|
Background
Owning one's own home and owning a car are associated with a healthier
and longer life. Conversely, living in a rented home and in a household
without a car increase one's chances of reporting a long-term illness
and one's risk of premature death.
While these
patterns are well-recognised, little is known about why tenure and
car access are so strongly linked to health and longevity. Existing
literature tends to assume that there is no direct link between
tenure or car access and health. Instead, owning one's home and
having a car are seen to be predictive of health and longevity simply
because they are markers of other factors which directly influence
health (such as income or wealth, or psychological characteristics
like self-efficacy or mastery). However, it may be that aspects
of tenure and car ownership - for example, housing conditions or
quality of residential environment, or ease of access to services
- are themselves directly health-promoting or health-damaging.
Aims and
Objectives
The aim of the study is to investigate whether housing tenure and
car ownership are associated with health simply because they are
markers for income/wealth or psychological traits, or because they
have direct effects on health. Focusing on people of working age,
the objectives are:
- to examine
the associations between long-term physical illness and mental
health on the one hand, and housing tenure and car ownership on
the other, taking into account income/wealth and psychological
characteristics;
- to examine
the role of housing quality, residential environment and use of
cars in influencing long-term physical illness and mental health,
and in helping to explain observed associations between tenure,
car access and health;
- to examine
the personal and social significance of housing tenure and car
ownership in peoples' everyday lives;
- to provide
a more comprehensive view of regional and urban planning, which
would relate health to housing, community development and employment
initiatives.
Study Design
The study has two components:
- a postal
survey of a representative sample of 2,000 working-age adults
in the Central Clydeside conurbation;
- in-depth
interviews with a sub-sample of around 80 respondents.
The survey will
collect data on income, wealth (housing equity, pensions, savings
etc.), housing tenure and housing conditions, features of the neighbourhood,
car ownership and use, psychological characteristics, mental health
and long-term illness. This will permit statistical modelling of
the relationship between tenure and car access and health, taking
into account income/wealth, psychological characteristics and features
of housing, the area and car use.
The in-depth
interviews will examine in more detail how renting/owning a home
and having/not having access to a car affect people's everyday lives,
lifestyles and experience of health and work. Comparing and combining
quantitative survey data with richer qualitative data, the study
design will clarify the meaning of measures commonly used in public
and private sector surveys and in small area classifications.
Policy Implications
Tenants in Local Authority housing and people in households with
no cars not only experience social disadvantage but are at greater
risk of poor health and early death. If recent government/public
health targets are to be reached, then the health of more disadvantaged
groups must be brought up to the levels currently enjoyed by more
advantaged groups. Reaching these targets requires action not only
from the health care sector but also from other central and local
government agencies (environment, housing, transport, employment
and education etc.). Evidence about the health promoting or health
damaging features of tenure and car ownership can be fed into health
impact assessments of local and central policy options. It can also
help to answer recent calls for urban planning to avoid a sectoral,
fragmented delivery of urban regeneration initiatives and to adopt
a more comprehensive approach relating health to housing, community
development and employment initiatives.
Project Summary
Reducing health inequalities turns on policies which tackle those
aspects of poor socio-economic position which are health damaging.
The project examined two aspects known to be associated with health
and longevity, looking at whether and how owning one's home and
owning a car might be health promoting and how, conversely, relying
on public housing and public transport might be health damaging.
The project investigated whether housing tenure and car ownership
are associated with health, simply because they are markers for
income and wealth and/or of psychological characteristics, or because
they also have direct effects on health. It is the first study to
be designed specifically to examine this issue.
The project
involved a quantitative survey of a representative sample of 3000
adults in the West of Scotland, together with a qualitative study
of a sub-sample of 43. It used eight self-reported measures of physical
and mental health, including self-rated health, limiting longstanding
illness, number of symptoms, depression and anxiety subscales of
the Hospital Anxiety and Depression Scale (HADS) and number of General
Practice visits in the last 12 months.
Key findings
- All eight
health measures were significantly associated with housing tenure
and car access. This was in part because tenure and car access
were related to socio-demographic characteristics, such as income,
social class, age, marital status and sex, which were themselves
independently related to health.
- Housing tenure
and car access were also related to psychological resources (self-esteem,
mastery and ontological security) which were themselves independently
related to health.
- Over and
above these socio-economic, demographic and psycho-social associations,
home and car ownership were also found to confer physical and
psychological benefits which were health-promoting. These included
(a) access to amenities (b) protection from such problems as damp
and cold housing, noisy or abusive neighbours, and threats to
personal safety, and (c) the inconvenience and insecurity of public
transport. Housing quality was the most important mediator between
tenure and health, followed by the quality of the neighbourhood,
and lastly by housing style.
- The associations
between the two asset-based measures used in the study were not
the same for all population groups. Most notably, housing tenure
and car access were more strongly associated with health and psycho-social
assets among men than women, and housing tenure was more strongly
associated with health among single than cohabiting people. Car
access was not a significant predictor of health for women, but
was for men. Looking in more depth at the association between
car ownership and health, cars were coded by car market segment
(executive, sport etc). Men with access to more expensive cars
had the highest self-esteem and mastery scores, and better health,
but market segment was not predictive for women.
- Building
on quantitative and qualitative findings from the project, the
concept of ontological security has been extended to shed light
on the practical and psycho-social benefits of home ownership
and access to cars. Both owning a home and a car seem to provide
a greater sense of personal security and protection from physical
and personal threats, and a sense of doing well in life. However,
in principle, social renting and use of public transport were
seen to have some advantages, such as lower costs and fewer personal
responsibilities; it was the ways in which they were provided
(such as poor quality dwellings or erratic and dirty public transport)
which were seen to be stressful, inconvenient and health damaging.
- Methodological
contributions of the project included the development of a wider
range of measures of psycho-social resources, including ontological
security, via a mixture of quantitative and qualitative methods.
It also tested the reliability of area-based measures of deprivation,
like ACORN, in predicting the socio-economic circumstances of
households in the area. Area-based indices were found to be an
unreliable marker of household socio-economic status.
- With respect
to policy, the project does not suggest that owner-occupation
and car ownership have any intrinsic benefits for health. Rather,
they suggest that public renting and public transport, as currently
configured, have health-damaging effects through both physical
and psycho-social pathways. Policies which reduced these effects
- for example, by improving the physical fabric of public housing
and the perceived threats to personal safety on public transport
- may help to reduce inequalities in health.
|
