What is Housing for Health?
Housing for Health priorities
Housing for Health process
Housing for Health projects in NSW
Housing for Health results
Housing for Health funding sources
Adding value to Housing for Health

What is Housing for Health?

Housing for Health is a copyright methodology for improving living conditions in Aboriginal communities. It was initially developed in the late 1980s in the far north west of South Australia. The group that came to be known as Healthabitat set about developing a methodology that focused on environmental changes that would lead to maximum health gains, particularly for children aged 0-5 years.

Research has shown that improving essential health hardware (fixing a leaking toilet, electrical repairs, having sufficient hot water, having somewhere to wash a baby or child, etc.) can lead to improvements in health status and reduce the risk of disease and injury.

Housing for Health priorities

The Housing for Health process aims to assess, repair or replace health hardware so that houses are safe and the occupants have the ability to carry out healthy living practices (HLPs).

All works carried out in the Housing for Health program are prioritised in terms of health benefit. The priorities are:

  • Safety - Immediate life threatening dangers, particularly electrical, gas, fire, sewage and structural safety issues are addressed as the highest priority.
  • Healthy Living Practices - After safety issues have been addressed, the prioritised list of Healthy Living Practices from 1 (most important) to 9 provides a focus for prioritising repair and maintenance:
    1. Washing people - ensuring there is adequate hot and cold water and that the shower and bath work.
    2. Washing clothes and bedding - ensuring the laundry is functional with separate taps for waste for the washing machine and tub.
    3. Removing waste safely - ensuring drains aren't blocked and that the toilets are working.
    4. Improving nutrition - assessing the ability to prepare and store food, making sure the stove works and improving the functionality of the kitchen.
    5. Reducing overcrowding - ensuring health hardware (particularly hot water systems and septic systems) can cope with the actual number of people living in a house at any time.
    6. Reducing the impact of animals, vermin or insects - on the health of people, for example, ensuring adequate insect screening.
    7. Reducing dust - to reduce the risk of respiratory illness.
    8. Controlling temperature - looking at the use of insulation and passive design to reduce the health risks, particularly to small children, the sick and the elderly.
    9. Reducing trauma - being non-life threatening issues.

These principles are also adopted by the National Framework for Design, Construction and Maintenance of Indigenous Housing and the National Indigenous Housing Guide (3rd edition). More information can be found on the Healthabitat website.

The first four points are considered critical healthy living practices, as they are essential for people to be able to practice healthy living. Most of the works carried out as part of this program focus on safety and these top four healthy living practices. The other 5 priorities are important for healthy living, but are usually beyond the scope of the project budgets.

References

Pholeros, Paul; Rianow, Stephan; Torzillo, Paul. (1993). Housing for Health: Towards a Health Living Environment for Aboriginal Australia. Healthabitat: Newport Beach, NSW.

Department of Family and Community Services (2003). National Indigenous Housing Guide (3rd edition) Commonwealth of Australia: Canberra.

Housing for Health process

The Housing for Health process consists of seven main stages:

  1. Project establishment
  2. Community consultation and feasibility study
  3. Preparing to implement Survey Fix 1
  4. Survey Fix 1 (SF1)
  5. Major fix works
  6. Survey Fix 2 (SF2)
  7. Reporting back and project completion

Stage 1: Project establishment

​The selection of Housing for Health projects is co-ordinated with relevant agencies including Public Health Units (PHU), NSW Aboriginal Land Council and the NSW Aboriginal Housing Office.

Selection of future projects takes into account a number of criteria including (but not limited to): need (condition of housing); availability of project management resources; ability to cluster projects in similar locations; other housing works undertaken by other programs, and the ability of Housing for Health to support or compliment other work being undertaken in the community.
 
Project Managers are engaged at this stage. 
 

Stage 2: Community consultation and feasibility study

The community consultation is an important part of the Housing for Health process, because the program only repairs or replaces items specifically related to safety and health, and the actual survey can be quite intrusive. It is important to clarify expectations with the community so that people are as aware of what the program doesn't deliver, as much as what it does. For example the program will cover most plumbing and electrical issues (as they relate to health and safety), but doesn't extend to painting or other aesthetic works.

It is at this stage that the community agrees to whether it wants a Housing for Health project or not. If the community agrees to a Housing for Health project, the Project Manager undertakes a feasibility study with the housing provider.

Stage 3: Preparing to implement Survey Fix 1

At this stage the logistics of running the project are worked out (access to the community, availability of local trades etc.) as well as the detail of the project, such as the number of houses to be included (some tenants may choose not to be involved), the general condition of the houses and plumbing, and the type of sewerage disposal systems.

At this stage each house to be included in the project is given a Housing for Health number that is different to the street address to ensure confidentiality.

Also at this stage team leaders are selected and local team members are arranged.

Stage 4: Survey Fix 1 (SF1)

SF1 consists of a comprehensive survey of around 240 items in all houses in the community. The surveys are carried out by teams of around four people (usually three community people and a health worker), and the first day is designated to training the teams in the testing and recording of those items. There is a standardised test for each item and the information is recorded on survey sheets. Survey teams also have a toolbox with them and any minor repairs not requiring a licensed trade are done on the spot. On average it takes around 45 minutes to an hour to complete the survey fix at one house.

The completed surveys are then taken back to a central point in the community where the information from the surveys is entered into a database, which takes about 5-10 minutes. Once entered into the database, a list of prioritised works required for each house is printed out for each trade (plumber, electrician etc.). The trades usually start about half a day behind the teams so they have enough work when they begin. The community are involved in the selection of trades and where possible, local and/or Aboriginal trades are used.

The trades report back to the Project Manager on the work carried out and the reason for the problem (i.e. routine maintenance, faulty or damaged). This information is noted in the database. The database becomes the tool for managing the project.

Stage 5: Major fix works

There are often works identified at SF1 that are too big to fix on the spot (such as rewiring a house), or require the replacement of particular items in a number of houses (such as stoves or hot water systems) and may need to be put out to tender.

These larger and more time-consuming works form the basis for the scope of the major fix works component of the project. From this information, the design, specification and schedule of works are developed. Work included in the major fix works is completed between SF1 and SF2 and can take around six to nine months depending on community size.

The major fix works are prioritised in accordance with the Housing for Health priorities.

Stage 6: Survey Fix 2 (SF2)

SF2 is carried out following the major fix work. This uses the same process as SF1, and addresses any works that may have either been missed at the first survey and upgrade or arisen since. The second survey also provides a comparison of house function at the first survey.

Stage 7: Reporting back and project completion

Once any work identified at SF2 is completed, a report of the work done to each house by each trade is provided to the community/ housing provider. Often included in the report is a list of works that the project was unable to cover within the budget, but would recommend for inclusion in any future programs the community/ housing provider may run. Again these are prioritised in terms of safety and the nine healthy living practices.

Housing for Health projects in NSW

In 1997, a trial of Housing for Health was undertaken in Muli Muli in the far north of NSW. Since this time the program has been expanded.

Between 1997 and end of 2017 NSW Health has now delivered 124  Housing for Health projects with communities surveying  3980 houses, fixing over 104,317 items directly related to improving safety and health and benefiting over 16,647 people.

The map NSW Housing for Health Projects by Local Health Districts 2018 shows the locations of completed and current Housing for Health projects around NSW.

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Housing for Health results

Outcomes of the Housing for Health Program can be measured in terms of health and house function.

The results of each Survey Fix are recorded as part of every project, with the two surveys providing a before and after assessment of house function.

The results of NSW Health Housing for Health Projects are presented two yearly in HealthStats NSW. The graphs show the difference in the function of the houses at Survey Fix 1 and Survey Fix 2 and present the overall improvements in the houses.

For each of the critical healthy living practices (listed along the bottom of the graph), there are a number of criteria that must be working to achieve a maximum score. For example, Washing People: Shower working, there are seven criteria that must be working fully. If only 6 out of 7 criteria are working, it is not considered OK. The graphs show only the percentage of houses where ALL of the criteria are met for each healthy living practices.

Overall the Housing for Health program in NSW has been able to demonstrate clear improvement in house function such as:

  • 9 fold improvements in electrical safety;
  • 4 fold improvement in fire safety;
  • Over 2 fold improvement in structural safety and access in houses;
  • Over 2 fold improvement in occupants' ability to wash themselves and to wash clothes and bedding;
  • 2 fold improvement in removing waste safety from homes;
  • Over 3-5 fold improvement in the ability to prepare, store and cook food in home

An evaluation of the NSW Housing for Health Program was completed in 2010. The evaluation report Closing the Gap: 10 Years of Housing for Health in NSW includes the finding that “Those who received the Housing for Health intervention had a significantly reduced rate of hospital separations for infectious diseases – 40% less than the hospital separation rate for the rest of the rural NSW Aboriginal population who did not receive the Housing for Health intervention.” This finding demonstrates that Housing for Health has a significant impact on improving the health of Aboriginal people in NSW.

Housing for Health funding sources

Housing for Health Projects in NSW are funded by NSW Health. In the past, contributions from a number of state and national funding programs have supported Housing for Health Projects, including:

  • Aboriginal Environmental Health Infrastructure Forum
  • NSW Aboriginal Communities Development Program (ACDP)
  • NSW Two Ways Together (TWT)
  • Australian Government Fixing Houses for Better Health Program (FHBH)
  • National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes 2009-2013
  • AHO Murdi Paaki Trial

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Adding value to Housing for Health

Over the life of each Housing for Health project (around 12-18 months), Project Managers work with community housing providers to ensure priority works and major fix works are carried out within reasonable timeframes. While the program has clear parameters, there is also the potential to engage communities around other issues that impact on the tenants health or housing hardware.

NSW Health's commitment to the Housing for Health program is a platform from which Public Health Units can continue to expand their work with Aboriginal communities, identifying and implementing other envirionmental health initiatives to address a broad range of health related issues. These are generally complementary public health activities that aim to:

  • Build on and expand the involvement of Environmental Health Officers (EHOs) and PHUs;
  • Explore and develop environmental health focussed projects in partnership with the communities;
  • Identify whether Housing for Health could form gateways for other service providers (e.g. local government, fire service, RSPCA, Landcare) to work in partnership with communities on other health-related issues.

This work:

  • Does not alter the Housing for Health methodology, but works alongside its implementation;
  • Is only explored in partnership with the community;
  • Can only be developed if there is goodwill expressed by the PHU and other related service providers to work in partnership;
  • Recognises the unique nature of each community and builds services/projects identified according to need, and agreed upon by the community and partner services;
  • Focuses on the active delivery of services/projects identified through the community consultation and health research.

The following are some examples and ideas. It is imperative that they are based on health-related identified, needs and community priorities:

  • Improving nutrition and nutrition related hardware within the house
  • Further examining the house fabric to help reduce incidence of asthma
  • Reducing internal house temperature through installation of awnings, insulation and shading through a tree planting program
  • Improving community responses to emergencies, working with the local fire service and SES
  • Well person health checks
  • Animal health programs
  • Pest management and control
  • Lung friendly house - reducing respiratory problems through reducing smoking inside house
  • Mr Germ - improving hygiene through washing hands
  • Mould project - Reducing respiratory problems
  • Energy use audits and power saving strategies
  • Cheap cleaning products demonstrations
Page Updated: Thursday 5 April 2018