This locality essay is intended to help you learn how the social context of your patients affects their health. Locality Project - How Homelessness affects Health in Hackney.

Housing and the Environment

I have chosen to look at the topic of Housing in the borough of Hackney. Based in east London with a population of 208,365 residents, (London Directory, 2010), Hackney is made up of many different nationalities and religions and the borough covers an area of 7.4 square miles. There are also many parks including Victoria and Clissold Park along with London Fields to name but a few, which provide families with or without gardens the opportunity to enjoy some greenery. The reason for my choice is that in Hackney there are many different types of housing, from 1960s estates through to £1,000,000 properties in Victoria Park, with very different demographic communities living in them. There are many different reasons why the type and quality of housing can affect a person’s health, both mentally and physically (Porter et al, 1999). The physical aspect can include damp rooms, inadequate ventilation, insects and rodents, and homes that do not meet the government’s standard (Denny and Earle, 2006) and are not fit for purpose. Mental health problems can occur from living in properties that are overcrowded, leading to loss of privacy which adversely affects mental health (Porter et al 1999), properties that are squalid, homes where people are the victims of domestic or sexual abuse (Denny and Earle, 2006), living on estates where there is a high crime rate, noisy, or simply living in a “bad area” (Porter et al 1999). Homelessness is another problem that affects people in Hackney. As of 2007, there were officially 1,060 households homeless in that year (Crisis.org, 2008). Giddens (2004) argues that those most at risk of homelessness are people with low incomes and those who have no specific job skills, which with Hackney being a relatively poor borough, is quite a high number, as confirmed by the charity Crisis (Crisis.org, 2008). Hackney has a lot of housing estates which are rundown and crime ridden, along with properties being over populated, unfit for tenure, and dwellings that are in serious need of renovation (Project, 1998); all contributing factors to health problems.

Community is described as a group of people living together in one place, especially one practising common interests (Oxford Concise Dictionary, 2001).There are many definitions of community which include a body of people having common rights, interests, or living in the same place under the same laws and regulations, society at large, a commonwealth state or the public in general (B and Media, 2010). Other ways to describe the term ‘community’ can be broken into sub categories, which Smith (2001) stated are the places or areas that people are geographically from, which is also known as the “locality”, an interest, which can be a group of people that share a common theme, including people sharing the same religious belief, sexual orientation or ethnic origin, through to communion, which is a community that shares a love of a particular church or religion. The term that Smith (2001) used is the ‘spirit’ of a particular community. However, traditionally community is a term used to describe a group of people living in a common location or area (B and Media, 2010). Another definition of community is community health or public health, which is concerned with the general health and wellbeing of the population. Wikipedia (2010) states that whilst the term community can be broadly defined, community health tends to focus on geographic areas rather than people with shared characteristics. Public health not only targets the general public for health campaigns but encourages local authorities to address health issues at a local level. This includes, for example, smoking in the home and the affects that it has on people. Finally, a very simplistic definition of community is a group of people living in the same locality and under the same government and society as a whole, the public (Answers.com, 2010). The definition that I believe is most useful for this essay is (B and Media, 2010) that states that community is a group of people living under the same laws and regulations, and Answer.com (2010) states that community is a group of people living in the same locality. I think this will apply to my project, as in Hackney there are many pockets of “communities”, from housing estates to street communities, as well as homeless groups or any other groups belonging to different affiliations. However, homeless communities can come under the heading ‘housed but homeless’, which includes people that are housed in conditions that are harmful to health (Porter,et al 1999). Overall, people that live in Hackney are part of a community and all live in the same locality but have many differing needs and requirements, and most have very differing views on other members of their community.

The first sociologist that I believe is most useful for my essay is Michael Senior. In his book, Health and Illness (1998), he has a chapter on the relationship between housing, its environment, and the effect that it has on health. He stated that ‘there are many aspects of housing that can affect health, the location or area that the property is in, noise levels, atmospheric pollution’. He goes on to talk about the level of crime in an area, vandalism and noise, the availability of safe places for people/children to relax, and the incidence of rodent infestations and damp. He stated that people of a poorer income are more at risk of being exposed to these risks as they have no choice as to where they are housed. (Acheson 1990, cited by Senior 1998), stated that families that have to share where overcrowding is an issue are more at risk of sanitation issues because of the amount of people sharing a bathroom or kitchen. This type of risk, I believe, is a big problem in Hackney, where there are a lot of substandard properties still waiting to be refurbished by the council. As Hackney has very diverse cultures, there are many families who have many more occupants than the property was designed for. Infectious diseases such as Tuberculosis are more problematic in overcrowded properties (Project, 1998). Project (1998) stated that it is not only the types of properties that people live in that affect health, but the environment that people have to live in, such as the quality of the air or pollution, the degree of community interaction, and the visual appearance of the area or neighbourhood. Project also stated (Project, 1998) that families that live in high rise blocks live in areas of high crime and are more at risk of high levels of mental stress. Due to the fact that Hackney has many flats and high rise blocks where they are more at risk of crime than suburban areas, I’m sure that many people suffer from anxiety and stress. However, Hackney has many open spaces and parks which are full in the summer months, and I am sure they are a source of stress release for families living in these types of properties.

Denny and Earle (2006) stated that homelessness affects health in a number of ways. People living on the street face particular threats, and their condition can bring feelings of isolation, stress and depression. The same group of people are also restricted in terms of access to proper food and nutrition (Denny and Earle, 2006). (Bines 2000, cited by Denny and Earle 2006) remarked that people that are homeless and live in bed and breakfast accommodation are eight times more likely to suffer from mental health problems. Many flats and high rise properties have flat roofs which gives rise to serious problems with damp, rising damp and condensation, which is detrimental to a person’s health. People with chronic conditions such as asthma, chronic obstructive pulmonary disease, and many other lung conditions are at a much higher risk of their condition being exacerbated by damp. Dampness causes respiratory health problems and acts as a stress which leads to depression, emotional stress, and an increased risk of physical illness (Porter,et al 1999). (Platt et al,1989, cited by Porter, Alder and Abraham, 1999) stated that there had been a collection of information from around 800 people to try and find out the connection between damp properties and the health of their inhabitants. It concluded that the relationship between respiratory problems, dampness and air spore count remained after all other possible explanatory factors were statistically ruled out.

There are many sources of information that are available on the subject of housing and the environment; however, most literature focuses on housing problems and the condition of properties that people live in, rather than the environment that they live in, apart from information regarding housing estates where crime, graffiti and vandalism is a problem. However, the vast amount of information that I gained was from books. I used many different types including books from well known sociologists, such as Anthony Giddens on Sociology. An advantage of reading his book is that even though it is a very long book, he breaks up the sections into bite-size chunks which, for someone like myself who doesn’t know or understand much about sociology, makes it easier to read, understand and digest. However, the only disadvantage to using this particular book was that on my topic of housing and environment, housing was not covered in very much detail. He tended to focus more on education and social classes; overall though a very good book, for first time readers of sociology. There were many other books which I found very useful for my essay. The ones that I found very easy to read were books which are aimed at A Level students, as they were broken into easy read sections; for example, Psychology and Sociology Applied to Medicine (Porter,et al 1999). This covered my topic of housing in some detail and was very easy to understand, the only disadvantage was that I had to wait a week or so for it to become available, as it was very popular for the reasons stated. I also had this problem with a few of the more popular books; other people doing the same essay also wanted them. I used many different types of books in my essay and found quite a few very easy to understand and read; however, there were some books such as Sociology of Health Care by Taylor and Field. (2003), and some by eminent sociologists such as Emile Durkheim, which were just too complicated for someone with the level of sociology knowledge that I have. Another source that I used quite frequently was the internet. It had masses of information on sociology, communities, and other information needed for my essay. I found it quite easy to access most information on the subjects that I needed; however, when you put in a phrase, word, name or term, a lot of information came back that was totally irrelevant, and it took some time to sift through information that was of no use to find information that was relevant and credible. Also, finding internet sites with sourced and cited information was difficult, as a lot of sites were general sites where random people would add their own information, such as Wikipedia.

The London borough of Hackney is a very diverse borough with many different types of people, properties and many parks and open spaces. The borough boasts the largest amount of green space in inner London, including 62 parks of which Victoria Park is the largest with a massive 330 hectares (London borough of Hackney, 2010). This provides families with access to green, open spaces all year round. They are especially useful for families who have no access to a garden and therefore often have nowhere that children can play safely, especially on estates with a high level of crime and vandalism. (Pollard et al 1997, cited by Project 1998) stated that young children who have no access to a park or green, open spaces are at a higher risk than the general population of suffering developmental problems such as malaise and intellectual problems. The parks also provide entertainment and amenities to keep families happy throughout the summer months, such as fairs, funfairs and concerts. By having these facilities I am sure that the mental wellbeing of these families is increased by having access to open spaces and natural land, as opposed to the constraints of living in an inner city borough such as Hackney. There are many housing estates, high rise blocks, private rental and privately owned properties. However, Hackney has a high level of social housing and has the second largest social rented sector in London, and the third largest issue of overcrowding in England (London borough of Hackney, 2010). A census compiled in 2001 by Hackney Council found that just over half of all properties in Hackney were social housing, with the rest being a mix of privately owned, shared ownership and properties owned outright (London borough of Hackney, 2010).

There are many health problems that can be found by living in certain conditions and environments, such as in properties that are overcrowded, which is defined by the number of bedrooms in a property against how many occupants the property has. It has been found that 1 in 10 children across the UK, including Hackney, live in properties in which they do not have their own bedroom and sleep on sofas. This can have serious implications for health, including family health, schooling achievements and social development (London borough of Hackney, 2010). It is no surprise therefore that people (children, teenagers and adults) turn to crime as a means to escape the confines of overcrowded properties or areas such as estates where they have nothing to do at all. It has been noted by Marsh et al. (1999) that overcrowding can contribute to ill health in the later years of a young person’s life. Marsh et al. found that there was a connection between stomach cancer, heart disease and lung cancer in those of the population who had lived in overcrowded properties in their childhood. Dampness is another problem that can and does affect the health of people living in high rise blocks and flats with flat roofs. It mainly affects high rise properties, especially the older ones where the materials were not as good as today’s (Independant surveyors association, 2010). Dampness can cause a multitude of health problems, including respiratory related illnesses, asthma, eczema and rhinitis (Marsh et al., 1999). In addition, there are the mental health problems that are associated with living in these properties which include depression and financial worries which can occur from having to replace damaged property. The Health of Londoners (1998) stated that the general mental health of occupants can be affected by property loss and damage. In the same body of text it was found that Hackney had 36,444 properties and 95% of its housing stock was in need of updating or renovation. I am sure that a large amount of that stock suffers from damp issues. However, Hackney does have a decent homes plan which plans to update all properties that have kitchens and bathrooms that are more than 30 years old, including making sure all properties are wind and watertight, and replacing bricks, windows and doors if they are not fit for purpose, (www.hackneyhomes.org, 2010). The housing and environment that people live in have a massive impact on their health and quality of life, both physically and mentally. The condition of people’s homes is the main influence on their health (Denny and Earle, 2006). The effects of poor housing on health have been recognised in scientific literature for over 150 years (Marsh et al., 1999). This is an issue that comes up time and time again in many different books and articles, that poor living accommodation, crime ridden estates and areas of social depravation can have a serious impact on people’s health, both physically and mentally.

I found that the overall health of people who live in Hackney is worse than the national average, and that levels of crime are of the highest in the country (http://www.apho.org.uk, 2010). This is inclusive of crime on housing estates and on the streets of Hackney. This, I feel, must contribute to the mental health and depression that some residents feel, living in a borough where they don’t feel safe. I also found out that Hackney has the third highest incidence of people being admitted to hospital with mental health problems (Project, 1998). Due to the many different types of bad housing conditions, I found that there were many reasons for people’s ill health due to living in these properties. This ranged from mobility problems for the elderly in homes that were badly designed, through to children who lived in overcrowded properties. High rise properties can also be difficult for families with children when lifts breakdown, making it very difficult to climb stairs and carry shopping. Although Hackney council try not to put families on high floors, they invariably do, which doesn’t allow children to play outside safely. However, as there are so many parks and green spaces in Hackney, children have more places to play than other inner city boroughs. Again, the fact that Hackney has a lot of parks must also promote a feeling of mental and physical wellbeing; having somewhere to relax and even take dogs on long walks. Alongside Victoria Park there are networks of bike routes which people can use to keep fit. I found also that Hackney has a very serious overcrowding problem with too many people in a property. This, I found, has contributed greatly to the mental and physical health of many who find themselves in this predicament. I have concluded that Hackney is trying to address this problem by building more social housing and revamping existing properties; however, I feel that it is a problem that may not be fully addressed due to a rising population and demand for properties that either haven’t been built yet or may never be built due to land constraints. This is bearing in mind that Hackney has 207,000 residents and 86,402 properties and is building only 1,891 homes over the next three years (London borough of Hackney, 2010).

My final point is regarding the homelessness problem that Hackney is facing. I have concluded that there are many reasons why a person may find themselves homeless, from people that have made themselves homeless deliberately, to people that have, for example, had to leave a violent or abusive home. The physical and mental health of these people is at a higher risk of deterioration than that of the general population. I found that people that are homeless have their health affected in a number of different ways, including physical threats, which is a major problem for those literally living on the streets, along with mental and social isolation and depression (Denny and Earle, 2006). I also found that there are different organisations in Hackney that are available to help the homeless, such as Homeless.org who advise people to contact the council and apply for one of very few hostels in the borough. They also advise people to contact Hackney Housing Advice Centre for help.

My overall conclusion is that Hackney is one of the poorest boroughs in London, and even by UK statistics is poor. It is also a borough with quite a high crime rate, both on housing estates and in terms of general crimes such as burglary, robbery and crimes against people (met.police.uk, 2010). It has a very diverse population and many different class tiers with differing health needs.

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