Does housing tenure predict health in the UK because it exposes people to different levels of housing related hazards in the home or its surroundings?
Introduction
Several studies have shown that in the UK, housing tenure (whether the home is owner occupied, rented from the public sector or rented from the private sector) is associated with mortality and morbidity. The OPCS Longitudinal Survey, a follow up of a 1% sample from the 1971 census, has shown elevated mortality rates among those living in rented accommodation compared to those living in owner-occupied dwellings. In the 1971–81 period, mortality was 26% higher for male and 21% higher for female Local Authority renters than for owner-occupiers, and in the 1981–89 period the corresponding excess among renters was 22% for males and 32% for females (Filakti and Fox, 1995). In the 1991 Census, owner-occupiers reported almost half the level of limiting long-standing illness (10.1%) reported by Local Authority tenants (19.7%) (Der, 1995). In the UK National Child Development Study, at ages 7 and 23 those living in owner-occupied households had better health than those living in households rented from the Local Authority, using five different health measures (height, `malaise', self-reported health, hospital admissions and psychiatric morbidity) (Fogelman et al., 1989).
Some commentators have suggested that household asset measures such as housing tenure and car ownership are more refined indicators of material well being than social class or employment grade (Davey Smith and Egger, 1992). Indeed for large sections of the population for whom occupational social class measures may be inappropriate (e.g. women, the very young or old, the non-employed), tenure may represent one of the most useful measures of socio-economic position (Moser et al., 1988), particularly since income data are not collected at census, and are difficult to collect in surveys.
Housing tenure is also used as a contributory variable in classifications, based on census data, of small areas such as wards or postcode sectors; such classifications are frequently utilised by national and local government and the private sector in the UK to measure and monitor health status in localities, to allocate resources, and to target markets [e.g. the Townsend and OPCS indices (Townsend et al., 1988; Wallace et al., 1995)]. Although it is extensively used in such classifications because it is highly predictive of health and other life chances, the reasons for tenure's predictive value are rarely examined.
An implicit hypothesis appearing to underlie the use of housing tenure in relation to health is that tenure is simply a marker of wealth or income, which are major determinants of health. If this hypothesis were correct then tenure would have little or no relationship with health once other measures of wealth or income are taken into account.
An alternative hypothesis is that features of housing tenure might in themselves be directly health promoting or health damaging, independently of other measures of material well being. If this hypothesis were correct then aspects of tenure (such as housing conditions or quality of residential environment) could be associated with health, over and above income or social class. In this model, the quality of the dwelling and its surroundings could be directly health promoting or health damaging, and thus might help to explain social class and area variations in health (rather than being confounded with income or social class).
Section snippets
Housing conditions and health
The literature on housing conditions and health suggests that there are various plausible mechanisms by which housing tenure might influence health. Dampness and mould, which are related to respiratory and chronic illness and psychological distress (Platt et al., 1989; Hunt, 1990; Hyndman, 1990; Packer et al., 1994), are more common in Local Authority rented homes. The Scottish House Condition Survey found evidence of dampness, serious condensation or mould in 13.5% of Scotland's housing stock
Sample
The data reported here were obtained in a survey conducted in 1992 of the oldest two age cohorts of `the West of Scotland Twenty-07 Study: Health in the Community'. This is a longitudinal study of three age cohorts (aged 15, 35, and 55 at first contact in 1987/8) designed to explore the processes producing social patterning in health by social class, gender, age, area of residence, marital status and ethnicity (Macintyre et al., 1989). One component of this study involves residents of two
Housing tenure
Overall, 55.4% respondents lived in owner occupied, and 42.1% in public sector rented, accommodation. In the most affluent neighbourhood, the West End, housing was predominantly owner-occupied (92.1%), while in the worst off neighbourhood, Pollok, it was predominantly rented (69.1%) (Table 1). [The majority of owner occupier respondents in Pollok are in fact previous Council tenants and have bought or are buying their home from the Council; 94.9% compared to 0.6%, 45.5% and 88.2% owner
Discussion
The preceding analysis suggests that housing stressors, housing type and neighbourhood conditions may be associated with poor health, independently of income, tenure, gender and area of residence. One possible interpretation of these findings is that negative perceptions of housing and neighbourhood conditions may be a reflection of underlying poor mental and physical health, or that self reported health and reports of housing and area conditions may both be influenced by the same negative or
Acknowledgements
The authors are supported by the Medical Research Council of Great Britain. They are grateful to all participants and staff involved with the West of Scotland Twenty-07 Study and to David Blane, Geoff Der, Russell Ecob and Susan Smith for comments on an earlier draft. An earlier version of this paper was given at the British Sociological Association Medical Sociology Group annual conference in York, September 1995. The opinions expressed are the responsibility of the authors alone.
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