Background
A green transition is needed to deal with climate change. Upgrading housing as part of this transition could bring multiple benefits – from improved energy security to reduced greenhouse gas emission. It may also improve health and reduce inequalities, particularly if low-income homes are upgraded with energy efficiency measures.
Our new study, CoSine: Co-benefits in health from Sustainable housing, explores how healthcare needs could change as homes are upgraded to become more energy efficient. We will link data on housing upgrades and the healthcare system in London, UK. We are also speaking to people who will be directly affected by these changes at different types of events.
To start, we held a workshop with residents from low-income households living in energy-inefficient homes. Eleven participants from across housing tenures took part in a two-hour discussion about:
- How housing affects health
- Which groups struggle to access government upgrade schemes
Here is what we learned.
A view of London, Michaelv01 on Pixabay
Housing-related health problems
Participants described a wide range of health challenges linked to their homes.
For many, physical strain was a major concern. Stairs, disrepair, and broken lifts make daily life difficult, especially for people with mobility or respiratory problems. These issues cause ongoing pain and limit independence.
Thermal comfort was another key issue. Rising heating (and cooling) costs, along with faulty heating and ventilation systems, leave many people unable to maintain comfortable indoor temperatures. This affects both physical and mental wellbeing.
Beyond the home itself, participants highlighted the importance of the neighbourhood environment. Feeling unsafe, poor lighting, limited green space, and disappearing community spaces all contributed to stress and reduced quality of life.
Damp and mould – widely discussed in research and the media – did come up in relation to overcrowding and issues with asthma and respiratory illness. However, three themes stood out overall:
- Managing pain and physical discomfort
- Maintaining adequate indoor temperatures
- Coping with financial pressures and stress
Stress emerged as a critical, cross-cutting issue. Participants described pressures linked to housing costs, housing insecurity, and poor living conditions. While mental health was not always discussed directly, it clearly underpinned many of the concerns raised.
Housing insecurity played a major role. Private landlords were often described as exploitative and neglectful, and some participants feared eviction if they requested improvements. While new legislation may offer stronger protection, awareness appeared limited.
In essence:
- Private rental sector lacks affordability, stability, and decent standards
- Social housing is under pressure – difficult to enter and difficult to transfer to more adequate options
- Homeowners struggle with maintenance costs and bills
- Many feel unsure where to turn for advice
This leaves people feeling trapped within the system.
Barriers to government housing upgrade schemes
The second part of the discussion focused on access to government schemes to upgrade housing. Participants identified several groups who may find this challenging, including:
- Older people
- People with disabilities or learning difficulties
- Those facing language barriers
- People in temporary housing
- People with insecure visa status
For older residents, digital access was a key obstacle, as many services are now online. Some also questioned whether upgrades were worthwhile if they expected to move into care in the future.
Housing instability was another major barrier. People moving in and out of temporary accommodation are unlikely to benefit from the schemes. In this sense, retrofit policies can unintentionally exclude those in the most precarious situations.
Participants also emphasised financial risks and uncertainty. For low-income households, even small risks can be prohibitive. Upfront costs, unclear benefits, and complex application processes all reduce uptake.
Focus group meetings like the one we organised seemed to be appreciated as somewhere to express views and voice concerns. Some people wished that the political process paid more attention to lived experience like this. This chimes with calls for greater community involvement in the green transition more widely.
When asked about how accessible government retrofit schemes are, the system was described as a ‘jungle’ and that the one stop shop principle was needed. Energy efficiency retrofits will go far in addressing many of the problems discussed while other interventions will be needed to address issues with physical accessibility, neighbourhood environment, and access to adequate housing in general.
Housing and related issues like climate change, green space, transport, access to services, income, and mental health all affect people’s lives. Residents sharing their lived experience helps policymakers to understand what problems they face and how to fix them. This makes housing improvement programs fairer, targeted to needs, easier to access, and more helpful. It also builds trust, so people feel their voices are valued. In the end, listening leads to transparency, healthier cohesive communities and a better quality of life.
Samina Begum, Patient and Public Involvement partner and facilitator
Funding and acknowledgement
This study is funded by the National Institute for Health and Care Research (NIHR) Advanced Fellowship Programme. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. We thank the participants and Alison Robert, Tower Hamlets Council of Voluntary Services, for her help including recruitment and signposting. More information:
CoSine – Co-benefits in health from Sustainable Housing (LSHTM)
Samina Begum1, Hameed Khan1, Megan Leach1, Debs Smith1, and Jakob Petersen2
1. Public involvement partner; 2. London School of Hygiene & Tropical Medicine, Public Health, Environments and Society, Keppel Street, London, WC1E 7HT, UK, jakob.petersen2@lshtm.ac.uk