Housing is a critical social determinant of health. It is also a political football reflected in a government system that is set up to fail the homeless and those who are experiencing severe housing deprivation.
Healthy housing for all can be achieved however, if there is a cross party, long term, agreement to do so. As we get closer to the election, being cognisant of the issues that are contributing to a managed decline in health (Managed-Decline-Final.pdf), will help us all decide which party has the policies that can clinch our vote.
Healthy housing is affordable, suitable, secure and a human right. Research shows that 85% of ill health arises from poor social determinants of health. Housing, as one of the key social determinants of health, is a major contributing factor to preventable ill health. But home ownership has been declining for the past 30 years, from a high of about 78% in the 1980s to about 55% today. Furthermore, more than 1.5 million New Zealanders now rent, that is about one in every three people.
The quality of housing is strongly associated with tenure, as rental housing is generally older, colder, damper and mouldier than owner-occupied housing. BRANZ research has shown that private rental properties are three times more likely to be cold and damp than owner-occupied homes. Māori, Pacific, disabled and low-income people with lower rates of homeownership are more likely to be exposed to these poorer rental housing conditions and consequently have higher levels of potentially avoidable housing-related hospitalisations.
Housing focused interventions and programmes such as affordable rent, insulation, heat pump and heating cost subsidies, provide a sustainable and long-term strategy to bridge the gap between housing and health, leading to improved patient population outcomes and reduced costs. In 2018, 28,000 children and 54,000 adults were admitted to hospital for potentially avoidable hospitalisations linked to poor housing. The average cost of each hospitalisation is about $17,000. That equates to approximately $1.4bn annually in 2018. It will be much more now due to the rising rate of homelessness and deprived housing – women, children and older people living in cars or couch surfing. This does not include the costs of health inequity.
Health inequities between Māori and non-Māori adults cost $863.3million per year. Direct costs of $39.9 million per year included costs from ambulatory sensitive hospitalisations and outpatient care, with cost savings from underutilisation of primary care. Indirect costs of $823.4 million per year came from years of life lost and lost wages.
The 2024/25 New Zealand Health Budget was approximately $27bn. Reducing housing related hospitalisations and politically determined structured health inequities would save a great deal more than $3bn a year which is not inconsequential. But the human story is missing from all these facts and figures. A recent Facebook post outlined a heartbreaking story of a homeless man (Stuart a pseudonym) helped by another who is a member of a Community Housing Group. Stuart is one of 6000 people who lack accommodation on any given night in New Zealand. Another 100,000 people in New Zealand are experiencing severe housing deprivation.
Without help, Stuart would not have been able to do the multiple journeys across his home city, over multiple days to get the necessary paperwork done in a system embedded with multiple ‘hoops to jump through’. The result was a tiny room with one bed and nothing else, in a boarding house for $280 a week. The accommodation took up most of his benefit of $372 a week. Whether it ended up being a good fit, is questionable. For many, like Stuart, the increasing difficulty in getting a job that pays enough to live a healthy life, adds to the daily struggle.
Government systems are supposed to help not hinder those in need. However, it seems that the relationship between the state and the people it governs could be seen as abusive. If that seems a step too far, we only need to look at the recent Coalition government policy that will force the homeless to ‘move on’ or be fined/jailed. The draft law has been criticised as it criminalises poverty and homelessness but does not address the underlying issues described above.
The draft law also reflects a shift in government power. Hannah Arendt argued that genuine power rests on collective support and acting together, whereas violence and abuse are instrumental and appear when power is in jeopardy. The coercion of the same people is used to suppress dissent and is often captured by those with narrow interests. The challenge for a democratic state is to keep such policies subordinated to law and answerable to the people over whom it is used. Some 98% of select committee submissions to the draft law, were against it. Hopefully, the government will listen to the people. If they don’t we all have a choice. Enroll and vote on the 7 November 2026.