Housing should provide an environment that is as safe and healthy as possible. Poor housing conditions can be a major cause of accidents and ill health.

Tackling problems of poor housing to protect the health, safety and welfare of the occupants is a key environmental health priority. The Housing Act 2004 has strengthened the position of EHPs in working to ensure that everyone has a decent home to live in. 

EHPs working in local authorities focus primarily on helping tenants living in private sector housing, by requiring landlords to carry out necessary repair or improvement works.

The English Housing Survey Headline Report for 2015-16 shows that in 2015, a fifth of dwellings (19% or 4.6 million homes) failed to meet the Decent Homes Standard. The private rented sector had the highest proportion of non-decent homes (28%) while the social rented sector had the lowest (13%). Among owner occupied homes, 18% failed to meet the Decent Homes Standard in 2015.

Many homes fail the Decent Homes standard because of problems such as disrepair or outdated fittings, poor sound insulation etc. Others have serious hazards which can pose a risk to health. Particular risks are associated with houses converted into flats - houses in multiple occupation (HMOs). EHPs also help owner-occupiers by giving advice and arranging grants or other financial assistance for repairs or improvements.

As well as those working for local authorities, there are EHPs working in the housing sector as consultants and trainers, and in housing associations.

The CIEH has produced a number of publications on housing, both on its own and with partners.

Reports on enforcement activity

▼ The health impact of poor housing 

The relationship between poor housing and ill health is a complicated one which involves many different factors. Evidence suggests that living in poor housing can lead to an increased risk of cardiovascular and respiratory disease as well as to anxiety and depression. Problems such as damp, mould, excess cold and structural defects which increase the risk of an accident also present hazards to health.

A useful summary of the key issues surrounding health and housing in the UK can be found the following document published by Parliamentary Office of Science & Technology.

PDF Icon   Briefing Note on Housing and Health   January 2011

A more detailed assessment can be found in the following World Health Organisation publication.

Environmental burden of disease associated with inadequate housing - methods for quantifying health impacts of selected housing risks in the WHO European Region
WHO Europe, June 2011. 

To assist its members and local housing managers in achieving a better understanding of the links between housing and health, the CIEH commissioned the Building Research Establishment (BRE) Housing Centre to produce a toolkit in 2008 entitled Good Housing Leads to Good Health. The aim of the toolkit is to show how links between homes and health can be made, including where possible, the cost benefit of some specifically linked housing and health issues.

Environmental health practitioners (EHP) are at the forefront of activities to prevent ill health occurring due to poor housing conditions. In 2012 we commissioned Dr Jill Stewart from the University of Greenwich to produce a publication drawing together a range of methods and good practice in adding to the environmental health and housing evidence base. Effective Strategies and Interventions: environmental health and the private housing sector, published in March 2013, showcases examples of innovative environmental health practices, including partnership working, to demonstrate the fundamental importance of re-focusing on housing as a social determinant of health and the potential for improved health outcomes and impacts. 

Cold homes – health and cost impacts

Living in a cold home can present serious risks to health, especially for those who suffer from existing long term conditions or for children and the elderly. CIEH is a member of the End Fuel Poverty Coalition of organisations campaigning for warmer homes, better energy efficiency and reduction in the number of households living in fuel poverty.

PDF Icon   The Health Impacts of Cold Homes and Fuel Poverty, Marmot Review Team for Friends of the Earth,   May 2011

A report produced by the BRE Trust for the CIEH, on behalf of FoE, in early 2011 estimates the number of dwellings within the English housing stock where the energy efficiency rating is considered poor. It then considers the associated estimated costs to the NHS of poor health as a result of these dwellings.

PDF Icon   The Health Costs of Cold Dwellings, BRE for CIEH,   February 2011

BRE Calculators

The Housing Health Cost Calculator (HHCC) is a tool for calculating the health costs of hazards in homes, and the savings made where these have been mitigated or significantly reduced. It has been developed by BRE in partnership with RH Environmental and gives housing enforcement teams a way of quantifying the important work they do day-to-day.

The Excess Cold Calculator is a tool developed by BRE to assist EHPs and Technical Officers in judging whether a property is likely to suffer from the excess cold hazard. It was developed by BRE with the support of the CIEH and is available to local authorities.

▼ Housing and Health Resource 

The Housing and Health resource was funded by Public Health England and developed by CIEH, drawing on an academic review of the evidence, and the input of an expert reference group.

It is designed to help facilitate a dialogue between housing and health professionals to encourage a better understanding of the link between housing and health outcomes, and how more effective partnership working can make a real difference to the health and well-being of individuals and local communities.

The aim of this resource is to better equip local decision makers and practitioners to improve health and wellbeing and reduce health inequalities by:

  • Promoting a better understanding of the relationship between the home environment and health and wellbeing and which part/s of the population may be most at risk.
  • Informing local discussions about the options to address housing issues as a means to improve health and wellbeing, and reducing health inequalities.
  • Help to build capacity in the local public health system.

The resource can be used by anyone in a local area. It can inform:

  • Joint Strategic Needs Assessments and Health and Wellbeing Strategies;
  • Commissioning and the development of integrated health care, social care and housing services;
  • Local housing strategies, plans and policies;
  • Elected members in their discussions with local communities about improving health and wellbeing.

This resource is designed to help develop a better awareness of the link between housing and health outcomes/inequalities and an understanding of how housing can influence physical and mental health and well-being.

If you have any questions contact the Policy team


▼ Housing Health and Safety Rating System 

The Housing Health and Safety Rating System (HHSRS) is a method of assessing housing conditions. It employs a risk assessment approach to enable risks from hazards to health and safety in dwellings to be minimised. The system applies to all dwellings, regardless of ownership.

The HHSRS addresses all the key issues that affect health and safety. It provides an analysis of just how hazardous a property is and includes evidence and statistical information to assist surveyors in making their judgements.

The key principle of the system is that a dwelling, including the structure and associated outbuildings and garden, yard and/or other amenity space, and means of access, should provide a safe and healthy environment for the occupants and any visitors.

The survey process considers the effect of any hazards in the property. Hazards are rated according to how serious they are and the effect they are having, or could have, on the occupants, ie ‘the effect of the defect’.

EHPs working in local authorities use the system to raise standards in the private sector by requiring owners to take action as necessary to remove or minimise hazards in their properties.

Guidance on the HHSRS

Guidance on the HHSRS has been produced by the Government as follows:

The CIEH has published guidance for private sector housing enforcement officers on the excess cold hazard.

Guidance on smoke and carbon monoxide alarms

From 1st October 2015 private sector landlords have been required by law to have at least one smoke alarm installed on every storey of their properties and a carbon monoxide alarm in any room containing a solid fuel burning appliance (e.g. a coal fire, wood burning stove). They must make sure the alarms are in working order at the start of each new tenancy. The requirements are being enforced by local authorities who can impose a fine where a landlord fails to comply with a remedial notice.

Guidance on the legislation - The Smoke and Carbon Monoxide Alarm (England) Regulations 2015 - has been produced by the Government:

Data on housing conditions

The main source of official data on housing conditions in England is the English Housing Survey.

Other data sources:

Information sources on the cost of poor housing

Housing Health Cost Calculator (HHCC)

The Housing Health Cost Calculator (HHCC) is a tool for calculating the health costs of hazards in homes, and the savings made where these have been mitigated or significantly reduced. It has been developed by BRE in partnership with RH Environmental. Details can be found on the BRE website.

▼ Houses in multiple occupation (HMOs) 

The Housing Act 2004 placed a statutory duty on local authorities to licence larger higher risk houses of multiple occupation.  The mandatory houses of multiple occupation licensing regime addresses poor management practices and aims to secure a reduction in death and injury from fire and other health and safety hazards, and ensures adequate provision of amenities.  In most local authorities, the responsibility for inspection and licensing of HMOs falls to environmental health practitioners.  

The definition of an HMO in the Housing Act 2004 is complex, but can be summarised as a building (or part of a building) which includes more than one unit of accommodation, and in which the occupiers share basic amenities. The building must be the main residence of the occupiers and they must pay rent (or equivalent).

The CIEH has defined six categories of HMOs:

  1. Houses divided into flats or bedsits where some amenities are shared
  2. Houses occupied on a shared basis where occupiers have rooms of their own
  3. Lodging accommodation where resident landlords let rooms
  4. Hostels, lodging houses, and bed and breakfast hotels
  5. Registered residential hotels
  6. Self contained flats with common parts such as stairways

Most HMOs are in the private rented sector, and provide an important source of accommodation for low income households. Unfortunately, some of the worst housing conditions are to be found in HMOs, including disrepair, inadequate means of escape from fire, lack of basic amenities and unsatisfactory management of such properties.

In addition to licensing powers, local authorities are responsible for the Housing Health and Safety Rating System, which provides a risk based evaluation tool for local authorities to identify and protect against potential risks and hazards to health and safety from any deficiencies identified in dwellings.

Local authorities concerned about the number of houses of multiple occupation in their area may issue an Article 4 Direction under the Town and Country Planning Act (General Permitted Development) Order 1995. The effect of issuing an Article 4 Direction is that planning permission must be sought before converting a single use dwelling into an HMO.

HMOs need to be properly managed; problems can occur in common areas, and where facilities are shared but no individual tenant has overall responsibility.

The Housing Act 2004 introduced a mandatory national system of licensing for all HMOs of three storeys or more and five or more occupants. HMO licences last for five years.  Local housing authorities (LHAs) are able to apply to the Secretary of State to extend HMO licensing to other types of HMOs or to specific areas, under certain conditions; this is known as Additional Licensing.  The Act requires LHAs to carry out a survey using the HHSRS within 5 years of the issue of a licence, in order to check whether there are any hazards present which should be dealt with under the rating system.

▼ Information for tenants 

If you are renting from a private landlord and you are experiencing poor housing conditions, your local council environmental health department may be able to help you. Contact details can be found on your council’s website which you can access via the GOV.UK website. If you can’t find an environmental health department, try searching under ‘private sector housing’.

If you are renting from the council, your local council environmental health department will not be able to help you directly, though they may be able to offer you advice on how to get help. For direct help, you should contact your local Citizens Advice Bureau or local Law Centre.

Before contacting any of the above you may find it helpful to read one of the following booklets:

Citizens Advice Bureau. Getting repairs done if you’re renting privately 

Shelter. Landlord and tenant responsibilities for repairs 

You may also find it helpful to look at the ‘Housing Health and Safety Rating System’ section on this page.

Please note that the CIEH cannot provide housing advice to members of the public.

▼ Resources 

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