View From the Ground, by Dr Claire Davies
Most GPs have a story that they are proud of, one in which they made a difference to a patient’s life. For me, my biggest achievement was in getting two patients rehoused. They were very different people, but both were mentally and physically troubled by violence relating to where they lived or whom they lived with, and were arguably more grateful and relieved than any patient I’ve ever called an ambulance for.
Writing a sincerely-meant housing letter for a patient now seems pointless, because there is no housing available for them to move to. Patients in our borough tell me that there is a 10-year waiting list to move to a bigger property. I don’t actually have time to write housing letters, and it shouldn’t be my role, but in the past, there have been times when a judiciously aimed, passionately written letter has made a huge difference for a patient. In theory, a GP should be sent a housing medical assessment form whenever there are health issues related to a patient’s housing. However, I have only been sent this form once in 20 years, and even when the patient’s housing is a significant issue, housing letters don’t change anything anymore.
Yet the housing conversation won’t move away from the GP. Patients regularly attribute their health problems to poor housing; issues can include noisy accommodation that causes sleep deprivation, living next to ‘problem’ neighbours, stifling spaces, and pollution and damp that triggers asthma. Some families in temporary accommodation have reported that broken lifts and hauling prams up multiple flights of stairs have caused back problems; others report overcrowding—with teenagers having to share a bedroom with unwell grandparents—and patients with serious rheumatic disorders having to sleep on a sofa. Patients are often anxious to tell us about their housing; perhaps they believe that doctors have the power to change the situation, but this couldn’t be further from the truth.
Crowded housing is stressful and detrimental to health and wellbeing. It increases tensions from family dynamics, exposure to factors such as tobacco smoke and infectious diseases of other household members, and the risk of injuries in the home. Housing problems can affect anyone in need of social housing, but ethnic minorities are often disproportionately impacted, with households from black and ethnic minority groups more likely to live in overcrowded housing than white British households.1
Pollution is another problem related to housing. In our practice area, there are multiple blocks of flats that overlook six lanes of the A12. In other flats it is impossible to have a window open in the summer, because of noise from trains. Patients say that transport companies claim the noise has been measured and is ‘acceptable’—but acceptable to whom? Children in Tower Hamlets have 10% less lung capacity than the national average,2 and numerous research studies have also linked pollution to poor mental health.3 The stressors in inner city life are, of course, multifactorial, but I secretly blame the A12.
Don’t get me wrong, not all social housing is undesirable. In many flats you can find shelves of family treasures and gardens bursting with roses. However, the problems associated with social housing are also endemic. One-third of families on our practice list are classed as vulnerable, and just one adverse event could cause them to need accommodation in hostels.
Furthermore, people fleeing domestic violence or problems with gangs are often offered housing that is outside of the borough—away from their extended family, their support network, their jobs, and their children’s school and friends. Starting from scratch is another secondary trauma; the choice is either to live alone elsewhere, or live here in fear—both will have a negative impact on health.
Poverty has never had a face in this country. People make themselves presentable to the world until they reach the point that they are in a sleeping bag on the street. The housing problem is invisible. You can live in an urban area of deprivation and still buy a £2 million pound house, go to nice shops, and steer clear of the issue, and only become aware of it when it is right under your nose.
It has recently been suggested that GPs could prescribe vegetables to patients. Although the idea itself is ludicrous, if I did have a blank prescription pad for social change, I would prescribe patients a spacious, sound-insulated, unpolluted, and green space-accessible house.
Dr Claire Davies