For most of human history, child mortality has been high. For centuries it was considered normal that 50% of children born would die by the age of 15. Childhood could be deadly, so even parents with numerous children knew that only a few might survive to become adults. Many of these deaths were eventually prevented by improvements to the environment in which children lived: thanks to better housing, clean water, proper nutrition, vaccines and attended births, child deaths are now rare.
Unfortunately we’re now going backwards again. A major health risk to young children in Britain is RSV (respiratory syncytial virus) which hospitalises about 33,500 children under five each year (there were nearly 31,000 hospitalisations in 2022-23), and causes 20-30 deaths. RSV causes breathing distress in young children, including wheezing, crackles and a caving-in of the chest between and under the ribs.
It is likely that many of these children could avoid hospitalisation and further illness if they had proper housing. Here are the key facts: children living in damp homes are three times more likely to have breathing problems including RSV. Of the children admitted to hospitals in England with breathing issues, a large percentage go on to develop asthma which requires chronic care. About 20% of these admissions could be avoided if children were living in suitable housing.
Even if you didn’t care about children’s wellbeing in itself, you might care about how much unwell children cost the NHS directly through hospital admissions, and the impact they have on parents who have to take time off work to care for them. You would think it’s a no-brainer to improve housing so that children don’t show up at hospital because of the very walls they live within.
The problem is that the people largely affected by suboptimal housing have little power to change it. Notably, damp is five times more common in private rentals than in owner-occupied homes. Roughly 20% of people live in private rented homes, with 520,000 of these properties in England posing serious health problems including cold, damp and mould. Even when these problems are raised with landlords, action doesn’t follow. Renters don’t have the ability to force landlords to improve living conditions, and instead fear an eviction notice or a higher rent being imposed.
Renting isn’t a lifestyle choice. Buying a property requires a down payment, regular income and being able to cover very high interest rate payments. In 2021, house price growth outstripped wage growth in more than 90% of England and Wales. House prices increased by 14% while average earnings fell by nearly 1%. It’s becoming increasingly difficult to buy property simply by working hard.
We’re basically living a real-life version of Monopoly. The rich become richer, acquiring more and more properties, either to rent, or as second, third or fourth homes. And those struggling month to month to cover the basic cost of living get stuck in rentals with little power over the conditions of their flats. And the health of their children often suffers as a result.
So this is an example of a public health crisis that won’t be solved by any specific medicine, personal choices, or even by improving hospital care. It is driven by inequality and the housing crisis, which are now inextricably intertwined with the nation’s health.
Progress is possible but would require three steps. The first is establishing clear data. We know that damp and mouldy homes are causing children to develop breathing problems, and that this is more common in rentals; we need the statistics to back this up.
The second step is to establish clear policy options. These would include greater protection for renters, including an independent regulator for people to report indoor air-quality problems; clear health standards that landlords must meet; and protections so renters could report problems without fear of retribution. A clear and logical set of policies like this would undoubtedly improve public health.
We know what to do to protect children. The stumbling block is the third step: political will – do we have leaders willing to tackle this problem and make it a priority? Observation of the current government over the past few years suggests the ministerial response would probably be, “why did you make the choice to be poor, and not rich like me?”
Progress in public health is always possible but it requires leaders willing to acknowledge a problem and want to solve it. Right now in Britain, we have a government that won’t even acknowledge there is one. Sadly I don’t believe there will be any action on housing issues until the next general election. For now we are stuck with leaders who seem intent on pulling both social attitudes and children’s health prospects back into the past.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
