Background Overcrowding, typically measured by household density, is increasingly common in urban areas of England. Living in overcrowded homes is associated with poor health and wellbeing and can impact children’s development. More spacious affordable housing is needed, but there is limited scope to increase affordable housing supply in the short term. This means families may live in overcrowded homes for several years and are thus vulnerable to long-term consequences. Previous research suggests that it is not only limited living space that impacts health and wellbeing – other factors in the household and wider environment contribute to these challenges. This study aimed to explore the experiences of families in crowded homes in the London boroughs of Tower Hamlets (LBTH) and Islington (LBI) to identify factors in the household and wider environment affecting family health and wellbeing that could inform a more holistic measure of overcrowding.

Methods Participants (n=34) were recruited from LBI and LBTH via community engagement teams, partner organisations, and local authorities. Residents with lived experience (n=20) and professionals who worked with families experiencing overcrowding (n=14) participated in a 1.5-hour focus group or a semi-structured interview to explore factors impacting family health and wellbeing. Data were recorded, transcribed, and analysed using inductive rapid thematic analysis.

Results Almost all participants with lived experience were minority-ethnic women (95%; n=19), with nearly half (n=9) being single parents. Professionals worked in housing, environmental health and public health roles in local authorities and community organisations. Participants believed that overcrowded housing contributed to physical and mental ill health, reporting low mood, anxiety, and exhaustion. Physical injuries and worsening health conditions (e.g., asthma) were associated with unsuitable environments (e.g, damp). Some reported that it affected their social life, relationships and impaired work and school performance. Families reporting disabilities and living in single-guardian households experienced particular challenges in overcrowded homes. Participants identified three features of the wider environment that affected their experience of overcrowding within the home; maintenance of the housing estate, suitability of the property, and communication with councils/landlords.

Conclusion These findings indicate that factors beyond the number of rooms and number of people can negatively impact the wellbeing of families living in overcrowded homes. Addressing housing conditions and enhancing communication with local authorities/landlords could alleviate the harmful effects of overcrowding while longer-term solutions are developed. A more holistic overcrowding measure considering factors like household composition, housing conditions and the wider environment could help to evaluate these priorities and inform interventions.