people are paying for precarious housing with their health. And too often, the mental and physical health of those living on low incomes from minoritised communities suffer the most. One of the ways we can support better health is to tackle the negative impact of insecure and inadequate housing.
Part of the work we do at Impact at Urban Health focuses on looks at the private rented sector – arguably the most insecure form of housing – as part of the multiple long-term conditions programme. As shown in the census data, the proportion of residents in Lambeth and Southwark living in privately rented homes is rising. The private rented sector has limited protections for tenants, and the existing ones are poorly enforced. The stress of potential evictions and rising rental costs increase anxiety and stress, which all contribute to mental and physical health conditions like hypertension and depression.
The private rented sector is growing and offers no safety net for households on lower incomes who are less able to cope with rent increases or absorb the cost of moving house at short notice. Where we work in South London, the impacts of housing insecurity are felt most by people on low incomes from minoritised communities, already living with chronic health conditions.
Evidence shows that private renters feel unable to ask for repairs and to challenge rent increases for fear of being evicted. Lower income work is often more insecure, compounding the stress of being able to pay rent. This coupled with the prejudices – structural and personal – that minoritised people face, it is often an uphill battle to secure and maintain a stable private tenure.
The multiple long-term conditions programme works with a range of partners to tackle housing insecurity and health in the private rented sector. This includes holistic, hands-on support for renters with Kineara, giving tenants better information and agency through Marks Out Of Tenancy, and improving regulatory enforcement with Justice for Tenants.