Home, Sweet Home? Measuring the effect of poor housing on health for the purpose of health economics analysis.

: English

Abstract

This thesis examines the health economics of housing and the economic rationale for preventing chronic illnesses linked to poor housing conditions, which cost the NHS at least £1.4 billion annually. A systematic review of literature undertaken for this thesis presents health economics evaluations of home improvements aimed at preventing health issues and identifies a gap in the literature. Building on an existing Housing Association study, this thesis investigates the application of health-related quality of life (HRQoL) tools in housing research within public health and health economics. Employing a mixed-methods approach, the thesis explores medical and social models of health in relation to housing. The natural experiment cohort study conducted with The Housing Association involved pre- and post-intervention assessments of self-reported health among 228 participants receiving home improvements. These improvements included retrofitting with double glazing and new boilers, with data collected on health conditions, demographics, and socioeconomic factors. Quantitative measures, including EQ-5D-3L and wellbeing assessments were analysed, and participants ranked housing-related statements according to their own interpretation of importance. The findings indicate that the cohort studied exhibited significantly poorer health across all comparator groups, including national, regional, and housing tenure norms (average EQ-5D score of 0.70) compared to UK population norms (0.86) and regional norms (0.81). The thesis critiques the validity of existing EQ-5D-3L tariffs, based on Paul Kind et al. (1999), in housing studies and further scrutinises EQ-5D-3L data for sensitivity in this context. To complement this analysis, 13 semi-structured interviews were conducted with tenants in North Wales, exploring common housing concerns and aspirations. Qualitative interviews revealed shared housing concerns and aspirations among tenants in both regions, highlighting the potential of qualitative research in health economics to inform housing-specific measures. The thesis concludes that such measures could enhance policy development, aligning with the biopsychosocial model of health and addressing tenant needs.

Date of Award	10 Oct 2025
Original language	English
Awarding Institution	Bangor University
Sponsors	Health and Care Research Wales (HCRW)
Supervisor	Rhiannon Tudor Edwards (Supervisor) & Nathan Bray (Supervisor)