Background The UK 2008 financial crisis led to austerity measures being introduced in the UK, severely affecting local government. Cuts to central government funding have led to reduced income for spending on local services that potentially promote health, such as housing services. Housing services include a variety of critical services targeted at providing homelessness prevention and relief. There is an extensive body of evidence demonstrating an association between housing, homelessness and poor health. We investigate whether those areas that experienced a greater decline in housing services expenditure, also experienced more adverse trends in premature mortality.

Methods We carried out a longitudinal ecological analysis using data on housing services net expenditure in 146 upper tier local authorities in England between 2013 and 2018, linked to all-cause premature mortality rate (deaths under 75 years) for males and females. To analyse local authority expenditure on housing services we utilised Revenue Outturn data provided by the Ministry of Housing, Communities & Local Government; data on premature mortality was acquired from Public Health England. We used an instrumental variable approach to investigate this relationship to address model endogeneity. We used central government funding allocated to local authorities as an instrument because we expect it to influence health through its impact on levels of service expenditure but not influence health outcomes directly. We analysed the relationship between housing services spending and mortality using two-stage least squares linear regression with robust clustered standard errors and fixed area and time effects. We also adjusted for time-varying confounding effects of local economic conditions. We calculated our models with alternative specifications to test the robustness of our findings.

Results Average expenditure per person on housing services decreased from £41 in 2013 to £30 in 2018. Each £10 per person reduction was associated with a 17.6 increase in premature mortality rate for males (95% CI: 2.1 to 33.0) and 12.6 in females (95% CI: 2.1 to 23.1). Over the six-year period, reductions in spending were associated with 8,900 additional premature deaths (95% CI: 1,200 to 16,500).

Conclusion Reduction in spending for housing services may in part explain recent adverse trends in mortality in England. Investment in housing and homelessness support is likely to have a positive impact on health outcomes. Limitations of this study include restricting the time period of analysis to after 2013 due to changes in local government funding policy, and the reliance on area-level mortality data calculated over 3-year periods.