Background Housing is recognised as a contributor to health. The pathways by which housing circumstances lead to inequalities in health, however, have not been extensively mapped in the UK. We sought to understand how people with professional and lived experience of housing in London conceptualised the relationship between housing and health in their local area, to inform local interventions .

Methods Council staff and volunteers working with people experiencing housing problems were recruited from two London boroughs for semi-structured interviews. Data collection and analysis using the framework approach was informed by a conceptual model developed by Swope et al, which uses USA data to propose how housing circumstances may lead to inequalities in health. Initial analysis was shared with participants to check validity of our interpretation and discussed with staff to explore priorities for intervention.

Results Fifteen council staff in housing, environmental health, strategy, and public health departments, and five representatives handling housing problems for BAME communities, asylum seekers and social housing tenants were interviewed in 2022 (n=20).

All participants recognised pervasive structural inequalities in access to adequate housing. Councils gave examples of how they sought to address these, but all participants observed that the ‘system’ was not adequate for marginalised groups.

Participants’ views differed in three key areas:

Firstly, all participants described gaps in data. Staff focused on the lack of data at population level, for example to monitor health outcomes of housing interventions to avoid admission into care, noting linked health and council service data was needed. In contrast, volunteers focused on a lack of information on individuals’ health and gave examples where lack of awareness of individual health status resulted in inadequate council responses to housing problems.

Secondly, participants conceptualised housing problems differently. For example, most council staff emphasised overcrowding. Volunteers in turn considered overcrowding as an inevitable trade-off for residents without affordable housing options near employment and social networks.

Thirdly, participants differed in their perceptions of the location of power to resolve housing problems affecting health. Volunteers’ expectations were focused on the council. Council staff in turn noted they had limited agency on some issues and considered the roles of national policy and the private sector.

Conclusion Participants’ perceptions of the pathway linking housing and health and their recognition of gaps in local data have implications for the kinds of interventions considered. This study had a narrow geographical focus. Its wider relevance needs to be explored.