Working at the ‘front door’ of the hospital means dealing daily with health problems caused by social inequality.
Every day my team and I care for just some of the 10,000 people who sleep rough in London each year. Many of them have severe respiratory infections and debilitating conditions in their limbs due to infection and cardiovascular problems.
Many become dangerously ill from the cold, and many more present with complications related to alcohol and drug abuse, self-medicating the stresses and trauma of being homeless.
We also care for homeless patients in acute mental health crisis – people who are extremely vulnerable, at serious risk of self harm or suicide. Rough sleepers are nine times more likely to die by suicide than someone who is housed – and it’s clear to me that the answer lies in a massive effort to ensure access to housing with investment in much better public services including mental health care on top.
There is an epidemic of homelessness, and the poorest in society are forced into overcrowded, substandard housing where they are at greater risk of illness and death.
The prime minister has made much grandstanding with his stated post-pandemic commitment to ‘build back better, build back greener’, but the Government’s flagship green homes grant has just been scrapped after only six months.
Now, the Government’s commitment to tackling both the housing and climate crises is empty rhetoric. This is unacceptable if we are to ensure the most vulnerable in society have the basic right of access to decent housing and avert climate disaster.
For two decades the Government has failed to provide enough quality, affordable housing – with profound and unequal effects on people’s health.
Research shows that these health problems are a ‘two-way’ phenomenon. While substance abuse and mental illness cause homelessness, many people develop these problems once they become homeless. Either way, the strain and isolation of being homeless greatly complicates treatment.
The dearth of affordable housing also means overcrowded living for the poorest in the country, putting them at the greatest risk of communicable diseases, including Covid-19 and TB. London holds the unenviable title of ‘TB capital of Western Europe’.
Each winter at work we brace ourselves as A&E overflows, ambulances queue up and hospital wards reach capacity
Some of the most socio-economically deprived and overcrowded areas of London have TB infection rates comparable to countries such as Algeria and Iraq, which have a GDP per capita rate much smaller than the UK, and Iraq has been beset by war and political turmoil for decades.
Meanwhile, I have cared for people with Covid-19 throughout the pandemic, and have witnessed just a fraction of the unquantifiable misery caused by the virus.
Recent data shows a strong correlation between the levels of overcrowding in councils in England and Wales and Covid-19 death rates. Newham Council, in east London, has the highest proportion of overcrowded homes in the country (25.5%) and the highest death rate.
It is quite clear that if you are physically unable to socially distance because of a lack of household space, you will inevitably find yourself at greater risk of becoming sick, and making those around you sick.
Black and brown people in the UK have a higher risk of death from Covid-19, which the ONS attributes to living conditions like poor-quality housing. They’re much more likely to live in overcrowded housing due to generations of entrenched structural racism.
Therefore, tackling housing inequality requires an understanding of racial injustices as well as economic inequality.
It should be a national scandal that the most marginalised in our communities are being forced to bear the brunt of the virus due to the Government’s failure to fulfil a basic function of the state – the provision of quality, affordable and safe homes for all of its citizens.
Meanwhile, the Government has overseen the expansion of a ‘financialised’ private housing market that allows private investors to buy houses as assets for profit rather than as homes.
The upshot of this is absurd: predatory rent prices leaving people impoverished, and five times more empty homes in the country than there are households in need of housing.
The homes that we live in are also some of the most poorly insulated in Western Europe. Poor housing costs the NHS approximately £1.4bn a year: cold, damp homes cause respiratory and cardiovascular diseases, and contribute to NHS winter pressures.
Each winter at work we brace ourselves as A&E overflows, ambulances queue up and hospital wards reach capacity.
This poor insulation also contributes to climate change accounting for 14% of domestic CO2 emissions in the UK. Housing and climate are two of the biggest public health crises we face.
It is estimated that 61million additional people will die globally if we allow global temperature rise to reach 2°C. If we are going to avert the worst consequences of the climate crisis these emissions need to be dramatically cut by 2030 – something that the now-scrapped green homes grant could have made a difference towards.
The past year has been a tragedy, but the post pandemic recovery is a genuine opportunity to start building a healthier, fairer, and greener, society. I’m joining a group of health workers with Medact, the health professionals’ charity, to make the public health case for a Green New Deal and demanding energy-efficient, affordable housing for all.
What we urgently need is a nationwide retrofitting scheme for all existing housing stock, which would mean installing new heating systems, improved insulation and rooftop solar panels to make all homes decent and efficient – creating hundreds of thousands of new jobs and paying for itself in just over seven years.
New housing units built as a part of a Green New Deal must be zero-carbon, energy and water efficient.
Given that the housing shortage is a crisis born of access and affordability rather than supply, we need rent controls that significantly reduce the cost of housing, ensuring that the most marginalised and vulnerable have access to safe and uncrowded homes.
This kind of scheme is not just climate action – it is also lifesaving preventative medicine.
It should dramatically improve the health and quality of life of the people that I care for everyday, and help reduce the severe pressure on our NHS.
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