WHO Housing, Health & Accessibility

Multi coloured graphic depicting the key elements in the guidelines "How housing can improve health and well-being".The WHO latest guidelines on housing and health have five key areas and accessibility is one of them. The “strong recommendation” is, “Based on current and projected national prevalence of populations with functional impairments and taking into account trends of ageing, an adequate proportion of the housing stock should be accessible to people with functional impairments.” In the remarks it argues that living in an accessible home improves both independence and health outcomes. Although the guidelines argue for a proportion of housing stock it has put the issue on the agenda. It shows it is as important as all other factors. However, the notion of proportion can lead some agencies to think that means specialised and segregated housing. It is worth noting that the lead author of this section is an Australian, Prof Peter Phibbs. The other key areas are crowding, indoor cold, indoor heat, and home safety. For more detail there is an additional document showing method and results of the systematic review that underpinned this section of the Guidelines – Web Annex F. and includes interventions such as home modifications and assistive technology. 

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Sea Change or Urban Uplift?

long view of a Perth city mall with shops and cafes under awnings and trees for shade. Tall buildings are in the backgroundA thoughtful article from an architectural group about ageing in the urban context. While some retirees will seek a sea change to resort-style living, others want to stay connected to their families and established neighbourhoods. The article critiques the age-restricted model and proposes alternatives, one of which is flexibility of design across the housing market so that people can receive care at home when it is needed. This fits with the principles of universal design as outlined in the Livable Housing Design Guidelines at Gold level. Other key points are inter-generational interaction, connectivity, inclusion, and proximity to conveniences. A good article on Aged Care Insite from an architect’s perspective. 

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CUDA’s Reponse to Accessible Housing Options Paper

A modern single storey home.Friday 30 November was the cut off date for submissions on the Accessible Housing Options Paper. You can download CUDA’s submission, for reference. For quick reference here is the Executive Summary of CUDA’s response:

“Australia needs housing that is fit for purpose. The preparation for a Regulatory Impact Assessment for a change to the National Construction Code provides a timely opportunity to meet our policy commitments also create housing that suits people across their lifespan. Housing is an important factor in determining our health outcomes and accessibility is recognised by the World Health Organisation as a major element.

Apart from increased size, Australian housing design has changed little in the last 50 or so years, save for fashionable cosmetic changes. Population demographics, community expectations, and the way we live our lives, have changed. Now is the time to be more inclusive in our mass market designs and consider all households – without the need for specialised design. Indeed, the inclusive, universal design approach, underpins the Livable Housing Design Guidelines – the guidelines that were developed by the housing industry.

Taking a disability-only approach as suggested in the Options Paper will discount the other beneficiaries when counting costs and benefits. In the early 2000s researchers called for a change in housing design to reflect an ageing population and our commitment to people with disability. They make the point that designing for these two groups includes convenience for many others, and that costs, if any, are minimal if considered at the outset.

The attempt to effect change through voluntary guidelines has failed. This is not surprising for an industry that relies on mandatory regulation to keep the fragmented house building system running smoothly and to maintain an industry-wide level playing field.

Finding the right terminology will be critical to finding the right outcomes. Misunderstandings about “accessibility” prevail. This term is quickly translated to “disabled design”. When improved access features are included in the NCC, it will become standard Australian Housing and no particular term will be needed. If a particular term is needed for the process of discussing change, we recommend the term “liveable” as in liveable cities. Alternatively we can jump straight to what it is, Australian housing.

The Building Ministers’ Forum (BMF) has asked that the Livable Housing Australia Guidelines at Silver and Gold levels be assessed. These Guidelines are well researched and tested over eight years and are referenced in many government publications and policies. For this reason, we recommend that the Gold level form the minimum requirements for inclusion in the NCC. Many of the elements over and above Silver level are cost neutral, are easy to apply and technically substantiated.

Gold level is framed around mobility issues (mobilising, reaching, bending, grasping).  Other disabilities can be incorporated within these spatial elements.  As these elements are based on the earlier Landcom Guidelines (2008), which were costed, we suggest that these costings be sourced and if necessary, updated.

Housing lies in a complex and contested landscape. While it is important for the industry to make a profit for shareholders, it is also important that they add value to the community from which they draw that profit.” 

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Tree change, sea change: think carefully first

A weeping willow tree shades the free range chickens. The house is hidden behind bushes and there are hills in the background.Fresh country air and room to breathe – it sounds perfect for retirement. Leaving the busy city behind for a care-free country life seems wonderful, but is it? City dwellers often find out the hard way that country living is often missing a few things they have taken for granted all their lives. Access to medical treatment, shops, entertainment and public transport can prove difficult as one couple found in this story. And the culture in regional and country towns is a little different to the big city too. Fitting in with country ways can take some adjusting. The story is nicely written and gives food for thought. However, this is not necessarily the experience of all retirees.

Editor’s note. I worked on the mid-north coast in community services for a few years and saw first hand how the romance of country living soon lost it shine. The article explains what I saw many times. 

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Housing quality improves health

A man in a bright yellow T shirt is painting and archway in a wall inside a home. The wall is grey and there are tools on the floor.Ever wondered what the long term effects of a home modification are? A longitudinal study from the UK shows that household improvements in social housing can reduce risk of hospital stays, particularly in older people. While the study picks up major improvements in chest and heart health, it also found that falls and burns were reduced too. Over the ten years of the study, they found that homes that were modified and upgraded correlated with reduced hospital events. That means savings in the health budget or beds freed up for other patients. Obviously it is better for occupants too. It is not clear how poor the condition of the housing was prior to the upgrade or modification relative to Australian housing. This is an academic paper outlining the methods and comparing to other studies, but the discussion and conclusions give you the take-home message – health and  the quality and design of housing quality are related and should be integrated in policy-making and planning. 

One key finding was: “Using up to a decade of household improvements linked to individual level data, we found that social housing quality improvements were associated with substantial reductions in emergency hospital admissions for cardiovascular conditions, respiratory conditions, and fall and burn injuries.”

The title of the study is, “Emergency hospital admissions associated with a non-randomised housing intervention meeting national housing quality standards: a longitudinal data linkage study”. Sarah Rodgers et al. Journal of Epidemiology and Community Health.

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