INNOVATION & IMPACT
Key innovative features of Housing for Health projects.
- Developing the Housing for Health methodology with standard, repeatable tests to assess the safety and health function of housing.
- Immediate fix work that improves houses from the first day of a project and builds community trust.
- Continual monitoring, development and refining of the Healthy Living Practices over 25 years, reinforces the links between health, housing function and the broader living environment.
- Using the Healthy Living Practices to prioritise all fix work and determine future upgrade works accurately.
- As monitoring health gain on each project can be costly and disruptive, Housing for Health projects use the detailed housing function data collected before fix work commences and similar data after all fix work has been completed. The improvement in house function, by detailed testing, is seen as the surrogate measure of “health gain”. This is supported by over 150 years of public health literature.
- Health gains have been dramatic for a relatively minor investment in house fix work. Where health monitoring of many Housing for Health projects has occurred over a long period of time, there is clear evidence of significant reductions in environmental related illnesses10.1(See the next section for more details)
- Reshaping departmental boundaries eg, the NSW Department of Health is running Housing for Health projects. A health department sees the value in improving living conditions and then goes on to link housing to many other health programs.
- Community involvement in all aspects of Housing for Health projects such as on the tools, fix work, data work, management of the project, community liaison and training. This has meant significantly better project results, better targeting of resources and the possibility of locally controlled ongoing housing maintenance and management.
- The use of the detailed project data, assembled into a national database, to influence national Indigenous housing and health policy.
- The R&D projects have led to involvement of a broad spectrum of professionals, academics and students.
The direct and wider impacts of the Housing for Health program.
Over 180 Housing for Health projects have improved over 7,000 houses with poor function since 1998. This represents around one third of Australia’s Indigenous housing stock. This has directly improved the lives of over 40,000 people.
R&D projects, as outlined previously, have had national impact during the same period. Proof of health gain from Housing for Health projects run over 10 years by a recent NSW Health report112showed a 40% reduction in hospital separations for a range of infectious diseases, for an average expenditure per house of $AUD 11,000.
The quantification of this gain, for a relatively low average cost per house, has national and international implications.
The data derived from the Housing for Health projects has been reused to inform the National Indigenous Housing Guide (first edition 1999 and now in its 3rd edition). This is now nationally accepted as the essential design guide document for all new and refurbished Indigenous houses. It enshrines the Housing for Health methodology, safety and health principles and project data.
The portability of the Housing for Health methodology to Nepal and New York in the last few years shows the principles are transferable internationally.
The Housing for Health program: nudging local, state and national government policy
The current National Partnership Agreement for Remote Indigenous Housing being rolled out across Australia ($AUD 5.5bn for Indigenous housing and infrastructure) by the Federal and all state governments. The program has incorporated the safety and nine Healthy Living Practices in all the guideline documents. Safety and health are now part of the national Indigenous housing agenda.
Healthabitat aims to ensure the Housing for Health principles are implemented by national programs over the next 10 years.
History has shown that housing principles and policy are not enough to guarantee function. There must also be a high level and local bureaucratic commitment to implementation.
Healthabitat has developed tools to evaluate house design documents against the NIHG principles and has proposed using the Housing for Health survey to test houses after construction and before occupation.
Healthabitat continues to advocate better construction supervision and ongoing housing maintenance to ensure functioning houses.
Healthabitat continues to advocate better construction supervision and ongoing housing maintenance to ensure functioning houses.
Independent evaluation of Housing for Health projects
Housing for Health projects, and the program as a whole, have been regularly monitored and evaluated over 25 years both internally and by external, independent review .
The constant internal monitoring and evaluation has been the reason for continued program development and improvement.
Two examples of the most comprehensive external evaluations are given below.
Example 1: An independent review of the national program 2002-2005.
‘SGS Economics and Planning Pty Ltd (SGS) and Tallegalla Consultants Pty Ltd (Dan Gillespie) were commissioned in January 2005 to complete an evaluation of the Fixing Houses for Better Health projects (FHBH)1232, 3 and 4 for the then Australian Government Department of Family and Community Services (FaCS).’
From the report’s findings:
‘Achievement of program objectives
Recommendation 1
That the success of the FHBH Projects in achieving the primary objectives of fixing the most critical health hardware deficiencies of dwellings located in participating communities and compiling a comprehensive database which records the ‘point-in-time’ condition of Indigenous housing be acknowledged and the FHBH Projects’ primary objectives be strongly endorsed as a means of improving Indigenous housing outcomes.
Recommendation 2
That the FHBH Project delivery method be acknowledged and endorsed as a successful means of program delivery, particularly with regard to good resource planning and achieving practical outcomes in relation to ‘on-the-spot’ fixing of health hardware deficiencies. It is a conceptually straightforward methodology which accords with best practice asset management principles, and which can be successfully applied by FHBH Project managers and participating communities. It has been shown to be appropriate and adaptable to its circumstances and to provide an objective ‘evidence-based’ means of assessing the status of Indigenous housing.
Recommendation 3
That the demonstration role of the FHBH Projects in capacity and partnership building be built upon, but with explicit regard for the limits to what this role can achieve, and with a recognition of the pressures inter-program coordination can place upon local project managers. High-level whole-of-government policy and program coordination (such as the Building a Better Future framework) should continue to be promoted as the primary means of improving the context in which the FHBH Projects operate, and should seek to leverage the demonstrated benefits that the projects provide.’
Example 2: An independent review commissioned by NSW Health on the health impacts of 10 years of Housing for Health projects in NSW. 1998-2009.
The NSW Department of Health has been managing a health and safety focused repair and maintenance program in Aboriginal community housing across NSW over the past 10 years.
The program has consistently identified improvements in house function for each project, increasing the ability of the householders to practice healthy living.
A detailed study using geo-coded hospital separations data was undertaken to identify if there have been any health benefits for the residents of the houses that have received the program.
The results exceeded expectations with regard to health benefits.
Public health evidence clearly demonstrates a link between the high burden of infectious diseases, particularly in children, and chronic diseases in later life. This program is not only contributing in the short term to reduced hospital separations for infectious diseases, but also in the long term to addressing in part, the epidemic of chronic disease in the Aboriginal population.
The current funding for Housing for Health ceases in 2009. Funds have been allocated for implementation of the program in urban areas as part of the NSW Government contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcome Health outcomes.
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 without the Housing for Health interventions.’
How to measure the success of Housing for Health projects:
- Improved house function for relatively low cost
- Quantified health improvements
- Local community employment in each project
…and the program as a whole:
- All project data improves new house (and upgrade) designs and specification, construction and ongoing maintenance,
- R&D products are used in the design, construction and maintenance of houses,
- The program’s longevity and the consistency of the Housing for Health principles and methodology
- The portability of the Housing for Health principles and methodology around Australia and overseas
- Long term staff retention and depth of accumulated organisational knowledge.
Housing for Health weaknesses
Healthabitat has been unable to:- Improve 100% of Indigenous houses to full function
- Influence Federal Government Indigenous housing policy, and the implementation of the policy, to the point where housing quality has improved to negate the need for Housing for Health projects
- Ensure the national uptake of the Housing for Health principles and methods into the initial detailed planning stages of the large scale, national, Indigenous housing projects currently being planned,
- Achieve recognition of the success of Housing for Health principles in improving Indigenous health from state (except NSW) and federal health departments.
These are weaknesses of the longer term Housing for Health program goals.