Research and analysis

Housing and health in local strategic health planning

Published 5 June 2026

Applies to England

Executive summary

Housing is a fundamental determinant of health. The quality, affordability, security and design of homes shape physical and mental health across the life course and are a major driver of health inequalities in England. Poor housing conditions are associated with preventable illness, injury and premature mortality, while high‑quality, secure and affordable homes support independence, wellbeing and resilience, and reduce pressure on health and social care services.

This report examines how housing is reflected within local strategic health planning in England, focusing on joint strategic needs assessments (JSNAs) and joint local health and wellbeing strategies (JLHWSs). It:

• provides a national overview of current practice
• identifies gaps and opportunities
• offers recommendations to support local systems to strengthen the use of housing data and evidence within strategic health planning

Purpose and approach

The report is intended as a reference document and practical tool for local councils, integrated care boards (ICBs), health and wellbeing boards (HWBs) and their partners. It aims to support local systems to:

• identify and interpret housing‑related health risks within their populations
• strengthen the inclusion of housing within JSNAs and strategic planning documents
• improve collaboration between public health, housing, planning, NHS and social care partners
• reduce adverse health outcomes and health inequalities linked to housing conditions

The report draws on a structured review of JSNAs and JLHWSs across England. Housing‑related content was identified, coded and analysed across a predefined set of themes, including housing hazards, space and design, affordability and security, and housing stock characteristics.

Main findings

The main findings of this report are that:

• housing as a determinant of health is widely acknowledged by local councils but depth of analysis is inconsistent. All local councils included housing in their JSNAs in some form, but the depth, quality and analytical strength of coverage varied substantially. Many JSNAs describe housing conditions but do not describe how specific hazards contribute to health outcomes or health and care system pressures
• some housing issues are underrepresented. Cold homes and fuel poverty were the most frequently included themes, while overheating, indoor air quality (IAQ), damp and mould, and accessibility were less frequently covered, despite strong evidence of health impacts
• inequalities are recognised but not always given full consideration. While ‘vulnerable groups’ are frequently mentioned, fewer JSNAs explore who is most affected by poor housing locally, why risks are concentrated or what barriers people face in reporting problems or accessing support
• evidence does not always translate into action. Fewer than half of JLHWSs included clear actions, implementation mechanisms or measurable outcomes relating to housing, and alignment between JSNAs and JLHWSs was inconsistent
• stronger strategic planning requires system working. Progress depends on collaboration between public health, housing, environmental health, planning, the NHS and the voluntary sector, supported by local data, shared intelligence and clear accountability

Recommendations

High‑quality JSNAs and JLHWSs should:

• treat housing as a core determinant of health and prevention priority rather than a contextual factor
• combine national data sets with local intelligence (including enforcement, stock condition and resident experience data) and residents’ lived experience
• clearly describe pathways from poor housing to health outcomes and system pressures
• explicitly address inequalities and barriers to reporting or accessing support, identifying who is most affected and why
• identify opportunities for cross-sector collaboration between housing, health, social care, planning and other partners
• translate evidence into action, with clear priorities, implementation mechanisms and monitoring

Conclusion

Housing plays a critical role in shaping population health and health inequalities. Recent legislative reforms and policy developments provide new opportunities to address housing‑related health risks, but their impact will depend on strong local leadership and effective strategic planning. By embedding housing more consistently and comprehensively in JSNAs, JLHWSs and their equivalents, local systems can support healthier homes, reduce avoidable harm and improve health outcomes for their communities.

Report overview

Context

Housing has become an exacerbated and increasingly visible concern in England, brought into focus by:

• recent tragedies, such as the death of 2-year-old Awaab Ishak due to mould in the home
• the COVID-19 pandemic
• cost-of-living challenges
• volatility of energy prices
• heightened awareness of the long-term issue that millions of households in England are living in poor housing conditions

Local systems are uniquely positioned to do more on housing and health, using new powers, funding streams and cross-sector partnerships. By acting now, local leaders can not only respond to immediate risks and inequalities, but also lay the foundations for healthier, more resilient communities in years to come. The government’s 10 Year Health Plan for England explicitly acknowledges the role of housing conditions as a preventative health measure. The plan calls for a shift from treating sickness to preventing it, with a focus on tackling the root causes of ill health, including housing.

This is in the context of local government reorganisation, the neighbourhood health framework and major legislative reforms that mark a change in how housing is regulated and how tenants are protected from housing-related harms, including:

• the Social Housing (Regulation Act) 2023, which:
  • empowers tenants to hold their landlords to account for poor housing conditions
  • enables the Regulator of Social Housing (RSH) to undertake regular inspections of housing providers and issue unlimited fines to landlords who are not performing
  • requires mandatory qualifications for managers of social housing
• the introduction of The Hazards in Social Housing (Prescribed Requirements) (England) Regulations 2025 (also known as Awaab’s Law), which set strict timescales for landlords to address hazards
• proposed reforms to consumer standards
• the Renters’ Rights Act 2025, which significantly strengthens protections for private rented tenants by:
  • abolishing ‘no fault’ evictions
  • extending Awaab’s Law and the Decent Homes Standard (DHS) to private rented homes, giving them parity with social tenants
• the Supported Accommodation (England) Regulations 2023, which require local councils to develop strategies to ensure access to supported housing in their areas as described in statutory guidance on local supported housing strategies
• the Warm Homes Plan and Fuel Poverty Strategy for England

Aim and objectives

This report may be used as a:

• reference document on housing and health
• tool to help local systems strengthen the use of housing data in strategic health planning

Its purpose is to support local councils and their partners to identify, interpret and act on housing-related risks and health impacts in their local populations and ensure that housing-related health risks are embedded in strategic health planning documents, such as JSNAs and JLHWSs. In future, subject to the successful passage of the Health Bill, JSNAs will inform neighbourhood health plans, which will replace JLHWSs. The neighbourhood health framework sets out further detail on neighbourhood health plans. The objectives of the report are to:

• provide a concise overview of the health effects of housing on physical and mental health and health inequalities
• present findings of a national review of how housing is included as a determinant of health in JSNAs and JLHWSs in England
• highlight examples of good practice in the coverage of different housing issues in JSNAs and JLHWSs
• summarise gaps in the coverage of different housing themes and opportunities in JSNAs and JLHWSs
• highlight national, regional and local data sources that local systems can use to support future housing-focused JSNAs and JLHWSs
• provide recommendations to help local public health systems to:
  • improve housing coverage in strategic health planning documents
  • work more closely with housing and planning functions to provide more health-outcome focused improvements to housing with a stronger focus on supporting the most vulnerable
• support the inclusion of comprehensive, evidence-based content on housing and health in JSNAs and JLHWSs
• build capability in housing and health

This report is not intended to assess or compare the performance of individual local councils. Instead, its purpose is to provide a high‑level picture of how housing is reflected in JSNAs and JLHWSs in England, and to offer recommendations that local areas may wish to consider. To maintain a system‑wide focus and avoid inadvertently benchmarking specific places, the report does not name individual local councils or include links to any of the JSNAs or JLHWSs reviewed. Given the focus of this report on local activity, there is little consideration given to regional or national activity, but we acknowledge that identifying opportunities for health improvement at all levels is critical. Housing as a determinant of health is a cross-system issue with action required at local, regional and national level.

Report structure

The report is structured as follows:

• the housing and strategic planning section provides a synthesis of the evidence on housing and health and describes the rationale for why housing should be a core component of JSNAs and JLHWSs
• the sections ‘Housing hazards’, ‘Space and design’, ‘Affordability, availability and security’ and ‘Housing characteristics’ summarise:
  • the health impacts associated with each of the themes reviewed
  • their coverage in JSNAs and JLHWSs, including gaps and examples of good practice
  • data sources and resources
  • recommendations
• the sections ‘Discussion and recommendations’ and ‘Conclusion’ discuss the strengths and weaknesses of the inclusion of housing in JSNAs and JLHWSs, as well as providing general recommendations (beyond those covered in recommendations for specific themes)
• the annexes provide supporting material, including the methods section and a description of the housing themes used in the analysis and the coding and scoring framework

This project involved a structured review of JSNAs and JLHWSs from local councils in England. Housing‑related content was:

• identified using a predefined set of search terms
• extracted into thematic categories
• analysed using a consistent scoring framework assessing presence of the theme, use of data, analytical depth and strategic integration

Regional teams and national colleagues undertook data extraction following a standard protocol, with a proportion of entries independently reviewed to support reliability.

See annex A for a more detailed description of the methods, including the limitations of this project.

Intended audience

This document is intended for use by:

• public health, health and social care professionals, environmental health officers and housing professionals and urban planners working in local councils or regional organisations
• ICBs
• HWBs
• NHS providers including GPs and primary care networks
• housing providers
• voluntary and community sector organisations with an interest in housing or who represent vulnerable groups
• local government elected members

Housing and strategic health planning

Why housing is important to health

Homes are vital for healthier and more resilient communities. Housing fundamentally shapes physical and mental health and wellbeing across the life course and is one of the most modifiable and powerful determinants of health. The quality, security and design of housing is a major influence on people’s health and wellbeing, and on health inequalities.

When homes are unsafe, insecure, unaffordable or poorly designed, the consequences for health can be profound, particularly with prolonged exposure. Poor housing conditions contribute to a range of adverse health impacts, including:

• increased risk and severity of cardiovascular and respiratory disease
• poor mental health
• increased risk of injuries
• slower recovery from illness

Preventable deaths can also be attributed to poor housing conditions.

Conversely, secure, affordable and well-designed homes can:

• foster independence
• improve both mental and physical health
• reduce health inequalities
• ease pressures on health and social care services

It is recognised that there is a relationship between adverse housing and health. That is, just as adverse housing conditions can lead to poor health outcomes and increased inequalities, underlying health conditions or other vulnerabilities may increase the risk of someone living in unhealthy or precarious housing.

Joint strategic needs assessments and joint local health and wellbeing strategies

The Health and Social Care Act 2012 sets out that decisions should be made as locally as possible for the leadership and provision of public services, involving people who use them and the wider local community. The act supports the principle of local clinical leadership and democratically elected leaders working together to provide the best health and care services based on evidence of local needs. JSNAs and JLHWSs are a required and important locally owned process to achieve this. Local councils and ICBs have equal and joint duties to prepare JSNAs and JLHWSs, through the HWB. JSNAs and JLHWSs are part of a continuous process of strategic health assessment and planning.

Statutory guidance on JSNAs and JLHWSs provides information about the development and usage of JSNAs and JLHWSs. In brief:

• JSNAs are used to identify the current and future health and wellbeing needs of local populations. JSNAs are produced by HWBs, who can undertake JSNAs in a way best suited to their local circumstances - there is no template or format required or mandatory data set to be included. Data sources vary in scope, frequency of collection and granularity, but collectively offer insight into population health
• JLHWSs are strategies for meeting the needs identified in JSNAs. Like JSNAs, they are produced by HWBs and are unique to each local area. They should explain what priorities the HWB has set to address the needs identified in their JSNAs and which organisations will take forward the actions agreed. In future, subject to the successful passage of the Health Bill, neighbourhood health plans will replace JLHWSs

Local councils are subject to duties under the Equality Act 2010 which apply to all functions including policy-making, service provision, commissioning, enforcement and public health.

Health in all policies

Health inequalities are caused by a complex mix of environmental and social factors which play out in a local area, meaning local councils have an important role to play in reducing them. Using strategic health planning documents including JSNAs and JLHWSs can be an effective way for local councils to describe and influence the impact of wider determinants of health on their communities, adopting the ‘health in all policies’ approach, described by the World Health Organization (WHO) and others. This report is focused solely on housing but there are several other areas (including employment, transport, spatial planning and natural environment) which are also relevant to population health and health inequalities.

Housing hazards

This section addresses the most prevalent hazards in the home, which represent some of the biggest threats to population health, contributing to preventable illness, injury and premature mortality, and impacting millions of households in England. Some of these hazards are likely to become more prevalent or relevant in the context of climate change (such as overheating) and other hazards that have not been captured in this work might emerge as important considerations (for example, flooding).

Cold homes and fuel poverty

Overview

Cold homes present a significant and complex public health challenge in the UK. Factors such as low income, rising energy costs and energy inefficient housing contribute to this widespread issue. Although the most visible consequences are often seen in the winter months, when mortality rates and hospital admissions rise, the risks associated with cold homes extend beyond this period. Chronic exposure to low temperatures can have cumulative effects on physical and mental health. The Adverse Weather and Health Plan supporting evidence provides an overview of the indirect and direct impacts of adverse weather (including excess cold) on the health and wellbeing of exposed populations. The UK Health Security Agency (UKHSA) cold mortality monitoring report for England provides information on deaths observed during cold episodes each year to inform public health actions. Reducing the number of cold homes is essential to reducing preventable illness, avoiding premature deaths and supporting health equity across communities.

As part of the English Housing Survey (EHS), households are asked whether they can normally keep comfortably warm in their living room during the cold winter weather. In the 2023 to 2024 survey:

• around 3.2 million households (13%) reported being unable to keep warm during winter, an increase from 9% in 2018 to 2019. Of these 3.2 million households, 1.6 million (52%) had at least one member with a health condition. The proportion of households with a health condition was lower among those who reported being able to keep warm (37%)
• around 1.1 million households with dependent children said they were not able to keep warm during the winter months. Of those, 352,000 households (32%) had a child with a health condition. There was a higher proportion of households containing dependent children with a health condition among those in cold homes (32%) compared with warm homes (18%), in both social and private sectors

The Department for Energy Security and Net Zero (DESNZ) publishes national fuel poverty statistics using the low income low energy efficiency (LILEE) definition, where a household is considered fuel poor if it has a residual income below the poverty line (after accounting for required fuel costs) and lives in a home with an energy efficiency rating below band C. From 1 April 2030, as part of minimum energy efficiency standards, all new and existing social rented properties must be at an Energy Performance Certificate (EPC) C or equivalent, or a valid exemption must have been registered. In 2024, approximately 2.7 million households (11%) in England were classified as fuel poor.

The government’s Fuel Poverty Strategy and Warm Homes Plan aim to improve energy efficiency, reduce bills and support the most vulnerable people, including the millions of households currently living in fuel poverty.

Health impacts and inequalities

There is consistent evidence that temperatures below 18°C are associated with increased health risks. Exposure to low indoor temperatures in the home can have wide-ranging and serious health consequences for physical health. Living in a cold home can:

• increase blood pressure, blood viscosity and the risk of blood clots forming in the body, in turn increasing the risk of death and illness from heart attacks, strokes, kidney disease and dementia
• reduce dexterity, increasing the risk of falls and injuries
• worsen symptoms of arthritis
• aggravate respiratory conditions including chronic obstructive pulmonary disease (COPD) and asthma, and worsen breathing problems
• suppress the immune system and increase susceptibility to chest infections, such as bronchitis and pneumonia
• result in death or severe illness from hypothermia

Living in cold homes can also have significant impacts on mental health and overall life chances, including:

• an increased risk of developing mental health conditions such as depression and anxiety
• greater likelihood of social isolation, as individuals may be reluctant to invite others into a cold home or may seek refuge elsewhere
• greater difficulty in carrying out daily activities, which can reduce independence and quality of life
• more frequent absences from work and school due to illness, which can affect both educational attainment in children and job security or income for adults
• a negative impact on children’s emotional wellbeing, resilience and ability to study, which in turn can affect long-term educational and work opportunities

People who are at higher risk of becoming seriously unwell due to living in cold homes include:

• people over the age of 65
• people with underlying cardiovascular or respiratory conditions
• people with mental health conditions, including people with dementia and Alzheimer’s who may not readily recognise that they are feeling cold
• people with disabilities, learning difficulties or cognitive impairment
• young children and babies
• pregnant women
• people who are housebound or otherwise have low mobility
• people who live alone and may be unable to care for themselves
• people in a lower income household

The health impacts associated with cold homes are not evenly distributed across the population. The adverse weather and health plan equity review and impact assessment 2024 covers evidence on inequalities in risks to health from adverse weather events (including excess cold). Certain groups, such as households with older adults, lone parents, children, those with lower incomes and ethnic minorities, are disproportionately affected by these conditions. These disparities are further exacerbated by obstacles to accessing assistance or reporting concerns, which can prolong exposure and lead to poorer health outcomes. Barriers to reporting housing concerns or accessing financial support to make the home warmer include language barriers, concerns about eviction, and fear of stigma. These may prevent some individuals from seeking help.

Coverage of cold homes and fuel poverty in JSNAs

Cold homes and fuel poverty were addressed by 85% (127 out of 149) of local council JSNAs, making it the most common housing theme. 

Table 1: presence and placement of cold homes and fuel poverty in JSNAs

Presence and placement - cold homes and fuel poverty theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	19	15%
Theme included with some contextual information	36	28%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	72	58%

Where cold homes and fuel poverty were mentioned briefly without elaboration in 19 JSNAs, this was typically in a single sentence - for example, a general statement defining what fuel poverty is or a figure on fuel poverty rates, with no or brief mention of its health impacts.

There were 72 local councils which featured the theme of cold homes and fuel poverty in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. These tended to include detail on issues such as the extent of fuel poverty, vulnerable groups and specific health impacts. This information was often included in a specific JSNA on cold homes or fuel poverty or given prominence in a chapter on the cost of living, excess winter deaths, housing or wider determinants of health. It was also commonly included in JSNAs for:

• older people, given their heightened vulnerability
• respiratory conditions or other conditions particularly affected by cold homes

Table 2: use of data on cold homes and fuel poverty in JSNAs

Use of data - cold homes and fuel poverty theme	Count	Percentage
No supporting data of the theme provided	10	8%
National data provided with no local contextualisation of the theme	1	1%
National data cited with local contextualisation or local data is referenced from a single source for the theme	70	55%
Local data from multiple sources cited	46	36%

Local councils used a variety of data sources about cold homes and fuel poverty in their JSNAs, mainly focusing on quantitative data such as:

• households living in fuel poverty
• fuel poverty gap
• properties with EPC ratings below C
• the proportion of pensioners receiving winter fuel payments
• households lacking central heating
• households using pre-payment meters
• fuel prices
• excess winter deaths

These figures came from multiple sources, including:

• the Census
• national and locally modelled fuel poverty statistics
• locally commissioned housing stock surveys

While many clearly referenced the origin of data, others omitted this information. This meant it was sometimes difficult to understand whether figures used related to the DESNZ fuel poverty statistics using the LILEE definition or were locally commissioned.

Some local councils also:

• provided dashboards showing fuel poverty trends by household or property type
• incorporated qualitative data to capture people’s lived experiences of how living in a cold home is affecting their health and wellbeing
• reported the Building Research Establishment’s (BRE) estimates of the financial burden of cold-related illnesses on health services

Table 3: analytical depth of cold homes and fuel poverty reporting in JSNAs

Analytical depth - cold homes and fuel poverty theme	Count	Percentage
No analysis of the impact of the theme provided	35	28%
High level mention of impacts of the theme provided	45	35%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	28	22%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	19	15%

As shown in table 3, there was a high level mention of relevant drivers, health impacts, subpopulations or contextual factors in 45 of the JSNAs - for example, “Cold homes, whether due to poor design, inability to pay for heating or a combination of the 2, contribute to excess winter mortality”.

There were 28 JSNAs which included more in-depth analysis of the theme on one of the following topics:

• local drivers
• impact on subgroups
• impact on health inequalities
• impact on health conditions
• impact on the health and social care system

There were 19 JSNAs that included a comprehensive analysis of 2 or more of these topics.

There was considerable variation in both the depth of detail and the analytical approaches employed when examining the issue of cold homes in JSNAs. Most frequently, JSNAs included DESNZ fuel poverty statistics for the local council compared to the national average, neighbouring authorities, or other areas of interest, such as core cities. Sometimes fuel poverty figures were provided by Lower-Layer Super Output Area (LSOA), and some JSNAs considered local or national trends over time. EPC data was also frequently reported with similar comparisons between the council and national figures and LSOA breakdowns. Several JSNAs included visual representations of this information.

Excess winter deaths are expressed as a ratio of the difference in all-cause mortality during winter months (December to March) compared with the average in the non-winter months (preceding August to November and following April to July). Some JSNAs quoted the proportion of excess winter deaths attributable to cold homes using (Office for National Statistics (ONS) data on winter mortality and applied it to data for their area.

A number of local councils reported the estimation in the Institute of Health Equity report Fuel Poverty, Cold Homes and Health Inequalities in the UK that 21.5% of excess winter deaths are attributable to cold homes, and used this to estimate excess winter deaths caused by cold homes in their area. It should be noted that this likely underestimates the true number, as deaths from chronic cold exposure can occur year-round, not just in winter.

Several local councils provided commentary or analysis on how different vulnerable groups are affected. For example: 

• for children, risks include:
  • chronic health issues (asthma, allergies, eczema, respiratory conditions)
  • poor development
  • inadequate weight gain
  • reduced educational attainment, which may affect long-term earning potential
• older adults are at risk as they:
  • typically spend more time at home, increasing their heating needs and cold exposure
  • may face reduced income, higher prevalence of chronic conditions and/or less effective temperature regulation due to age or medication
• people with long-term illness or disability may:
  • require increased energy for medical equipment and maintaining health, including heating to prevent muscle stiffening
  • spend more time at home
• Gypsy and Traveller communities often face significantly higher fuel costs due to reliance on gas bottles and generators powered by petrol or diesel for electricity, with caravans typically offering poor insulation. Many Gypsy and Traveller families are also excluded from financial support as they may not have a supply from a regulated fuel company or a permanent address
• for pregnant women, exposure to cold environments can elevate blood pressure during pregnancy and is associated with an increased risk of stillbirth

Some JSNAs included data related to these vulnerable groups - for example, the number of older people or the number of stillbirths. There was less frequent coverage of other groups which may be vulnerable to cold homes, such as people with mental health conditions and people with learning disabilities. Others reported correlations between local fuel poverty data and housing or household characteristics (including age of occupants, ethnicity, deprivation and/or tenure). 

Several JSNAs described the impact of cold homes on health and social care. For example, costs associated with taking action on cold homes compared with the costs to health and social care. This was reported by:

• national cost estimates of cold homes from BRE
• locally modelled estimates
• listing the number of cold-related housing hazards reported to them and estimates of those likely to result in medical interventions

Other aspects of cold homes included in JSNAs included:

• discussion of the national policy context, ensuring readers are aware of the broader framework and funding landscape in relation to addressing fuel poverty
• examination of the connection between fuel poverty and general poverty, emphasising how limited resources often force families to choose between heating their homes and meeting other essential needs such as food and clothing, a situation commonly referred to as the ‘heat or eat’ dilemma
• consideration of the roles of various professionals and the importance of collaboration with the NHS, energy providers and the wider health and social care system in supporting individuals vulnerable to health risks associated with cold homes
• identification of challenges related to tackling cold homes in specific property types or in off-gas grid locations, with some local councils indicating that these issues are more prevalent in certain areas of their locality
• recognition of emerging health concerns arising from household strategies to cope with cold homes, such as:
  • families attempting to retain heat by keeping windows and doors closed, which can inadvertently foster mould growth and dust mite infestations
  • increased use of alternative heating sources, particularly wood fuel in open fires or wood-burning stoves, which poses significant IAQ risks due to particulate matter containing particles of less than 2.5 micrometres in diameter (PM2.5) emissions

Coverage of cold homes and fuel poverty in JLHWSs

Cold homes and fuel poverty appeared in just under half 45% (65) of the 145 local JLHWSs that were reviewed.

Table 4: strategic integration of cold homes and fuel poverty in JLHWSs

Strategic integration - cold homes and fuel poverty theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	29	45%
Referenced the theme in local or regional housing strategies and/or public health action plans	8	12%
Referenced specific interventions, schemes or governance to address the theme	28	43%

Most local councils (37) that included cold homes in their JLHWSs included a general objective to reduce fuel poverty, without specifying how this would be achieved or including measurable targets. Often these statements simply acknowledged the impact of cold homes on health and wellbeing. However, of these 37, 8 local councils did refer to other strategic documents such as housing strategies, energy action plans, overarching council plans or dedicated fuel poverty or affordable warmth strategies, which likely contained more detailed actions.

Among the 28 local councils that did include specific actions or commitments regarding cold homes and fuel poverty within their JLHWSs, the following recurring themes emerged:

• advice and support for households, including:
  • emphasising enhancing access to energy and warmth advice, financial assistance (including grants and loans) and targeted interventions for those most vulnerable. Support referenced included services provided through internal initiatives, external referrals and collaborative partnerships between healthcare providers and energy suppliers
  • embedding referral and information-sharing processes into existing programmes targeting at-risk populations, such as individuals eligible for seasonal flu vaccinations or young people in contact with school nurses
  • the development or provision of single-point-of-access services and alignment with National Institute for Health and Care Excellence (NICE) guideline on excess winter deaths and illness and the health risks associated with cold homes to prevent illness and mortality associated with cold homes
• public health campaigns intended to educate households about the health risks associated with cold homes, identify who might be vulnerable and promote available support
• workforce training, including:
  • initiatives focused on improving awareness of affordable warmth resources. This included training sessions for health and housing professionals and other relevant professional groups which aimed to increase understanding of the link between cold housing and health and to clarify referral pathways for affected populations
  • providing training for staff who visit vulnerable households
• improving the energy efficiency of homes, which included commitments to:
  • upgrade the energy efficiency of existing council-owned homes
  • construct new homes to higher energy standards, including to Passivhaus standards
  • invest in district heating systems
  • prioritise higher energy efficiency through local plans and planning policies

Relatively few JLHWS documents contained explicit targets or mechanisms for performance monitoring. Where these were in place, examples included:

• commitments to report on the number of council homes retrofitted or pledges to reduce fuel poverty by a certain percentage over a defined period through specified interventions
• reporting on the number of households receiving different types of energy or financial support

In some instances, JLHWS documents did not reference cold homes directly. However, relevant strategic commitments appeared within JSNAs, featuring similar themes to those outlined above.

Summary and recommendations

There are opportunities for local systems to use JSNAs to provide a clear, evidence-informed picture regarding cold homes, including:

• who is affected
• where risks are concentrated (and why)
• what this means for the wider health and care system
• how vulnerable households can be targeted for support

To improve their coverage of cold homes, JSNAs should include:

• a strong overarching narrative about the serious health risks cold homes pose, recognising them as a preventable health risk with major impacts on respiratory, cardiovascular and mental health outcomes. This should reference NICE guidance on the health risks associated with cold homes and the national adverse weather and health plan, which emphasise the need for year-round planning, proactive identification of at-risk households and cross-system working
• interpretation of data to show:
  • where cold-home risk is highest
  • which dwellings increase vulnerability (based on local housing stock characteristics such as property age, EPC rating and type of heating system)
  • the relationship with inequalities, income and deprivation. It can be beneficial to overlay insights about fuel poverty with data about housing tenure in the area (for example, proportion of social rented, private rented and owner occupied stock) because fuel poverty does not occur uniformly across tenures
• a clear description of how cold homes affect the health and care system, including identifying links with:
  • respiratory admissions
  • cardiovascular events such as heart attacks, stroke and heart failure
  • winter pressures
  • excess winter deaths (while noting that deaths can occur year-round)
• an overview of existing support mechanisms in place to address cold homes and mitigate their impacts, which may include:
  • existing affordable warmth and retrofit programmes
  • energy advice services
  • private rented sector enforcement activity (including how enforcement is triggered in private rented sector and social housing)
  • emergency support funds and how they can be accessed
  • relevant pathways between health and social care and housing that are or could be better used to identify and support vulnerable people, including health-based referral or home-assessment pathways
• description of how cold-home risk is related to wider strategic agendas for the local area, including:
  • winter pressures (while noting that death and illness from cold occur year-round)
  • respiratory, cardiovascular, musculoskeletal, mental health and dementia
  • child and older adult health
  • cost of living
  • deprivation and health inequalities
  • decarbonisation, retrofit programmes, climate adaptation and resilience stock-condition strategies
  • implementation of national policy including Awaab’s Law, the Renters’ Rights Act, the Fuel Poverty Strategy and the Warm Homes Plan

Overheating

Overview

Overheating is a major problem in England, with around 2.9 million households reporting uncomfortable indoor temperatures in 2023 to 2024. As climate change raises the frequency and intensity of heatwaves, overheating poses an increasing public health risk. The adverse weather and health plan supporting evidence provides an overview of the indirect and direct impacts of adverse weather (including heat) on the health and wellbeing of exposed populations. However, adaptation for heat should not be at the expense of protecting against cold.

Home overheating peaks during heatwaves, when spikes in hospitalisations and mortality can be observed. Data consistently shows that hot weather leads to an increase in deaths. However, the data does not show a simple or consistent pattern when it comes to emergency hospital admissions during hot periods. Further investigation of emergency hospitalisations during heat periods is required. The UKHSA heat mortality monitoring report for England provides information on deaths observed during heat episodes each year to inform public health actions. However, homes can reach harmful temperatures at any time of the year.

A range of factors influence how much a home is exposed to sunlight and its risk of overheating. These include the home’s:

• size
• layout
• massing (shape, form and size)
• orientation
• location in relation to other dwellings
• use of shading
• extent of glazing

There is also geographical variation in overheating risk, with the highest levels of overheating observed in London and the South of England. Urban dwellings are more prone to overheating due to the urban heat island (UHI) effect. Nonetheless, evidence demonstrates that dwellings located in the cooler regions of England and outside of urban areas are also susceptible to indoor overheating in the current climate.^{[footnote 1]} Poor building design, inefficient insulation and inadequate ventilation are all drivers of overheating, not just outdoor temperature or UHIs.

Health impacts and inequalities

Prolonged exposure to heat in the home is associated with a range of adverse physical and mental health impacts. Temperatures above 25ºC raise the risk of heat-related deaths, with greater danger at higher temperatures. However, effects can be seen at lower temperatures than this. The adverse weather and health plan equity review and impact assessment 2024 covers evidence on inequalities in risks to health from adverse weather events (including heat).

Risks to physical health include:

• heat exhaustion, which results from either dehydration or sodium depletion and can cause symptoms such as malaise, vomiting, circulatory collapse and core body temperature ranging from 37ºC to 40ºC. If left untreated, it may progress to heat stroke
• heat stroke, which is a medical emergency in which the body’s thermoregulatory mechanisms fail. This condition is characterised by confusion, disorientation, convulsions, loss of consciousness, hot dry skin and a core body temperature exceeding 40ºC. If not promptly treated, heat stroke may lead to cellular death, organ failure, permanent neurological damage or death
• conditions such as heat cramps (muscle pain from dehydration and loss of electrolytes), heat rash (itchy, raised spots with mild swelling), heat oedema (ankle swelling from vasodilation and fluid retention) and heat syncope (dizziness or fainting due to dehydration or vasodilation)
• exacerbation of chronic cardiovascular and respiratory conditions, thereby increasing the chances of heart attacks, strokes and breathing problems. It can also exacerbate kidney diseases and electrolyte disorders

There are also potential mental health and cognitive impacts from heat. Elevated night-time bedroom temperatures can negatively impact sleep quality, impacting wellbeing and productivity, and increasing the risk of accidents. Heat exposure may also exacerbate symptoms for those with dementia and schizophrenia. Exposure to heat has also been found to be associated with:

• increased suicide risk
• increased risk in hospitalisations due to mental illnesses

Although high temperatures can affect the health of all individuals, certain groups are especially susceptible to heat-related risks, including: 

• people suffering from cardiovascular, respiratory or cerebrovascular disease, diabetes, kidney disease or Parkinson’s disease
• pregnant women
• people aged 65 and over, as:
  • thermoregulation is controlled by the hypothalamus and can be impaired in older adults
  • older adults are more likely to have a health condition that puts them at risk
  • overheating may make older adults more susceptible to falls and urinary tract infections due to dehydration
• babies and young children (particularly those aged 5 years and under) due to:
  • their decreased ability to sweat, reducing their ability to cool down
  • their having core temperatures that rise faster during dehydration
• immunocompromised individuals
• people on certain medications that potentially affect heart or kidney function, cognition or ability to sweat
• people with low mobility or who are bed-ridden, due to their restricted ability to adjust their environment during hot spells
• people who experience alcohol or drug dependence
• people experiencing homelessness, including rough sleepers and those who are unable to make adaptations to their living accommodation such as ‘sofa surfers’ or those living in hostels

This is reflective of the unequal distribution of the risks of climate change. Not only are certain groups more vulnerable to the consequences of climate change (such as overheating), they may also be less able to adapt and mitigate its effects. 

Coverage of overheating in JSNAs

Overheating appeared in 7% (11) of the 149 local council JSNAs reviewed. 

Table 5: presence and placement of overheating in JSNAs

Presence and placement - overheating theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	7	78%
Theme included with some contextual information	2	11%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	2	11%

In the 7 JSNAs that mentioned content on overheating briefly, it was typically in a sentence highlighting ‘excess heat’ in the home as a hazard to health, with only a brief, or no, mention of health impacts.

There were 2 local councils that featured overheating in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. One of these included a dedicated section on excess heat in the housing and health needs assessment and the other integrated it in a properties vulnerable to heat document. The content included:

• the increasing risk of overheating homes and its impacts on health
• properties that are vulnerable
• residents that are vulnerable
• deaths due to excess heat
• guidance on keeping cool in the home

Table 6: use of data on overheating in JSNAs

Use of data - overheating theme	Count	Percentage
No supporting data of the theme provided	7	64%
National data provided with no local contextualisation of the theme	2	18%
National data cited with local contextualisation or local data is referenced from a single source for the theme	1	9%
Local data from multiple sources cited	1	9%

Data on overheating homes which was referenced included:

• BRE data on housing costs associated with overheating homes
• data on heatwaves in England
• heat-related deaths during heatwaves in England
• local survey data on overheating homes

Data on overheating was minimal. No local councils reported the EHS data on overheating homes, with only one carrying out and reporting a local survey of households’ experiences of overheating homes. There was no use of local temperature data, nor any reported local or national data on changes to healthcare usage during heatwaves. One council reported costs associated with excess heat but with no detail of how these costs were estimated.

Table 7: analytical depth of overheating reporting in JSNAs

Analytical depth - overheating theme	Count	Percentage
No analysis of the impact of the theme provided	2	18%
High level mention of impacts of the theme provided	6	55%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	1	9%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	2	18%

Just 3 JSNAs provided in-depth analysis of the theme. A strong example included mapping of local areas at increased risk of overheating, based on:

• property types prone to overheating
• neighbourhoods with higher average temperatures
• areas with a higher proportion of occupants with certain vulnerabilities to excess heat (deprivation, age and living alone)

No other JSNA used local data to explore moderators of exposure or vulnerability to heat. However, several JSNAs did provide a narrative summary of some of the impacts and moderating factors of overheating in a broader sense. This included reference to: 

• vulnerable groups and specific health impacts associated with overheating
• building characteristics associated with higher risk of overheating, for example:
  • top floor flats
  • homes with limited opening windows
  • homes with little shading either due to external construction of internal limitations, including highly modifiable ones like a lack of curtains or blinds or energy inefficient appliances that release excess heat
  • homes that have centralised heating systems that occupants have less control over
  • homes that are very well insulated without additional provision for ventilation or shading
  • homes that have poorly maintained or absent ventilation systems
  • homes that are west or south facing
• emerging risks, including:
  • changes to the frequency of heat waves and concerns over housing stock that is poorly adapted to cope
  • homes that have been retrofitted to be more energy efficient but are now more prone to overheating
  • people working at home and spending more time exposed to high temperatures than they may have typically done in a conventional workplace

Coverage of overheating in JLHWSs

Overheating appeared in just 2 (1.5%) of the 145 local council JLHWSs.

Table 8: strategic integration of overheating in JLHWSs

Strategic integration - overheating theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	1	50%
Referenced specific interventions, schemes or governance to address the theme	1	50%

One local council included a general statement about aspirations for housing to be good quality with protections in place to reduce overheating risk (among other aspects of poor housing). The other local council included specific strategic priorities and timeframes for action. These related to improving workforce awareness of how to respond to high temperatures and improving the housing stock itself to make it better adapted to overheating.

Interestingly, some of the local councils that included detailed analysis of overheating as a risk in their JSNAs included no mention of overheating in their JLHWSs. Some of the JSNAs themselves included actions to address overheating, even where these were absent in JLHWSs, for example: 

• improved training for education, housing and healthcare sectors to contextualise heat risk
• interventions to reduce overheating risk, such as promotion of support for low-cost households to maintain thermal comfort during periods of extreme heat, particularly for vulnerable groups

Summary and recommendations

There are opportunities for local systems to use JSNAs to provide a clear, evidence-informed picture regarding overheating, including:

• who is affected
• where risks are concentrated (and why)
• what this means for the wider health and care system
• how vulnerable households can be targeted for support

To improve their coverage of overheating, JSNAs should include:

• a strong overarching narrative about overheating, which outlines the significant health risks associated with overheating, explaining that it is driven by climate change, building characteristics and inequalities in housing quality and adaptation readiness. It should reference relevant national guidance, including the heat-related components of the adverse weather and health plan, which emphasise the need for proactive year-round system planning. JSNAs should also clarify that overheating is not an issue limited to heatwaves and that many homes experience unsafe indoor temperatures at other times of the year due to issues with design, insulation, solar gain and ventilation constraints, among other factors
• interpretation of data from national and local sources to show where overheating risk is highest, which dwellings increase vulnerability (based on local housing stock characteristics such as ventilation and shading characteristics, and single aspect-dwellings and top floor flats which are known to be more impacted by excess heat), and the relationship with inequalities, income and deprivation. JSNAs could explain why certain neighbourhoods, dwelling types, tenure types or resident characteristics face greater exposure, and how this aligns with local inequality and vulnerability patterns
• acknowledgement that health professionals and frontline staff need to have:
  • an awareness of tenant rights
  • pathways to support tenants to access existing protections
  • duties introduced by Awaab’s Law
  • existing housing enforcement powers relating to excess heat hazards within the housing health and safety rating system (HHSRS)
• a description of how overheating risk is related to wider strategic agendas for the local area, including:
  • climate change
  • inequalities
  • building design for new social housing
  • planning policy
  • retrofit strategies to avoid unintended consequences of better insulated homes
  • NHS heat-related admissions and seasonal pressures
  • wider housing strategies and environmental health work
• suggestions for meaningful indicators for monitoring and accountability relating to overheating, which may include:
  • number of high-risk dwellings
  • number of heat-related complaints or enforcement actions
  • uptake of overheating adaptation measures (for example, ventilation and shading)
  • targeted interventions in high-risk buildings
  • numbers of referrals from health and social care services relating to unsafe indoor temperatures
  • patterns of emergency health service use during heat periods (with caveats that illness occurs outside heatwaves too)

Damp and mould

Overview

Damp and mould present a significant public health issue, affecting millions of homes in England and posing serious risks to residents’ health. The tragic death of Awaab Ishak in 2020 brought national attention to the devastating consequences that can result when these hazards are not addressed, underscoring the urgent need for robust prevention and intervention.

Estimates of damp and mould prevalence from the EHS suggest that 5% (1.4 million) of dwellings in England suffered from damp in 2024. Estimates of the number of households with damp and mould is typically much higher (27%) when occupants self-report.

Out of the 1.3 million damp homes reported in the EHS 2023 to 2024, over 600,000 had at least one member with a health condition. An estimated 534,000 households with dependent children were living in damp homes. Of those, 122,000 had a child with a health condition.

The DHS, published in January 2026, introduced a standalone criterion dedicated solely to damp and mould, requiring landlords to prevent it, identify it early and take prompt, effective action.

Health impacts and inequalities

Damp and mould within the home can produce allergens, irritants, mould spores and other toxins that are harmful to health. Even if visible mould is not present, dampness alone can increase the risk of health problems.

Damp and mould primarily affect the airways and lungs. The respiratory effects of damp and mould can cause serious illness and, in the most severe cases, death.

The respiratory effects include:

• general symptoms such as coughing, wheezing and shortness of breath
• increased risk of airway infections
• development or worsening of conditions such as rhinitis, asthma, bronchitis and COPD

In 2019, the presence of damp and/or mould in English residences was estimated to be associated with approximately 5,000 cases of asthma and approximately 8,500 lower respiratory infections among children and adults and 1% to 2% of new cases of allergic rhinitis.^{[footnote 2]} This study used the conservative estimate of 4% of households being affected by damp and mould, acknowledging that if damp and mould incidence is actually higher, as per self-reported figures, the total number of cases of asthma and allergic rhinitis could be 3 to 8 times greater.

In addition to the respiratory impacts, damp and mould can also affect the eyes and skin, including: 

• irritation of the eyes, potentially leading to allergic conjunctivitis
• eczema and other patches of itchy skin or skin rashes
• other fungal infections (including, but not exclusively, those of the skin), especially in people with weakened immune systems

The presence of damp and mould can also affect mental health. This could be due to:

• unpleasant living conditions
• destruction of property and belongings
• anxiety related to:
  • physical health impacts
  • looking after a relative suffering from damp and mould-related illnesses
• frustration with poor advice or being blamed for damp and mould
• social isolation associated with not wanting visitors in the home
• delays in response or repairs following reporting of damp and mould and/or poor quality of repairs

Everyone is vulnerable to the health impacts of damp and mould, but certain people are at greater risk of more severe health impacts. This includes:

• people with a pre-existing health condition (for example, allergies, asthma, COPD, cystic fibrosis, other lung diseases and cardiovascular disease) who are at risk of their condition worsening and have a higher risk of developing fungal infections and additional allergies
• people who have a weakened immune system, such as people who have cancer or are undergoing chemotherapy, people who have had a transplant or people who are taking medications that suppress their immune system
• pregnant women and their unborn children, and women who have recently given birth, who may have weakened immune systems
• people living with a mental health condition
• children and young people whose organs and immune systems are still developing and are therefore more likely to suffer from physical conditions such as respiratory problems
• older adults due to their increased likelihood of existing conditions, higher susceptibility to respiratory illness and greater time spent indoors
• people who are bedbound, housebound or have mobility problems, making it more difficult for them to get out of a home with damp and mould and into fresh air

Exposure to damp and mould is associated with higher incidence of hospital admissions for respiratory infections.

Certain groups are more likely than others to live in homes with damp and mould, and some groups are more likely to face barriers to reporting damp and mould, increasing their likelihood of prolonged exposure. This may be particularly relevant for people with low levels of health literacy who may not make the connection between their housing conditions and symptoms.

Groups who are most likely to live in homes with damp and mould include: 

• people with a long-term illness
• people who struggle to heat their homes, are experiencing fuel poverty, or both
• people on low incomes
• people with disabilities
• people from ethnic minority backgrounds
• people living in temporary accommodation

Those who are most likely to face barriers to reporting damp and mould include: 

• people from ethnic minority backgrounds
• people who have moved to the UK within the past 10 years, including people seeking refuge and foreign students
• people moving in and out of homelessness, in insecure tenures, or who have a fear of eviction in the private rented sector
• people with a learning disability or a neurodiverse condition such as autism
• people living with a mental health condition
• people who are dependent on alcohol, drugs or both
• people in receipt of welfare benefits
• people who live in houses in multiple occupation (HMOs)
• people without a diagnosed mental health condition or registered disability but with either temporary or on-going support needs

Coverage of damp and mould in JSNAs

Damp and mould appeared in 36% (54) of the 149 local council JSNAs reviewed. Its limited inclusion (compared with cold homes, for example) highlights a gap between evidence of the health impacts of damp and mould and its translation to structured consideration in JSNAs.

Table 9: presence and placement of damp and mould in JSNAs

Presence and placement - damp and mould theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	26	48%
Theme included with some contextual information	17	31%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	11	20%

Only 11 authorities featured damp and mould in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Some local councils included discrete modules on damp and mould, covering issues such as the health risks, who is vulnerable, and prevention and redress strategies. Others included damp and mould prominently in multiple sections, commonly including it in overarching chapters on housing and health or the wider determinants of health, JSNA summary chapters and fuel poverty chapters. 

Content on damp and mould was mentioned briefly, without elaboration in 26 JSNAs. This was typically in a single sentence - for example, very general statements like “poor housing, including cold or damp homes, contributes to the development of many long-term conditions” but without any further mention of damp and mould within the JSNA.

Table 10: use of data on damp and mould in JSNAs

Use of data - damp and mould theme	Count	Percentage
No supporting data of the theme provided	31	53%
National data provided with no local contextualisation of the theme	6	10%
National data cited with local contextualisation or local data is referenced from a single source for the theme	15	26%
Local data from multiple sources cited	6	10%

Of the 24 local councils reporting on damp and mould, the most common source of data was EHS data on the proportion or number of affected households. Some only provided national figures, while others provided local estimates, sometimes broken down by LSOA. Others reported data from locally commissioned reports on their housing stock. Some referred to data from the Census (2011 and 2021). Some local councils included reports submitted to environmental health teams and actions taken, such as penalty notices and statutory housing notices, including trends over time. 

A few of the JSNAs reviewed incorporated economic evidence - most frequently citing the BRE estimates of the costs of damp and mould to the NHS of £38 million, rather than reporting local economic data.

Some JSNAs included resident feedback, gathering information on residents’ lived experiences of damp and mould. Others carried out local surveys of the proportion of residents living with damp and mould.

Table 11: analytical depth of reporting on damp and mould in JSNAs

Analytical depth - damp and mould theme	Count	Percentage
No analysis of the impact of the theme provided	7	13%
High level mention of impacts of the theme provided	29	53%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	12	22%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	7	13%

JSNAs varied in focus, with some examining exposure differences by household and housing characteristics. For example, some JSNAs highlighted higher rates of damp and mould in larger, ethnic minority and low-income households, as well as privately rented homes.

Some local councils identified vulnerable groups, but they did so less often and less thoroughly than for cold homes. Children and people with asthma or COPD were most frequently mentioned; a couple mentioned older adults, and other at-risk groups like pregnant women and immunocompromised individuals were not mentioned at all.

Some local councils discussed the impact of damp and mould on health and social care, covering things like hospital admissions for respiratory infections in children, or reported research on the number of disability adjusted life years (DALYs) and deaths associated with childhood asthma or reported links between hospital discharge and readmission, although it was unclear whether this was based on local data or a reference to research.

Several JSNAs reported the BRE cost estimates associated with damp and mould. One took this further and commissioned a health impact assessment on the cost of private sector housing in the local council and cost of prospective housing interventions required to address hazards like damp and mould.

Some JSNAs reported information that may help local systems prioritise areas for intervention on damp and mould (either explicitly or implicitly) - for example, asthma prevalence across different wards.

Others discussed some of the causes of damp and mould, sometimes making links to particularly salient issues within their local community - for example, areas prone to flooding or property types that could not easily be retrofitted to reduce damp and mould risk. Some drew links with wider trends, such as cost of living and wetter winters associated with climate change.

Coverage of damp and mould in JLHWSs

Of 145 local council JLHWSs, 13% (19) included content on damp and mould.

Table 12: strategic integration of damp and mould in JLHWSs

Strategic integration - damp and mould theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	10	53%
Referenced specific interventions, schemes or governance to address the theme	9	47%

Of the 19 JLHWSs that included damp and mould, 10 did not include any strategic links or proposed actions in relation to damp and mould, but made general statements about aims to improve the quality of homes, and addressing damp and mould as part of this, or statements which just acknowledged the harm caused by damp and mould without any mention of commitments to improving housing conditions.

There were 9 local councils which described particular interventions, schemes or governance mechanisms intended to address damp and mould, signalling planned or ongoing action. These included details on current and future initiatives, such as: 

• working with housing providers to:
  • identify and support tenants diagnosed with conditions known to worsen due to damp and mould
  • encourage the uptake of energy efficiency measure by landlords
  • implement landlord accreditation schemes that educate property owners about mitigating environmental hazards
  • develop a damp and mould charter
• staff training to:
  • raise awareness of health impacts associated with damp and mould and how to signpost vulnerable people to advice and support
  • ensure that professionals working with families are better informed about landlords’ responsibilities
• improving referrals processes by:
  • conducting an in-depth audit of how residents and healthcare professionals can access support and advice regarding housing issues like damp and mould
  • reviewing services for vulnerable adults and exploring opportunities to integrate support on housing conditions into business-as-usual activity
• raising public awareness on the health risks of damp and mould and what can be done to address it through information and advice
• using selective licensing to improve standards in homes
• promoting higher standards in new build housing to ensure new homes are adequately ventilated to prevent the build-up of moisture in the home
• investing in housing stock to address hazards like damp and mould

Summary and recommendations

There are opportunities for local systems to use JSNAs to provide a clear, evidence-informed picture regarding damp and mould, including who is affected, where risks are concentrated (and why), what this means for the wider health and care system and how vulnerable households can be targeted for support.

To improve coverage of damp and mould, a high-quality JSNA could include:

• a strong overarching narrative about damp and mould as significant public health issues, including:
  • clarity that damp and mould are not lifestyle issues or due to tenant behaviour
  • describing them as health risks arising from housing conditions such as insufficient ventilation, structural defects, leaks, cold homes, overcrowding and prolonged disrepair
  • reference to national guidance on damp and mould
• interpretation of data from national and local sources to show where damp and mould risk is highest, which dwellings increase vulnerability (based on local housing stock characteristics) and the relationship with inequalities, income and deprivation. This should include:
  • an outline of the specific characteristics of local housing that increase damp and mould risk (or, if limited data is available, general housing characteristics that increase risk)
  • local surveys of residents’ experience of damp and mould, given the likely underestimate of damp and mould prevalence provided by the EHS
  • identification of those at increased risks of harm due to age related vulnerabilities, as well as those who are at increased risk of exposure to damp and mould and those at increased risk of barriers to reporting or having damp and mould issues fixed
• acknowledgement that health professionals and frontline staff need to have an awareness of tenant rights, including existing protections for tenants, duties introduced by Awaab’s Law and pathways through which tenants can seek support or take action to address damp and mould
• reference to the importance of avoiding blaming residents for the emergence of damp and mould, while sensitively discussing small changes to household behaviour which could mitigate the issue
• descriptions of governance, system roles and enforcement pathways for identifying, triaging and escalating damp and mould cases, including the role of environmental health teams and housing enforcement. These could also describe how information is shared locally across public health, housing, NHS partners, landlords and the voluntary sector, or if it is not, proposals to facilitate this
• a description of how damp and mould risk is related to wider strategic agendas for the local area, including:
  • health inequalities
  • child and older adult health
  • respiratory, cardiovascular and musculoskeletal conditions, and mental health and other vulnerabilities exacerbated by damp and mould
  • cold homes and fuel poverty
  • overcrowding
  • retrofit programmes
  • housing strategies
• suggestions for meaningful indicators for monitoring and accountability relating to damp and mould, which may include:
  • prevalence of damp and mould in stock condition data sets
  • private rented sector enforcement activity data - for example, reporting of damp and mould hazards and remediation time scales
  • engagement or training coverage on damp and mould for health and social care professionals
  • health or community-related referrals for support to address damp and mould hazards

Indoor air quality

Overview

IAQ is an important determinant of health. Chapter 5: climate policies and indoor health of the health effects of climate change report (2023) describes various factors affecting IAQ, including:

• outdoor sources
• urban planning and layout
• ventilation
• indoor pollutants

Important pollutants originating from both within and outside the home include: 

• particulate matter: indoor levels are affected by particulate matter generated from both outdoor sources (including road transport, industrial activities, construction sites and natural sources) and indoor sources (including domestic appliances and activities that involve burning, such as boilers, heaters, fires, candles, incense, stoves and ovens). Particulate matter is also generated from cooking, smoking and cleaning activities
• nitrogen oxides (NOx): nitric oxide and nitrogen dioxide (NO₂) are major components of outdoor air pollution. Together they are often referred to as NOx and are products of combustion. Outdoor sources include motor vehicles, energy production and industry. Indoor levels are affected by outdoor NOx coming inside, and NO₂ in particular can be produced by burning gas, oil, paraffin, coal or wood in domestic appliances (boilers, heaters, fires, stoves and ovens). Tobacco smoking and candles are also sources
• carbon monoxide: a colourless, odourless and highly poisonous gas formed from the incomplete combustion of gas, wood, coal or oil in fuel-burning appliances such as boilers, cookers, heaters, stoves and open fireplaces. Faulty or poorly installed and maintained appliances or blocked flues all increase risk
• chemicals (volatile and semi-volatile organic compounds - VOCs and SVOCs): VOCs are widely used in building materials and construction products (including paints, varnishes and waxes), furnishing and consumer products (detergents, cleaning products and air fresheners) and personal care products. They are also emitted while using electronic devices such as photocopiers or printers. SVOCs are used in many indoor materials or products including plastic, pesticides, flame retardants and plasticisers
• formaldehyde: a VOC which is present in many building materials, furniture, coatings and finishes, and household products. It is also found in tobacco smoke, produced in chemical reactions, and can be emitted through cooking
• radon: a colourless, odourless, radioactive gas that comes from the decay of small amounts of uranium and radium that occur naturally in all rocks and soils. It is infrequently a problem in outside air but can accumulate in buildings, particularly in certain geographical areas
• allergens in dust, including:
  • house dust mites: microscopic organisms which thrive in warm, humid environments and are commonly found in household dust, particularly in mattresses, bedding, carpets, clothing, upholstered furniture (pillows and sofas) and soft toys
  • pet dander: proteins found in the skin flakes, urine and saliva of pets, like cats and dogs, which can become airborne and trigger allergic reactions

Additionally, damp and mould impair IAQ by increasing concentrations of airborne mould spores, allergens and irritants. However, there may also be trade-offs in addressing hazards. For example, improving the airtightness of a property may make it warmer, but may also necessitate improvements to ventilation systems to avoid poor IAQ.

Health impacts and inequalities

Poor IAQ can have serious and lasting health impacts, particularly for certain vulnerable groups. Health professionals are well-placed to educate communities, identify at-risk individuals and advocate for measures that improve air quality and reduce exposure. 

Poor IAQ has wide-ranging physical and mental health effects. The extent of harm depends on the type and concentration of pollutants, duration of exposure and how an individual encounters the pollutant, as well as factors such as an individual’s age and whether they have existing health conditions. 

For children, exposure to indoor air pollution at the various stages of their childhood (birth and infancy, pre-school and school age) can cause: 

• respiratory problems: wheezing, rhinitis, allergies, asthma and coughs, risk of respiratory infections and diseases, and pneumonia
• slower development of lung function
• reduced cognitive performance
• eczema, dermatitis, conjunctivitis, and skin and eye irritation
• the start of atherosclerosis

Indoor pollutants such as PM2.5 and PM10 and NO₂ from gas cooking or heating can irritate the airways, exacerbate and trigger allergies and asthma, contribute to the development of COPD and increase the frequency and severity of respiratory infections. House dust mites, pet dander and mould (covered in more detail in a separate section) can irritate and trigger allergic reactions of the eyes, nose, throat and skin, leading to redness, itchiness, sore throat and runny or blocked noses. Poor IAQ has been associated with higher rates of hypertension, heart disease and stroke. Radon gas is the leading cause of lung cancer after smoking. 

At low levels, exposure to carbon monoxide can cause headaches, drowsiness, dizziness, chest pains, nausea and vomiting as well as cognitive impairments. At high levels, carbon monoxide poisoning can cause sudden collapse, loss of consciousness and death. There were around 25 deaths each year from accidental carbon monoxide poisoning in England and Wales from 2005 to 2023 (see Cross Government Group on Gas Safety and Carbon Monoxide Awareness).

There is growing evidence that poor IAQ affects mental health and cognitive outcomes. Pollutant exposure has been linked to poorer sleep, heightened stress and anxiety, and potential impacts on memory and attention. For children, who are still developing physiologically and spend large amounts of time indoors, exposure to indoor pollutants may contribute to adverse neurodevelopmental outcomes.

The health impacts of poor IAQ are not experienced equally. Children, older adults and people with pre-existing respiratory or cardiovascular disease are particularly susceptible to harm. People living in areas of higher pollution, such as close to busy roads or industrial sites, are also at increased risk of exposure to pollutants.

Socioeconomic inequalities also shape individuals’ exposure to air pollution. Lower-income households are more likely to live in smaller dwellings with inadequate ventilation, rely on cheaper and more polluting fuels or live in overcrowded homes where pollutant concentrations can accumulate to harmful levels more quickly. Urban or industrial areas with higher levels of outdoor pollution further compound these risks, disproportionately affecting deprived communities.

Coverage of IAQ in JSNAs

IAQ featured in 16% (24) of the 149 local council JSNAs reviewed. 

Of the 24 local councils that included content on IAQ, in many cases, its inclusion was limited.

Table 13: presence and placement of IAQ in JSNAs

Presence and placement - IAQ theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	10	42%
Theme included with some contextual information	5	21%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	9	37%

When JSNAs mentioned IAQ briefly without elaboration, this was typically in a single sentence - for example, a general statement about air quality in the home impacting health without any further detail.

A further 2 local councils included content on IAQ with some contextual detail of the theme’s importance but with minimal prominence within the JSNA. For example, one JSNA included the statement:

The linkages between poor indoor air quality and ill health, particularly CVD [cardiovascular disease], respiratory symptoms, sensory irritation, lung cancer and other cancers, are well established.

There were 9 local councils that featured IAQ in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Local councils in this category typically included aspects like sources of air pollution, vulnerable groups and specific health impacts, and it was typically included in chapters related to air quality, air pollution or the environment.

It should be noted that while there was limited coverage of IAQ in JSNAs, IAQ in the home may be represented in other relevant strategic documents for local councils, like air quality strategies, which were not reviewed for this report.

Only 3 local council JSNAs provided supporting data related to the IAQ theme. Those that did focused on a single data source (national data on deaths, A&E attendances and hospital admissions associated with carbon monoxide poisoning) or a single source of pollution (solid fuel). Some JSNAs acknowledged the lack of available national and local data on IAQ.

The lack of information on IAQ included by local councils may be attributed to the limited research and data available in this area. In England, there is no routinely collected information regarding indoor air pollution levels within residential settings, largely due to the resource-intensive nature of conducting comprehensive IAQ assessments in homes. As a result, data is generally derived from research studies that examine a limited range of pollutants in a small sample of homes over short time periods, offering only a partial view of concentrations and often lacking detailed information about occupant activities.

While predictive modelling could potentially address the challenges associated with resource-intensive data collection, its effectiveness is fundamentally limited by the diversity of indoor environments. Because homes vary so widely in their design, use and occupant behaviour, it is extremely difficult to define a ‘representative’ indoor setting that could serve as a reliable baseline for comparison. This lack of a standard reference point means that models struggle to capture the full range of IAQ conditions across the UK, meaning it would be difficult to build a comprehensive, quantitative understanding of current pollutant concentrations in homes or how these may change over time.

Table 14: analytical depth of reporting on IAQ in JSNAs

Analytical depth - IAQ theme	Count	Percentage
No analysis of the impact of the theme provided	2	8%
High level mention of impacts of the theme provided	14	58%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	6	25%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	2	8%

Of the JSNAs that provided analysis of factors that influence people’s exposure to air pollution, consideration was given to:

• location of the home - for example, proximity to traffic or industrial sites
• urban versus rural locations
• building characteristics
• health impacts
• vulnerabilities related to existing health conditions, age or both
• relationship between IAQ and deprivation
• compounding factors that increase people’s risk of experiencing poorer health outcomes due to air quality (such as poor quality housing and low income)
• research on IAQ and the development of health conditions and symptoms
• research on home interventions to reduce fine particulate matter exposure effects on health outcomes
• factors causing poor IAQ, including specific sources of particulate matter
• data on solid fuel usage, including analysis of why people use solid fuel

While some local councils covered multiple of these areas well, most included a very brief discussion of moderating factors and health impacts of poor air quality. However, it should be noted that several JSNAs referenced separate air quality implementation plans and strategies, which may have included information and actions to address poor IAQ in the home.

Coverage on IAQ in JLHWSs

Only 2 (1.5%) of the 145 local council JLHWSs included content on the IAQ theme.

Table 15: strategic integration of IAQ in JLHWSs

Strategic integration - IAQ theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	1	50%
Referenced specific interventions, schemes or governance to address the theme	1	50%

Of these 2 JLHWSs, one referred to specific interventions, schemes or governance planned to tackle IAQ, which indicated action to be delivered, though with less detail than for other themes. This was an intervention working with a local university on IAQ research projects.

Summary and recommendations

IAQ was among the least frequently mentioned housing risks in JSNAs, with most making no mention of IAQ. When it was included, coverage was often limited to a short reference without data or explanation of the health impacts. IAQ in the home is sometimes included in air quality plans and strategies but it should also be captured within JSNAs and JLHWSs, so that the information is visible to a public health audience.

There are opportunities for local systems to use JSNAs to provide a clear, evidence-informed picture regarding IAQ, including:

• who is affected
• where risks are concentrated (and why)
• what this means for the wider health and care system
• how vulnerable households can be targeted for support

To improve coverage of IAQ, a high-quality JSNA could include:

• a strong overarching narrative which frames the health risks of IAQ and the importance in addressing it. This should:
  • explicitly recognise IAQ as an important determinant of health which is distinct from outdoor air pollution, since many pollutants occur at higher concentrations indoors than outdoors and are linked to significant respiratory, cardiovascular, cognitive and developmental risks
  • make clear that poor IAQ is often a building-performance issue, but that there are also significant benefits to be had by raising public awareness in terms of what individuals can do to improve home ventilation and reduce exposure
  • reference the NICE guideline on IAQ in homes, which presents evidence on interventions for new and existing homes that can improve IAQ, as well as how to influence people’s knowledge, attitudes and behaviours regarding indoor air pollution
• interpretation of data from national and local sources to show where risk from poor IAQ is highest, including:
  • which dwellings increase vulnerability (based on gas safety, heating systems and appliance condition) and the relationship with inequalities, income and deprivation
  • reference to the fact that IAQ is chronically under-reported in JSNAs, often because dedicated local data is limited
  • reference to the lack of a single national data set providing information on IAQ in homes. However, several data sources offer relevant insights, including those listed in the resources section
• a description of opportunities to raise public and professional awareness (among households, landlords and health and social care professionals) about sources of indoor pollution, the health impacts of poor IAQ and the importance of ventilation. This could be supported by:
  • acknowledgement that health professionals and staff need to have an awareness of existing protections available to tenants
  • reference to chapter 5 of the health effects of climate change 2023 report, which highlights in particular that healthcare professionals should be aware of the interventions that could be recommended to patients with allergies and pregnant women
• a description of the ways in which IAQ intersects with cold homes, damp and mould, and retrofit works
• a description of how IAQ issues may be identified (for example, during housing inspections or fire service checks, or by health visitors)
• a description of interventions available address IAQ, as described in chapter 5 of the health effects of climate change 2023 report. These include controlling emission sources and applying ventilation
• acknowledgement of the role that the heating of homes has on indoor and outdoor air quality and that heating decarbonisation is an important part of improving air quality. JSNAs may identify where planning and building control departments can consider IAQ in new developments and increase awareness of the impact of retrofit schemes to avoid unintended harms

Trip and fall hazards

Overview

Trips and falls in the home are a leading cause of injury, loss of independence and premature mortality, particularly among older adults. Trip and fall hazards can include:

• structural issues such as uneven flooring, poorly maintained or overly steep staircases
• inadequate fixtures and fittings such as missing window restrictors, poor lighting or missing handrails
• environmental factors such as loose rugs or cluttered living spaces

Homes with inadequate adaptations for the occupants also present trip and fall risks. This is covered in the section on accessible housing. 

Unlike hazards such as cold homes or damp and mould, which primarily contribute to chronic health conditions, trip and fall hazards can have immediate health impacts. A single fall can result in fractures, head injuries or long-term disability. Health professionals can play a crucial role in identifying at-risk individuals, promoting home safety assessments and supporting interventions that reduce the incidence and impact of falls. 

Health impacts and inequalities

Falls are one of the leading causes of injury-related hospital admissions in England. In 2023 to 2024, there were over 200,000 emergency hospital admissions among people aged 65 and over attributed to falls (see Fingertips public health profiles falls indicators). Most of these incidents occur in the home, making domestic environments a critical focus for injury prevention.

The consequences of falls extend far beyond the initial injury. Hip fractures, for instance, are associated with a significant risk of loss of independence, as many patients do not regain their previous level of mobility, with many requiring long-term care. Furthermore, falls resulting in serious injuries such as head trauma or fractures are linked to increased mortality risk, particularly within the first year following the incident. 

Although anyone can experience a fall, older adults are disproportionately affected due to age-related changes in balance, muscle strength, vision and bone density. Chronic health conditions such as osteoporosis, arthritis, diabetes or neurological disorders like Parkinson’s disease further elevate the risk of falling and sustaining serious injuries. 

Children are also at higher risk, with trips and falls being the leading cause of unintentional injuries in the home for those under 5 years old. Young children are particularly vulnerable due to their developmental stage and natural curiosity, which often leads them into risky situations, such as climbing on furniture or stairs.

Falls are not purely a physical health issue: they are also a major driver of psychological consequences, including reduced confidence, social isolation and anxiety about continuing to live at home. The fear of falling again can lead to activity restriction and further functional decline. 

Falls risk and emergency hospital admission due to falls (and subsequent fractures) varies significantly across, and within, regions.

There are clear inequalities in exposure to trip and fall hazards. Evidence suggests that people living in rented or social housing, those on lower incomes and households in overcrowded accommodation are more likely to encounter environmental risks such as poorly maintained floors or stairs, lack of safety features like handrails, and cluttered or cramped living spaces. These factors compound the burden of falls on already disadvantaged groups, reflecting the intersection of age-related vulnerability and social and economic disadvantage.

Coverage of trip and fall hazards in JSNAs

Out of the 149 local council JSNAs reviewed, 34% (50) included content under the trip and fall hazards theme. 

Table 16: presence and placement of trip and fall hazards in JSNAs

Presence and placement - trip and fall hazards theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	16	32%
Theme included with some contextual information	30	60%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	4	8%

Where content on trip and fall hazards was mentioned briefly, this was typically in a sentence or 2 - for example, a figure on the cost of unaddressed fall hazards in the home to the NHS, a sentence on fall prevention or the risk of falls in the home or statistics on fall hazards in the home.

There were 4 local councils which featured trip and fall hazards in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Local councils in this category tended to include details such as:

• the number of hospital admissions due to falls in the home
• the cost of falls in the homes to society
• strategies to reduce falls in the home and resultant savings for society and the NHS
• vulnerable groups and high-risk properties
• hazards and health impacts

This information was mentioned in general housing documents but also in JSNAs on trips and falls, accidents and housing conditions, and a private rented sector impact assessment.

Table 17: use of data on trip and fall hazards in JSNAs

Use of data - trip and fall hazards theme	Count	Percentage
No supporting data of the theme provided	30	60%
National data provided with no local contextualisation of the theme	9	18%
National data cited with local contextualisation or local data is referenced from a single source for the theme	8	16%
Local data from multiple sources cited	3	6%

Of the 20 local councils that included trip and fall hazard data, the most common data cited was HHSRS category 1: fall hazards in the home. This was cited at both a national and local scale.

Some JSNAs included local and national data on hospital admissions due to falls in the home. The sources of data varied. One council reported statistics about ambulance service data, stating: “Most falls which the ambulance service attends happen at home (council =68%)” but did not provide the source of this information. Another council reported local data from a university trauma and injury intelligence group, which gave the number of A&E attendances recorded as relating to falls and the percentage of these recorded as occurring in the own person’s home.

There were 2 strong examples for ‘use of data’ where local councils had commissioned research from BRE. One included a health cost calculator which outlined the number of hazards in the home and the costs associated with falling on stairs, falling between levels and falling on level surfaces. Another had commissioned a private sector housing health impact assessment which looked at housing hazards relating to trip and fall hazards for the private rented sector, presenting the number of hazards, estimated number of instances requiring medical attention and costs to the NHS and society.

Table 18: analytical depth of reporting on trip and fall hazards in JSNAs

Analytical depth - trip and fall hazards theme	Count	Percentage
No analysis of the impact of the theme provided	7	14%
High level mention of impacts of the theme provided	31	62%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	10	20%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	2	4%

The JSNAs varied in their focus when analysing the theme of trip and fall hazards. It was most common for local councils to identify vulnerable groups and risk factors of falls in the home. Vulnerable groups identified included older people and children, with several JSNAs mentioning people with learning difficulties. A few JSNAs also considered deprivation as a risk factor, highlighting those living in more deprived areas as more likely to have multiple long-term conditions, a lower level of physical activity and poorer housing conditions, all of which contribute to increased risk of falls.

Poor housing quality was also included by some local councils as a risk factor for falls in the home - for example, clutter, lack of handrails, poor lighting, uneven flooring or rugs and generally a lack of suitable and accessible housing. A brief mention of cold homes increasing the risk of falls was also commonly included.

Several JSNAs explored the impact on health and social care, often citing estimated costs of unaddressed hazards to the NHS or highlighting that falls are the largest cause of emergency hospital admissions for older people in their local area. It was noted by some that falls are a major cause of individuals moving from their home into long-term nursing or residential care. One council broke down the typical health outcomes (quadriplegic, femur fracture, wrist fracture and treated cut or bruise) by the first-year treatment costs for trip and fall hazards in the home (falls on the level, falls on stairs and steps and falls between levels).

Some JSNAs also explored analysis of falls prevention interventions through home modifications, often citing research of the cost effectiveness. A strong example considered this by looking at the cost of mitigating fall hazards by tenure, including the average cost per dwelling and the cost of mitigating falls hazards in the home for the local population in the most deprived quintile of the population.

Coverage of trip and fall hazards in JLHWSs

Trip and fall hazards appeared in 10% (15) of all 145 local council JLHWSs reviewed.

Table 19: strategic integration of trip and fall hazards in JLHWSs

Strategic integration - trip and fall hazards theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	9	60%
Referenced specific interventions, schemes or governance to address the theme	6	40%

Nine JLHWSs did not include any strategic links or proposed actions in relation to trip and fall hazards. These examples gave general statements on the number of people who fall and the impact on individual health and the health service, or statements to highlight the opportunities of falls prevention in the homes, but gave no strategic links or actions.

There were 6 JLHWSs which referred to specific interventions, schemes or governance to tackle trip and fall hazards, including:

• promoting and increasing referrals to ‘health homes’ services, which include falls prevention among older people
• improving the provision and co-ordination of services to prevent and treat falls
• adapting homes to prevent the incidence or trips, slip and falls
• ensuring homes are safe, well and warm to decrease home accidents, including falls
• tackling risk factors for trips and falls in the home such as physical inactivity, poor hydration and nutrition, sensory impairment and home hazards, providing a focus for healthy ageing activity

These commitments were relatively vague in comparison with other themes and only one included any outcome measure, which was called ‘number of falls’.

Summary and recommendations

There are opportunities for local systems to use JSNAs to provide a clear, evidence-informed picture regarding trip and fall hazards, including who is affected, where risks are concentrated (and why), what this means for the wider health and care system and how vulnerable households can be targeted for support.

To improve coverage of trips and falls, a high-quality JSNA could include:

• a strong overarching narrative about trips and falls as significant risks to public health, particularly for older people and children
• interpretation of data from national and local sources to show:
  • where risk from trips and falls is highest
  • which dwellings increase vulnerability (based on local housing stock characteristics) and the relationship with inequalities, income and deprivation
  • the specific characteristics of local housing that increase risk from trip and fall hazards (or if limited data is available, general housing characteristics that increase risk)
• a clear description of how trip and fall hazards affect the health and care system, including identifying links with emergency hospital admissions
• acknowledgement of the critical role that health professionals can play in identifying at-risk individuals, promoting home safety assessments and supporting interventions that reduce the incidence and impact of falls

Space and design

The design and suitability of homes have a major influence on whether people can live healthy, safe and independent lives. Unlike ‘housing hazards’, these issues are less about acute risks and more about whether homes provide the conditions necessary for long-term health and wellbeing and social inclusion. Some aspects of space and design are determined by the National Planning Policy Framework, which sets out the government’s planning policies for England.

Housing quality

Overview

The overall design quality and liveability of a home significantly influence comfort, wellbeing and daily functioning. Features such as natural light, space, noise protection and access to outdoor spaces contribute to health and wellbeing. Health professionals can advocate for high-quality housing design, ensuring that homes support physical and mental health and meet the diverse needs of occupants. Good design can help to create buildings and places that are for everyone. It can help break down unnecessary physical and psychological barriers and exclusions caused by the poor design of buildings and places.

Health impact and inequalities relating to housing design quality and liveability include:

• noise
• light
• outdoor space

Noise

The scientific evidence supporting a causal link between noise and physical and mental health has increased and strengthened significantly in the past decade (up to 2026). It can, however, be difficult to disentangle the health effects from external versus internal noise sources, because noise can directly interfere with people’s enjoyment of external amenity areas (such as gardens and balconies) and because many people prefer to have open windows in warmer weather.

Exposure to excessive noise at home has been linked to a range of negative health outcomes, including increased stress levels, sleep disturbances and elevated risk of cardiovascular and metabolic conditions. Persistent background noise, whether from traffic, neighbours or internal household sources, can interfere with concentration and relaxation and impact mental health. For children, chronic noise exposure may affect cognitive development and educational attainment.

The health impacts of noise are not experienced equally. Neurodiverse people and people with pre-existing mental health conditions are particularly susceptible to harm. People living in areas of higher pollution, such as close to busy roads or industrial sites, are also at increased risk of external noise exposure. Socioeconomic inequalities also shape individuals’ risk of negative health outcomes from noise. Lower-income households are more likely to live in dense, overcrowded or poor-quality homes where noise can be a significant issue. They are also typically less able to invest in noise mitigation measures or to relocate to a quieter area, and those in rented accommodation are dependent on their landlords to listen to, accept and act on their concerns.

Quiet homes support restful sleep, promote relaxation and foster an environment conducive to both physical and mental recovery. As such, well-insulated homes that minimise noise intrusion from outside and from adjacent homes play a crucial role in safeguarding health and enhancing day-to-day comfort for all occupants. Priority should be given to situating homes within quieter neighbourhoods, away from major sources of environmental (such as transport) or neighbourhood (for example commercial, industrial or leisure) noise. When this is not possible, homes should feature good acoustic design (for example, ensuring at least one external wall facing a quiet street, courtyard or green space). Ventilation strategies should consider noise, IAQ and risk of overheating holistically rather than in isolation.

Light

Natural light plays a vital role in creating a comfortable and healthy home environment. Exposure to daylight is linked to numerous health benefits, including improved mood, better sleep quality and enhanced concentration. Homes that receive ample natural light often feel more spacious and inviting, supporting the wellbeing of their occupants. Conversely, homes that are dark or poorly lit can have negative effects, such as contributing to feelings of depression, reducing energy levels and making everyday tasks more difficult. Insufficient daylight can also impact physical health, exacerbating issues like eyestrain and disrupting natural circadian rhythms. In addition, dark homes may increase the risk of accidents and falls, particularly among older adults, by making hazards less visible. Therefore, ensuring that homes are designed to maximise natural light is essential for both physical and mental health, as well as overall quality of life. 

Outdoor space

Private outside space, such as a garden, balcony or patio, can also support health and wellbeing. Having direct access to an outdoor area enables individuals to spend time in fresh air and natural light, which has been shown to boost mood, reduce stress and improve sleep quality. A private outside space can encourage physical activity, whether through gardening or exercise. For children, it can provide a safe environment for play and exploration, supporting their development and overall wellbeing. Additionally, outside spaces offer opportunities for social interaction, relaxation and connection with nature, all of which are important for mental health. In densely populated or urban areas, the availability of private, quiet outdoor space can also help mitigate the negative effects of noise and overcrowding, providing a retreat for quiet reflection.

Coverage of housing quality in JSNAs and JLHWSs

A narrative summary of the inclusion of content related to housing quality is provided as only a small number of JSNAs and JLHWSs (6) included content relevant to this theme. 

Throughout JSNAs, housing quality is frequently referenced as important for health and wellbeing. However, there is typically little explanation of what aspects of housing quality are important for health and wellbeing. Where it is defined, this is usually in terms of the absence of hazards or references to basic standards, such as the DHS, a minimum standard of decency.

A few JSNAs explicitly acknowledged the significance of adequate internal space or access to outdoor areas, but without linking to proactive strategies to support this. One JSNA mentioned the use of a design panel to influence housing quality and another acknowledged that planning restrictions and conservation orders can impact the provision of homes, but these were rarely linked to broader health outcomes.

There was only a single example of a JSNA advocating for proactive design measures aimed at promoting health, rather than merely minimising risks. This was in relation to the Livewell accreditation standard.

Overall, the narrative across JSNAs suggests a prevailing emphasis on minimum requirements and hazard avoidance, rather than a holistic approach to designing homes that actively support long-term health, wellbeing and social inclusion.

Summary and recommendations

There are opportunities for local systems to use JSNAs to provide a clear, evidence-informed picture regarding housing design and its role in improving health and wellbeing. To improve coverage of housing design, a high-quality JSNA could include:

• discussion of the importance of design quality as a determinant of health, explicitly linking aspects such as natural light, noise levels, internal space, safety of layouts and access to outdoor environments with evidence on physical and mental health outcomes. This should:
  • include recognising the cumulative impacts of poor design - for example, how noise and insufficient daylight contribute to anxiety, low mood, sleep disruption and increased cardiovascular risk; how cramped or cluttered homes raise the likelihood of accidents; or how lack of private outdoor space affects children’s development, family wellbeing and opportunities for physical activity
  • be clear that housing quality contributes to inequalities, as poor design conditions are more likely to be experienced by lower‑income families, residents in temporary accommodation and those living in converted or high density housing
• interpretation of national and local data to provide an overview of local issues. While nationally consistent data sets on housing quality are limited, JSNAs should draw on available sources and use proxies if needed
• analysis of the drivers of poor housing quality and associated inequalities. This should include:
  • exploration of the structural and local drivers that shape housing quality, including the prevalence of poor‑quality conversions, high density development, limited planning enforcement capacity, older stock with inherent design limitations, housing affordability pressures that push residents into unsuitable homes, and constraints on access to outdoor space in some neighbourhoods
  • identification of the populations, tenures and dwelling types most affected, and consider how these intersect with existing inequalities (for example, age, disability, deprivation and ethnicity)
• a description of how housing quality is related to wider strategic agendas for the local area, including mental health, child development, healthy ageing, climate resilience, planning policy, social inclusion and neighbourhood development. This should also acknowledge potential interactions between housing quality and other housing themes such as overcrowding, IAQ, cold homes and overheating
• a description of how health professionals can advocate for high-quality housing design, such as:
  • using clinical evidence to contribute to development of local plans
  • responding to pre-application consultations with a health focus
  • partnering with communities to amplify lived experience
  • working with housing and planning organisations to develop health-based design checklists
  • using professional credibility to influence culture and narratives

Overcrowding

Overview

Overcrowding occurs when the number of occupants exceeds the space needed for safe and comfortable living and affects hundreds of thousands of households in England. Overcrowding is shaped by both the number of occupants in a home and by dwelling design. Even if formal overcrowding thresholds are not breached, small or poorly laid-out homes may still feel cramped, limiting privacy, personal space and opportunities for study, rest and other activities of daily life.

While overcrowding is formally recognised as a hazard in the HHSRS, in this report it is included as a theme because it is fundamentally about the fit between household needs and available space. It represents one of the clearest ways in which design and occupancy pressures intersect, with significant implications for both physical and mental health. 

In England, overcrowding is typically measured using the ‘bedroom standard’, described in the Housing statistics and EHS glossary. According to the EHS, the proportion of households living in overcrowded homes, as per this measure, has remained stable at 3% over the 10-year period between the 2013 to 2014 survey and the 2023 to 2024 survey. According to the 2023 to 2024 EHS, over 800,000 households were overcrowded and over half of those households (449,000) had at least one person with a health condition. The proportion of households containing an occupant with a health condition was higher among those living in overcrowded homes (55%) compared with those not in overcrowded homes (38%).

Health impacts and inequalities

The health impacts of overcrowding are wide-ranging. In terms of physical health, overcrowded homes increase the risk of infectious disease transmission, including respiratory infections such as influenza and tuberculosis, as well as gastrointestinal conditions. Crowded conditions also exacerbate the impact of damp, mould and poor ventilation, intensifying risks for asthma and other respiratory problems.

Mental health effects are also significant. Overcrowding is associated with higher levels of stress, anxiety and depression due to lack of privacy, disrupted sleep and higher risk of family conflict. Children living in overcrowded homes may struggle to find quiet space for homework or play, affecting educational attainment and wellbeing. Adults may experience strain on relationships and reduced opportunities for social participation.

Overcrowding disproportionately affects low-income households, families with children and ethnic minority groups. It is strongly linked to housing affordability pressures, particularly in high-cost urban areas. Households living in temporary accommodation are also more likely to suffer from overcrowding. The health burden of overcrowding therefore reflects both housing supply and wider socioeconomic inequalities. 

Coverage of overcrowding in JSNAs

Overcrowding appeared in 58% (87) of the 149 local council JSNAs reviewed. 

Table 20: presence and placement of overcrowding in JSNAs

Presence and placement - overcrowding theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	22	25%
Theme included with some contextual information	31	36%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	34	39%

Where overcrowding was mentioned briefly, this was typically a sentence or 2 of high level information, including some or all of the following:

• the number or percentage of households overcrowded in the local council
• a brief mention of the health impacts of overcrowding
• a description of those who are vulnerable to living in overcrowded conditions

There were 34 local councils which featured overcrowding in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Local councils in this category tended to include data on overcrowding, define overcrowding and its extent, and outline the health risks for different groups and the inequalities associated with overcrowding. This information was often spread across several documents in the JSNA, frequently in ‘housing’ JSNAs but also in JSNA annual summaries, housing quality documents and JSNAs dedicated to specific groups such as adults or children and young people. 

Table 21: use of data on overcrowding in JSNAs

Use of data - overcrowding theme	Count	Percentage
No supporting data of the theme provided	16	18%
National data provided with no local contextualisation of the theme	2	2%
National data cited with local contextualisation or local data is referenced from a single source for the theme	58	67%
Local data from multiple sources cited	11	13%

Of the 71 local councils reporting overcrowding data, the most common source was the English Census 2011 and 2021, which includes occupancy ratings and bedroom standards. The EHS was another common source of data. Local councils used this to provide data on the rate of overcrowding and breakdowns of overcrowding by tenure. Local councils also included overcrowding data from the English indices of deprivation housing domain, which measures levels of household density. Stronger examples used one or more of these sources to present local data.

Stronger examples also included breakdowns such as overcrowding data by ethnicity and tenure. One example included a local case study on overcrowding looking at an overcrowded HMO. Another looked at overcrowding using the bedroom standard, through a private sector house condition survey, looking into overcrowding as one of its sub areas. A few JSNAs provided local data on the number of households on the housing register who needed alternative housing due to being overcrowded in their current home.

Table 22: analytical depth of reporting on overcrowding in JSNAs

Analytical depth - overcrowding theme	Count	Percentage
No analysis of the impact of the theme provided	22	25%
High level mention of impacts of the theme provided	43	49%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	14	16%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	9	10%

High level mentions of the impact of the overcrowding theme included:

• a high level description of the link between overcrowding and deprivation
• the effects on physical and mental health outcomes such as the spread of disease, respiratory conditions, psychological distress and depression
• educational and mental health impacts on children

It was also common for there to be a high level mention of populations and tenures which experience a higher proportion of overcrowding.

Eight JSNAs provided a comprehensive analysis of 2 of more of those drivers and impacts listed above.

Examples of where JSNAs provided in-depth analysis included:

• detail on subpopulations most likely to be affected by overcrowding, with strong emphasis on children, ethnic minorities and people from a lower socioeconomic background
• comprehensive analysis of health impacts of overcrowding, referencing a variety of evidence reviews to do this
• description of housing affordability as a driver of overcrowding. Some JSNAs linked overcrowding to the risks and impacts of living in unlicensed HMOs

Coverage of overcrowding in JLHWSs

Overcrowding appeared in 12% (17) of the 145 local council JLHWSs reviewed.

Table 23: strategic integration of overcrowding in JLHWSs

Strategic integration - overcrowding theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	13	76%
Referenced the theme in local or regional housing strategies and/or public health action plans	1	6%
Referenced specific interventions, schemes or governance to address the theme	3	18%

There was one JLHWS which referenced overcrowding in local or regional housing strategies or public health action plans. This example said:

Local policies and planning should consider overcrowding in the allocation of social and public housing and review the appropriateness of current criteria for the number of people per home.

Three referred to specific interventions, schemes or governance planned to tackle overcrowding. One council committed to the establishment of an overcrowding commission, including a review to identify ways to mitigate the harmful health impacts of families living in overcrowded housing. Another committed to track a decrease in the number of overcrowded households as part of their strategy. The third council committed to “enable pregnant women, babies, and children to live in a safe and warm home environment which is not overcrowded.”

Summary and recommendations

There are opportunities for local systems to use JSNAs to provide a clear, evidence-informed picture regarding overcrowding, including who is affected, where risks are concentrated (and why), what this means for the wider health and care system and how vulnerable households can be targeted for support. To improve coverage of overcrowding, a high-quality JSNA could include:

• interpretation of data from national and local sources to show:
  • where overcrowding is most prevalent
  • the impacts on health and wellbeing (including for children’s development, mental health and infection prevention and control)
  • which dwellings increase vulnerability (based on local housing stock characteristics)
  • the relationship with inequalities, income and deprivation
• a clear description of how overcrowding affects the health and care system, including demand for primary and secondary care due to transmission of infectious diseases and exacerbation of long-term conditions
• identification of local driving factors for overcrowding, which:
  • may include inadequate supply, unaffordable housing, unsuitable properties, lack of accessible homes, household composition changes and housing insecurity
  • should be considered in the context of social housing waiting lists, housing allocations, temporary accommodation, local distribution of HMOs, patterns linked to household characteristics, demographic change, planning policy and provision of larger homes, lack of joined-up planning and public health input into new housing developments
• opportunities to work with planning and building colleagues on adopting the nationally described space standard in the local area

Accessible housing

Overview

Accessible and adaptable homes are critical for people living with disabilities, long-term conditions or reduced mobility to enable them to live safely, independently and with dignity. Accessible and adaptable homes can allow people with disabilities, mobility limitations, sensory impairments and long‑term conditions to manage their daily activities safely, reducing the need for formal care or residential settings.

A life course approach to housing means recognising that people’s housing needs change as they move through life, from childhood and family life to older age, illness or disability. It focuses on providing homes that are safe, adaptable and supportive at every stage, so people can live well, stay independent and avoid harm as their circumstances change. Thinking at the design stage about how a home will be used can overcome barriers experienced by some users. People’s needs, including the needs of disabled people, older people and families with small children, are often considered too late in the day. Demand for accessible housing is likely to increase with an ageing population living with increased multimorbidity and housing adaptations can be an important way of creating age-friendly environments and enable people to ‘age in place’ and recover from illness or injury without disruptive moves.

In England, Access to and use of buildings: Approved Document M (volume 1) is the building regulation in place describing features to ensure that people are able to access and use buildings and their facilities. However, the accessibility of any dwelling will depend on the individual occupant’s needs. Proposed changes to the planning system would ensure a national minimum of at least 40% of new housing being built to accessibility standards. 

Accessible housing, where homes are designed for occupants’ needs, may reduce the risk of trips and falls (described in the trip and fall hazards section) and allow people to be safely discharged from hospital. In addition to physical benefits, accessible housing may improve mental health and wellbeing by enabling people to move safely around their home, engage with family and community and maintain control over daily routines. More widely it may reduce health and social care costs.

It is important to acknowledge that while homes are a critical enabler of safe, independent living for many people with different needs, a range of other factors also affect individuals’ daily lives, such as the accessibility of their wider neighbourhood, including the built environment and transport infrastructure. This report focuses on housing specifically, but housing cannot be considered in isolation in the local context.

Health impacts and inequalities

There is a chronic undersupply of accessible housing, which disproportionately affects people with disabilities, older adults and low-income households. The EHS 2018: accessibility of English homes - fact sheet reports that only 9% of homes in England in 2019 had all 4 accessibility features that make it visitable for most people, including wheelchair users. The EHS 2019 to 2020: home adaptations report found that 1.9 million households in England had one or more people with a health condition that required adaptations to their home.

People who cannot access suitable housing are more likely to experience preventable ill‑health. Inaccessible homes create barriers to mobility, safety, self‑care and social participation, and long waiting times for adaptations and accessible homes can worsen inequalities.

An undersupply of accessible and adaptable housing can harm health by forcing disabled and older people to live in homes that increase falls and injury risk, reduce day‑to‑day functioning and make it harder to manage long‑term conditions safely at home. The WHO housing and health guidelines identify accessibility of housing for people with functional impairments as a major housing-related determinant of health. The Centre for Ageing Better’s Accessible Homes Factsheet 2025 describes regional inequalities in the presence of accessibility features in homes. People living on low incomes are less likely to be able to fund adaptations to, or relocation from, homes that are inaccessible or unsuitable.

Coverage of accessible housing in JSNAs

Accessible housing appeared in 35% (52) of the 149 local council JSNAs reviewed.

Table 24: presence and placement of accessible housing in JSNAs

Presence and placement - accessible housing theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	27	52%
Theme included with some contextual information	16	31%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	9	17%

Where content on accessible housing was mentioned briefly, this was typically in a single sentence - for example: “Appropriate housing adaptions and/or access to supported housing options can enable vulnerable residents maintain their independence and facilitate timely discharge from hospital”, but without any further mention of accessible housing within the JSNA.

There were 9 local councils which featured accessible housing in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Local councils that fell into this category tended to outline the scale of the issue, included local data relating to accessible housing, those affected and the impact of appropriate housing on health. This information was often included in ’ageing well’ or ‘older people’ JSNAs, learning disability needs assessments and general housing documents. 

Table 25: use of data on accessible housing in JSNAs

Use of data - accessible housing theme	Count	Percentage
No supporting data of the theme provided	33	63%
National data provided with no local contextualisation of the theme	5	10%
National data cited with local contextualisation or local data is referenced from a single source for the theme	13	25%
Local data from multiple sources cited	1	2%

The most common way for local councils to present data on accessible housing was through local data on Disabled Facilities Grants (DFGs) and adaptation statistics such as the number of adapted homes or the money spent by the local council on home adaptations each year. DFG data was used in a variety of ways by local councils. For example, one local council presented graphs on:

• the average cost of DFGs at completion
• DFG approvals and completion
• local council investment in aids and adaptations
• tenure of DFGs completed
• DFG age at time of approval
• DFG working days from receipt to completion

Another way that local data was sourced on accessible housing by local council was through resident surveys. One local council reported findings from both an older adults housing survey for residents and focus groups for older people to identify major needs and priorities in relation to the housing supply. Another local council used self-reporting to collect data, reporting in their JSNA that:

in 2020, 37% of people in [local council] reported that their housing was not accessible or only partially accessible, with considerable implications for their ability to live independently.

One local council referred to a review of disability accommodation needs for their area, sourced from a social care partnership commissioning data pack, to highlight the unmet adapted housing need for wheelchair users.

Table 26: analytical depth of reporting on accessible housing in JSNAs

Analytical depth - accessible housing theme	Count	Percentage
No analysis of the impact of the theme provided	9	17%
High level mention of impacts of the theme provided	27	52%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	9	17%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	7	14%

Those that gave a high level mention of impacts included statements outlining the health risks of living in homes with poor accessibility and a lack of accessible accommodation, including poor health and potentially life changing accidents. Older people and people with disabilities were often discussed as groups most affected by a lack of accessible housing. Some JSNAs also mentioned those with low income, those with a physical or mental health condition and large families. One council also mentioned people who are obese and another council highlighted that disabled children are least likely to be living in suitable housing compared with all other age groups of disabled people. Others linked home aids or adaptations to mitigating falls-related environmental hazards with improving quality of life for older people who are losing mobility.

Some local councils also gave a high level mention of the impact of accessible housing on health and social care, linking adaptations to supporting individuals to maintain independence and facilitate timely discharge from hospital with preventing and reducing care needs. One JSNA said:

national research suggests that good housing (including specific aids and adaptations) for people living with dementia can reduce or delay demand for health and social care services.

There were 9 JSNAs which included a more in-depth analysis of the theme by including detailed analysis of one of the following:

• local drivers
• impact on subgroups
• impact on health inequalities
• impact on health conditions
• impact on the health and social care system
• a brief mention of other factors

Seven of the JSNAs provided a comprehensive analysis of 2 of more of these drivers and impacts. 

The stronger analytical examples explored the impacts in more depth. Some broke down the groups affected by a lack of accessible housing and the impact this has on their physical and mental health and their day-to-day life. One local council, for example, gave a detailed account of the positive impact that accessible housing has for those with dementia. Another described in detail the impact on disabled people and their carers.

An example discussing the impact on older people and disabled people included the following:

For people with mobility issues, many aspects of life are improved by the provision of accessible homes and related support services. As people age, there is a greater risk of social exclusion, of loneliness and isolation, and mental health problems such as depression. Lack of suitable housing undermines an individual’s wellbeing and contributes to social isolation. For disabled people, and those with chronic illness or injury, lack of accessible housing limits choice and leads to them to reside where suitable accommodation is built, not where it is required - this often means being displaced from an existing social circle. Faced with unaffordable or unsuitable housing options, people are forced to move away from their social networks leading to, or exacerbating, social isolation and loneliness.

Some JSNAs discussed how an ageing population suggested there will be an increased need for accessible and adaptable housing, but with this comes an already existing undersupply and challenges with the cost. One council outlined as part of this that:

adapting an existing home to meet personal needs can present challenges, particularly in the private rented sector, due to short term tenancy agreements, poor conditions, and overcrowding.

The cost savings of accessible housing was also discussed by some.

Coverage of accessible housing in JLHWSs

Accessible housing appeared in 26 (18%) of the 145 local council JLHWSs reviewed.

Table 27: strategic integration of accessible housing in JLHWSs

Strategic integration - accessible housing theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	4	15%
Referenced the theme in local or regional housing strategies and/or public health action plans	1	4%
Referenced specific interventions, schemes or governance to address the theme	21	81%

Strategies addressing the theme typically included commitments to increase the number of accessible homes or promote home adaptability through means such as building regulations, working with planners and housing providers, and offering grants (including DFGs). There was often an emphasis on committing to enable people to live independently in their homes for longer.

Compared with some of the other themes, commitments to action on accessible housing in JLHWSs were quite general, providing more of an aim to promote accessible housing or increase the supply without an action plan or explicitly stating that progress would be monitored. For example, one stated the ambition of ‘housing to promote independence and accessible homes to all’ but with no further details.

Summary and recommendations

A high‑quality JSNA should recognise the critical role of accessible housing in preventing avoidable ill‑health, reducing inequalities, supporting timely hospital discharge and alleviating pressure on health and social care systems. To strengthen local strategic planning, JSNAs should:

• draw on national and local data sources to assess the scale and distribution of local need, with consideration of DFG demand, waiting lists for accessible homes, unmet need identified through social care assessments and the proportion of homes meeting basic accessibility criteria. As part of this, JSNAs could:
  • describe how unmet accessible housing need disproportionately affects certain vulnerable groups and may describe the impact of undersupply of accessible housing on discharge from NHS settings
  • conduct audits to understand whether existing adaptation schemes meet the needs of their population
• outline the impact of provision or lack of accessible housing on system flow, including:
  • delayed discharge
  • avoidable long hospital stays
  • premature moves into residential care
  • increased demand for domiciliary care
• describe existing support pathways in place to address unmet need, including adaptation services and handyperson schemes, and how these can be accessed. This might include:
  • consideration of how to strengthen referral and triage systems between health, social care, housing, hospitals and community partners
  • identification of opportunities to pool or align funding (for example, through the Better Care Fund) to provide consistent provision and reduce fragmentation between services
• identify relevance of accessible housing to other strategic priorities, including:
  • ageing well strategies
  • fall prevention
  • hospital discharge
  • planning and new build standards
• identify opportunities for workforce development for health, care and housing professionals on:
  • identifying accessibility needs
  • understanding disability rights
  • knowing what support is available locally
  • recognising when housing contributes to deteriorating health

Specialist and supported housing

Overview

For the purpose of this report, specialist and supported housing is defined as non-general needs accommodation designed for people with different or more complex support needs, including (but not limited to): 

• assisted living and extra care housing
• supported living (for example, for people with learning disabilities, mental health conditions or physical impairments)
• sheltered or retirement housing
• care leavers and young people’s supported housing
• housing for people experiencing domestic abuse
• housing for asylum seekers
• step-down accommodation (accommodation that people move into after leaving hospital when they are ready for discharge but not yet able to return home independently)

There are multiple and interchangeable definitions of what constitutes supported housing by national governments, local authorities, regulatory bodies, umbrella organisations and providers. Broadly, these fall within an overarching concept of supported housing being accommodation which is provided alongside care, support or supervision to help people with specific needs to live as independently as possible in the community.

A supported housing review was published in 2023 which presents the results of a large-scale study of the supported housing sector, aiming to understand the demographics, size and scope of the sector and forecasts demand and supply.

Homes England’s funding guidance provides further information on specialist housing for the purpose of government-funded housing programmes. Specialist housing is a broad category and there is wider variety in the provision of specialist housing. Ministry of Housing, Communities and Local Government (MHCLG) guidance on housing for older and disabled people says that local council “plans need to provide for specialist housing for older people where a need exists”.

The supported housing regulation government response also sets out the new requirements that will apply for supported housing based on the Supported Housing (Regulatory Oversight) Act 2023 which aims to:

• tackle a number of rogue providers in the sector who are taking advantage of a lack of regulation
• ensure that all residents receive good quality support in good quality accommodation

Specialist and supported housing can have substantial benefits to individuals’ physical and mental health and broader wellbeing. MHCLG has published a national statement of expectations for supported housing which makes recommendations for standards of accommodation, drawing from best practice examples.

Appropriate provision can reduce hospital admissions by ensuring that people with complex needs live in environments that are safe, stable and designed to support daily functioning. For those already in hospital, access to suitable accommodation is often a prerequisite for safe and timely discharge, helping to avoid prolonged stays and enabling people to recover in a setting that meets their needs.

Health impacts and inequalities

High‑quality specialist housing can also delay or prevent the need for long‑term residential care by enabling people to maintain independence for longer. Beyond physical health, specialist accommodation provides essential support for recovery from mental ill‑health, substance misuse, domestic abuse and other vulnerabilities, offering stability and tailored support that general needs housing cannot provide. However, demand for different forms of specialist and supported housing frequently outstrips supply, with marked disparities between the types of provision available and the needs of local populations. These gaps are compounded by geographical variation, with some areas facing acute shortages while others have limited or unevenly distributed provision. As a result, people with similar levels of need may experience very different health outcomes depending on where they live, reinforcing existing inequalities and limiting opportunities for independence, recovery and wellbeing.

One of the reasons for the lack of specialist and supported housing is that current social policy limits this accommodation type to those with the most complex needs and whose level of care is comparable to that of a care home in relation to the rent standard and guidance.

An undersupply of specialist and supported housing can have direct health harms by trapping people, many of whom are particularly vulnerable, in inappropriate settings and interrupting recovery. Research from the National Housing Federation on supported housing and hospital discharge found that a lack of supported housing is often a barrier to discharging patients from the NHS, conferring substantial costs on the health system and with adverse effects on the health and recovery of individuals. These impacts are unequally distributed, exacerbating health inequalities because the groups most reliant on specialist and supported housing are already at higher risk of poor health and socioeconomic disadvantage.

The government is working with housing providers to assess the scope for the delivery of specialised supported housing supply through the new Social and Affordable Homes Programme, which has been designed to be flexible to support a greater diversity of supply.

Coverage of specialist and supported housing in JSNAs

Specialist housing appeared in 45% (67) of the 149 local council JSNAs reviewed. 

Table 28: presence and placement of specialist housing in JSNAs

Presence and placement - specialist housing theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	30	45%
Theme included with some contextual information	24	36%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	13	19%

Where content on specialist housing was mentioned briefly, this was typically a sentence:

• providing statistics - for example, “in [local council] 71% of adults in contact with secondary mental health services lived in stable and appropriate accommodation, higher than the England average of 58%”
• highlighting the need for specialist housing and providing no or only a brief mention of health impacts - for example, “Poor or unsuitable housing is a major public health risk contributing to care needs, and addressing this, for example by specialist housing and adaptations, can prevent and reduce care needs” 

There were 13 local councils which featured specialist housing in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Local councils that fell into this category tended to outline the local specialist housing offer, and highlight gaps and issues, using local data to support this. The health impacts of appropriate and inappropriate accommodation and groups in need were often included. This information was often included in a specific JSNA on specialist housing or supported accommodation or given prominence in housing chapters or learning disability needs assessments. 

Table 29: use of data on specialist housing in JSNAs

Use of data - specialist housing theme	Count	Percentage
No supporting data of the theme provided	38	57%
National data provided with no local contextualisation of the theme	1	1%
National data cited with local contextualisation or local data is referenced from a single source for the theme	20	30%
Local data from multiple sources cited	8	12%

Local councils often included data from a variety of sources on the current numbers and proportions of people living in specialist housing. One local council used data provided by their adult care services to provide the numbers of people in specialist housing but also broke this down by many factors including:

• the number of placements by type and year
• the number of individuals by age in supported accommodation by year
• the proportion of accommodation placements by type and ethnicity
• the number of supported accommodation placements by gender and type
• the number of people in supported accommodation by district

Some took this further and projected future need. For example, a local council used their housing and economic development needs assessment data where they estimated the numbers of additional specialist dwellings for older people in the local council over the years from 2011 to 2036 and displayed this on a graph.

It was also common for local councils to give quantitative data on the rate of stable and appropriate accommodation compared with inappropriate and unstable accommodation. Groups included:

• adults with learning disabilities
• people with mental health needs
• older people
• autistic adults
• care leavers
• vulnerable cohorts - for example, domestic abuse survivors

Sources for this data included NHS data, Office for Health Improvement and Disparities (OHID) Fingertips public health data and local council adult social care data.

Some local councils also measured their provision and quality of specialist housing compared with England and regional averages. Others included housing stock and market intelligence, looking at gaps in supply, condition of existing stock and community assets.

Of the JSNAs that included data on specialist housing, some included qualitative data - for example, local consultations to identify important issues (such as accommodation suitability, unmet needs and barriers to independent living). Feedback on lived experiences and perspectives of specialist housing also consisted of stakeholder workshops and resident questionnaires.

Table 30: analytical depth of reporting on specialist housing in JSNAs

Analytical depth - specialist housing theme	Count	Percentage
No analysis of the impact of the theme provided	11	16%
High level mention of impacts of the theme provided	36	54%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	14	21%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	6	9%

In terms of analysis, JSNAs included discussion of the supply and demand gaps for specialist housing. Some local councils discussed a significant shortfall in specialist housing, including for the increasing ageing population, those with learning disabilities and autism who have few alternative options, and also those with mental health housing needs.

In terms of health outcomes, local councils often outlined how poor and unsuitable housing contributes to higher hospital admissions, worsening mental health and delayed hospital discharge. Positive impacts outlined included improved independence and wellbeing through supported living, reduced demand for acute and residential care and lower rates of social isolation where housing schemes included social support. Financial and system pressures were discussed by local councils, including the high costs of care and pressures on local council budgets.

A strong example came from a local council’s ‘adult supported living and accommodation-based care JSNA’. This example provided a comprehensive analysis of contextual factors, including legislation, the national picture of demand, and cost and challenges. It also included a detailed section on causes and risk factors, which identified population groups at an increased risk for requiring specialist accommodation and some of the demographic and economic factors that may contribute towards the increased risk, including age, disability, ethnicity and deprivation.

Coverage of specialist and supported housing in JLHWSs

Specialist housing appeared in 12% (17) of the 145 local council JLHWSs reviewed.

Table 31: strategic integration of specialist housing in JLHWSs

Strategic integration - specialist housing theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	1	6%
Referenced specific interventions, schemes or governance to address the theme	16	94%

Commitments made in JLHWSs included:

• improving the provision of, and access to, specialist housing available and providing a variety of suitable and quality options for those with specialist needs and the ageing population. For example, one JLHWS stated: “We will… Facilitate quality, choice, and diversity of housing for people with care and support needs to achieve a proportional move towards maximising independence for working-age adults”
• using a joint protocol across partners and guidance from frameworks, such as a local housing framework
• undertaking a review to understand current and future specialist housing needs to match demand with the right supply and greater choice

Commitments usually included an emphasis on taking these actions to enable people to live well at home or independently and reduce the need for longer term care.

There was only one example which explicitly mentioned an indicator to monitor progress, which was extra care housing built.

Summary and recommendations

A high‑quality JSNA should recognise the critical role of accessible housing in preventing avoidable ill‑health, reducing inequalities, supporting timely hospital discharge and alleviating pressure on health and social care systems. The review identified substantial variation in how specialist housing is described across JSNAs and JLHWSs. To strengthen local strategic planning, JSNAs should include:

• best practice set out in the national statement of expectations for supported housing to assess local need
• a clear narrative on health impacts, describing how specialist and supported housing:
  • prevents ill‑health
  • reduces admissions
  • supports safe discharge
  • stabilises mental health
  • supports recovery from substance misuse or domestic abuse
  • promotes longer‑term independence
• interpretation of local and national data to describe demand, unmet need and projected future need for specialist and supported housing. This should:
  • include data from adult social care, learning disability and autism registers, mental health services, homelessness data, housing registers and any local assessments of supported or extra‑care housing need
  • analyse inequalities and which groups are most affected by gaps in provision
• an overview of the local specialist housing landscape, identifying what accommodation is available, where it is located, its quality, its alignment with need and any gaps between demand and supply. This should include recognition that different models of specialist housing are not always described consistently, making it harder to assess provision and ensure quality
• a description of system impacts, including how insufficient specialist housing contributes to:
  • delayed discharge
  • avoidable acute admissions
  • increased social care demand
  • higher costs for the NHS and local councils

Through the Supported Housing (Regulatory Oversight) Act, local councils will be required to produce supported housing strategies to assess current and future need for supported housing in their area. The strategies will assist local councils and housing providers with long-term planning and delivery to meet demand.

Affordability, availability and security

Even when homes are physically safe and well designed, their benefits are only realised if people can access them, afford to move in, stay there and maintain them. Affordability, access and housing security are therefore critical determinants of health. Without secure, affordable housing, households face instability, financial stress and the risk of homelessness. This section covers the themes of housing affordability and temporary accommodation.

Housing affordability

Overview of the theme

Housing affordability is a critical determinant of health and wellbeing. When housing costs are high compared with income, households are exposed to a range of material and psychosocial stressors that shape both immediate and long‑term health outcomes. Affordability pressures can also lead to housing insecurity, specifically having to move home frequently, not out of choice.

High housing costs can create persistent financial pressure, leaving households with limited disposable income after rent or mortgage payments have been made. This strain is closely associated with increased stress, anxiety and depression. Households may be forced to make difficult trade‑offs between paying for housing and meeting other basic needs, such as food, heating, childcare, transport and healthcare. Over time, this chronic strain can reduce financial resilience, exacerbate existing health conditions and increase the risk of mental health problems.

When a substantial proportion of income is spent on housing, households may struggle to afford essentials that directly support health. These include nutritious food, adequate heating, necessary medications and participation in social or physical activities. For families with children, these financial constraints can affect healthy development, educational participation and opportunities for play and socialisation.

Health impacts and inequalities

Affordability pressures intersect with wider inequalities - including income, ethnicity, disability, household composition and tenure - meaning that the health impacts of unaffordable housing are disproportionately felt by groups already experiencing disadvantage.

National Institute for Health and Care Research (NIHR)-funded research exploring the impact of housing insecurity on the health and well-being of children and young people found various negative physical and mental health impacts associated with housing insecurity, which may be heightened by conditions such as escaping domestic violence and migration status.

Affordability pressures often force households into the lowest‑cost segments of the market, where homes are more likely to be overcrowded, poorly insulated, affected by damp and mould, or lacking adequate ventilation.

Coverage of housing affordability in JSNAs

Housing affordability appeared in 77% (115) of the 149 local council JSNAs reviewed. 

Table 32: presence and placement of housing affordability in JSNAs

Presence and placement - housing affordability theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	21	18%
Theme included with some contextual information	51	44%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	43	37%

Where housing affordability was mentioned briefly, this was typically a brief outline, or a mention of affordability data with little to no elaboration on the health impacts, for example:

Nationally the demand for affordable housing is rapidly increasing and pressures on housing services are being seen across the country. The lack of affordable housing continues to add to housing pressures in the borough with the ratio of house prices to full time earnings increasing.

There were 43 local councils which featured housing affordability in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Local councils in this category tended to:

• provide a comprehensive overview of the influence of housing affordability on health
• provide multiple housing affordability figures
• describe the housing affordability local need
• comment on factors contributing to availability of affordable housing

This information was often included as a subsection in housing chapters, as part of ward profiles or in overarching JSNA summaries.

Table 33: use of data on housing affordability in JSNAs

Use of data - housing affordability theme	Count	Percentage
No supporting data of the theme provided	21	18%
National data provided with no local contextualisation of the theme	1	1%
National data cited with local contextualisation or local data is referenced from a single source for the theme	55	48%
Local data from multiple sources cited	38	33%

It was common across JSNAs for house price data to be included. This was typically sourced from ONS house price statistics or HM Land Registry price paid data. Data presented often included median house prices, house price trends over time and average house prices by dwelling type.

Housing affordability ratios were another common data type to be included across JSNAs. These are typically defined as median house price divided by median annual earnings. These were often used to:

• compare regional ratios
• highlight affordability trends
• highlight pressures on lower-income households

An example using a regional comparison included the statement: “in 2020, the median ratio of house prices to resident earnings in [local council] was 18.66. This is higher than the value for London at 11.78.”

Another data type included was rental price data, often sourced from ONS private rent statistics. Data included monthly rents, median and lower-quartile rents, rent increases over time and rent to income or percentage of income spent on rent.

Some local councils used income and earnings data from the ONS annual survey of hours and earnings to calculate housing affordability, demonstrate low-income vulnerability and identify gaps between wage growth and house price growth.

Some local councils also included data on the supply of affordable housing in their JSNAs. This included:

• annual affordable housing completions
• net affordable housing need
• estimated current deficits
• the proportion of new developments required to be affordable

The English indices of deprivation ‘Barriers to Housing and Services’ domain data was also cited to reflect housing affordability.

Table 34: analytical depth of reporting on housing affordability in JSNAs

Analytical depth - housing affordability theme	Count	Percentage
No analysis of the impact of the theme provided	34	30%
High level mention of impacts of the theme provided	58	50%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	17	15%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	6	5%

Drivers of housing affordability discussed across JSNAs included:

• house prices rising faster than incomes
• rising private rents and insufficient housing allowances
• a shortage of social and affordable homes
• high land and construction costs
• local population growth outpacing housing supply

Some local councils also discussed issues such as the expansion of tourism and second homes, a shortage of mid-sized and family homes, and mortgage interest rate increases.

Across JSNAs, the impact of housing affordability on a wide range of population groups was described. This included:

• low-income households (often identified as the most severely affected)
• young adults and first-time buyers
• single-parent families
• private renters
• people with disabilities or complex needs
• key workers
• people at risk of homelessness

Impacts of housing affordability discussed by local councils included:

• the mental health impacts of unaffordable housing, with stress, anxiety and depression linked to unaffordable housing in many JSNAs
• the physical health impacts of unaffordable housing. Local councils discussed how unaffordable housing forces people into poor quality, overcrowded and cold homes with corresponding adverse health outcomes as described in previous sections of this report
• worsening affordability being linked to an increased risk of homelessness and insecure housing, including hidden homelessness, insecurity of tenure and temporary accommodation
• financial hardship and poverty, with high housing costs pushing households into or deeper into poverty, limiting remaining income for essentials (such as heating, food, childcare and transport)
• community stability and cohesion, with several local councils discussing how families needing to relocate to cheaper areas may lose social networks
• system level pressures such as increased demand for council housing, temporary accommodation and social care support. Pressures on planning, health services and regeneration strategies due to rising housing need were also noted

This excerpt from one particularly strong example shows how rural housing affordability was described in one JSNA:

Affordability and a lack of affordable and social housing is seen by many as a key issue for rural X. Large areas of the county fall within the Green Belt, Areas of Outstanding Natural Beauty and Areas of Special Scientific Interest, many settlement areas are subject to conservation area regulations and land prices are high which drives up the cost of housing in rural areas.

Being within easy reach of London makes many of the villages an ideal choice for commuters; house prices are cheaper than London, while salaries in London are higher, this means local people on a median salary are finding it increasingly difficult to afford the current housing market. This together with the loss of council homes under Right to Buy, and the increased cost of private renting leaves some people with little choice but to move away, continue living at home with relatives or remain in the expensive and insecure private rented market. This impacts people feeling secure in their homes and feeling part of the wider community.

Creating affordable housing also has an economic benefit with the economy being boosted by £1.4 million and generating £250,000 in government revenue for every ten houses built.

Needs of specific groups: age: Nationally, young people are one of the worst groups being hit by the cost-of-living crisis and its impact on housing as mortgage rates increase making it harder to own your own home and landlords pass on the increase to renters. Affordability is a growing national issue and the situation is particularly pronounced for young graduates and professionals.

Coverage of housing affordability in JLHWSs

Housing affordability appeared in 34% (49) of the 145 local council JLHWSs reviewed.

Table 35: strategic integration of housing affordability in JLHWSs

Strategic integration - housing affordability theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	19	39%
Referenced the theme in local or regional housing strategies and/or public health action plans	3	6%
Referenced specific interventions, schemes or governance to address the theme	27	55%

JLHWS typically included high level outlines of the data, issues and local context regarding housing affordability. Of those JLHWSs that described delivery plans, the majority described an aim to increase the supply and quality of, or improve access to, affordable housing. Some also outlined that they would do this by working collaboratively and supporting existing partnerships, for example: “We will continue to work with housing providers and the private sector to deliver new affordable homes and tackle homelessness.”

Others also aligned their commitments to deliver on affordable housing through existing local plans, housing strategies or council schemes.

One council mentioned building on their ‘rent it right’ model and the collaborative approach between the local council and private landlords to develop opportunities to provide good quality, affordable accommodation. Another JLHWS included a commitment to ‘support schemes that provide good quality, warm and affordable housing’, and another committed to influence the housing strategy to increase affordable homes. One particularly strong example had a goal relating to increasing the supply of affordable housing and included:

• introducing an ‘affordability standard’ for future housing provision, alongside increasing council-owned affordable rental properties
• using development management, the housing strategy and the local plan to deliver a minimum provision of 35% of new residential developments to be affordable
• ensuring that the local plan would identify major development sites that can deliver 10 or more additional homes and set targets for the mix of units in terms of type, size and tenure (including first, key worker and affordable homes)
• ensuring residents would have access to a range of affordable new build homes, prioritising housing for people with an established connection to the local area

Few local councils mentioned explicitly how they would monitor progress, but those that did included monitoring the proportion or number of affordable homes built or available.

Summary and recommendations

Improving housing affordability is central to reducing health inequalities, supporting financial resilience, and enabling households to access safe, secure and suitable homes. To strengthen local strategic planning, JSNAs should include:

• an evidence-based description of local affordability pressures, including:
  • scale and distribution
  • breakdown by tenure and demographic factors
  • assessment of intersection with other vulnerabilities
  • consideration of gaps in local intelligence
• an assessment of opportunities for collaboration between housing and planning teams and public health teams. This could include:
  • identifying where affordability considerations may be embedded into local plans, housing strategies and regeneration policies
  • using data on population health outcomes in JSNAs to influence decisions about where affordable homes should be prioritised
• a description of cross‑sector referral mechanisms between healthcare providers, welfare advice services, homelessness prevention teams and housing support services. This should recognise the role that frontline professionals (health, housing, social care and voluntary sector) have in identifying when affordability issues are affecting health and referring people for advice and assistance

Temporary accommodation

Overview of the theme

Temporary accommodation (TA) refers to housing provided by local councils for households who are homeless and owed a statutory duty under homelessness legislation. It should be noted that, as described in annex A, homelessness more broadly was out of scope for this report. TA includes bed and breakfast accommodation, hostels and other types of social and private sector accommodation. TA is intended to provide short-term relief while longer-term housing solutions are secured, but in practice many households spend extended periods in temporary settings due to shortages of affordable long-term housing. The MHCLG tables on homelessness show that as of June 2025, over 172,000 children were living in TA in England alone.

The use of TA has risen significantly in recent years. While TA fulfils a critical statutory function, it is often poor quality and can present distinct health risks, particularly when it is overcrowded, poorly maintained or located far from family, schools and support networks. The Child poverty strategy and the National plan to end homelessness both describe government action to improve the quality of TA and prevent homelessness.

Health impacts and inequalities

The child poverty strategy recognises living in TA as a deep form of poverty.

Living in TA is associated with a range of negative health outcomes. TA is often some of the poorest quality housing and properties are often small with limited basic facilities, meaning residents are at increased risk of illness and accidents and have reduced opportunities to carry out daily activities. The instability of frequent moves between placements can disrupt continuity of healthcare, education and support services, exacerbating existing health conditions. 

The cross-party housing, communities and local government committee ‘Child mortality in temporary accommodation’ report shows that TA was also identified as a factor in the deaths of 74 children between 2019 and 2024, 58 of whom were under the age of one.

Families in TA often report high levels of stress, anxiety and depression linked to insecurity, stigma and lack of control over their living environment. Children in TA are at particular risk of disrupted routines, reduced opportunities for play and learning, behavioural difficulties and poorer educational outcomes. For further information, see:

• the Children’s Commissioner report ‘Bleak houses’ which showed that families in TA report high levels of stress
• the UK Parliament housing, communities and local government committee report on children in temporary accommodation which concludes that TA is often unsuitable and harmful for many families, with impacts on children’s health, development and safety
• Homes England’s analysis of the wellbeing impacts of temporary accommodation which shows that living in TA is associated with significantly worse wellbeing outcomes
• Shelter’s research on the use of temporary accommodation which found that families are often living in TA for prolonged periods, which harms children’s development, wellbeing and life chances

The child poverty strategy states:

The government will introduce a temporary accommodation notification system, where local housing authorities would notify educational institutions, health visitors and GPs when a child is placed in temporary accommodation. This would enable health and education providers to respond appropriately to support children experiencing homelessness and mitigate the harmful impacts of living in temporary accommodation.

The strategy also says:

We will strengthen protections against poor housing conditions in temporary accommodation, and ensure that families in temporary accommodation are proactively contacted by health services. We will introduce a clinical code for children in temporary accommodation to improve data on accidents and admissions to better identify and prevent incidents.

Low-income households, lone parents and ethnic minority groups are disproportionately represented in TA.

Coverage of TA in JSNAs

TA appeared in 58% (86) of the 149 local council JSNAs reviewed. 

Table 36: presence and placement of TA in JSNAs

Presence and placement - TA theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	26	30%
Theme included with some contextual information	36	42%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	24	28%

Where TA was mentioned briefly, this was typically a general sentence on the rate of households in TA within the local council, with an accompanying graph, or general statements like ‘temporary accommodation is a risk to health’.

There were 24 local councils which featured TA in their JSNA as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Local councils in this category tended to provide:

• an outline of what TA is
• local council duties with regard to TA
• data on TA and trends
• the health impacts of living in TA
• impacts on children or other groups specifically identified as vulnerable

This information was often included in chapters on housing and homelessness, mental health or specific groups such as adults or children and young people.

Table 37: use of data on TA in JSNAs

Use of data - TA theme	Count	Percentage
No supporting data of the theme provided	13	15%
National data provided with no local contextualisation of the theme	1	1%
National data cited with local contextualisation or local data is referenced from a single source for the theme	59	69%
Local data from multiple sources cited	13	15%

A common national source was MHCLG’s statistics on homelessness. From this, local councils included local data on the number of households in TA and the types of TA that residents were living in. The Fingertips public health profiles indicator on households in TA was also commonly included in JSNAs.

Some local councils also used their own housing services administration data. This included data such as:

• the number of households in TA
• length of stay in TA
• demographics of households in TA
• location of TA placements
• numbers of children in TA
• causes of homelessness

A few local councils also included data from surveys or audits. For example, one used a domestic abuse needs assessment to quantify families needing safe TA.

Table 38: analytical depth of reporting on TA in JSNAs

Analytical depth - TA theme	Count	Percentage
No analysis of the impact of the theme provided	33	38%
High level mention of impacts of the theme provided	36	42%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	13	15%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	4	5%

The depth to which TA was analysed across JSNAs varied, with a range of drivers, impacts and subpopulations discussed.

Drivers of TA use discussed included the housing market, shortages of affordable housing, high private rental costs and limited social housing availability, poverty and cost of living pressures. Some local councils discussed health, family and social circumstances such as family breakdowns, and young people leaving care and lacking independent housing options.

Impacts of TA discussed included:

• physical health, with living in TA being associated with higher rates of respiratory infections, skin conditions and accidents and injuries in children
• mental health, linking stress, anxiety and depression with TA due to instability and frequent moves. Living in TA also disrupts routines, creating a lack of privacy and poor sleep
• adverse effects on children and young people, including delayed development for babies, missed vaccinations and barriers accessing healthcare, poor education attainment and risk of behavioural problems and social isolation
• social and economic impacts, including inability to work due to instability, increased public sector costs, reduced community connection when placed out of area, and difficulty accessing support services when moved frequently

Populations affected which were often discussed across JSNAs included:

• families with children
• single adults
• people experiencing domestic abuse
• asylum seekers and refugees
• people with disabilities or long-term conditions
• young people and care leavers
• ethnic minority groups
• people with complex needs

A strong example:

• highlighted why the issue of TA is important (including the impacts)
• gave the local content for their council (including the numbers in TA and the groups living in TA)
• discussed the inequalities relating to TA in their locality (including by age and accommodation type)

Coverage of TA in JLHWSs

TA appeared in 19% (27) of the 145 local council JLHWSs.

Table 39: strategic integration of TA in JLHWSs

Strategic integration - TA theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	15	56%
References national policies or government objectives but nothing locally specific	1	4%
Referenced the theme in local or regional housing strategies and/or public health action plans	1	4%
Referenced specific interventions, schemes or governance to address the theme	10	36%

One JLHWS referenced TA in a local or regional housing strategy or public health action plan. This was done by linking in the local homelessness prevention strategy which included TA provision.

Of the 10 JLHWSs that referred to specific interventions, schemes or governance to address TA, commitments on TA tended to be high level, focusing on reducing the number of residents, households, children or families in TA. As well as this, one council included an outcome to reduce or eliminate the use of bed and breakfast accommodation as temporary housing.

One council included the commitment to deliver ”appropriate and timely support - for example, by reducing out of area TA placements and time in TA.”

Another local council gave the numbers of people in TA and included a commitment to reduce these numbers by 10% per year. Other local councils reported plans to measure success by reducing the numbers of households in TA and the number of children and families in TA.

Summary and recommendations

Given the scale of TA nationally and the increasing number of families with children living in unstable and often poor‑quality accommodation, local systems have an important opportunity to strengthen their assessment of, and response to, this issue. To support this, JSNAs should:

• describe the scale, distribution and characteristics of TA in the local area, ensuring clarity on how long households are typically placed, the quality of provision and the health implications of placements, especially for children and other vulnerable groups
• map out local pathways, including how individuals move into, through and out of TA, to identify opportunities for more coordinated support, earlier intervention and improved referral routes between housing, public health, social care, primary care and the voluntary sector. More targeted actions and monitoring can be supported by local intelligence on quality of TA settings, common hazards, household compositions and length of stay
• acknowledge the relevance of TA to other local strategic agendas, including child health and safeguarding, mental health, homelessness and rough sleeping and local housing and planning policy. JSNAs may also highlight local implications of national policy such as the child poverty strategy and the national plan to end homelessness

Housing stock characteristics

This thematic cluster focuses on how well local councils understand the physical condition of their housing stock and housing standards locally.

Dwelling characteristics

Overview of the theme

England’s housing stock is highly diverse, ranging from pre-war terraced housing to post-war estates and new-build developments. Understanding the characteristics of local housing stock is therefore essential to identifying where hazards are likely to occur, which groups are most affected and how housing interacts with wider health inequalities. Without this baseline knowledge, local councils cannot effectively target interventions or anticipate emerging risks. JSNAs should include this information and JLHWSs should acknowledge housing stock intelligence as essential to understanding public health risks. Some local councils commission modelling of their housing stock enabling them to understand prevalence of hazards at the level of individual dwellings.

Listed buildings and homes in conservation areas present distinct challenges for improving housing quality and tackling cold, damp, mould and other hazards. Their historic fabric, planning constraints and higher retrofit costs mean that essential adaptations - such as insulation, ventilation improvements or energy‑efficiency measures - may be technically difficult, financially prohibitive or refused through planning processes. As a result, households living in these older properties may be disproportionately exposed to cold, poor IAQ and associated health risks, with limited ability to modify their homes to mitigate these issues. Recognising these constraints is important for understanding local patterns of vulnerability and for designing realistic, place‑sensitive approaches to improving housing conditions.

There are strong links between stock characteristics and risks such as excess cold, damp and mould, overheating, falls, poor IAQ and accessibility barriers, described in other sections of this report.

Health impacts and inequalities

Different housing types present different health challenges. For example:

• older homes may be prone to damp, mould or excess cold
• high-rise blocks may increase risks linked to overheating or accessibility
• converted properties may pose hazards related to fire safety or natural light

Risks arising from different dwelling characteristics are not distributed evenly. People living in older housing stock, in the private rented sector or in low‑income households are more likely to experience poor dwelling conditions and to face barriers to resolving them.

Areas with concentrations of older, energy‑inefficient properties often exhibit higher rates of excess cold, damp and disrepair. Poor‑quality conversions and HMOs can present particular concerns, including inadequate fire safety, lack of natural light and ventilation, and structural or overcrowding risks. These conditions disproportionately impact groups already vulnerable to poor health, including older adults, disabled people, people with long‑term conditions, ethnic minority communities and families living in insecure or low‑cost accommodation. As a result, inequalities in dwelling characteristics translate directly into inequalities in health outcomes, healthcare demand and wellbeing.

Coverage of dwelling characteristics in JSNAs and JLHWSs

Dwelling characteristics appeared in 35% (52) of the 149 local council JSNAs reviewed. Of these, 43 included local data relating to dwelling characteristics. Out of the 145 JLHWSs, a small minority (3.5%, 5) included dwelling characteristics. 

A narrative summary of content related to dwelling characteristics has been provided, as JSNAs included little analytical depth on this theme, and very little content was included across JLHWSs.

Most of the JSNAs that included the theme dwelling characteristics provided data on dwelling counts by type, using data from ONS, the Census and the Valuation Office Agency (VOA). Some local councils took this further by comparing accommodation type to different age groups and tenures. Others also included ONS data on households by number of rooms.

There were also multiple JSNAs including dwelling age, using data from VOA to show dwellings by age. One JSNA stated:

Like many rural areas, [local council] has high proportions of older and larger homes. As of 2024, an estimated 26% of all dwellings were built before 1900, compared to 15% in England as a whole.

Some went further, linking property age with different issues - for example, linking disrepair in the local area to older housing stock or associating older housing stock with energy inefficiency.

Data on heating systems was also included across quite a few of the JSNAs. This tended to be central heating data from the census, for example:

The most common heating system (61%), is a gas fired boiler and radiator system; 13% of properties are heated using an oil boiler and radiators; 11% are heated using electric storage heaters.

Linked to this there were also some mentions of, and data provided on, houses with insulation. One local council noted a high level association between poorly insulated housing and excess winter deaths.

Of the 5 JLHWSs that included dwelling characteristics, all gave very brief mentions of the theme. Two gave high level details regarding their housing stock age and property type, one had the aim to increase the percentage of homes with good energy insulation, another outlined that they had made good progress on insulation of their housing stock, and one committed to ensuring the ‘right type’ of housing. There were no further details provided.

Summary and recommendations

Many JSNAs reviewed included some data on dwelling characteristics - such as property type, age, heating systems and insulation - but few provided detailed interpretation of what this means for local health outcomes. A strong JSNA should set out a clear, evidence‑informed overview of the local housing stock, including:

• a narrative describing the composition of local housing, including the age profile of homes, dwelling types (for example, terraced, high‑rise, converted flats), construction characteristics and heating systems, and how these factors relate to known health hazards. This may include identification of neighbourhood‑level or tenure‑specific differences in housing stock quality such as concentrations of older private rented accommodation
• identification of where dwelling characteristics intersect with other determinants of health such as age or deprivation
• use of national and local data sources, including census data, VOA data, EPC ratings, local housing condition surveys and environmental health intelligence, to build as complete a picture as possible. Where local data gaps exist, JSNAs should acknowledge these and identify options for future intelligence‑gathering
• a description of links between dwelling characteristics and other themes, including cold homes, air quality and housing quality, which might inform targeted action

Dwelling energy efficiency

Overview of the theme

The government’s standard assessment procedure (SAP) is used to monitor the energy efficiency of homes. It is an index based on calculating annual space and water heating costs for a standard heating regime and is expressed on a scale of 1 (highly inefficient) to 100 (highly efficient, representing zero energy costs).

According to the energy efficiency chapter in the EHS 2024 to 2025, the energy efficiency of the English housing stock has shown continuous improvement, with the mean SAP rating increasing from 45 points in 1996 to 67 points in 2023. This long-term upward trend was evident across tenures and largely driven by improvements in the prevalence of common energy efficiency measures across the stock. 

There are 2 primary methods of increasing the energy efficiency of existing dwellings: upgrading the dwelling’s heating system and improving insulation.

The EHS reports that between 1996 and 2023, the proportion of homes with central heating increased (from 80% to 93%), while the proportion of homes with room heaters as their main heating source - the least cost-effective and most inefficient method of heating - decreased from 12% to 3%. There have also been increases in the installation of insulation and full double glazing, and in the use of condensing boilers (generally considered the most efficient boiler type). National policy to improve energy efficiency and keep homes warm is described in the warm homes plan and fuel poverty strategy.

Energy‑efficiency upgrades can improve indoor environmental quality by making homes warmer, drier and less prone to damp, especially when paired with well‑designed ventilation systems, which can reduce humidity, mould and energy use. However, poorly specified or installed systems can undermine these benefits, leading to noise, inadequate airflow, pollutant build‑up and occupant disengagement. Retrofit works can temporarily raise VOC levels, and airtight buildings without added ventilation can increase concentrations of particulate matter, carbon dioxide, radon and biological contaminants. Heat pumps can improve air quality when they encourage more window opening, but homes with limited ventilation still face elevated pollutant levels. Overall, energy‑efficiency measures can improve indoor environmental conditions, but only when ventilation, installation quality and occupant behaviour are fully integrated into the design and operation of the retrofit.

Health impacts and inequalities

Improving energy efficiency in lower‑income UK homes can make indoor environments warmer and more affordable to heat, which helps reduce cold‑related illness and supports better respiratory and mental health. The benefits, however, depend heavily on the type of intervention and whether adequate ventilation is provided. While upgraded boilers and glazing tend to reduce hospital admissions for COPD and cardiovascular disease, loft insulation without added ventilation has been linked to increased admissions and higher indoor pollutant levels. When ventilation is properly integrated, energy‑efficiency measures can generate substantial long‑term health gains. Broader strategies that reduce indoor PM2.5 - such as fabric improvements, cleaner heating and behaviour changes - are projected to significantly extend life expectancy and reduce mortality, especially among older adults.

While national data from the EHS shows long‑term improvements in the energy efficiency of England’s housing stock, significant variation persists between tenures, neighbourhoods and dwelling types. These variations translate into unequal exposure to cold homes, fuel poverty and associated health harms (as described in earlier sections of this report).

Coverage of dwelling energy efficiency in JSNAs and JLHWSs

Energy efficiency appeared in 42% (63) of the 149 local council JSNAs reviewed. Of these, 38 included local data relating EPC ratings or energy efficiency. Of the 145 JLHWSs, 15% (22) included content on energy efficiency. 

A narrative summary has been provided in relation to energy efficiency. Broadly there was substantial overlap with content on cold homes and damp and mould, with similar data sources used for those themes in JSNAs. Many JSNAs also linked housing stock characteristics to energy efficiency, particularly older housing stock and homes being off the grid.

With regards to the data included across the JSNAs, all included some energy performance data. This was presented using the percentage of homes in given EPC rating categories or by median or average SAP scores. Some local councils analysed the data further by looking at EPC distribution by tenure, housing type and neighbourhood, LSOA, or all 3.

Given the overlap with the cold homes and damp and mould themes, the heath impacts reported were similar to those described in those sections, including cardiovascular and respiratory diseases, asthma and infection. Similarly, JSNAs also discussed the mental health effects from the financial stress and higher excess winter deaths from poor thermal efficiency. JSNAs also identified similar vulnerable groups to those discussed in content on cold homes and damp and mould, including older people, low-income families and single parents, private renters, rural households off grid and people with pre-existing medical conditions.

Benefits of improved energy efficiency were also discussed across JSNAs. This included economic benefits of reduced household bills and corresponding reduced financial stress, lower fuel poverty rates, reduced NHS and social care costs and strengthened energy security. Environmental benefits discussed included lower carbon emissions, improved air quality and the contribution to local and national net zero targets.

Many JSNAs also referenced evidence that:

• insulation, heating upgrades and ventilation improvements reduce hospital admissions
• retrofits have positive cost-benefit ratios, often saving more than they cost
• multi-agency targeted schemes bring substantial health and financial benefits

Of the JLHWSs that included content on energy efficiency, most included an aim to improve energy efficiency of the housing stock and this was often linked to lowering the impact on the environment or combatting cold homes. Methods to improve energy efficiency described in JLHWSs included:

• acting across local systems and establishing partnerships
• signposting residents towards local and national energy efficiency support schemes
• promoting national standards such as minimum energy efficiency standards
• retrofitting existing housing
• advice services for residents
• net zero carbon policies on new housing developments and adopting higher design and construction standards which support low carbon developments, such as Passivhaus
• using a targeted private rented sector inspection programme to ensure the minimum statutory housing and energy efficiency standards are met

Ways of measuring progress in JLHWSs included monitoring the number of energy efficiency and safety measures delivered through the safe and warm homes grant and EPC ratings as an indicator.

Summary and recommendations

Understanding the energy efficiency of local housing stock enables targeted, cost‑effective interventions and helps local councils meet statutory responsibilities under Awaab’s Law, the fuel poverty strategy and climate‑related adaptation frameworks. A strong JSNA may include:

• a clear narrative explaining the health and wellbeing implications of dwelling energy efficiency, including impacts on cold‑related illness, fuel poverty, respiratory and cardiovascular risk and inequalities, including the unintended consequences for indoor environmental quality
• explanation of how energy efficiency interacts with other hazards, recognising, for example, that:
  • retrofit measures without ventilation improvements can worsen IAQ
  • improved insulation can increase overheating risk without shading or ventilation
  • cold homes can exacerbate damp and mould prevalence
• consideration of alignment with other strategic priorities including alignment with local climate adaptation strategies, housing decarbonisation plans and fuel poverty initiatives. This may also reference national policy including the fuel poverty strategy and the warm homes plan

Housing standards

Overview of the theme

In England, housing standards are measured using a combination of legal frameworks, inspection tools and basic housing quality standards all of which are designed to protect people’s health, safety and wellbeing. These systems were established to help identify when homes are unsafe to live in - and guide what local councils, landlords, regulators and others are required or able to do in response.

The HHSRS is one of the main legal tools, introduced by the Housing Act 2004. It is used by environmental health officers to assess whether a home presents a risk to the health of its occupants. The system covers 29 hazards, including damp and mould, cold homes, overcrowding and fire safety risks. Each hazard is scored based on the likelihood and potential severity of harm it may cause. If a serious risk - known as a category 1 hazard - is found the local council is legally required to take enforcement action against private landlords and social housing providers, with the exception of when it applies to their own housing stock.

Local councils are expected to address issues in homes they own through their own internal processes. However, they are still subject to external oversight. RSH carries out proactive inspections of social landlords, including local councils. Tenants of social landlords can also raise complaints through the Housing Ombudsman or pursue legal action under the Homes (Fitness for Human Habitation) Act 2018. 

In certain circumstances, the HHSRS applies to owner-occupied homes and local councils can take enforcement action. This is typically when there is a wider public health risk to vulnerable individuals. While enforcement is rare in this context, it is an option in extreme scenarios such as hoarding, risk of structural collapse and fire risk. 

The DHS sits alongside the HHSRS and provides a benchmark for what constitutes a ‘decent’ home. To meet the DHS, a home must meet 4 criteria. It must:

• be free from category 1 hazards (as per the HHSRS)
• be in a reasonable state of repair
• have adequately modern facilities
• provide sufficient thermal comfort

A reformed DHS was published in January 2026 and must be complied with in social and private rented sectors from 2035.

The EHS 2024 to 2025 reported that there were 2.3 million dwellings (9%) that had a HHSRS category 1 hazard in 2024. It also found that in 2024, 15% or 4 million dwellings failed to meet the DHS, similar to 2023 but lower than in 2019 (17%).

It is important to note that the ability to enforce these standards is dependent on local capacity and capability and in some areas is limited by a shortage of environmental health officers.

Health impacts and inequalities

Homes that do not meet basic housing standards expose residents to a wide range of preventable health risks. The DHS and the HHSRS capture major hazards (such as excess cold, damp and mould, fire risk, carbon monoxide, fall hazards, overcrowding and inadequate sanitation) that have well‑established links to physical and mental health outcomes. Housing standards therefore act as a critical foundation for protecting and improving health and preventing illness and injury. The specific health impacts of major hazards are described in relevant sections earlier in this report.

Certain groups are consistently more likely to live in non‑decent homes, including low-income households, ethnic minorities, private renters, older people and lone parents and single‑person households, with marked regional inequalities. Improving housing standards more broadly should shift overall population health outcomes, reducing harms across society. By improving the quality of housing at scale, it becomes possible to improve health outcomes in general while still focusing targeted support on those individuals or groups most vulnerable to poor housing conditions. This is in line with the principle of ‘proportionate universalism’ as described by Professor Sir Michael Marmot and discussed in the Institute of Health Equity report ‘Towards health equity: a framework for the application of proportionate universalism’.

Despite the existence of nationally recognised standards, repeated failures in repairs, fear of retaliatory eviction or long waiting periods for enforcement can prevent households from reporting issues. This can lead to a reduced sense of security and control in the home environment, with consequences for health and wellbeing. Lower‑income households often have limited ability to move, challenge landlords or fund improvements. They may face language barriers, a lack of awareness of their rights and limited access to support, making them particularly vulnerable to prolonged exposure to hazards.

Geographical inequalities also play a key role. Areas with older housing stock, concentrations of deprivation or high numbers of HMOs often experience higher rates of non‑decent homes. Poor housing standards reinforce existing health inequalities. Residents already at higher risk of poor health are also more likely to be exposed to inadequate housing, as described in the housing quality section of this report.

Coverage of housing standards in JSNAs

Housing standards appeared in 36% (54) of the 149 local council JSNAs reviewed. 

Table 40: presence and placement of housing standards in JSNAs

Presence and placement - housing standards theme	Count	Percentage
Theme included briefly without elaboration on the issue’s relevance	25	46%
Theme included with some contextual information	12	22%
Theme covered in detail with either a dedicated subsection or frequent mention throughout the JSNA	17	32%

Where housing standards were mentioned briefly, this was typically in general statements such as ”A few homes in [LA] failed the decent homes standard 33 in 2020 (n = 2483, just over 2% of homes)” or by providing a high level overview of the health impacts or cost to the NHS of non-decent homes. A further 12 local councils included content on housing standards with some contextual detail of the theme’s importance but with minimal prominence within the JSNA.

There were 17 local councils which featured housing standards in their JSNAs as a dedicated subsection or integrated it throughout the housing content in a structured way, giving it significant prominence. Local councils in this category tended to:

• provide a comprehensive overview of the HHSRS and the DHS
• provide statistics on the cost of poor housing to the NHS
• report on data and trends relating to housing standards
• provide a breakdown of data and impacts for different groups and housing types

This information was often included in the general housing chapters, or specific chapters on housing quality.

Table 41: use of data on housing standards in JSNAs

Use of data - housing standards theme	Count	Percentage
No supporting data of the theme provided	13	22%
National data provided with no local contextualisation of the theme	10	17%
National data cited with local contextualisation or local data is referenced from a single source for the theme	23	38%
Local data from multiple sources cited	13	22%

A commonly used data source across JSNAs was the EHS, from which local councils reported on:

• the percentage of non-decent homes
• prevalence of hazards (for example, excess cold, falls and damp)
• tenure comparisons (owner‑occupied versus private rented versus social rented)
• demographic breakdowns (for example, older people, disabled people and families)

Local councils often included data on the percentage of their homes meeting or failing to meet the DHS. For example, one JSNA said:

The condition of social housing in [local council] has significantly improved since the Decent Homes Standard was first introduced in 2003, with well over 90% of council and housing association homes now meeting the criteria. The position regarding private rented housing is less clear, since no study of conditions has been carried out since 2009 - this estimated that only 69% of private sector homes in [local council] met the Decent Homes Standard.

Some local councils used their own housing stock conditions surveys to describe housing standards. For example, one JSNA said:

Local assessment shows that around 91% of all residential council properties were of decent standard in 2016. A private housing condition survey, conducted in 2008, showed that only around a half of all privately owned or rented properties in [local council] were of decent standard; this was much higher compared to the national rate of around 38%.

Some local councils included BRE housing stock models and reports to estimate the number of category 1 hazards in their area, the cost to mitigate housing hazards and the cost of health impact modelling. One local council commissioned BRE to produce housing stock models to help them understand the condition of the private sector housing stock within their area. Findings included:

• an estimation of the number of category 1 hazards within the locality, including by housing tenure
• the estimated cost of mitigating these hazards
• a local estimate of the number of harmful events due to poor housing conditions locally which require medical treatment each year
• the cost to the NHS treating accidents and ill health caused by housing hazards

Another local council presented data from their housing conditions survey produced by BRE to show by ward the percentage of rented housing in disrepair and the percentage of rented housing with a category 1 HHSRS hazard.

Table 42: analytical depth of reporting on housing standards in JSNAs

Analytical depth - housing standards theme	Count	Percentage
No analysis of the impact of the theme provided	21	35%
High level mention of impacts of the theme provided	20	33%
An in-depth analysis of one of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	10	17%
An in-depth analysis of 2 or more of the following for the theme: relevant drivers, health impacts, subpopulations or contextual factors	9	15%

There were several health impacts of homes that do not meet basic standards described, including:

• respiratory and cardiovascular disease
• mental health issues (including anxiety, depression and psychological distress from poor housing conditions)
• injuries and falls
• infections and gastrointestinal illness (linked to poor sanitation and disrepair)
• increased mortality (especially winter deaths)
• developmental issues for children (delayed cognitive development, poor educational attainment, and emotional and behavioural issues)

Local councils also discussed the impact on the health and care system. Some outlined that poor housing contributes to avoidable hospital admissions, delayed discharges and social care demand. Some also used estimations of the cost to the NHS, for example: “It is estimated to cost the NHS £1.4 billion per year to treat those who are affected by poor housing.” One local council also broke down the cost of each category 1 hazard to the NHS.

When local councils discussed drivers of the issues around housing standards, it was mainly in relation to the housing stock characteristics. Issues discussed included:

• high numbers of older houses (for example, pre‑1919 terraces) which are associated with disrepair
• fall hazards
• higher percentages of homes failing the DHS across private rented and owner-occupied tenure
• poor insulation and energy efficiency of the housing stock leading to excess cold

Populations affected which were discussed by local councils included:

• children and young people who are vulnerable to damp and mould, overcrowding, unsafe home environments, an increased risk of injuries and developmental impacts
• older adults who are at high risk from fall hazards, excess cold, disrepair due to living alone or low incomes
• people with disabilities or long-term conditions who may have a higher exposure to hazards and housing that does not meet standards, creating difficulties with daily living

Effective JSNAs provided evidence and description about why and how specific groups are impacted by poor quality housing.

Coverage of housing standards in JLHWSs

Housing standards appeared in 19% (28) of the 145 local council JLHWSs reviewed.

Table 43: strategic integration of housing standards in JLHWSs

Strategic integration - housing standards theme	Count	Percentage
No strategic links or proposed actions in relation to the theme	12	43%
General references made to national policies or government objectives but nothing locally specific	2	7%
Referenced the theme in local or regional housing strategies and/or public health action plans	6	21%
Referenced specific interventions, schemes or governance to address the theme	8	29%

Of the 8 JLHWSs that committed to specific actions on housing standards, the approach was varied. Some made general statements about the intention to improve the standard of homes, for example: “We are ensuring all local council housing meets the decent homes standard.”

There were some examples of commitment to improve standards where partnership working was incorporated, such as working with housing colleagues, landlords and the voluntary and community sector. One council committed to work with landlords to improve standards through the decent homes pilot and any future licensing schemes. The council also included milestones to produce a proposal to undertake a housing stock condition survey and evaluate the decent homes pilot scheme. One council also committed to “raise awareness of the rights and expectations of private tenants, the danger of poor living conditions and what to do in case of poor housing.”

Few JLHWSs explicitly mentioned monitoring, but those that did proposed using the DHS to measure progress - for example, a reduction in the number of non-decent homes. One committed to do this by saying they would “promote and monitor the application of national housing standards which improve health, including Nationally Described Space Standards, Minimum Energy Efficiency Standards, Housing Health and Safety Rating System (HHSRS)” through “workforce development, increased awareness and understanding of the relevant standards.”

Summary and recommendations

Housing standards are a core component of creating safe and healthy homes. Existing national standards, including the DHS and the HHSRS, provide nationally recognised frameworks for identifying and assessing risks within the home, which have well‑established links to avoidable illness, injury and premature mortality. Understanding these risks is essential for assessing local public health needs and prioritising action. JSNAs should make clear that hazards within homes contribute to significant health risks. Certain tenure types, particularly parts of the private rented sector, experience disproportionately high levels of hazards, reinforcing existing inequalities. Enforcement intelligence such as inspection outcomes, improvement notices and data from licensing schemes remains an under‑used but critical source of local insight.

Overall, improving housing standards should be recognised not as a technical compliance activity but as a core prevention priority. JLHWSs should embed housing standards within broader system planning, ensuring that pathways, data flow and professional awareness support earlier identification of unsafe homes and more coordinated responses across housing, health and social care services.

A high-quality JSNA should:

• explain the DHS and HHSRS frameworks and how they support assessment of local housing related health risks
• present and interpret local housing standards data, including:
  • the number and proportion of non-decent homes (by tenure where possible)
  • the distribution of HHSRS category 1 and 2 hazards
  • the most common local hazards
  • patterns of disrepair and non-compliance
  • data from selective licensing
  • HMO licensing and other landlord engagement programmes and enforcement activity
• outline which groups are disproportionately affected and how poor housing standards drive inequalities
• describe how unsafe or non-decent homes increase demand for health and social care
• identify where data‑sharing and collaboration could be strengthened between environmental health, housing enforcement, public health and NHS partners in a local area. This may include:
  • describing referral pathways from health and social care professionals into housing enforcement and advice services
  • introducing joint workforce training to improve recognition of, and response to, unsafe homes

Discussion and recommendations

Coverage of housing within JSNAs and JLHWSs

Despite housing being a well-evidenced determinant of health, its inclusion within JSNAs in England is highly variable. However, all local councils had captured housing in JSNAs in some capacity. Table 44 shows the percentage of JSNAs and JLHWSs that included each of the themes described in this report. Coverage of themes ranged from 85% (cold homes and fuel poverty) to just 7% (overheating). The full context behind the reasons for this is out of scope of this report. There are several reasons why some housing issues may not be strongly represented within JSNAs, including evidence gaps, limited capacity and economic pressures. In addition, as described in earlier sections, some housing issues may be captured in other local strategic planning documents, depending on the approaches used in each local area.

Table 44: percentage of JSNAs and JLHWSs reviewed that included each of the housing themes described in this report

Theme	Percentage of JSNAs including the theme	Percentage of JLHWSs including the theme
Cold homes and fuel poverty	85%	45%
Housing affordability	77%	34%
Temporary accommodation	58%	19%
Overcrowding	58%	12%
Specialist housing	45%	12%
Dwelling energy efficiency	42%	15%
Housing standards	36%	19%
Damp and mould	36%	13%
Accessible housing	35%	18%
Dwelling characteristics	35%	3.5%
Trip and fall hazards	34%	10%
Indoor air quality	16%	1.5%
Overheating	7%	1.5%

Characteristics of effective inclusion of housing within JSNAs

As described in the introduction of this report, the core purpose of JSNAs and JLHWSs is to identify and understand the health and wellbeing needs of the local population, with the aim of improving overall community health and reducing inequalities. They should draw on a range of evidence and data to inform priority setting for local areas. It is important that JSNAs and JLHWSs include specific objectives, well-defined activities, measurable indicators and evaluation mechanisms to ensure effective implementation.

JSNAs typically included housing as either a standalone ‘housing JSNA’ or integrated it across multiple different JSNA chapters, giving it prominence in chapters on health issues that housing affects (including respiratory, cardiovascular and musculoskeletal conditions and mental health and dementia) or in chapters on disability, children or older people. Both approaches have their benefits. Standalone housing JSNAs typically included more detail and analysis on housing and health than those that wove housing issues into multiple chapters. However, there is nothing to prevent JSNAs on certain conditions from going into a similar amount of detail. Including housing issues in multiple chapters may also carry the added benefit of better reaching the professionals involved in strategy and support for particular conditions or populations. Local systems should choose the approach that best reflects how they use JSNAs.

From a housing perspective, the strengths of some of the most effective JSNAs reviewed include:

• recognition of housing as a fundamental determinant of health, shaping physical and mental health, mortality risk, health and social care demand, and long-term inequalities
• use of robust, triangulated evidence to describe the condition of the local housing stock and how risks differentially affect specific groups
• use of national data sets, supplemented with local intelligence, including acknowledging any limitations and how patterns compare with regional or national trends
• data accompanied by commentary explaining what it means and what it is a useful proxy for, not just presented as numbers
• consistent attribution of data sources, to make it easier for users to understand underlying data assumptions applicable to hazards
• interpretation of data, as well as description, including analysis of how local housing risks are generated, whether by:
  • the age and condition of stock
  • affordability pressures
  • poor-quality TA
  • climate-related hazards
  • planning and development patterns
  • gaps in enforcement and regulatory capacity
• articulation of system-level pathways through which poor housing leads to health impacts and how these pathways can be better used to get households the support that is needed to address hazards in their homes
• explicit consideration of inequalities, identifying which communities, neighbourhoods or demographic groups face disproportionate exposure to substandard, unsafe or unsuitable housing
• description of where specific housing conditions are linked to health conditions (for example, asthma, COPD, injuries, cardiovascular disease and mental health impacts) where the evidence supports it
• recognition that addressing poor quality homes is not just about supporting those who are already vulnerable, but also about reducing the risk in the general population of developing ill health in the first instance by reducing exposure to well-established health hazards that are largely preventable
• acknowledgement of the importance of preventative action to ensure that new homes are designed and built to better protect households

Stronger JLHWSs included:

• clear strategic priorities and specific, tangible actions with dates for completion
• where possible, targets - for example, specifying the number of homes retrofitted, the number of households supported to access interventions or the number of referrals
• figures to be invested and the number of homes or households anticipated to benefit
• monitoring health outcomes

Limitations of coverage of housing within JSNAs

There were however some limitations to the way that housing was described and included in some JSNAs, including:

• a tendency to acknowledge housing in general terms, for example, stating that “poor housing affects health” or “housing is a key determinant” without unpacking which housing conditions are most relevant locally, who is affected or how these conditions contribute to specific health outcomes. High level statements provide only a limited foundation for strategic planning
• over-reliance on descriptive data with limited interpretation of it or the reporting of national data only without any contextualisation of local health needs, local stock characteristics or health inequalities
• a tendency to group various housing-related factors and health outcomes together without clearly delineating which specific housing conditions lead to particular health effects. For instance, stating that exposure to issues such as overcrowding, damp, indoor air pollutants and low temperatures is associated with illnesses including eczema, hypothermia and heart disease, without explicitly identifying the precise relationships between each housing condition and individual health outcomes
• limited discussion of inequalities. While some did this well, many JSNAs note that certain populations are “more vulnerable” without specifying which groups, why they are disproportionately affected or how exposure varies by ethnicity, socioeconomic status, age, disability, tenure type or geography. This lack of specificity reduces the ability of local systems to target interventions effectively. In addition, while several JSNAs discussed inequalities in housing conditions, very few discussed wider inequalities, such as barriers to reporting housing hazards
• absence of discussion of the interface between housing and the NHS, such as hospital discharge pressures linked to inaccessible homes, poor quality housing increasing re-admissions and the role of unsafe and inappropriate housing in driving demand for primary and secondary care
• lack of tailored approaches and actions for different groups. Different housing tenures require different interventions and few JSNAs made this clear or had strategies to address poor quality housing for people in different circumstances, informed by local intelligence

Other housing-related themes which emerged in the analysis

In addition to the pre-identified thematic categories, a number of other themes emerged in the analysis.

In relation to housing affordability, themes which emerged included:

• housing insecurity: several JSNAs and JLHWSs acknowledged the impact insecure housing has on health and wellbeing. However, no data sources were provided to support their conclusions
• furniture poverty, with local councils noting that even when people are housed, they may be living without housing essentials - for example, furniture, which affects their health and wellbeing
• size of social housing waiting lists, some of which were broken down by vulnerable group - for example, those with children - and data on waiting list size
• recognising the needs of specific groups - for example, people with learning disabilities or autism - in social housing allocations
• data on new homes (such as social or market sale) being built
• tenure mix, change in tenure and impact on house prices and availability
• developing ways to work with landlords to help them create more stable tenancies

In relation to housing stock characteristics, themes which emerged included:

• efforts to understand resident satisfaction with their landlords
• creation of private sector landlord forums to improve standards

Housing-related themes which may also warrant consideration

There are several housing related themes which were not explicitly identified in the analysis of JSNAs or JLHWSs but which may warrant consideration by local areas now or - because of external factors like climate change or changing policy priorities - in the future. Local areas will know their populations best and which themes might require further exploration. These could include:

• community-led housing (including through community land trusts and housing co-operatives): these provide an alternative approach to housebuilding, contributing to market diversification and possibly facilitating community engagement, with corresponding impacts on health and wellbeing
• fire: fire is a recognised hazard within the HHSRS and the subject of specific building regulations. Certain buildings are more at risk of fire and it is an important consideration for areas with high volumes of retrofitting and refurbishment
• flooding: climate change may introduce a need for consideration of retrofitting and adaptation broadly, including flood proofing properties that are prone to floods. Local areas may also wish to consider potential housing supply impacts for areas that are prone to floods and which might see people requiring rehousing
• retrofitting and adaptation: retrofitting and adaptation of existing homes can deliver significant health, energy and climate benefits. However, these interventions can also introduce new risks if they are not designed and implemented in a joined‑up way and local systems may wish to give consideration to unintended health harms and ensure that retrofit activity does not inadvertently exacerbate health risks for occupants. Local councils could consider the findings of the National Retrofit Hub’s 2026 report ‘health place and retrofit’
• permitted development rights (PDR): housing delivered through PDR can make a meaningful contribution to housing supply, but evidence and practice suggest there are important health, wellbeing and inequality considerations that local systems may want to take into account when assessing its impacts and risks. In particular, systems might consider where housing quality, location and occupancy patterns interact with deprivation and vulnerability

Recommendations

Use of JSNAs and JLHWSs

1. JSNAs and JLHWSs are uniquely positioned to ensure that housing issues are understood as system-wide prevention priorities, not niche concerns for housing teams to deal with. JSNAs and JLHWSs must therefore frame housing not as background context but as a core issue.

2. In some local areas, there were examples of strong actions within JLHWSs but no or very little mention of the same issue within JSNAs, and vice versa. It is crucial, to inform local planning and facilitate action, that housing is well represented in both JSNAs and JLHWSs, and any other strategic planning documents used in local areas.

3. JSNAs should facilitate the development of strategic commitments, actions and outcome measures included in JLHWSs by:

• quantifying and describing the local scale of housing-related issues, including describing how services identify housing-related health risks
• taking a systems approach to the evidence base - for example, identifying trade-offs between different hazards and mitigating actions
• identifying data and intelligence gaps
• highlighting populations disproportionately harmed (and why different groups are vulnerable)
• summarising the limitations of current local responses as well as existing work that could be built upon
• identifying local system opportunities and barriers
• recommending meaningful indicators for monitoring and evaluation

Use of data

4. Local councils hold rich enforcement and stock condition data (‘housing intelligence’) that the health system rarely accesses. JSNAs should integrate this intelligence to inform targeted improvement of housing conditions and direct resources where they will have greatest health impact.

5. JSNAs should present meaningful, well-interpreted data using both national and local data sets. Best practice would also be to include insights on lived experience from local qualitative intelligence, to enrich local and national quantitative data. These insights help humanise data and may provide insight into the types of support mechanisms that are needed that data alone does not provide. JLHWSs should commit partners to strengthening data quality and granularity and provide a framework for structured monitoring and annual reporting. Relevant data sources can be found linked throughout this report, and additional data sources can be found in the resources section. Local councils should also:

• note there are limitations to LSOA level data published in national data sets including the EHS and fuel poverty statistics, due to their sample sizes and modelling approaches. These limitations further justify the need to use both local and national data sets for all the themes in the report
• seek to understand health inequalities locally beyond national trends

Roles and responsibilities

6. JSNAs and JLWHSs should describe governance, enforcement mechanisms and system responsibilities. This should include mapping current local support and identifying gaps and opportunities to fill them.

7. JSNAs should describe how cases flow between health, housing, social care and voluntary sector partners. JLHWSs should commit to strengthening cross-sector referral pathways so that vulnerable residents are able to access support. JLHWSs ensure these pathways are visible and improve coordination.

8. JSNAs and JLHWSs should outline the role of health and social care professionals including:

• communicating the health risks of housing hazards
• signposting affected individuals to available support, including tenant protections that already exist through existing housing legislation and new protections in relation to emergency cold-related hazards through Awaab’s Law
• recognising unsafe or unheated housing, supporting residents to understand their rights, and linking them to referral pathways or enforcement action where appropriate

9. Local areas should consider taking a holistic approach to addressing housing hazards. Both public health campaigns and practical interventions to improve housing quality should consider the importance of addressing issues in a way that does not create new ones. For example, there may be trade-offs between making homes warmer and poorer IAQ and overheating risk. A joined-up approach is needed to make homes safe.

Policy context

10. JSNAs should provide clarity on the policy context, regulatory environment and potential partnerships. For example, cold homes as an issue sits at the intersection of housing standards, energy efficiency and health and social care. Effective JSNAs would include detail on national policy in each of these areas and how cross-cutting work could be better joined up, including any preparation required by the system to implement new policy.

Conclusion

Housing is a fundamental determinant of health, with conditions, affordability and security shaping a wide spectrum of health outcomes, including respiratory and cardiovascular disease, mental health, injuries, child health and long-term conditions. Beyond direct health impacts, housing also influences broader life opportunities such as educational attainment and employment. The consequences of poor-quality housing continue to place considerable strain on both NHS and social care services.

Importantly, the effects of housing on health are not fixed - they are amenable to change through targeted, cost-effective and locally achievable interventions. Recent legislative changes, such as Awaab’s Law and the strengthened tenant protections introduced through the Renters’ Rights Act, mark a pivotal moment for system-wide alignment. Health professionals have an increasingly important role to play, not only in identifying housing hazards and understanding the new resident protections, but also in supporting those most at risk, many of whom would not otherwise receive such assistance.

The government’s 10 Year Health Plan is explicitly focused on prevention and recognises the vital importance of improving housing conditions. Meanwhile, increased devolution and the evolution of neighbourhood health models have created new mechanisms for local action. Place-based partnerships and local commissioning decisions offer further opportunities to address housing as a core component of health and wellbeing, ensuring that strategic planning and interventions are responsive to the needs of communities. JSNAs and JLHWSs are examples of familiar and critical strategic documents that are central to this activity and provide the opportunity to leverage further improvement in health outcomes. The principles described in this document are applicable to other strategic health planning documents, such as neighbourhood health plans.

For housing to be meaningfully and effectively embedded in JSNAs and JLHWSs, collaboration between those who have influence in housing and health is essential to address the risks and inequalities that arise from poor housing. Further learning, support and sharing best practice can support those who are in this space to make the best use of local levers and deliver for their populations.

Annex A: methods

Document identification

JSNAs and JLHWS were collected for all upper tier and unitary local councils (153) in England. The most recent and publicly available versions in November 2024 were accessed. We obtained 145 JLHWS and 149 local council JSNAs. Where documents were not readily available, direct contact was made with local public health teams to request access. The documents that were not obtained were unavailable to access because they were being updated.

Identification of housing themes

A set of housing themes was predefined to guide data extraction. These themes reflected known drivers of housing-related health risks and existing national, regional and local policy priorities. The thematic categories can be found in annex B. A ‘general or other’ housing category was also used during data extraction to capture content that did not clearly align with one of the predefined themes. There are several other housing-related themes of varying relevance in different parts of the country. Due to capacity, it was not possible to produce an exhaustive list of themes against which to analyse JSNAs and JLHWSs.

It was decided that homelessness (apart from TA) was out of scope for this project. Qualitative feedback suggests that homelessness was covered in some capacity by most local councils, potentially due to local councils already having a statutory duty to carry out a homelessness review and publish a strategy. The inclusion of homelessness within this review would have widened the scope of an already broad review and would not have been feasible given the capacity available for this work.

Flooding as a theme on its own was also considered to be out of scope, but there was the chance for anything related to flooding and housing to be picked up in the ‘other’ section.

Data extraction

Each JSNA and JLHWS was reviewed using a predefined list of housing-related search terms. Relevant excerpts were then copied into a data extraction spreadsheet under the predetermined thematic categories. For example, text relating to homes that are excessively cold was placed under ’cold homes and fuel poverty’.

Data extraction was carried out by DHSC regional teams. To support consistent identification and recording of housing content, regional teams received a data extraction protocol, data collection spreadsheet and a series of training sessions to familiarise themselves with how to extract and record the housing data.

Each JSNA and JLHWS was reviewed electronically using a predefined list of housing-related search terms. These terms were piloted and refined (see annex B). Where content related to one or more themes, text was copied to all relevant themes. Where housing-related content appeared within diagrams, tables or images that could not be directly copied, a note was made to review these during analysis.

Data analysis 

Following data extraction, each housing theme was analysed using a structured framework with 4 dimensions - ‘presence and placement’, ‘use of data’, ‘analytical depth’, and ‘strategic integration’ - to evaluate how consistently and meaningfully each housing-related theme is captured within JSNAs and JLHWSs.

Details of each data analysis dimension are provided below.

Presence and placement 

This dimension assesses whether the housing theme is mentioned in the JSNA and, if so, the level of visibility and prominence devoted to it. This dimension will help identify whether the theme is treated as a core concern with the JSNA, only as a peripheral reference, or omitted entirely. 

Use of data 

This dimension evaluates the extent to which housing data is used within the JSNA and the nature of the data sources. This assessment enables comparison of how data is used for different housing themes, including the balance between national statistics and locally specific data and the comprehensiveness of data that is drawn upon.

Analytical depth 

This dimension explores the depth of analysis applied to each housing theme within the JSNA. For example, the extent to which it explores the mental and physical health impacts, drivers of the issue, impact on different subgroups and health inequalities, the impact on health and social care, or any other locally relevant analysis of the data. This measure will help distinguish surface-level discussion from more nuanced, equity-informed analysis demonstrating relevance to public health priorities.

Strategic integration in the JLHWS 

This dimension considers the extent to which the housing theme is embedded in the JLHWS and linked to actionable responses. This measure helps identify whether the housing theme is included as a strategic priority in JLHWSs and reflects the degree to which the JLHWS functions as tools for action, not just description. 

Defining thematic clusters

Scores were recorded for each theme and a summary of findings reported in the main body of the report. These scores were used to identify variation in practice, gaps in coverage and stronger examples of the particular theme’s inclusion in JSNAs and JLHWSs. For the purpose of presenting the findings, the housing themes were organised under 4 thematic clusters:

• housing hazards (cold homes and fuel poverty, overheating, damp and mould, IAQ and trip and fall hazards)
• space and design (housing quality, overcrowding, accessible housing and specialist and supported housing)
• affordability, availability and security (housing affordability and TA)
• housing stock characteristics (dwelling characteristics, dwelling energy efficiency and housing standards)

Treatment of emerging or cross-cutting content 

During data extraction, a general or other category was used to capture housing-related content that did not clearly align with one of the predefined themes. This material was subsequently reviewed thematically to identify any other housing issues commonly occurring. This content was discussed within the theme most relevant to it. 

Two additional themes, ‘vulnerable cohorts’ and ‘housing and healthcare’, were originally included as predefined housing themes to be analysed in the same way as the others. However, during analysis it became clear that references to vulnerable groups and interactions between housing and the healthcare system consistently occurred within the context of other housing themes, rather than as discrete issues in their own right. For this reason, these themes were not analysed separately. Instead, insights relating to vulnerable groups and the healthcare system were integrated into the analytical narrative for each of the remaining housing themes.

Inter-rater reliability

To support the reliability of the coding process, approximately 10% of entries within each thematic category were independently reviewed by a second assessor using the same scoring criteria. The Cohen’s Kappa inter-rater reliability of this review was 0.866, which indicates a very high level of agreement.

Limitations

There are several limitations that should be considered when interpreting the findings of this report.

This review is based solely on publicly available JSNAs and JLHWSs, and the analysis reflects only the content accessible at the time of data collection (November 2024). In some cases, JSNAs or JLHWSs may not have been accessible and therefore the data set may not represent all documents currently in use across England. In addition, local councils use different formats, terminology and chapter structures, which may affect the ease of identifying housing content. This variation may have influenced how consistently themes were captured during extraction.

The report does not attempt to interpret why certain information was or was not included within these documents; it only describes what was found. The review did not involve direct engagement with local councils to validate findings or understand contextual reasons for variation in content. Likewise, the report describes whether data was included but does not evaluate whether data used by local councils was accurate, up to date or appropriately interpreted. It also does not analyse whether a local council’s JLHWS correctly interpreted its JSNA or what the outcomes are of inclusion (or not) of housing within these documents.

Caution should be taken when interpreting themes across different documents which may use different definitions or thresholds. For example, while several JSNAs may reference ‘older people’ within a specific theme, the review did not assess whether this consistently referred to a specific age range or factor in different definitions for ‘older adults’ in different populations.

This review focuses specifically on JSNAs and JLHWSs and does not assess other strategic planning documents that local councils may use to describe housing-related health needs, such as housing strategies, local plans, homelessness strategies or climate adaptation plans. As a result, relevant housing and health content may exist elsewhere without being captured in this analysis.

Some JSNAs and JLHWSs reviewed were several years old and may no longer fully reflect current local context, activity or strategic priorities. The relevance and role of JSNAs may also shift as local systems transition towards new models such as neighbourhood health plans, potentially altering how housing issues are considered within strategic planning. Some of the documents reviewed pre‑date major legislative changes and therefore cannot be expected to reflect current statutory responsibilities or best practice.

JSNAs are typically produced by teams with a public health or healthcare focus, and may not fully capture the activity, intelligence or priorities of housing, planning, environmental health or other local council teams whose work directly affects housing conditions. As such, JSNAs may not always reflect the full picture of local housing-related activity.

Although the review used a structured framework, assessments of presence, analytical depth or strategic integration inevitably involve some subjective interpretation, even with efforts to ensure consistency.

This review does not examine wider built environment factors such as transport, access to health and retail services, green infrastructure or the spatial distribution of new development, which also influence health outcomes but were beyond the scope of this project.

Annex B: housing themes and descriptions

General housing

Prose or data which makes reference to general housing and health content - for example, statements or acknowledgements of housing as a wider determinant of health.

Damp and mould

Prose or data related to damp and mould in housing, for example:

• outlining the health risks related to damp and mould in the home
• groups vulnerable to damp and mould
• statistics on the prevalence of damp and mould within the housing stock

Cold homes and fuel poverty

Prose or data related to housing that cannot be adequately heated, for example:

• number of households living in fuel poverty
• number of homes failing the HHSRS due to excess cold
• data on excess winter deaths or illness due to cold homes
• number of households receiving financial support or advice to meet their energy needs

Energy efficiency

Prose or data related to the energy efficiency of homes, for example:

• percentage of dwellings with EPC rating C or above
• median EPC by tenure
• details of funded energy efficiency schemes
• number of households receiving support with energy efficiency interventions

Overheating

Prose or data related to overheating of homes, for example:

• the impact of climate change on the risk of overheating
• percentage of overheating homes by tenure
• excess deaths and illness due to overheating of homes

Overcrowding

Prose or data related to overcrowding, for example:

• number of rooms in a home and number of bedrooms relative to household size
• occupancy ratings

Indoor air quality

Prose or data related to air quality in the home, for example:

• ventilation
• particulate matter
• VOCs

Trip and fall hazards

Prose or data related to trip and fall hazards in the home. For example:

• number of falls reported in over 65s
• number of homes with category 1 or 2 trip and fall hazards

Housing standards

Prose or data related to housing standards, for example:

• percentage of homes failing the DHS
• percentage of homes with category 1 or 2 hazards as per the HHSRS

Accessible housing

Prose or data related to housing which facilitates independent living and the wellbeing of people with accessibility requirements in their home, for example:

• percentage of different types of accessible housing
• waiting list for accessible social housing

Specialist housing

Prose or data related to housing which accommodates vulnerable people that is not general needs housing.

Housing quality

Prose or data related to aspects of housing quality, for example:

• natural light in the home
• space standards

Housing affordability

Prose or data related to the affordability of housing - for example, housing affordability ratio measuring the (median) house price to income ratio in an area.

Vulnerable cohorts

Prose or data outlining cohorts that are vulnerable to hazardous housing, for example:

• pregnant women
• children
• older adults
• care leavers
• individuals with health conditions

Housing and healthcare

Prose or data related to the impact of poor-quality housing on the healthcare service - for example, delayed discharge.

Dwelling characteristics

Prose or data related to specific features and attributes of buildings such as:

• heating systems
• insulation
• age of property
• type

Temporary accommodation

Prose or data related to TA as somewhere for those who are homeless or at risk of homelessness to live while waiting for longer-term housing. This may also be referred to as emergency and initial housing or accommodation. TA could include:

• a room in a shared house
• accommodation from a private landlord
• short term council or housing association tenancy
• a hostel, refuge or other housing with support

Other housing content

Prose or data related to any other content that does not fit into any of the other categories.

JSNA self-reflections

Some local councils have reflected on their JSNA within the document itself - for example, highlighting gaps in their data.

Assessor self-reflections

Category for any reflections from you as the assessor.

Resources

Cross cutting

Local council housing statistics, published by MHCLG

London datastore produced by the Greater London Authority, which provides data for London and England

The national adaptation programme sets the actions that government and others will take to adapt to the impacts of climate change in the UK

Public health outcomes framework (Fingertips)

Overheating

Heat summary - State of evidence (UKHSA)

DESNZ energy follow-up survey (EFUS) includes a report on overheating risks and retrofit. It should be noted that the evidence for energy efficiency measures for housing retrofit is not clear cut

Addressing overheating risk in existing UK homes report, commissioned by the Climate Change Committee

Met Office seasonal advice for homes in the event of severe weather

Overheating: Approved Document O, which is the building regulation in England that sets standards for overheating in new residential buildings

Assessing the future heating and cooling needs of the UK housing stock report, published by DESNZ in 2025

Centre for Urban Systems for Sustainability and Health (CUSHH) research brief on dwelling and household characteristics and summer indoor temperatures

Lomas KJ and Porritt KM. Overheating in buildings: lessons from research article, Building Research and Information 2017: volume 45, pages 1 to 18 (viewed on 3 June 2026)

Damp and mould

National guidance on understanding and addressing the health risks of damp and mould in the home for social and private rented housing providers to help understand the health risks of damp and mould and respond urgently and effectively to it

The London damp and mould checklist, developed by ADPH London in partnership with London’s public health system partners, which is designed to support health and social care professionals who see patients in primary, community and secondary care settings, to identify and respond to damp and mould

Shelter housing advice on damp and mould problems

Indoor air quality

The inside story: health effects of indoor air quality on children and young people, a report by the Royal College of Paediatrics and Child Health in collaboration with the Royal College of Physicians

Chief Medical Officer’s annual report 2022: air pollution

Air quality expert group report on indoor air quality 2022 (Defra), which identifies key sources, health risks, evidence gaps and policy challenges

Ventilation: Approved Document F, which is the building regulation in England that sets standards for ventilation requirements

Public Health England guidance on volatile organic compounds in indoor space

Burn Better, Breathe Better campaign page (Defra)

UK maps of radon produced by the UK Health Security Agency

Defra and local authority air quality monitoring networks tracking outdoor pollutant concentrations, which may be used as proxies for potential indoor infiltration

Trip and fall hazards

NICE guideline 249 (NG249) on falls in older people and people 50 and over at higher risk

NICE public health guideline 30 (PH30) on unintentional injuries in the home: interventions for under 15s

OHID guidance on falls to inform healthcare professionals in assessing risks and preventing falls and fractures

Montero-Odasso M and others. World guidelines for falls prevention and management for older adults: a global initiative, Age and Ageing 2022: volume 51 (viewed on 3 June 2026)

Housing quality

Town and Country Planning Association (TCPA) guide for local government on adopting the healthy homes principles

TCPA healthy homes principles and evidence briefing

Homes England healthy homes guidance

Public Health Wales planning healthy places guidance for embedding health in planning policy

Jephcote C and others. Spatial assessment of the attributable burden of disease due to transportation noise in England, Environment International 2023: volume 178 (viewed on 3 June 2026)

Housing Ombudsman spotlight on noise complaints

Overcrowding

House of Commons Library research briefing on overcrowding

Nationally described space standard, published by MHCLG, which sets minimum internal space standards for new dwellings. It is not a building regulation but can be adopted by local councils through their local plans

Guidance for local councils on licensing for houses in multiple occupation, published by MHCLG

Accessible housing

Access to and use of buildings: Approved Document M, which is the building regulation in England that sets standards for accessibility and inclusive use of buildings, including dwellings

House of Commons Committee report on disabled people in the housing sector

Older People’s Housing Taskforce report on housing that promotes wellbeing and community for an ageing population

Centre for Ageing Better accessible homes factsheet

Centre for Ageing Better guide to accessible homes

Age UK information guides and factsheets, including ‘AgeUKIG17: Adapting your home’

Lifetime Homes standard, which describes 16 design criteria that support adaptability of homes for different life stages

Specialist and supported housing

Age UK information guides and factsheets, including ‘FS64: Specialist housing for older people’

Age UK overview of assisted living and extra-care housing

Age UK overview of sheltered housing

National Housing Federation report on the financial benefits of supported housing

National Housing Federation report on the health and wellbeing benefits of supported housing

Housing Learning and Improvement Network report on supported housing for people with learning disabilities and autistic people in England

Local Government Association best practice and insights report on improving choice for people with a learning disability

Housing affordability

Department for Work and Pensions family resources survey, which provides information about the incomes and living circumstances of households and families

House of Commons Library articles on affordable housing in England

NICE guideline 214 (NG214) on integrated health and social care for people experiencing homelessness

Temporary accommodation

Homelessness statistics, published by MHCLG

Dwelling energy efficiency

Household energy efficiency statistics, published by DESNZ

Statistics on energy performance of buildings certificates (EPCs), published by MHCLG

Housing standards

House of Commons Library research briefing on housing conditions in the private sector

1. Lomas, KJ. Summertime overheating in dwellings in temperate climates, Buildings and Cities 2021: volume 2, pages 487 to 494 (viewed on 3 June 2026) ↩

2. Clark SN and others. The burden of respiratory disease from formaldehyde, damp and mould in English housing, Environments 2023: volume 10, page 136 (viewed on 3 June 2026) ↩