HOUSING AND HEALTH IN AUCKLAND - ARPHS Information/HealthyEnvironments... · Buying on a low income 14 ... Fitting insulation to older New Zealand houses im- ... HOUSING AND HEALTH

Working with the people of Auckland, Counties Manukau and Waitemata

Auckland Regional Public Health Service

HOUSINGAND HEALTHIN AUCKLAND

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DisclaimerWhile the Auckland Regional Public Health Service (ARPHS)

of the Auckland District Health Board (ADHB)commissioned this report, the opinions in this document

may not necessarily reflect those of ARPHS (ADHB).ARPHS sees this as a useful resource for informing people and

assisting with discussion on housing and health issues.The information in this document has been gathered from existing literature.

While every effort has been made to ensure the information is accurate,no liability is accepted by ARPHS (ADHB) or its funder

for the accuracy or omission of any statement or information.

This document is available on theAuckland Regional Public Health Service website - www.arphs.govt.nz

Everyone has the rightto a standard of living

adequate for the health and wellbeing of themselves and their family ...

including housing

Universal Declaration of Human Rights, Article 25’’‘‘

HOUSING AND HEALTHIN AUCKLAND

A SUMMARY OF SELECTED RESEARCH

Published byAuckland Regional Public Health Service

Auckland District Health BoardPrivate Bag 92605 Symonds St

Auckland New Zealand2005

ISBN 0-476-01403-4

By Jenny RankineWords and Pictures

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6 Cold, damp and mould 25Cold, damp, mould and health 25

Occupant behaviour 26Initiatives about cold, damp and mould 26Possible actions 27

7 Hazards and injury 28Vehicle injuries 28

Fire 28Heating and hot water hazards 28Poisoning 29Falls 29Glass hazards 29Electricity 29Safety initiatives 29Possible actions 29

8 Beyond monocultural housing 30Designing appropriate housing for

Maori whanau 30Initiatives about Maori housing 30Designing houses for Pacific families 31Initiatives about housing for Pacific people 31Possible actions 31

9 Conclusion 32

Appendix 1 - Key concepts 33Health 33House 33Household 33Home 33

Abbreviations 34

Notes 34

References 39

CONTENTS

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Executive Summary 5

Relationships between housing and health 6

1 Introduction 7

2 Swings in national housing policy 8Statutory responsibilities for housing 9

Treaty of Waitangi 9International obligations 9Possible actions 9

3 Affordability - the high costof housing 11

Affordability and health 11The scope of the problem 12Affordability and the Accommodation Supplement 13Stuck in a rent trap 13Buying on a low income 14Housing gaps for mental health service users 14Affordability initiatives 14Possible actions 15

4 Crowding 16When is a house overcrowded? 16

Crowding and health 16Official statistics underestimate crowding 18Populations facing the most crowding 18Other characteristics related to crowding 19Locations most affected 19Mobility 19Initiatives about crowding 20Possible actions 20

5 Substandard housing 21Substandard housing and health 21

Poor housing over a lifetime 21The scope of the problem 22Initiatives about substandard housing 23Possible actions 24

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AND HEALTH IN AUCKLAND

T HIS report summarises selected recent researchinto housing and health in the Auckland urban re-gion. It was commissioned by Auckland Region-

al Public Health Services, which has a housing brief.It is written for public health and health promotionworkers, local government, Housing New ZealandCorporation (HNZC) and non-governmental organisa-tions with an interest in housing issues.

Policy and rights� Changes in government housing policy have had anegative impact on the supply and quality of housing inAuckland, especially for households on low incomes.Policy has swung from a high level of state provision,to reliance on the market, sale of state housing stock,and subsidy of market rents for people on low in-comes. It swung back to income-related rents for statehouses and an attempt to build state housing levels,while maintaining rent subsidies in the private market.� There is no right to adequate housing under NewZealand law.� One group of non-government organisations(NGOs) considers that the government is in breach ofthe clauses on discrimination in the UN InternationalCovenant on Economic, Social and Political Rights,which it has ratified, because of the concentration ofhousing deprivation among Maori and Pacific people.

Affordability� Affordability is commonly defined as a percentageof housing cost, usually 25%, to income, rather than bywhether there is enough money left over for basic liv-ing after paying housing costs.� In 2001, 23% of Auckland households were paying40% or more of their net income on housing.� Families in unaffordable housing often do not havemoney for food, especially nutritious food, or healthservices.� Unaffordable rents force families into substandard,overcrowded or unhealthy housing, where they cannotafford heating in winter and which may force them tomove often or endure periods of homelessness.

Crowding� Crowding is a persistent and increasing problem indeprived areas of Auckland.� Crowding is strongly associated with a range ofinfectious diseases, including meningococcal disease,tuberculosis, acute rheumatic fever, respiratory infec-tions and illness, and Helicobacter pylori (bacteria thatcause stomach ulcers).� Crowding is stressful for children and adults, and inchildren also increases emotional problems and bed-wetting, delays development and reduces schoolachievement.� Census figures for small area units of around 90households give the closest official indication of the

extent of crowding, although official statistics underes-timate crowding.� Crowding in Auckland is getting worse for Pacificchildren, and for what Statistics New Zealand calls the‘Other’ ethnic group - mostly recent African and Mid-dle East migrants - while it is improving for Maori andPakeha.

Substandard housing� There is no single set of agreed criteria for assess-ing housing quality.� The poorest people, facing the most discrimination,are more likely to be forced into substandard housing.The number of Auckland people living in garages andcaravans is likely to be severely underestimated.� Living in a substandard house is an independentand additional source of stress; it also affects physicalhealth through allergens, pest infestation, poorly func-tioning heaters or stoves and toxic chemical exposure.� Long periods in poor housing during childhood hasa negative effect on adult health.

Cold, damp and mould� One in four New Zealand houses (300,000) are un-insulated.� New Zealand houses are cold by internationalstandards, and people on low incomes are more likelyto live in uninsulated and cold houses.� People living in damp and mouldy houses are morelikely to have respiratory conditions and a wide rangeof other medical symptoms than those in dry homes,regardless of other factors.� Fitting insulation to older New Zealand houses im-proves residents’ health, reduces GP visits, absenteeismat work and school, and saves more than it costs.

Hazards and injury� Poor housing increases the risk of injury from lackof fencing, unflued gas heaters and exposed heatingsources, unprotected high windows, balconies andstairs, faulty wiring or appliances, poor storage, break-able window glass, flammable materials and lack offunctioning smoke alarms.� The longer people live in poor housing, the more itaffects their mental and physical health; children areparticularly vulnerable.

Beyond monocultural housing� Housing policy, regulation and design have as-sumed Pakeha cultural norms, and have consistentlybeen viewed as discriminatory by Maori.� Housing and health initiatives for Maori should bebased on rights guaranteed by the Treaty of Waitangi.� Existing state housing stock is particularly poorlysuited to housing large Pacific families.� Maori and Pacific people have identified design al-ternatives to existing monocultural housing.

EXECUTIVESUMMARY

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Table 1 - Relationships betweenhousing conditions and health

OTHERCHRONIC

CONDITIONS+

INJURIESPOISONING

PSYCHO-SOCIALHEALTH

CULTURALHEALTH

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� � � � �

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� � � � �+ Includes heart and circulatory conditions; gastric and nutrition problems; headaches and skeletal problems.

# Includes stoves and unflued gas heaters

Source: Chiefly from Ministry of Pacific Island Affairs, Scoping Report on Status of Housing for Pacific Peoples.

INFECTIOUSDISEASES

RESPIRATORYHEALTH

AFFORDABILITY

SUBSTANDARDHOUSING

CROWDING

COLD

DAMP ANDMOULD

FAULTYHEATINGSOURCES #

POLLUTANTSAND PESTS

NOISE

MONOCULTURALHOUSING

LACK OFSHELTER

Note: Throughout this report, decimal points have been rounded to the nearest whole number.

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1 INTRODUCTION

THE Auckland Regional Public HealthService commissioned this summaryof existing research about the rela-

tionship between housing and health in theregion to contribute to this work.

This report has been written for publichealth and health promotion workers, lo-cal government and organisations interest-ed or involved in housing issues. It aimsto summarise current knowledge, identifygaps and list interventions which havebeen suggested, tried elsewhere or trialledin the region.

Much of the research assumes a com-mon understanding of key concepts, in-cluding families, households, houses,homes and health. However, this is notthe case. Different cultures in Aotearoaunderstand and live these concepts in dif-ferent ways. These meanings are exploredin Appendix 1.

Much of theresearch

assumes acommon

understandingof .. families,

households,houses, homes

and health.However, this

is not the case.

The Auckland Regional Public Health Serviceis undertaking work on housing

as a determinant of healthin the Auckland region.

Robert Graham

Several sources identified governmenthousing policy as a major influence onhousing-related health and social prob-lems. The report starts by describingchanges in this policy over the last 14years.

The affordability of housing is identi-fied as a direct influence on health, sum-marised in section three. It is also an indi-rect influence, as unaffordable housingprices force households into substandard,crowded, cold, damp, mouldy and hazard-ous accommodation, which poses addi-tional health risks. These factors overlap,but for clarity have been separated and aresummarised in sections four to seven.

Many sources identified a public hous-ing stock designed for Pakeha norms andsmall families as a problem for large fami-lies, Maori and Pacific households. Thereport describes the results of recent con-sultations with these communities abouttheir housing needs in section eight.

At the end of each section, the reportlists existing housing initiatives and otherpossible actions suggested in the research.

This report is not an exhaustive sum-mary - it draws from only those sourceslisted in the references.

Gil Hanly

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2 SWINGS INNATIONAL HOUSING POLICY

Housing policy has zigzagged sharply in the last 14years. From broad state provision of subsidised

housing and accommodation benefits, policychanged to market rents and sales of state housing,

followed recently by diminished state provision.1

IN 1990, people on low incomes received different levels of assistance, depending on whether they were state or

private tenants. The Housing Corporationsubsidised mortgages and rents (at 25% ofhousehold income), and the Department ofSocial Welfare provided an accommoda-tion benefit for private tenants.

In 1992 the government replaced theHousing Corporation with a state-ownedand commercially-oriented company,Housing New Zealand. It also raised rent-als to market levels by July 1996, whichbreached some state house tenancy agree-ments.2

The Accommodation Benefit was re-placed in 1993 by an AccommodationSupplement (AS) available to all low-in-come tenants. Its complex formula wasadjusted for need, income and location; atfirst it paid 65% of the difference between25% of tenants’ total income and theirrent, raised to 70% in 1997.

The Accommodation Supplement ini-tially appeared to be much more generousthan the previous benefit, but it led to rap-id rent increases and left many tenantsworse off. For example, in South Auck-land between 1993 and 1997, rents rose atfour times the rate of inflation and houseprices climbed even more, while there waslittle growth in the number of houses.Johnson’s report for the Child Poverty Ac-tion Group (CPAG) says: “..the Accom-modation Supplement has proved to be alandlord subsidy … increasingly burden-some for taxpayers.”3

The change to market rents in statehouses fostered overcrowding and has hada strong impact on housing in Auckland,and especially on families with low in-comes.

Between 1992 and 1999, the govern-ment sold huge amounts of state housingassets. The number of state-owned rental

units dropped from nearly 70,000 to59,000 as they were sold to private buy-ers. The state-owned mortgage fund wasended in 1992 and by 2000 sales of statemortgages to private buyers had reached$4 billion. This revenue was not re-invest-ed in social housing. No new state hous-ing was built or bought in the 1990s andmaintenance of existing houses was re-duced.

In 2000 the government re-introducedincome-related rents for just over 50,000households living in state houses. At thattime “a further 150,000 households or400,000 people remained in private rentalhousing, living in financial circumstancessimilar to those of state tenants”.4

Current housing policy has been de-scribed as “minimal state involvementcouched in the rhetoric of state support”.5

In 2003, 58% of households on HousingNew Zealand’s waiting list were in Auck-land, and the number of families in high orurgent need of a state house topped 4,000.

The Government plans to build, buy orlease more than 3,300 state houses to2007, 73% in Auckland.6 This level ofsupply will barely match populationgrowth. A third of this new stock will beleased, reducing the supply for low incomefamilies who do not qualify for state hous-es.

This means the situation for low-in-come families renting private houses is un-likely to change from where it was in2000. At the rate of government spendingon additional state housing, it will take upto 20 years to replace the 10,000 housesearlier sold in less than seven. The stressof this under-investment in housing is be-ing felt most in Auckland, which in 2001had 31% of the New Zealand populationand the highest demand for housing.

The Accommodation Supplement (AS)has become built into property values andthe expectations of landlords and tenants.The AS cost taxpayers $352 million in the1993/4 financial year, but within six yearsit had reached $864 million, twelve timesthe rate of inflation. Johnson says this riseresults directly from the inequality be-tween rich and poor which grew duringthe 1990s, and which is maintained by cur-rent housing policy.7

Total AS payments are likely to doubleover the next 20 years to more than$1,000 million a year in 2021. Thisamount would build around 5,000 statehouses, enough to house the families cur-rently in high need of a state house andwith some left over to get the Governmentoff this financial treadmill.

Johnson and CPAG says this gives thegovernment a choice. It can funnel

“The situationfor low-income

familiesrenting private

houses isunlikely to

change fromwhere it was in

2000.”

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Robert Graham

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HOUSING


around $50,000 per household to land-lords through AS payments over 20 years,or it can spend this amount on alternativesto help solve the housing shortage.

New Zealand has a low level of stateand other social housing (6%) comparedwith many European countries, where itmakes up to 40% of the total.8 Housingpolicy has largely ignored the non-govern-ment social housing sector, which is un-derdeveloped compared to Europeancountries.

The Government is reviewing the Resi-dential Tenancies Act 1986. Building theFuture: The New Zealand Housing Strate-gy was released in May 2005. This setsthe direction of housing policy and out-lines a ten-year programme of action.

The strategy’s priorities are to improveaccess to affordable and sustainable hous-ing and home ownership, improve housingquality, develop the private rental sector,strengthen housing sector capability andmeet diverse needs. Recommendationsfrom the strategy’s discussion documentare included in other parts of this report.

Statutory responsibilitiesfor housingThere is no right to adequate housing un-der New Zealand law. The Health Act1956 and the Building Act 1991 requirelocal councils to monitor housing condi-tions and building standards, contain over-crowding and act on substandard housing.

However, councils rely on complaintsfrom tenants to act on dangerous or un-healthy rental housing. Councils cannotrequire upgrading unless a fire hazard, forexample, is likely to cause almost certaindeath.

A former chief executive of HousingNew Zealand described this regulatory re-gime as lax and discriminatory, with inade-quate penalties that deal only with crowd-ing.9

The Local Government Act 2002 mayenable councils to play a more importantrole in meeting housing needs.

The recent leaky building crisis - rot-ting frameworks needing complete re-placement in many nearly-new buildings -resulted from changes introduced in theBuilding Act 1991. This crisis has sparkedpublic debate on “excessive deregulation”about new buildings in the Act, but notabout substandard older housing.10,11

Treaty of WaitangiUnder Article 3 of the Treaty, all Crownagencies should ensure that Maori citizens

enjoy the same rights as others. However,Maori have been substantially disadvan-taged by housing markets and policies.12

The translation of monocultural policyinto housing design has produced a stockof small state houses that are unsuitablefor extended Maori families.

Housing policy has also assumed thatthe family unit is independent, autono-mous and self-supporting. This is lesscommon in Maori or Pacific households,where household bills often come secondto extended family expenses (see Appen-dix 1).

Criticism of the way government hous-ing policy has failed Maori has been long-standing and consistent (See Beyond Mo-nocultural Housing). One report said thattreating everyone the same had failed toachieve equal outcomes for Maori and Pa-keha.13

International obligationsThere is consistent evidence of discrimina-tion in private and state rental housing,and there have been no recent policy initi-atives to counter this. Tenants are reluc-tant to take action due to a shortage ofhouses, fear of eviction and lack of knowl-edge about how to complain. This im-pacts particularly on Maori, Pacific peo-ples, those with mental health problems,and other stigmatised populations.14,15,16,17,18

Although the New Zealand Govern-ment has signed the UN InternationalCovenant on Economic, Social and Cul-tural Rights (ICESCR), which includes aright to adequate housing, it has not in-cluded this right in our laws.

A group of NGOs argues that the Gov-ernment is in breach of the Covenant’sclause banning discrimination because ofthe concentration of housing deprivationamong Maori and Pacific people.19

POSSIBLE ACTIONS� Include the right to adequate housing in law by either –

� Amending the Bill of Rights� Including in housing or human rights legislation a specificrequirement that all people, including homeless people, areadequately housed� Including ICESCR rights in a New Zealand constitution� Including rights and minimum housing standards in aHousing Charter.20

� Develop a major role for social housing in the New ZealandHousing Strategy, with partnerships between HNZC, local gov-ernment, third sector NGOs, iwi, Pacific communities, charitabletrusts and other providers.21

� Assess the health impacts of major new housing policy initia-tives during their development, using the Health Impact Assess-ment guidelines adopted by the Ministry of Health.

“New Zealandhas a low levelof state andother socialhousing (6%)compared withmanyEuropeancountries,where it makesup to 40% ofthe total.”

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� Provide Government incentives for NGO social housingproviders, including shared equity, revolving loan funds, mort-gage guarantees and advisory services.22

� Fund the NZ Housing Strategy with $500 million a year fora decade to increase the supply of social housing.23

� Involve Maori in developing a Maori housing strategy.24

� Create a Maori Housing Authority.25

� Require local bodies by law to retain their current overalllevel of direct provision of social housing.26

� Revise the Health Act to include and enforce minimumhousing standards.27

� Monitor more effectively the safety standards, building reg-ulations and tenants’ rights in boarding houses.28

Other policy-related possible actions follow other sections ofthis report.

POSSIBLE ACTIONS (continued)

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3 AFFORDABILITY-THE HIGH COST

OF HOUSING

Housing is affordable if it is –� Adequate – this includes the quality of the

house, whether it suits the household’s needs,and whether it is in reach of work, shops,

schools and community facilities;� And if households have enough income left

over from mortgage or rent to cover otherbasic living costs, and provide

an acceptable standard of living.29

COMMON definitions focus on the ratio of housing costs (usually a maximum of 25-30%) to gross in-

come, rather than whether householdshave enough money left over for basic liv-ing after rent or mortgage payments.

The AMP Housing Affordability Index(HAI) is an ongoing measure of affordabil-ity for house buyers. It compares wages,house prices and mortgage interest ratesto work out how many years it takes tobuy a house on the average wage.

It shows that affordability in late 2003was better than in the mid-1990s and notgreatly different to the late 1990s. How-ever, the deposit gap has increased andcrossing the threshold to home ownershiphas become more difficult.30

A report by Business and EconomicResearch Ltd (BERL) found that in 1996at least 23,000 Auckland tenant house-holds, or 6%, were paying unaffordablerents and predicted this would rise.31 Thisfigure did not include households in sub-standard, crowded or unsuitable accom-modation, or those paying unaffordablemortgages.

The 2000/01 Household EconomicSurvey found that 23% of Aucklandhouseholds were paying 40% or more oftheir net income on housing. Tenanthouseholds were paying a larger propor-tion than owner-occupiers.32

The 2003 NGO submission says theextent of the unaffordable housing prob-lem cannot be overstated.

Affordability and healthUnaffordable housing costs encouragecrowding, force people into substandardhouses or to live without heating. All ofthese also impact on health and are dealtwith in the following sections.

Renting is bad for your health – rentershave higher death rates from cardiovascu-lar conditions and other causes than own-er-occupiers, even when other socio-eco-nomic variables have been taken into ac-count.33

Renting and owning also lead to differ-ences in how people rate their own health,levels of long-term illness and how oftenthey go to their GP. This may be becauseowner-occupiers can afford better homesin better locations, making them lessstressful to live in.34

Households that are paying more than30% of their income in housing costs of-ten do not have enough left to pay foritems essential to good health, includingnutritious food and health services.

Low-income households tend to buyfood high in fat, sugar and salt because itprovides more energy per dollar than low-fat food.35 One Auckland mother of four“spoke of wanting to be able to give herchildren ‘healthy food like apples’ but in-stead having to buy a box of mutton flapsand a 20 kilo bag of potatoes with whichto feed her family for a week”.36

The 1997 National Nutrition Surveyfound that 12% of households report feel-ing stressed because of not having enoughmoney for food; almost a third of thesehouseholds were Pacific people.

“I have no money set aside forfood. I’ll pay the bills first and then ifthere’s money left over I’ll buy food…we don’t make a list or check the cup-boards before shopping because there’snothing in them to begin with. There’snothing in the fridge.”37

A survey of a random sample of low-income households throughout New Zea-land found that 44% paid at least 40% oftheir net income on housing and one infour paid at least half.38 Lack of moneymeant that at least once in the previousthree months, three out of five had notbeen able to buy essential foods. Overhalf had not been able to visit a doctorwhen they needed to. Two out of five hadbeen unable to visit the doctor at leastthree times.

“Your kids’ health suffers. Pre-scriptions - they just come up out ofthe blue. Well, there’s your meat mon-ey because it has just gone on prescrip-tions.”39

Several participants described having

Robert Graham

“I’ll paythe bills first

and then ifthere’s money

left overI’ll buy food.”

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“Well, there’syour meat

money becauseit has just

gone onprescriptions.”

to choose between food, heating, medicalcare and obligations to their whanau orfamilies in the Pacific (see Appendix 1),and sometimes having to choose whocould eat and who could do without.

“The amount of money we have forfood changes each week depending onwhat cultural occasions come up. Ifthere’s none then there’s more moneyfor food. If there’s many, then its backto jam and bread… Ideally it wouldtake about $150 to feed everyone well,but even on weeks when there’s nocultural things, we still don’t have thatmuch.”40

Medical and dental care are frequentlysacrificed in these situations.

The availability of health services,shops that sell cheap, healthy food, andaffordable facilities for physical exerciseare important for health in deprived neigh-bourhoods where people may not be ableto travel far.

The scope of the problemHousing affordability became rapidlyworse during the first half of the 1990s,then steadied and has not improvedsince.41 By 1998, 8% of households werebelow the poverty line (half of the medianhousehold income) solely because of theirhousing costs. The steep increase in hous-ing costs was caused by the Government’sintroduction of the Accommodation Sup-plement and market rents in 1996,42 aswell as the cost of first mortgages and im-migration.43 Migrant populations areheavily concentrated in Auckland.

Those least able to compete in thehousing market are squeezed into sub-standard, overcrowded or unhealthy hous-ing when housing costs rise and haveslightly more options when costs fall.They often cannot afford heating in winterand may have to move frequently or en-dure periods of homelessness.

More families on low incomes are ap-plying for Special Benefits to pay for theirunaffordable housing. Of those on SpecialBenefits, an estimated 37% are receivingthe maximum AS.44

In 1996, Auckland City had the highestnumber of households paying rents over30% of their income (12,000 or 9%) fol-lowed by Manukau City (5,541 or 7%).45

These figures are acknowledged to be sub-stantial underestimates.

In 2001, two out of five Aucklandhouseholds in the bottom 20% incomeband were paying unaffordable rents, morethan double the proportion in 1988.Households which include Maori and Pa-

cific peoples, people in what Statistics NZcalls the ‘Other’ ethnic group, familieswith children, solo parents, single personhouseholds, and people with disabilitiesand chronic illnesses are much more likelyto live in unaffordable housing.

In November 2003, the HNZC hadmore than 3,200 high-need applicants inAuckland waiting for a house, but only219 houses became free in that month.

In 2003 CPAG worked out the differ-ence between affordable (25% of house-hold income) and market rents for typicalSouth Auckland households who were re-ceiving an Accommodation Supplement.

A family of two adults and three chil-dren in a three-bedroom house on the low-est 25% of household earnings was payingabout $170 a week more than they couldafford. A single parent family on the Do-mestic Purposes Benefit in a two-bedroomflat was paying $100 a week more thanthey could afford.46

‘Alatini’s 2004 survey of 103 Tonganhouseholds in Otara also illustrates the ex-tra costs facing private tenants on low in-comes. Two-thirds of the state house ten-ants in the survey were paying 25% or lessof their income on rent, while 54% of pri-vate tenants were paying between a quar-ter and a half. Fourteen percent were pay-ing more than half.47

The research also says emergencyhousing is insufficient. Women leavingdomestic violence refuges and people withlong-term mental illness leaving hospitalhave difficulty finding adequate housing.

Table 2 - Households on Housing NZCwaiting lists in April 2005Area Severe

NeedSignificant

needModerate

needLow need

Total

Glen Innes 1 141 264 131 537Grey Lynn 4 137 120 59 320Henderson 1 423 401 165 990Mangere 17 370 178 54 619Manurewa 3 181 276 81 541Mt Albert 2 82 133 132 349Mt Roskill 1 287 291 84 663New Lynn 4 258 253 87 602Onehunga 1 188 114 58 361Otahuhu 9 142 131 31 313Otara 1 112 154 50 317Panmure 1 110 218 95 424Papakura 1 38 47 51 137Takapuna 5 97 109 72 283Auckland Total 51 2566 2689 1150 6456

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HOUSING


Affordability and theAccommodation SupplementThe Accommodation Supplement (AS)pays up to 70% of the difference between25% of tenants’ total income and theirrent, depending on need, income and loca-tion.

Just over half of all Auckland tenanthouseholds receive the AS. The averagevalue of the supplement did not drop whenincome-related state rents were re-intro-duced, which suggests that private tenantsreceiving the AS had similar incomes topublic tenants. Across New Zealand,three in every four people needing the ASare private tenants paying market rents.Most are on a benefit and the majority arehouseholds with children.

The New Zealand Poverty Measure-ment Project calculated that despite theintroduction of the AS, between 1993 and1998 the number of households below thepoverty threshold nationally increasedfrom 18.5% to 19.3% after housing costswere taken into account. Most of the in-crease in poverty came from renters pay-ing market rents. The project estimatesthat in 1998 housing costs made uparound 60% of the income shortfall forfamilies living in poverty.48 The povertygap trebled for private renters and morethan quadrupled for state tenants.

A higher proportion of Maori and whatStatistics NZ calls people of ‘Other’ eth-nicities (mostly recent African and MiddleEast migrants) receive the AS than Pacificand Pakeha people. Johnson estimates inthe CPAG report that an extra 1,500Auckland households each year will needthe AS to help pay their housing costs.

Stuck in a rent trapHousing markets have been described as“powerful engines of inequality” whichtake income from renters and give it toowners through tax exemptions, tax de-ductions and subsidies.49 New Zealand’sprivate rental market is made up of a largenumber of small investors, each owningonly a small number of properties.

Historically, New Zealanders havebeen proud of their comparatively highlevel of home ownership. In 1991, almostthree-quarters of Aucklanders were own-er-occupiers. More adults lived in homeswith a mortgage than without, and only27% of households rented.50

Home ownership has dropped sincethen, more in Auckland than elsewhere.By 2001, only 64% of Aucklanders wereowner-occupiers and 36% were renting.

Home ownership dropped more amongthe poorest communities than the wealthi-est. Only about 12% of the new Aucklandhouseholds in that decade were owner-occupied; almost all new households onthe lowest incomes were renting.

Between 1991 and 2001 Aucklandrenting levels rose most (10%) in Wait-akere City, where home ownershipdropped by 15%. Manukau City was sec-ond with a 13% drop in ownership and an8% increase in renting. Auckland City hasthe highest level of renting at 40%. Thiscity also has a large student population onlow incomes and young professionals andcouples with no children who do not wantto buy a house.51

Home ownership tends to be loweramong Maori and Pacific populations inthe eight largest cities than in the rest ofthe country. These groups are more likelyto have younger populations, have largerand younger families and to be on lowerincomes. According to 2001 census data,in the four Auckland urban council areas,56% of Pakeha households owned theirhome, compared to 26% of Maori and24% of Pacific households.52

Although most people over 65 live intheir own homes, ethnic differences in old-er people’s ownership rates have in-creased. In 1996, three-quarters of Pake-ha older people lived in their own mort-gage-free homes compared to half of olderMaori and 25% of older Pacific people.

Sixty-two percent of Pacific peoplelive in rented houses; in Auckland Pacificpeople make up 44% of HNZC tenants.53

The majority of Tongan tenants in‘Alatini’s 2004 Otara survey predictedthey would never be able to save enoughmoney to buy their own home.

“No, never with the income we have,which is mainly shared amongst medi-cal bills. I guess that is why they call ita dream.”54

Crowded households are less likely toown and more likely to rent. In 2001,68% of uncrowded households ownedtheir own house, but only 38% of crowd-ed households were owner-occupied.55

It is almost impossible for the poorestquarter of New Zealand households to geta mortgage to buy a house because of thelack of low-income state loans and a dropin their real wages. This rent trap is par-ticularly difficult for populations such asPacific peoples, who have significantlylower individual and household medianincomes than the general population.

Rent and house prices have grownfaster than income since 1993.56 Totalhousing costs for renters increased by166% from 1987, while tenants’ incomes

“Housingmarkets havebeen describedas ‘powerfulengines ofinequality’which takeincome fromrenters andgive it toowners..”

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rose by only 59%.57

These steep rises in Auckland havetrapped low-income households in renting.The tax system combined with the abate-ment regimes for the AS and other benefitsdiscourages people from moving off bene-fits to low-income employment. “At itsmost extreme, the current regimes pro-duce an effective marginal tax rate of125% for some people.”58

The AS formula ensures that most re-cipients’ housing costs are well over 30%of their income, up to 40% in the cities.AS does not help households save enoughdeposit for a mortgage. For many fami-lies, this has been the case for decades.

The fall in home ownership rates islikely, over time, to result in higher hous-ing costs for retired people and increasedgovernment spending on accommodationsupplements.59

Buying on a low incomeLow income people lucky enough to beable to save a deposit can get only smallloans, so they can afford only housing thatis substandard, of poor quality or wouldneed major repairs in the near future.60, 61

The Auckland Regional Council’s Af-fordable Housing Strategy suggested that$175,000 was the minimum price in 2003for a reasonable quality, entry-level, com-mercially-built new brick and tile houseand section in Auckland.

According to the Regional Growth Fo-rum, in 1999 nearly two out of five Auck-land households had an income of $30,000or less.62 A $175,000 house is out of thereach of a household on $30,000. Assum-ing this household was able to save a 20%deposit (a very difficult thing to do) andwas receiving the AS, they could affordonly a $155,000 house at 8.5% interestwith a 25-year mortgage.

Without the AS, this household couldafford only a house costing $116,000.While the AS does increase the purchasingpower of this household, it is not enoughto buy a new entry-level home. And eventhese modest prices would be out of thereach of the 30% of households earningunder $30,000.

Research with Maori indicates thatmost want to own their own home, but fora substantial proportion this has been anunachievable dream for more than a dec-ade, and it was impossible to raise theamount needed for a deposit in AucklandCity and South Auckland.63

One literature review suggests that themost effective overseas government homeownership initiatives have focussed on the

“In 1999nearly two out

of fiveAuckland

householdshad an income

of $30,000or less.”

availability and cost of mortgage financefor people with low incomes.64

Housing gaps formental health service usersAn estimated 3% of New Zealanders, oraround 240,000 people, have serious, on-going and disabling mental illness needingtreatment from mental health or alcoholand drug services. More than half do notget treatment. One study estimated thatup to half of people with ongoing and dis-abling mental illness may have problemswith their housing.65

Most mental health service users inter-viewed for this study reported major prob-lems finding affordable housing. They didnot want to live long-term in clustered orgroup housing for people with mentalhealth problems. They found the movefrom residential mental health treatment toindependent living to be a major hurdle.

Most transitional short-term housingrequires rent in advance, a bond payment,or a mental health needs assessment, all ofwhich were problems for interviewees.They also said there is little housing forolder people who have been in mentalhealth institutions for a long time and whowill always have high support needs.

Owing money to the Department ofWork and Income was common amongmental health service users, as they mayneed grants for bond and rent advancesmore than once a year if they move in andout of hospital.

New Zealand affordabilityinitiatives� In 2003, the HNZC Housing Innova-tion Fund was established for iwi, commu-nity, church and ethnic groups who wantto provide housing in Special Housing Ac-tion Zones such as South Auckland. Theymust target low income groups and meetat least 15% of the project cost.� Non-profit organisations using volun-teer labour, such as Habitat for Humanity(HFH), could build a new brick and tilehouse for $130,000 in 2003. HFH pro-vides no-interest mortgages and uses 500hours of labour from the eventual low-income owners to build its houses. It iscurrently building up to 29 houses in Clen-don. However, its resources are limited.In the Auckland region HFH has been ableto build only 42 houses for 227 people inthe last 11 years.66

� Some similar projects have been lesssuccessful. One Group Self-Build Pro-

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gramme resulted in buildings which didnot meet resource consent, leaving partici-pants owing mortgages on unliveablehouses.67

� The Auckland Regional AffordableHousing Strategy proposes a raft of af-fordable housing action areas and tools foradoption by local authorities. One com-monly used overseas tool is inclusionaryzoning, which requires up to 30% of alldevelopments over a certain size to in-clude an affordable housing component.

The NGO submission noted that theonly councils which had agreed to developtheir own action plans were Manukau andWaitakere City. The Manukau City Af-fordable Housing Strategy proposes sup-port for affordable living in the large newFlatbush area, and in the retail precincts ofManurewa and Papatoetoe.� Housing New Zealand has developedsome initiatives aimed at commercial de-velopers and landlords. It has promotedlease arrangements with the private sector,guaranteeing owners a ten-year, risk-freemarket rental from HNZC. The HNZCdoes not disclose the extent of the schemedue to commercial sensitivity; the NGOsubmission sees it as an expensive inter-vention which will worsen house afforda-bility in the long-term.68

� HNZC also sponsored a new Commu-nity Development Award category in theRegistered Master Builders 2004 House ofthe Year Awards, to recognise affordable,good quality housing built to meet a com-munity and social need.� HNZC and Kiwibank are piloting amortgage insurance scheme, for those ableto afford repayments but unable to qualifyfor mortgage finance through other banks.There were 279 approvals by December2003 from 9,000 enquiries.� The energy-efficient Now Home dem-onstration project is being planned forNew Lynn, using current sustainable tech-nologies and funded by the Foundation forResearch, Science and Technology. Thispartnership project involves WaitakereCity Council and other organisations, andthe house is expected to sell for approxi-mately $180,000.69

� The inaugural meeting of HousingAotearoa, a national umbrella group forsocial housing organisations, was held inOctober 2004. It defines community-based housing as “communities workingtogether to define their housing needs andto meet those needs, using public and pri-vate funds where necessary”.� An Affordable Housing Project isplanned in the Urban Form Design andDevelopment Work Strand of the Sustain-able Auckland Cities Programme. It will

involve local and central governments insustainable approaches to Auckland regionaffordable housing.

Overseas affordability initiatives� The USA has introduced the Low In-come Housing Tax Credit programme, andlocal grants or low-interest loans for non-profit organisations that build or rehabili-tate affordable rental housing.70

POSSIBLE ACTIONS� Create an aggressive building programme of new affordablehousing in areas of high demand, by the HNZC, local councilsand NGO social housing providers.71

� Trial the use of inclusionary zoning and developer incentivesto increase the Auckland supply of affordable housing for rent orpurchase.72

� Require Auckland councils to implement the Auckland Re-gional Affordable Housing Strategy.� Explore regional trusts, housing associations and other struc-tural options to improve local council provision of social hous-ing.73

� Create direct Government incentives for local bodies to ex-pand social housing in areas of emerging need, such as refugeesand mental health service clients.74

� Encourage mortgage lenders and businesses to invest in socialand affordable housing.75

� Change the AS to a level which ensures that only 25% ofhousehold spending goes on housing.76

� Introduce capitalisation of the AS by non-profit communitygroups using shared equity between the group and the house-hold.77

� Funding adequate home ownership programmes for low-in-come families, which could include –

� Rent-to-buy arrangements� Deposit assistance� Mortgage guarantees and top-ups� Programmes tailored for women on low incomes, Maori,

Pacific people, and other financially disadvantaged groups.� HNZC-brokered bulk mortgage agreements with main

stream lenders.78, 79

� Encourage state and community partnerships using modelssuch as housing co-operatives, community land trusts and co-housing.80

� Plan a common Auckland housing strategy jointly betweenstate and local government.81

� Purchase of Auckland land now to ensure a future supply ofland for social housing.82

� Establish an annual locality-based housing needs assessmentby government with local councils, including the level of demandfor extra housing, the condition of existing houses and whetherthere is enough affordable housing.83

� Develop low-cost communal and supported housing for olderpeople.84

� Increase provision of suitable rental houses near mental healthand other support services.85

� Carry out a national education campaign about tenant andlandlord rights and obligations to counter discrimination.86

� Develop and monitor agreed measures of housing affordabili-ty.87

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4 CROWDING

Crowding levels are gradually falling in NewZealand, as they are in most industrialised

countries. However, this is not true forAuckland, where it is a persistent andincreasing problem in deprived areas.

“The smallsize of most

lower-pricedrental housesensures that

any largehousehold

will fit at leastone official

definition ofcrowding.”

CROWDING increases when housing becomes less affordable for people

on low incomes, and the researchindicates that it will only decrease signifi-cantly when enough housing is providedto bring demand and prices down.

When is a house crowded?There is no objective measure of crowd-ing; standards usually reflect the assump-tions of dominant rather than minoritygroups. For example, there has been noresearch into Maori or Pacific concepts ofcrowding. Using the lounge for sleepingwas mentioned by Maori and Pacific peo-ple in several studies, but would count ascrowding in most definitions (see BeyondMonocultural Housing). Some definitionsuse the number of usual residents dividedby the number of rooms or bedrooms; oth-ers take into account the age, gender andcomposition of the household.

The Statistics NZ 2003 report uses theCanadian National Occupancy Standard(CNOS), which has not been validated inresearch with New Zealand parents butenables comparisons with Canada andAustralia. It assumes that -� There should be no more than twopeople per bedroom.� Couples share a bedroom.� Children under five years of either sex,and children under 18 years of the samegender, can share a bedroom.� A child aged five to 17 should notshare a bedroom with one under five ofthe opposite gender.� Single adults 18 years and over andany unpaired children require a separatebedroom.

Over 70% of New Zealand houseshave three bedrooms or less. Rentedhouses are likely to be smaller; for exam-ple, only 2% of rented Otara East housesin the 2001 census had five bedroomscompared to 11% of owned houses. The

majority of rented houses in three of themost crowded area units in South Auck-land had three bedrooms. Houses withfour or more bedrooms are usually inmore affluent suburbs.

The small size of most lower-pricedrental houses ensures that any large house-hold will fit at least one official definitionof crowding.

Crowding and healthPeople who live in housing defined ascrowded have poorer physical and mentalhealth than people in uncrowded housing.It is difficult to prove that crowding is thedirect cause, due to the interrelated effectsof poverty and poor quality housing, butthe link is compelling. There are strongassociations between housing defined ascrowded and meningococcal disease, tu-berculosis, acute rheumatic fever, respira-tory illness and Helicobacter pylori (bacte-ria that causes stomach ulcers).88

“My third daughter has asthma[from] the condition of this house.The Housing know the total number ofour family but they still not do any-thing about it like transferring us to abigger house of four bedrooms. Theserooms are too small and also the spaceinside of the whole house.”89

Crowding was the most important riskfactor for meningococcal disease in Bak-er’s study of Auckland children from 1997to 1999.90 Figure 1 illustrates the relation-ship from 2000 to 2004.

Baker found a four-fold increase inrates for children under five in the mostcrowded 20% of houses compared to theleast crowded 20%, and a five-fold in-crease for those aged 5 to 14 (see Figure2). Reducing overcrowding was the keypreventive measure recommended.

“Overcrowding can be a health risksimply because people are cramped intospaces too small for them to be able toavoid illness or disease.”91 Having morethan five people in a New Zealand house isassociated with hepatitis B infection.92

Other crowding-related conditions are –� Cellulitis, an infection of the skin sur-rounding a scratch or insect bite that ismost common in children under five andadults over 60.93

� Bronchiectasis, a permanent wideningof the airways leading to regular seriouslung infections.94

There is consistent evidence thatcrowding is stressful for children andadults.95, 96, 97 According to Lynch’s 2000Healthful Housing study: “After a periodof time of living in overcrowded accom-

Robert Graham

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AND HEALTH IN AUCKLAND��

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Average family living in a six-room house• Median of 2.6 adults in household

• Additional adults Meningococcaldisease risk

2X

5X

10.7X

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Figure 2- Relationship between thenumber of people living in a houseand the risk of meningococcal disease

From Housing and Health, Ed Howden-Chapmanet al, p 66.

Number of children under 8 by CAU in crowded households

Figure 1 -Childhood crowdingand meningococcalB cases 2000-04

© Auckland Regional Public Health Service 2005

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modation the stress of overcrowding be-comes so overwhelming that people nolonger have the emotional strength tomove out of the situation.”98

One couple who moved to Aucklandfound housing in a two-bedroom state unitalready occupied by two of their olderdaughters, a granddaughter and five oth-ers. Moving in with their three teenagechildren increased the number of peopleliving in the house to 13.

“It was terrible actually. … It wasreally stressful then, cos there were alot of them, and they were all young.… And they would come over duringthe day and the house was full. … Ohit was terrible.”99

Crowding is also related to disturbedsleep and poorer results at school for stu-dents.

Official statisticsunderestimate crowdingIn 2001, according to the Canadian Na-tional Occupancy Standard (CNOS), 8%of Auckland households (29,211) werecrowded compared to 5% nationally. Al-most 9% of the region’s children lived inhouseholds defined as crowded. Howev-er, all sources acknowledge that the cen-sus and other official data underestimatethe amount of crowding in New Zealand.The most crowded households are oftenthe most reluctant to tell officials abouttheir living arrangements, especially if theyinclude overstayers or illegal immigrants.

Johnson’s CPAG report cites an esti-mate of 50,000 overstayers between 1995and 2003, mostly living in Auckland.Crowded households may also fear cuts totheir benefits or removal of their childrenbecause of unhygienic conditions. Pakehaare most likely to be counted in officialstatistics about crowding and Pacific peo-ple most likely to be undercounted.100

The NGO submission, and qualitativestudies using visitors who gained the trustof crowded households, suggest that thecensus probably severely underestimatescrowding in Auckland.

For example, in 2001 Housing NZCorporation staff used rental data aboutcrowding and estimated that 8% of house-holds selected for the Healthy HousingProgramme would be overcrowded. TheEnd of Pilot Report found the actual ratewas 54%.

Populations facingthe most crowdingPacific peoples are far more likely to beliving in households defined as crowdedthan other ethnic groups.101 Several re-searchers stressed that overcrowding isforced on Pacific people and is not achoice.102 In 2001, 43% of Pacific peoplelived in households defined as needing ex-tra bedrooms (23% needing one and 20%at least two). Of those living in house-holds defined as needing at least two extrabedrooms, 41% were Pacific people.

Pacific people were the most likely ofall ethnic groups (37%) to live in extendedfamilies. Pacific people whose living con-ditions were defined as crowded weretwice as likely (74%) to live in an extend-ed family. Around 28% of Pacific peoplelived in households with seven or moreusual residents in 2001.

‘Alatini’s 2004 survey of 103 Tonganhouseholds in Otara found that approxi-mately 16%, mostly state house tenants,regularly had occupants sleeping in theliving room because there were notenough bedrooms. One resident said:

“New Zealand houses and New Zea-land society does not accommodate forTongan way of living. Instead, it caus-es large families to live in overcrowdedhomes.”103

The correlation between “an unafford-able housing market and the overcrowdingof households” was a dominant theme inthe study.104

One in four households in what Statis-tics NZ calls the ‘Other’ ethnic category -mostly recent African and Middle East mi-grants - were defined as needing at leastone extra bedroom, 23% of Maori and20% of Asian people. Five percent of Eu-ropeans lived in houses labelled crowded.Maori (38%) were the second biggestgroup among those defined as needing atleast two extra bedrooms.

Official statistics of crowding in Auck-land are improving for Maori children, butworsening for Pacific children.105 Up toone in three Pacific children in Aucklandlives in a house defined as crowded; “..thenumber of Pacific children living in over-crowded conditions increased by nearly8% from 1996 to 2001, while the numberof Maori children … dropped by 7%, andPakeha children … fell by 15%”.106 Thesmall ‘Other’ ethnic group has had thesharpest increase in crowding according tothe census.

“Officialstatistics of

crowding inAuckland areimproving for

Maorichildren, but

worsening forPacific

children.”

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Locations most affectedFifteen percent of houses in Manukau Citywere defined as crowded compared witharound 2% in North Shore City. Howev-er, as crowding is concentrated in smallareas, these averages are misleading. Atthe level of council wards, crowdingranged from 0.8% in North Shore City to30% in Mangere.

Since 1986, the census has identifiedManukau City households as consistentlythe most crowded. Nineteen of the 20census area units (containing approximate-ly 90 households) in the country definedas the most crowded are in Manukau City(see Table 3). Between 1986 and 2001,the number of households defined ascrowded in Manukau City increased by37% compared with a national decline of11%. The number of households labelledas crowded also increased in WaitakereCity by 22% and Auckland City by 12%.

“In 2001, nearly 13,000 children livingin [Otara, Mangere, Papatoetoe and Ma-nurewa] were living in overcrowded con-ditions … one-fifth of all the children liv-ing in overcrowded houses nationally.Furthermore, the problem of overcrowd-ing appears to have worsened in thesesuburbs .. while it remained stable or im-proved” in the rest of the Auckland regionand the country.110

In 2001, Manukau City had the highestproportion of Maori and Pacific house-holds defined as crowded. Auckland Cityhad the highest proportion of Asian house-holds that were defined as crowded.

MobilityHigh housing costs, the stresses of crowd-ing, and evictions mean that Aucklandpeople on low incomes and those with amental illness are much more likely tomove house frequently.111

Tenants are more mobile than owner-occupier households, and private rentersmore mobile than state tenants.112 Johnsonreports that a 2002 CPAG survey of 31South Auckland primary schools foundthat nearly one in three children in thepoorest (decile one) schools are likely tochange schools in any given year. This istwice the transience rate of schools rateddecile three or higher.

The average length of all tenancies in2002 was less than 15 months, with morethan half ending within ten months.113 Theintroduction of income-related rents in2000 contributed to a drop in the mobilityof state housing tenants, from a nationalaverage of 33% in 2000 to 15% in 2003,and by 70% in some areas of Auckland.

Other characteristicsrelated to crowdingHouseholds defined as crowded paid ahigher proportion of weekly rent in rela-tion to income in 2001, and were morelikely to receive government benefits thannon-crowded households.107 Six percentof houses in the bottom 20% of householdincome were defined as needing at leastone extra bedroom compared to 2% ofthose in the top 20 percent.108 Privatelandlords owned 60% of housing definedas crowded and the state owned 34%.109

Households labelled as crowded weremore likely to include two or more fami-lies (42%), solo parent families sharingwith others (35%), and households of acouple and children and others (28%).Over half of one-parent Pacific familiesliving with others were defined as crowd-ed, and over 43% of Maori solo parentfamilies living with others.

In 2001, over 31% of households de-fined as crowded contained extended fam-ilies, compared with only 3% of non-crowded households. One in five Pacifichouseholds consisted of extended families;13% of Asian; 11% of Maori; 9% of ‘Oth-er’ and 3% of Pakeha households.

Table 3 - The 20 most crowded area unitsin New Zealand

StatisticsNewZealand,2003

“Housing NZestimated that8% ofhouseholds inthe HealthyHousingProgrammewould beovercrowded.The actual ratewas 54%.”

Area unit

Number Percent1 Harania North 273 43.5

2 Otara West 231 41.8

3 Flat Bush 306 41.3

4 Viscount 303 41.2

5 Ferguson 294 40.8

6 Otara East 324 38.6

7 Otara North 114 38.4

8 Otara South 246 38.1

9 Clover Park 300 37.9

10 Arahanga 135 37.5

11 Mangere Central 210 36.8

12 Harania East 339 36.2

13 Harania West 297 34.7

14 Mascot 222 31.6

15 Wiri 261 30.3

16 Walmsley 255 29

17 (Rotorua)18 Grange 111 28.5

19 Aorere 273 27.9

20 Favona 312 27.4

Households needing one or more extra bedrooms

(all except one are inManukau City)

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One study found that many youngMaori people move from one householdto another and have no permanent ad-dress. “They stay with family until rela-tionships become strained or overcrowd-ing is at its limit and move on to the nexthouse where the cycle is repeated.”114

New Zealand initiatives aboutcrowding� The Healthy Housing Programme pilotsupplied health information, insulation,ventilation and in some cases extra roomsto houses in Mangere, Otara and Onehun-ga from 2001 to 2002. It aimed to reducecrowding by building larger homes, ex-tending houses and rehousing families inmore suitably-sized accommodation. Hos-pital admissions dropped, while outpatientvisits, use of the emergency departmentand GPs increased as a result of pro-gramme referrals.

This successful intervention is beingapplied in Glen Innes, Point England,Otara, Mangere and Wiri.� The five-year Housing, Crowding andHealth Study began in 2003, involving allHNZC tenants and applicants, about85,000 households. He Kainga Oranga,the Housing and Health Research Pro-gramme in Wellington, will match tenantinformation with NHIS information aboutovernight hospital visits.115

POSSIBLE ACTIONS� Establish nationally validated standards for crowding, withinput from tangata whenua, Pacific people, and other key stake-holders.116

� Ensure that new state housing and private developments in-clude sufficient large houses to cater for the proportion of largerfamilies in the Auckland region.� Ensure that housing planning in Auckland takes into accountthe needs of changing population demographics.� Introduce five-yearly monitoring by health sector staff of cen-sus data about the pockets of greatest crowding impact, followedby distribution to local bodies for discussion with communitycommittees to encourage a targeted focus.117

� Establish three-yearly reporting on the status of regional hous-ing and health by district health boards (DHBs) and HNZC.� Re-establish channels for public health staff to recommend pri-ority for housing assistance on health grounds.118

� Introduce programmes which address the economic pressuresdriving informal immigration from the Pacific, to help relievehousing pressure on Pacific families.119

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5 SUBSTANDARDHOUSING

SUBSTANDARD housing includes those which are cold, damp and mouldy. These issues are described

in the next section. This section dealswith other aspects of poor housing.

Substandard housingand healthThe National Health Committee said in1998: “The poor physical condition ofsome rental properties, including someowned and administered by local and cen-tral government, are compounding [theproblem of disease associated with over-crowding].”121

Estimates of the proportion of peoplewith chronic mental illness living in sub-standard or inappropriate housing in NewZealand range from 20 to 35%.122

Kearns et al in 1993 found that themental wellbeing of people with psychiat-ric conditions was correlated with thequality of their housing. Poor housing,lack of money and limited social contactcontributes to depression and anxiety inthis population, and made them more like-ly to be re-hospitalised. A study of themental health of people on the edge ofhomelessness found a significant improve-ment when they were re-housed in statehouses.123

Kearns also found that living in a sub-standard house is an independent and ad-ditional source of stress for people on lowincomes, and said “..the despair amongthese populations cannot be adequatelydescribed in a series of statistical tablesand conceptual diagrams”.124 Substandardhousing conditions may lead to social iso-lation because occupants are reluctant toinvite guests into their homes.

UK research has found an associationbetween mental disorders and structuralproblems in rented housing.125

Physical health is affected by old, dirtycarpet, which contains dust, allergens andtoxic chemicals and is often found in sub-standard housing. This can result in aller-gic, respiratory, nerve and blood-relatedillnesses.

Pest infestations are associated withasthma. Cockroaches can cause allergiesand have become an important trigger forasthma in inner-city America.126 Childrenwith asthma who are exposed to cock-roaches are more likely to be admitted tohospital. Mice are also an important causeof allergy and asthma.

Poorly functioning heaters or stovescan expose residents to nitrogen dioxide,which is associated with asthma. Theyalso result in increased levels of carbonmonoxide, which causes headaches andfatigue, and poisoning from oxygen star-vation at higher levels.

Portable gas heaters have produced upto five times the acceptable outdoor levelsof nitrogen dioxide inside homes in anAustralian study. This toxic gas worsensrespiratory and asthmatic conditions.127

Leaded paint has been found in statehouses during the Healthy Housing Pro-gramme.128 Lead exposure can cause per-manent damage in children’s brains and isassociated with high blood pressure.129

Noise contributes to irritability, sleep-lessness and feelings of helplessness.

Several local and overseas studieshave found that moving to better qualityhousing improved the mental and physicalhealth of people living in substandard ac-commodation.130, 131, 132, 133

Poor housing over a lifetimeThe congregation of poor people in areasof poor housing creates a neighbourhoodeffect. For example, primary health care isless available in areas with high Pacific andMaori populations.134

However, one recent study of NorthShore City and Waitakere City found that,while neighbourhoods on the more afflu-ent North Shore had better overall accessto community resources than Waitakereneighbourhoods, within each city deprivedareas had on average better access tocommunity facilities as a whole than moreaffluent areas.135 More research is neededto establish how this positive feature canbe replicated.

The longer people live in poor hous-ing, the more it affects their mental andphysical health, and children are particu-larly vulnerable. Housing conditions inchildhood have a long-term health effectindependent of socio-economic conditions

“The longerpeople live inpoor housing,

the more itaffects theirmental and

physicalhealth.”

“It is the poorest populations, most prone toforms of discrimination, who have least control

over their housing circumstances and thus are mostafflicted by housing-related health problems.”120

Gil Hanly

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“In a scarcehousing

market, fewtenants wantto risk their

accommodationby

[complainingabout

substandardhousing].”

and even if housing conditions later im-prove.136 A number of adult conditionsincluding Helicobacter pylori (bacteria thatcause stomach ulcers), disability, stomachcancer and severe ill-health have beenlinked to recurrent crowding or poorhousing in childhood.137 There is an asso-ciation between poor housing conditionsas a child and death from common adultdiseases that is independent from othersocial and economic deprivation.138

The scope of the problemThere are few reliable statistics about sub-standard housing. For example, the gov-ernment ICESCR report to the UN uses a1993 figure of 3,000 substandard dwell-ings nationally, with a high incidence in theEast Coast and Northland. However, in2003 the Co-operative Housing Associa-tion of Aotearoa NZ, with extensivehands-on experience in Northland commu-nities, cited the number as 5,000 in North-land alone.139

Compared to housing in other OECDcountries, New Zealand housing is moreoften built of wood, which requires fre-quent maintenance to keep up to standard.

The Building Research Association ofNew Zealand (BRANZ) carried out twonational house condition surveys in 1993/4and 1999/2000. In the more recent sur-vey, it found that one in four buildings wasin poor condition and the cost of repairingthe more serious defects averaged $4,000per house. Auckland houses were gener-ally in the worst condition in both surveys.

Structural problems found in the sur-vey included -� Leaks from roofs and around windowscausing major structural damage.� Rotting floors.� Disintegration of interior cladding; ex-terior cladding flapping in the wind be-cause it was not properly connected to theframes.� Clearance not maintained aroundstoves.

Other reports suggest a low standardin rental housing. In 1988, HNZC saidthat low income housing in Auckland is ofpoorer quality than in most other parts ofNew Zealand. In 1998 Parliament’s SocialServices Committee criticised delayedmaintenance in state rental houses. The2001 Our Home Our Place hui agreed thatneglected maintenance of Otara statehousing in the 1990s had resulted in fallinghousing standards.

The economic recession in the 1990salso delayed maintenance in private rentalhouses. Local councils have deferred

maintenance and modernisation of theirhousing;140 in 2000 a national summaryfound that local council housing for olderpeople, much of it older bedsitting rooms,was inadequate.141

Older people on fixed low incomes donot want their rent to go up, so may beforced to accept lower standards at a costto their health.142

Qualitative studies also support thispicture. People in Auckland emergencyhousing said in a 1998 survey that theycommonly found new tenancies in a poorstate of hygiene and repair, with brokenwindows, cracked hand-basins and leakingtoilet pipes.143 Four out of five state ten-ants in the 1999 Mercy House Glen Innessurvey were dissatisfied with the poorcondition of their houses and the lack ofresponse to maintenance calls.144

“My house always has somethingto be fixed. When I report it to Hous-ing most of the time they never comeand I live with things broken. Theycome when I keep reporting four orfive times.”145

“I rang up HNZ for their help whenit’s heavy rain, plus any rainy day it’sleaking in my living room.”146

Otara households reported rat andcockroach infestations in 1999147 and in‘Alatini’s 2004 survey of Tongan house-holds. Six out of ten state house tenantsin that survey, nearly half the home ownersand one third of private tenants, had prob-lems with pest infestations.

Four out of five of Glen Innes house-holds reported pest infestations such ascockroaches, rats, mice or fleas in 1999.148

In 2004, the Otara tenants also report-ed a major difference in the response ofprivate landlords and HNZC to structuralproblems.149 Three-quarters of privatelandlords responded efficiently and reliablyto problems, whereas more than half theHNZC tenants expressed some dissatisfac-tion with its response time. Almost one infive had been waiting two years or morefor resolution of complaints includingphone lines, carpeting and insulation.

“I have a leak in the ceiling for overtwo years and reported it to HousingNZ and still no-one has come.”150

While much New Zealand research hasfocussed on state housing, overseas stud-ies suggest that the private rental sectormay have more substandard housing.151

New Zealand landlords are required underthe Residential Tenancies Act 1986 tomaintain their houses to an acceptablestandard, but enforcement relies on tenantcomplaints. In a scarce housing market,few tenants want to risk their accommoda-tion by doing this.

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The 2001 census reported the numberof people living in tents, caravans, shedsand boats in Manukau City as 204, with198 in Auckland City, 168 in WaitakereCity, and 33 in North Shore City.152

This is likely to be a severe underesti-mate. Otara residents reported “typically”sleeping in uninsulated garages and cara-vans in a 1999 report.153 One in five Ton-gan households in ‘Alatini’s 2004 Otarasurvey used garages for accommodation,and said this was common among otherPacific households.

The census counts this temporaryhousing only on residential sites, whenhouseholders declare it, but does not in-clude people who have been living forsome time in licensed camping grounds.There are indications that people in hous-ing difficulty live in caravan parks despiteregulations against this.154

New Zealand initiativesabout housing standards� In 2000, a local initiative involvedmature Otara residents visiting door-to-door to distribute information aboutdealing with pests, moisture, mould,health and safety, tenancy issues andbenefit entitlements. This OtaraAmbassadors’ Programme was repeatedin 2002. Manukau City Council has sincefunded two community health workers tocontinue this work.�The Healthy Housing Programmepartnership between DHBs and theHNZC has upgraded insulation andventilation, carried out maintenance andacted on families’ health and social needsin state houses in six Auckland suburbs(see Crowding, page 20).�The HNZC Energy Efficiency Projectis upgrading damp and uninsulatedhousing (see Cold, damp and mould, page26).�HNZC’s Local Government HousingFund provides 50:50 matching funds forlocal councils to modernise or buy socialhousing.�Housing New Zealand’s CommunityRenewal Programme aims to reducesocial exclusion, foster communities, andimprove the physical assets andappearance of neighbourhoods. It startedin 2001 and is under way in Clendon,Talbot Park and Northcote Central.�The Building Research Association ofNew Zealand and Wellington School ofMedicine researchers are developing aHealthy House Index, using a

combination of existing research, healthdata from the BRANZ House ConditionSurvey, surveys of resident’s views oftheir own health, general practice andhospital data. It aims to provide acommon language for inter-agencycommunication.�The Building Act gives the BuildingIndustry Authority more power and willrequire local councils and private housinginspectors to be certified.�Statistics New Zealand is developing adatabase of the incidence of substandardhousing and is surveying housing qualityacross the country.�Standards New Zealand is developingbuilding industry standards.�The HNZC Development Guideincludes universal design features, makingnew properties suitable for a wider rangeof tenants.�The Government has started a whole-of-government initiative on substandardhousing. The NGO submission criticisedits approach and the lack of progressbeyond talks within governmentagencies.155

Overseas initiativesabout housing standards�The Housing for Health programme isan Australian initiative with Aboriginalcommunities. It involves home vists toassess the impact of housing on health,fixing safety faults and providing health-related items the same day as the visit, ortraining community members to providethem.156

�The UK and the USA have severaluseful approaches to improve substandardhousing. The UK Government hasadopted an aim to make all public housingup to standard by 2010. It has introduceda Housing Health and Safety RatingSystem, where trained buildingprofessionals identify health hazards andrate them using tables of probable healtheffects. The system requires localauthorities to repair any house rating over1,000 points.�The USA Residential Lead-BasedPaint Hazard Reduction Act 1992provides federal funds to state and localhealth departments to determine theextent of childhood lead poisoning, screenchildren, develop neighbourhood-basedprevention projects and remove lead fromhouses.157

“The 2001censusreported thenumber ofpeople livingin tents,caravans,sheds andboats inManukau Cityas 204 .. Thisis likely to bea severeunderestimate.”

Robert Graham

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�One USA project is repairing privatehouses with public health funding. PublicHealth Seattle is replacing mould andwater damage, installing exhaustventilation, repairing leaks and replacingcarpet in 70 houses. It has negotiated anagreement with private landlords that therent will not increase and tenants canremain for at least two yearsafterwards.158

�Some countries have introducedcompulsory inspection schemes thatrequire owners to disclose outstandingrepairs when they sell their houses.159

�The Lifetime Homes checklist of 16design features, developed in 1991, isrequired in all new social housing inNorthern Ireland and Wales and is beingconsidered in UK legislation. It includesprovision for wheelchairs and otheraccessibility features, and is proven tosave money in later adaptations and byreducing the need for older people tomove to residential care.160

�The Netherlands adopted the SeniorCitizen Label as a consumer qualitycertificate for older people’s housing.Housing has to satisfy 31 basicrequirements based on flexibility, cost,neighbourhood and local needs.161

�Smart homes are being trialled in aUK support programme for older people.These houses use electronic andcomputer-controlled technology tooperate doors, windows, heating, lighting,taps, security devices, phones andsurveillance. They also save money byhelping older people stay in their homesdespite increasing disability. Withoutsubsidies, however, this technology is notaffordable for older people on lowincomes.162

POSSIBLE ACTIONS� Introduce uniform national codes which cover housing ventila-tion, moisture, carpeting, mould, injury hazards, exposure to toxicsubstances, privacy, noise, lighting, energy efficiency, accessibilityand other factors affecting health.163, 164

� Introduce licensing, quality marks and energy-efficiency rat-ings for private rental properties which depend on meeting mini-mum standards for health.165, 166

� Introduce renewal grants, loans, tax relief and other incentiveschemes to encourage private landlords to rectify structural prob-lems and maintain their rental houses.167, 168

� HNZC ensure that its housing stock is up to a set standard by2015.� Increase housing inspections by local councils.169

� Use Health Impact Assessments by local council public healthworkers to evaluate the health implications of new zoning deci-sions and housing developments. Permission could be denied todevelopments that do not include necessary infrastructure such asshops, schools, recreation space, parking and transport systems.170

� Adequately fund home improvement assistance for older peo-ple.171

� Strengthen the Residential Tenancies Act to provide more pro-active and effective monitoring and enforcement of housing stand-ards.

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6 COLD, DAMPAND MOULD

Compared to housing in other OECD countries,New Zealand housing is inadequately heated

and usually cold.

THE World Health Organisation(WHO) recommends an indoor tem-

perature of 18°C, or 21°C for young,elderly or disabled people. The NZ Build-ing Code requires temperatures to be ableto be maintained above 16°C in old peo-ple’s homes and childcare centres. Olderpeople often do not notice temperaturechanges as quickly as younger people.

Below 12°C, cold hands and feet andslight lowering of core temperatures cancreate a short-term rise in blood pressurewhich is dangerous for older people.

One million New Zealand homes, morethan two out of three, were built beforeminimum insulation was required in 1977.In 2001, one in four (300,000) had no in-sulation, and about half are only partly in-sulated.172

New Zealand houses are cold. Thetemperature in almost a third of New Zea-land homes is below WHO recommenda-tions.173 A 1989 survey of 36 units forolder people found that minimum dailytemperatures in the living room were be-low 16°C more than one third of the timeduring the year.174 The BRANZ House-hold Energy End-Use Project (HEEP)from 2002 found that average house tem-peratures do not seem to have risen sincethe 1970s. The mean temperature inAuckland houses was 16.5°C. Uninsulat-ed houses were on average 1.4°C colder.

Those who need to heat their homesfor the longest are often least able to do sobecause of low incomes and inefficienthousing. Living in healthy temperatureswould take more than 10% of their in-come.

Some older people and other low-in-come households may therefore keep theirroom temperatures too low for comfort,enduring ‘voluntary hypothermia’ to savemoney. In the 2001 census, 36,000 peopledid not have any form of heating. In1996, 18 in every 1,000 New Zealandersand 31 in every 1,000 Maori women lived

in a dwelling where no heating was used.

Cold, damp, mould and healthDampness and cold are the most commonhealth hazards of poor housing. “A dampdwelling is more difficult to heat and apoorly heated dwelling more susceptibleto damp. Cold air has a higher relativehumidity, increasing the risk of condensa-tion indoors and providing a more favour-able environment for the growth ofmoulds and micro-organisms.”175 Over-crowded housing is more likely to bedamp, especially if poorly aired or shut inbad weather.

Portable, unflued gas heaters, commonin New Zealand homes, carry their ownhealth risks (See Substandard housing andhealth, page 21).

In poorly insulated houses, moisturefrom cooking, drying and cleaning willcondense as dampness. In bedsits or whena bedroom door is open, if the room iscolder than other parts of the house thisdampness will condense on the bed.

Howden-Chapman cites English, USAand Dutch studies which found that thedamper the houses were, the more likelytheir occupants were to be ill with a widerange of medical symptoms, regardless ofsmoking, income or crowding.176

Children living in damp houses aremore likely to have respiratory problems,fevers, sore throats, headaches and skinproblems than those in dry homes. Adultsymptoms include nausea, vomiting, con-stipation, blocked noses, breathlessness,backache, aching joints and fainting. Eld-erly people are more vulnerable.

Maori and Pacific households weremore likely to report cold and damp intheir homes, and had higher rates of respi-ratory illnesses than Pakeha households.177

More than half the Otara residents in a2004 survey believed the condition of theirhouses could affect the wellbeing of ahealthy person, largely due to cold andmould from lack of insulation. Duringwinter, families who could not afford heat-ing were forced to huddle into one roomin the evening. A higher proportion of pri-vate tenants reported problems with coldthan state tenants.

“Poor ventilation in my house causesthe asthmatic person to constantlyhave asthma attacks.”178

Dust mites, tiny parasites that live incarpets and mattresses, are an asthma trig-ger. Dust mites need moisture to breedand rarely survive under 50% humidity.Asthmatics who live in damp housing havemore asthma attacks, use more asthma

“.. insulatingcold houses

more thanpays for itselfby improving

people’s healthand saving

electricity.”

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“Indoortemperatures

under 16°Csignificantlyincrease the

risk ofrespiratoryinfections.”

drugs and have to go to the hospital moreoften.179

A UK study found that using steamand heat to eradicate house dust mites re-duced asthma symptoms for people in thehouse, and improved allergic reactions.For people who had a ventilation systeminstalled in their bedroom, this improve-ment continued for 12 months.180

Damp houses encourage the growth ofmoulds and fungi, which are strongly asso-ciated with respiratory problems and asth-ma.181 Everyone is exposed to some mouldspores every day, but in large numbersmould spores usually cause health prob-lems. A third of New Zealand householdsreported visible mould in a 2002 nationalsurvey.182

Mould can produce allergic reactions,respiratory problems, nose and sinus con-gestion, eye or throat irritation and skinrashes. People who already have asthmaare at greater risk, as even a small numberof spores could trigger an asthma attack.

Certain types of greenish-black mouldsproduce toxins that cause coughing, runnynose, burning sensations in the mouth ornose, nose bleeds, headache, fatigue andskin irritation at the site of contact.

There are few standards for judgingacceptable quantities of mould; it is usual-ly measured by the size of visible mouldpatches. Active mould is easily smelt.One study found the amount people wor-ried about mould affected their reportingof respiratory symptoms.183

“Like the mould’s black marks onthe wall, in the bedrooms and that, cosit smells.”184

Cold houses have been associated withpoorer general health and increased use ofhealth services. Indoor temperatures un-der 16°C significantly increase the risk ofrespiratory infections. One study of 1,376South Auckland children in Pacific familiesfound that more than half had cold homesand 37% reported damp, which were asso-ciated with asthma and probable depres-sion for the mothers.185

New Zealand has greater seasonal fluc-tuations in death rates, particularly inthose aged over 65, than countries withmore extreme climates. More than fourout of five deaths at home from a drasticdrop in body temperature (hypothermia)are in people over 65. One Aucklandstudy found that cold stress was the domi-nant climatic factor in cardiovasculardeaths.186

Concern about family health in a dampand mouldy home, a reluctance to receiveguests, and the cost of repairs can causeemotional distress. Women are more like-ly than men to be emotionally upset due to

disturbed sleep and frustration from tryingto keep a mouldy house clean and organ-ise repairs.

Occupant behaviourPeople’s actions can be as important as theconstruction of the house in makinghomes damp. Leaving the window openduring a shower, drying wet clothes out-side and airing a house regularly will lowerthe level of dampness in the air comparedto an identically built house where peopledo none of these things.

A series of Otara hui in 1998 foundthat many residents did not understand theimportance of insulation and ventilation.Some people did not know how to useheaters or set temperatures. The impor-tance of ventilation to reduce dangerouslevels of carbon monoxide from unfluedgas heating was not widely known.

The British Medical Association con-cluded in a major report: “A warm, damp-free healthy indoor environment requiresadequate ventilation, heating and insula-tion. Strategies that do not address allthree factors are unlikely to succeed.”187

New Zealand initiativesabout cold, damp and mould� The Housing, Insulation and HealthStudy found that insulating cold housesmore than pays for itself by improvingpeople’s health and saving electricity. Itinvolved 1,400 households in Otara andsix other locations around the country.The people in the houses reported thattheir health improved, adults visited theirfamily doctor significantly less and bothadults and children took fewer days off.These benefits were valued at $3,640 perhouse, twice the $1,800 cost of installinginsulation.188

� HNZC started its 10-year Energy Effi-ciency project in 2001. It aims to improvethe living environment of all state housesbuilt before 1977. It involves installing orimproving ceiling and floor insulation, hotwater cylinder and pipe wraps, adjustingthermostats, improving housing heatingand ventilation and redressing dampnessunder houses.� Since 1995, the Energy EfficiencyConservation Authority (EECA) has in-stalled insulation in ceilings and underfloors, wrapped hot water cylinders andpipes, put in draught stopping on doorsand windows, energy-efficient light bulbsand damp proof goundsheets in 12,000older homes. This has cost the Govern-

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ment $15 million. Projects work in part-nership with local community groups us-ing previously unemployed local people todo the work. Current projects are run-ning in South Auckland and WaitakereCity.

Since 2002 EECA has focused on lowincome households, with some partner-ships with HNZC. EECA is seeking morefunding partnerships with other govern-ment agencies and the private sector, asthe savings in health are greater than thosein energy.� A Winter Heating Information Packhas been developed in Christchurch forresidents and agencies that carry out homevisits.� Researcher Cameron Grant is carryingout a study in central and west Aucklandabout the relation of childhood pneumoniato crowding, damp, mould, leaks, heating,nutrition and primary care. Results areexpected in late 2005.

Overseas initiatives aboutcold, damp and mould� The UK has introduced several initia-tives to help low income households incold homes. The Home Energy EfficiencyAct 1995 requires local councils to haveplans for improving the energy efficiencyof housing in their area and to reportprogress to government.189

� The UK Government has adopted aFuel Poverty Strategy, which includesgrants to households in rented and owner-occupied homes to improve the energyefficiency of their houses and winter fuelpayments for people over 60.190

� The UK National Heart Forum’s FuelPoverty Toolkit educates primary healthworkers about the links between lack ofmoney to afford heating fuel and ill health,helps them identify people suffering fromthis fuel poverty and refer them to availa-ble grants.191

� California passed the Toxic Mold Pro-tection Act in 2001, which calls for stand-ards for permissible levels of mould andrequires information about mould contam-ination to be provided in housing sales.� The New York City Department ofHealth has also issued Guidelines on As-sessment and Remediation of Fungi in In-door Environments.

POSSIBLE ACTIONS� Expand retrofitting programmes which provide insulation andventilation in older houses.� Implement policies to improve energy efficiency in house-holds with low incomes.192

� Improve state rental housing standards, including ventilation,dehumidifiers or air-conditioning, extraction fans and good insu-lation.193

� Require all properties to display an energy-efficiency warrantof fitness or rating before being rented out or sold.� Apply building regulations about insulation retrospectively toprivate landlords.194

� Use passive solar building design rather than building housesoff the ground.195

� Provide households in high-risk accommodation with infor-mation about how to reduce damp and cold.196

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7 HAZARDSAND INJURY

The vast majority of accidents and injuries toNew Zealanders over 65 happen at home.

ONE UK report stated that more than one-third of all adult injuries happen in the home. However, the literature

surveyed for this report concentrated oninjuries to children. Every year 15,000New Zealand children are hospitalised be-cause of unintentional injuries, most com-monly in their home.197 Many more aretreated at hospital or private emergencyclinics or by GPs.

The vast majority of these injuries arepreventable and predictable. Safekids saysit is more effective to remove hazards orseparate children from them than to relyon constant supervision around hazards.

The UK British Medical Associationsaid that household injuries were highestin the private rental sector, indicating inad-equate monitoring and maintenance bylandlords.198 Comparable information forNew Zealand was not available in the re-search surveyed.

In the UK, injury rates for children inpoor families are more than three timesthose of children in affluent families. Pre-venting injuries is a low priority for fami-lies living in poverty, who do not haveenough food or money to pay bills.199

Poor housing can increase injury risksthrough exposed heating sources, unpro-tected upper windows, high balconies andstairs, breakable window glass in high-traffic sites, flammable materials and lackof functioning smoke alarms. The 1999Mercy House Women’s Advocacy Groupstudy concluded that unintentional injuriesfor children were inevitable in Glen Innesstate houses due to the high numbers ofyoung children, poor housing design, lackof safety features and lack of tenant in-come to fix them.

Vehicle injuriesNearly every day a New Zealand child ishospitalised after being hit by a vehicleand around 20 child pedestrians die everyyear. Two out of five of these children arereversed over in their own or a neighbour-ing driveway. Shared driveways or a lackof fencing between driveways and play

areas triple the risk of injury.In the Glen Innes survey, four out of

five houses had inadequate fences arounddriveways; some had none and most werepartially fenced and easy for children toclimb over. One third shared a driveway.

“We asked Housing NZ for a fenceto stop the children from going on theroad, but no reply. We are so close tothis busy road.”200

FireFires are a major cause of mortality, par-ticularly among poorer people who aremore likely to smoke. Five New Zealandchildren on average die in house fires eachyear, and another 20 are injured.

Children in rental properties seem tohave a higher risk than those in owner-occupied homes. In 70% of fatal fires, asmoke alarm would have helped the vic-tims to escape.201 In 1999, 10% of GlenInnes houses surveyed had no smokealarms and another 10% were faulty.

Tenants who do not know how smokealarms work may also disconnect themfrom the battery when the batteries rundown, or not replace batteries.

Two Auckland emergency housing cli-ents in the Healthful Housing study spokeof fire hazards in rental houses from apoorly installed wood-burning heater anda stove with faulty wiring.202 Both askedfor the hazards to be repaired but they didnot feel they got satisfactory responses.

Housing NZ Corporation is currentlyinstalling smoke alarms in its houses butthere is no requirement for private land-lords to do this. People who have theirpower disconnected due to money short-ages have to use candles, increasing therisk of fire.

Heating appliances andhot water hazardsAround 640 New Zealand children arehospitalised for burns and scalds everyyear, most under five. Around one in fouris from household water which has comeout too hot from the tap. Almost onethird of the Glen Innes tenants said in1999 that their water was too hot whenthey held their wrists under the hot tap formore than a few seconds.

The majority of older New Zealandhouses have water coming out of the tapat 60°C or higher, which will burn a child’sskin in one second. New houses have hadtempering valves installed since 1993,which enable water to be stored at 60°C

Gil Hanly

“In the UK,free window

guards, a massmedia

campaign,home

inspection andlandlord

regulation ledto a 50%

decrease infalls and a

35% drop inchild deaths in

two years.”

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and come from the tap at 55°C. At 55°Cit takes ten seconds for water to burn achild or older person. However, theHEEP study of 217 houses reported inac-curate thermostat and valve control in upto one third of houses in 2002.

Each year ovens are involved in burnand scald injuries to children when theytouch hot elements, pull pots off stovetops or climb on oven doors so that ovenstip hot food. More than one in three GlenInnes houses surveyed by Mercy House in1999 did not have their ovens chained tothe wall or the floor, making them a tip-ping hazard.

Open fires and unflued gas heaters re-lease small particles which irritate thelungs and may reduce people’s resistanceto illness. Poorly maintained gas applianc-es can release carbon monoxide, high lev-els of which may be deadly.

PoisoningOn average, three New Zealand childrenwill be hospitalised every day as a result ofunintentional poisonings from medicines,cleaning or garden chemicals, most in theirown home.

FallsMore than a child a day is hospitalised dueto a fall from stairs, steps, a balcony, deckor window. In the Mercy House survey ofGlen Innes houses, more than a third hadwindows with a fall height of two metresor more. Most of these windows had nosafety catches to prevent children climbingout. Several balconies had inadequatehand rails, usually with concrete surfacesbelow.

A 2004 survey of Otara householdsidentified ongoing safety concerns amongstate housing tenants.

“The steps going upstairs are too dan-gerous for my kids. I even got a letterfrom my family to give to HousingNew Zealand describing our situationand the need for us to move to a one-storey building.”203

Glass hazardsOn average, five children a week are hos-pitalised for injuries from plate glass,mostly at home. Most of the glass in pre-1991 houses is not safety glass, so it shat-ters into jagged edges. Safety glass ismuch stronger, breaks less easily and ei-ther fractures into pieces too small to in-jure or stays in place. It is also more ex-

pensive. Tenants are responsible for thereplacement of broken glass in rentedhouses. However, glass only needs to bereplaced to pre-existing quality, which inmost homes is ordinary glass even indoors, side panels and low-level glazing.

ElectricityEvery two weeks on average, a child ishospitalised due to contact with an electriccurrent, usually as a result of a faulty ap-pliance or wiring, or poking metal objectsinto live sockets or appliances.204 Insuffi-cient power points can lead families to usemultiboxes, which will not cut the electri-cal flow in a fault. None of the Glen Inneshouses surveyed by Mercy House hadsafety shutters on power points and one infive tenants reported either exposed wiresor electrical cabling they considered un-safe.

Safety initiatives� The HNZC Modernisation Programmestarted in 2001 and aims to improvearound 15,500 houses built before 1979.It involves modernising kitchens and bath-rooms, installing additional power points,adding driveways, parking and fencing,adding rooms and installing heating devic-es.� Safekids is working with HNZC onsafety issues in state houses following itsSafe as Houses report.� In the UK, free window guards forpeople living in high-rise buildings, togeth-er with a mass media campaign, home in-spection and local regulation for landlordsled to a 50% decrease in falls and a 35%drop in child deaths in two years.205

� Preventive home visits required byDenmark cities contributed to a markedreducation in the hospital bed occupancyrate among people over 75.206

POSSIBLE ACTIONS� Require public health representation on all bodies settingbuilding standards.� Improve monitoring of health and safety standards in rentalhousing.207

� Require a warrant of fitness that includes safety checks for allrental properties before they are rented out.� Adequately fund preventive safety audits of older people’shousing.208

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8 BEYONDMONOCULTURAL HOUSING

“..these houseswere designed

by Englishpeople who

are happy tohave their

washingmachine nextto the sink..”

Designing appropriatehousing for Maori whanau

Housing policy, regulations and thedesign of houses have largely assumed Pakeha cultural norms, and

regulatory bodies may be resistant toMaori housing initiatives.209 See Appendix1 for Maori perspectives about housing.

“..these houses were designed byEnglish people who are happy to havetheir washing machine next to the sinkor even wash their pants in the sink …well I wasn’t going to be happy wash-ing my babies’ nappies in there … they(Housing Corporation) acted as if itwas my problem and then I had to goto the bottom of the list and there wasnothing I could do…”210

Maori have consistently criticised statehousing policy and practice for failingMaori, and not including Treaty of Waitan-gi principles.211

Maori researchers have also identifiedhealth initiatives as failing Maori if they donot take into account Maori people’spoorer access to social resources, and ifthey are based on whole population analy-ses.212 They have argued for health pro-motion initiatives to be based on Treatyrights, using Maori needs as a startingpoint.

Initiatives aboutMaori housing� Housing New Zea-land is developingMaori housing strate-gies and in 2002 re-leased design princi-ples for Maori hous-ing. (See Appendix 1for Maori perspectivesabout housing.)� Maori architectshave worked on plansfor the Healthy Hous-ing Programme inAuckland.� Five current pilot Maori housingprojects are underway, including a housein Blenheim.213

“Maori whanau generally preferlow density residential developments

Table 4 - Tapu and noa relationships for rooms in a house

From HNZC Design Guide Ki te Hau Kainga

which allow good opportunities foroutdoor living, communal gatherings,gardens and safe tamariki playspace.”214

Design features include -� Flexibility to adapt to residents’changing needs and fluctuating occu-pancies. Allowance needs to be madefor future extensions and additionalbuildings such as a garage, wing addi-tion or kaumatua flat. These flats needtwo bedrooms so that a grandchild orcaregiver can live in.� Large living rooms able to accom-modate a whanau gathering of up to20 people. This can be likened to amarae wharenui (meeting house)where visitors are received, welcomedand sleep, where meetings and celebra-tions are held and sometimes where atupapaku (deceased family member)will lie.� Kitchens able to comfortably ac-commodate two or more people, espe-cially when catering for gatherings,and kitchen storage which allows forbulk foods and big pots.� Outside preparation and washingareas for seafood and other food prep-aration, cooking and eating.� Distinctions between tapu (sacredor prohibited) and noa (common orprofane) functions. For example, allfood facilities must be separate frombathrooms, toilets and laundries. Thedining room or kitchen should not benext to the laundry, toilet or bathroomand nor should a living or dining room.The laundry and bathroom should gen-erally be kept separate.

Main Laundry Toilet Bathroom Living Dining Kitchenentry room room

Bedroom � ~ ~ ~ ~ � �

Kitchen ~ � � � � �

Dining room ~ � � � �

Living room � � � �

Bathroom � ~ �

Toilet �

Laundry �

~ Neutral

� Conflict

� Desirable relationship

Gil Hanly

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Designing houses forPacific familiesState houses from the 1960s and 1970s areparticularly poorly suited to Pacific fami-lies, lacking the space to adequately enter-tain guests during Pacific gatherings (seeAppendix 1 for Pacific perspectives abouthousing).215

Initiatives about housingfor Pacific people� Housing New Zealand is developingPacific housing strategies and in 2002 re-leased design principles for Pacific hous-ing.� The Tokelau Community HousingProject is refurbishing an existing statehouse and designing and building a newstate house in East Porirua for a multi-gen-eration family.216

� Pacific people have identified some ba-sic needs -

� Larger family homes.� A large, square main room whichcan be used for meeting, eating, sleep-ing and relaxing.� Big kitchens so several people cancook at once, with large, high up stor-age areas.� Separation of private family spacesfrom the rooms used by visitors.� More and larger toilets and bath-rooms.� Larger bedrooms.� Fences for children.� No shared driveways so familiescan line up in their own driveways, es-pecially for family gatherings.� An outdoor food preparationarea.217, 218

POSSIBLE ACTIONS� Establish a Maori Housing Authority.� Provide training and other programmes to enable iwi, hapuother Maori organisations, and Pacific groups to provide housingservices.� Ensure Maori and Pacific input into community renewal, ur-ban design and sustainable development initiatives.� Develop programmes allowing collective ownership; forexample –

� Collective ownership of land and individual ownership ofmortgages, with loans secured against the house rather thanthe land� Whanau-owned homes with whanau-based mortgages� Iwi, hapu or whanau-owned rental housing.219

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9 CONCLUSION Evaluations have shown that theHealthy Housing Programme and theEECA insulation retrofitting programme,for example, have had a positive effect onresidents’ health. Several other initiativesare too recent to have been evaluated.

Interventions suggested by the re-search fall into five broad categories – pol-icy changes; funding increases for provi-sion of social housing; improved housingstandards; incentives and sanctions for pri-vate landlords; and improved monitoring.

Many suggestions from the researchare included in the Governement’s Build-ing the Future: The New Zealand HousingStrategy and some positive housing initia-tives such as the Healthy Housing Pro-gramme have been given ongoing support.

The Strategy is potentially far-reachingand exciting; however, many of its pro-posed strategies are broad and exploratoryand lack any specific outcomes or meas-ures.

Until now, there has been no nationalco-ordination or prioritisation of housinginterventions, so they have tended to be adhoc. Building the Future provides a moreco-ordinated overview, but there is noguarantee that any housing strategy willlast beyond its originating government.

The research reviewed here stressesthat only a co-ordinated and sustained ef-fort, backed by significant additional andlong-term funding, will be able to shift thecorrelation between poor health and poorhousing in deprived areas of Auckland.

“..only aco-ordinated

and sustainedeffort, backedby significant

additional andlong-term

funding, willbe able to shiftthe correlation

betweenpoor housing

in deprivedareas of

Auckland andpoor health..”

Gil Hanly

Gil Hanly

T HE RESEARCH summarised in this report indicates that ill-health and

poverty related to poor or crowdedhousing have become entrenched indeprived areas of Auckland.

Many sources stressed the seriousnessof housing poverty as a contributor topoor health and social problems. Profes-sor Mason Durie said that housing is moreimportant to Maori health than the deliv-ery of health services.220 A group ofNGOs said in 2003 that “..the extent ofthe unaffordable housing problem cannotbe overstated.”221 The Child Poverty Ac-tion Group refers to the re-appearance of“a widespread cycle of social disadvantagereinforced by housing poverty”.222

There are many gaps in the researchsummarised here. For example, there isno locally validated measure of crowding,little local research about crowding andhealth, and almost no longitudinal re-search.

Although affordability and discrimina-tion in housing are major issues for mentalhealth service users, there is little informa-tion about health impacts for this popula-tion. This summary did not include adultdomestic injury figures or the relationshipbetween household injuries and tenure.

This report lists several recent housinginitiatives, almost all relating to the statehousing sector. There are very few initia-tives in privately-owned rental housing.

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HealthIn 1948 the World Health Organisationdefined health as a state of complete phys-ical, social and mental wellbeing, and notmerely the absence of disease or infirmity.The 1986 Ottawa Charter lists the prereq-uisites of health as peace, shelter, educa-tion, food, income, a stable ecosystem,sustainable resources, social justice andequity. These definitions are commonlyused in New Zealand.

Despite these holistic understandings,almost all the literature reviewed concen-trated only on the physical and, less often,mental health effects of housing on indi-viduals. They did not question the nucle-ar-family design of houses.

Common models of Maori health gobeyond individual physical health to in-clude whanau health as well as spiritual,mental and physical health. “To be a totalperson ... in one’s own right is from aMaori perspective to be in an unhealthystate.”223

For many Pacific people, illness is seenas directly related to the disruption of akin-based social order, and both the causeand the cure are sought in the realm of thefamily.

“Consequently, Samoan and CookIslands people seek to ameliorate theill health linked with living in NewZealand by attempting to maintaingood family relationships over longdistances. They do this by sendingmoney, food and clothing ‘back home’,by attending family occasions in theIslands, and by hosting family membersin New Zealand.”224

These concepts of health make housingthat isolates Maori and Pacific peoplefrom their whanau or wider family lesslikely to contribute to their wellbeing.

HouseHousing policy assumes that a house is abuilding which can be rented or bought toaccommodate a family or as a money-earning investment. When the familychanges or moves, the house can be sold.

One Maori study said that an essentialrole of all houses was to support the “con-tinued collectivity of whanau, hapu andiwi, and their ability to sustain a cul-

“Theseconcepts of

health makehousing whichisolates Maori

and Pacificpeople from

their whanauor wider

family lesslikely to

contribute totheir well-

being.”

APPENDIX 1 -KEY CONCEPTS

ture”.225 This study supported collectivehome ownership as a model for Maori, asindividual home ownership reduceswhanau strength and creates dependencyon the state.

HouseholdNew Zealand laws and policies abouthousing have assumed that households areindependent economic units and familiesare made up of only parents and children.This is often not true for Maori and Pacificfamilies, and may not be the case for manyother families.

Modern whanau are responsible for -� The organisation of “gatherings tomark important events in the lives of indi-vidual members or the whole whanau”, themost important of which are tangihanga(funerals).226

� The management and care of groupproperty, such as marae, whakapapa orfamily history, and taonga or heirlooms.� The support of individual members andparent-child families.

“One of the values associated with thewhanau is that one’s home should be opento one’s kin. Having people to stay, oftenfor long periods, is part of life.”227

Maori households often view contribu-tions to tangihanga and other whanau obli-gations as calls on their income whichcome before household bills. Maorihouseholds are therefore not always inde-pendent economic units, but part of thewider whanau economy.

Pacific households usually have exten-sive obligations to their church and theextended family around New Zealand andin their country of origin. Their economymay be based on the extended family rath-er than the household. Money earned bymembers of a household is often a re-source for the extended family. How it isspent may be decided by a senior familymember who does not live in the house-hold.228

In the mid-1990s, Pacific peoples werethe most likely of the main ethnic groupsto live in extended families, often of threegenerations.229

HomeEmergency house clients in Auckland in1998 said five things turned a house into ahome –� Having a secure tenancy or ownership� Being able to personalise it� Being able to offer hospitality� Being able to set the rules� Being able to choose where to live.230

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Older people see “home” as a place ofsecurity and refuge, where they can retaincontrol over their lives and remain inde-pendent.231

For Maori people, home usually hasadditional meanings, expressed as turanga-waewae – “a place to stand from whichone can whakapapa back to the land”.232

Depending on tribal affiliation, Maori peo-ple may have more than one turangawae-wae.

In this sense, home is a place whichmust be maintained for future generations.“The individual basis of ownership, thecapital investment and the realisable assetthat can be sold when no longer required,represents almost the direct opposite of[this] Maori concept of home.”233

ABBREVIATIONSAS - Accommodation SupplementBERL - Business and Economic ResearchLtdBRANZ - Building Research Associationof New ZealandCHR - Centre for Housing Research/Kainga TipuCNOS - Canadian National OccupancyStandardCPAG - Child Poverty Action GroupDHB - District Health BoardEECA - Energy Efficiency ConservationAuthorityGP - General practitioner, family doctorHEEP - Household Energy End-UseProject, BRANZHNZC - Housing New Zealand Corpora-tionICESCR - International Covenant onEconomic, Social and Cultural RightsNGO - Non-Government organisationOECD - Organisation for Economic Co-operation and DevelopmentWHO - World Health Organisation

NOTES1 Joint NGO submission in response to the NewZealand Government’s Second Periodic Reportto the UN Committee on Economic, Social andCultural Rights, Housing in New Zealand, 2003, p13.2 Centre for Housing Research/Kainga Tipu,Changes in the Structure of the New ZealandHousing Market, Wellington, 2004.3 Johnson, Alan, Room for Improvement: CurrentNew Zealand Housing Policies and TheirImplications for Our Children, Child PovertyAction Group, 2003, p 8.4 Joint NGO submission, Housing in NewZealand, p 14.5 Johnson, Room for Improvement, p 9.6 Housing New Zealand Corporation, Buildingthe Future: Towards a New Zealand HousingStrategy Discussion Document, Wellington, 2004.7 Johnson, Room for Improvement, p 18.8 HNZC, Building the Future.9 Lennon, Michael, Housing Provision in NewZealand, in Housing and Health – Research Policyand Innovation, Philippa Howden-Chapman andPenelope Carroll, (eds), Steele Roberts, Wellington,2004, p 73.10 Joint NGO submission, Housing in NewZealand, p 25.11 Lennon, Michael, Housing Provision in NewZealand, p 73.12 Joint NGO submission, Housing in NewZealand.13 Maori Women’s Housing Project, For the Sakeof Decent Shelter, Housing Corporation of NewZealand, 1991, p 62.14 Ibid15 Ministry of Housing, Discrimination AwarenessStudy, 1994, cited in Howden-Chapman, Philippa,Nigel Isaacs, Julian Crane and Ralph Chapman,‘Housing and Health: The Relationship BetweenResearch and Policy’, International Journal ofEnvironmental Health Research 6, 173-185, 1996.16 Peace, Robin, Susan Kell, Lynne Pere, KateMarshall, Suzie Ballantyne, Mental Health andIndependent Housing Needs Part 1, A summary ofthe research, Ministry of Social Development,2002.17 Te Puni Kokiri, Regional Housing Issues –Feedback from Maori, Wellington, 1998.18 Milne, Kiri and Robin Kearns, ‘Housing statusand health implications for Pacific people in NewZealand’, Pacific Health Dialog, vol 6, no 1, 1999.19 Joint NGO submission, Housing in NewZealand.20 Ibid.21 Ibid; Johnson, Room for Improvement.22 Joint NGO submission, Housing in NewZealand.23 Johnson, Room for Improvement.24 Joint NGO submission, Housing in NewZealand; Housing New Zealand Corporation,New Zealand Housing Strategy – Reports fromstakeholders, 2002.

Robert Graham

Robert Graham

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25 Ibid.26 Joint NGO submission, Housing in NewZealand.27 Lennon, Michael, Housing Provision in NewZealand.28 Peace, Robin, Mental Health and IndependentHousing Needs.29 HNZC, NZ Housing Strategy - Reports fromstakeholders; Stone, Raewyn, Auckland RegionalAffordable Housing Strategy and Draft ManukauCity Affordable Housing Action Plan, report toManukau City Council, 2003.30 Centre for Housing Research/Kainga Tipu,Housing Costs and Affordability in New Zealand,Wellington, 2004.31 Joint NGO submission, Housing in NewZealand, p 16; Business and Economic ResearchLimited, Affordable Housing in the AucklandRegion; Issues, mechanisms and strategies,Wellington, 1999.32 CHR, Housing Costs and Affordability in NewZealand.33 Waldegrave, Charles, Peter King and RobertStephens, Changing housing policies, poverty andhealth, in Housing and Health – Research Policyand Innovation, Philippa Howden-Chapman andPenelope Carroll, (eds), Steele Roberts, Wellington,2004, p 145.34 Centre for Housing Research/Kainga Tipu,Accommodation Options for Older People inAotearoa/New Zealand, Wellington, 2004.35 New Zealand Network Against Food Poverty,Hidden Hunger – Food and Low Income in NewZealand, 1999, p 19.36 Lynch, Kate, Healthful Housing, School ofSociology and Women’s Studies, Massey University,2000, p 18.37 Cheer, Tarin, Robin Kearns and LaurenceMurphy, Housing policy, poverty and culture:‘Discounting’ decisions among Pacific peoples inAuckland, New Zealand, Paper presented to theannual meeting of the American Association ofGeographers, New York, 2001.38 Waldegrave, Charles, Robert Stephens and PeterKing, The Monetary Constraints and ConsumerBehaviour in New Zealand Low Income House-holds, The Family Centre Social Policy ResearchUnit, Lower Hutt, 1999.39 Ibid, p 149.40 Cheer, Housing policy, poverty and culture, p21.41 Johnson, Room for Improvement.42 Ibid.43 Solomon, Neil, Everybody’s Got to be Some-where: Household crowding and children of theAuckland region – trends and impacts, AucklandDistrict Public Health Service, 2002.44 HNZC, Building the Future.45 BERL, Affordable Housing in the AucklandRegion.46 Johnson, Room for Improvement.47 ‘Alatini, Moses Ngaluopea, Housing and RelatedSocial Conditions of the Tongan CommunityLiving in Otara/Ko e Fale Nofo’anga’ pea mo ‘eneFekau’aki mo e Mo ‘ui ‘a e Käinga Tonga Nofo ‘iOtara, MA thesis, University of Auckland, 2004.

48 Waldegrave et al, Changing housing policies,poverty and health, p 146.49 Dunn, James, Michael Hayes, David Hulchanski,Stephen Hwang and Louise Potvin, Housing as aSocio-economic Determinant of Health: A Canadianresearch framework, in Housing and Health -Research Policy and Innovation, Philippa Howden-Chapman and Penelope Carroll, (eds), SteeleRoberts, Wellington, 2004, p 24-5.50 Johnson, Room for Improvement.51 Auckland City Council et al, Quality of Life inNew Zealand’s Eight Largest Cities, 2003.52 Ibid.53 HNZC, Building the Future.54 ‘Alatini, Housing and Related Social Conditionsof the Tongan Community living in Otara, p 126.55 Statistics New Zealand, What is the Extent ofCrowding in New Zealand - An analysis ofcrowding in New Zealand households 1986-2001,Wellington, 2003.56 HNZC, Building the Future.57 CHR, Changes in the Structure of the NewZealand Housing Market.58 HNZC, NZ Housing Strategy - Reports fromstakeholders, p 69.59 CHR, Changes in the Structure of the NewZealand Housing Market.60 Maori Women’s Housing Project, For the Sakeof Decent Shelter, p 42.61 HNZC, Building the Future.62 Auckland Regional Council, Auckland RegionalAffordable Housing Strategy, Regional GrowthForum, 2003.63 Maori Women’s Housing Project, For the Sakeof Decent Shelter; TPK, Regional Housing Issues.64 CHR, Housing Costs and Affordability in NewZealand.65 Peace, Robin et al, Mental health and Independ-ent Housing Needs.66 Habitat for Humanity, http://www.habitatnz.co.nz/, downloaded October 2004.67 Joint NGO submission, Housing in NewZealand.68 Ibid, p 23.69 The Now Home, http://www.nowhome.co.nz/index.html, downloaded October 2004.70 CHR, Housing Costs and Affordability in NewZealand.71 HNZC, New Zealand Housing Strategy –Reports from stakeholders.72 CHR, Housing Costs and Affordability in NewZealand.73 Ibid.74 Joint NGO submission, Housing in NewZealand.75 CHR, Housing Costs and Affordability in NewZealand.76 Lynch, Healthful Housing.77 Joint NGO submission, Housing in NewZealand.78 Johnson, Room for Improvement; Waldegrave,Changing Housing Policies, Poverty and Health.79 Manukau City Council, Collaborative ActionPlan on Child Poverty in Manukau, Te Ora oManukau/Manukau the Healthy City, 2003.

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80 CHR, Housing Costs and Affordability in NewZealand.81 HNZC, Building the Future.82 Johnson, Room for Improvement.83 HNZC, New Zealand Housing Strategy –Reports from stakeholders.84 Ibid.85 Ibid.86 Ibid.87 CHR, Housing Costs and Affordability in NewZealand.88 Gray, Alison, Definitions of Crowding andEffects of Crowding on Health – A literaturereview, Ministry of Social Policy, 2001;

Statistics NZ, What is the Extent of Crowding inNew Zealand?89 Mercy House Women’s Advocacy Group, withthe Poverty, Policy and Participation Equity Project,Massey University Albany, and Te Waipuna PuawaiMercy Oasis, Healthy Housing: A Child Healthand Safety Survey of Glen Innes Housing NewZealand Homes, Auckland, 1999, p 13.90 Baker, Michael, Jasminka Milosevic, TonyBlakely and Philippa Howden-Chapman, Housing,crowding and health, in Philippa Howden-Chapmanand Penelope Carroll, (eds) Housing and Health -Research, Policy and Innovation, Steele Roberts,Wellington, 2004.91 Johnson, Room for Improvement, p 28.92 Milne, A, Allwood, GK, Moyes, CD et al, Aseroepidemiological study of the prevalence ofhepatitis B infections in a hyperendemic NewZealand community, Int. J. Epid., 16, 84-90, 1987,cited in Solomon, Everybody’s Got to be Some-where.93 HNZC, New Zealand Housing Strategy –Reports from stakeholders.94 Ibid.95 Smith, Carolyn, Housing stressors, social supportand psychological distress, Soc. Sci. Med, vol 37, no5, p 603-612, 1993.96 Gray, Definitions of Crowding and the Effects ofCrowding on Health.97 Bullen, Chris, Housing and Health Research inAuckland, in Housing and Health – ResearchPolicy and Innovation, Philippa Howden-Chapmanand Penelope Carroll, (eds), Steele Roberts,Wellington, 2004.98 Lynch, Healthful Housing, p 17.99 Ibid, p 16.100 Solomon, Everybody’s Got to be Somewhere, p16.101 Statistics NZ, What is the Extent of Crowding inNew Zealand?102 Eg, Milne, Housing status and health implica-tions for Pacific people in NZ.103 ‘Alatini, Housing and Related Social Condi-tions of the Tongan Community living in Otara, p133.104 Ibid, p 153.105 Johnson, Room for Improvement.106 Ibid, p 33.

107 Statistics NZ, What is the Extent of Crowding inNew Zealand?108 Ministry of Social Development, The SocialReport, Wellington, 2003.109 Statistics NZ, What is the Extent of Crowding inNew Zealand?110 Johnson, Room for Improvement, p 34.111 Kearns, Robin, Extending the agenda of housingand health research, in Housing and Health –Research Policy and Innovation, Philippa Howden-Chapman and Penelope Carroll, (eds), SteeleRoberts, Wellington, 2004, p 159.112 Johnson, Room for Improvement.113 HNZC, Building the Future.114 Maori Women’s Housing Project, For theSake of Decent Shelter, p 21.115 He Kainga Oranga/Housing and HealthResearch Programme, The Housing, Crowdingand Health Study, www.wnmeds.ac.nz/Academic/Dph/research/housing/hnzcohort.html, downloadedNovember 5, 2003.116 Gray, Definitions of Crowding and the Effectsof Crowding on Health.117 Solomon, Everybody’s Got to be Somewhere.118 Ibid.119 Johnson, Room for Improvement.120 Milne et al, Housing status and health implica-tions for Pacific people in New Zealand, p 84.121 National Advisory Committee on Health andDisability, The Social, Cultural and EconomicDeterminants of Health in New Zealand: Action toImprove Health, 1998, p 32.122 New Zealand National Housing Commission,1988, cited in Howden-Chapman, Philippa et al,Housing and Health: The Relationship BetweenResearch and Policy; Peace et al, Mental healthand Independent Housing Needs.123 Kearns, Robin, Carolyn Smith and Max Abbott,The Stress of Incipient Homelessness, HousingStudies, 7, 280-98, 1992.124 Kearns, Robin and Carolyn Smith, Housingstressors and mental health among marginalizedurban populations, Area, vol 25, no 3, 1993, p 228.125 CHR, Accommodation Options for OlderPeople in Aotearoa/New Zealand.126 Krieger, James and Donna Higgins, Housingand Health: Time Again for Public Health Action,American Journal of Public Health, vol 92, no 5,758-765, 2002.127 Department of the Environment andHeritage, Technical Report No. 9: Unflued GasAppliances and Air Quality in Australian Homes,ACT, 2004.128 Housing New Zealand Corporation, TheHealthy Housing Programme – End of PilotReport, Auckland, 2002.129 Krieger, Housing and Health: Time Again forPublic Health Action.130 Howden-Chapman, Housing and Health: TheRelationship Between Research and Policy.131 Dunn, Housing as a socio-economic determinantof health: A Canadian research framework.132 Kearns, The stress of incipient homelessness.133 Wells, Nancy, Housing Quality and Women’sMental Health: A three-wave longitudinal study,Presented to the Housing in the 21st Century

Notes (continued)

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conference, Gävle, Sweden, 26-30 June, 2000.134 Milne, Housing status and health implications forPacific people in NZ.135 Field, Adrian and Karen Witten, Who gets towhat? Access to community resources in two NewZealand cities, Urban Policy & Research, Issue 22,(in press).136 British Medical Association, Housing andHealth – Building for the future, Board of Scienceand Education, UK, 2003, p 25.137 Krieger, Housing and Health: Time Again forPublic Health Action; Howden-Chapman,Philippa, Housing Standards: A glossary of housingand health, in Journal of Epidemiology andCommunity Health, ch11569, Module 2, 2/1/04,www.jech.com, p 3-4.138 Howden-Chapman, Philippa, HousingStandards, p 3-4.139 Joint NGO submission, Housing in NewZealand, p 25.140 HNZC, Building the Future.141 McKinlay, Douglas, 2000, cited in ARC,Auckland Regional Affordable Housing Strategy.142 CHR, Accommodation Options for OlderPeople in Aotearoa/New Zealand.143 Lynch, Healthful Housing.144 Mercy House Women’s Advocacy Group,Healthy Housing: A Child Health and SafetySurvey of Glen Innes Housing New ZealandHomes.145 Ibid.146 Ibid.147 Otara Housing and Health Local SolutionsProject, Action on Housing and Health in Otara –A report to the National Health Committee,Auckland, 1999.148 Mercy House Women’s Advocacy Group,Healthy Housing: A Child Health and SafetySurvey of Glen Innes Housing New ZealandHomes.149 ‘Alatini, Housing and Related Social Condi-tions of the Tongan Community living in Otara.150 Ibid, p 124.151 British Medical Association, Housing andHealth – Building for the future, p 35.152 Auckland City Council et al, Quality of Life inNew Zealand’s Eight Largest Cities.153 Otara Housing and Health Local SolutionsProject, Action on Housing and Health in Otara.154 Grant, Joy, Long-Stay Accommodation inCaravans and Mobile Housing, Auckland RegionBackground Report, Auckland Regional Authority,1982.155 Joint NGO submission, Housing in NewZealand.156 Bailie, Ross, Is this what they mean by freerange? Researching housing and health in remotecommunities in the Northern Territory, in Housingand Health – Research Policy and Innovation,Philippa Howden-Chapman and Penelope Carroll,(eds), Steele Roberts, Wellington, 2004, p 102.157 Krieger, Housing and Health: Time Again forPublic Health Action.158 Ibid.159 HNZC, Building the Future.160 CHR, Accommodation Options for Older

People in Aotearoa/New Zealand.161 Ibid.162 Ibid.163 Howden-Chapman et al, Housing and Health:The Relationship Between Research and Policy.164 Krieger et al, Housing and Health: Time Againfor Public Health Action.165 British Medical Association, Housing andHealth – Building for the future.166 HNZC, Building the Future.167 British Medical Association, Housing andHealth – Building for the future.168 CHR, Accommodation Options for OlderPeople in Aotearoa/New Zealand.169 Howden-Chapman et al, Housing and Health:The Relationship Between Research and Policy.170 Krieger et al, Housing and Health: Time Againfor Public Health Action.171 CHR, Accommodation Options for OlderPeople in Aotearoa/New Zealand.172 He Kainga Oranga/Housing and HealthResearch Programme, The Housing, Insulationand Health Study - Preliminary results, 2003,www.wnmeds.ac.nz/Academic/Dph/research/housing/publications.html, downloaded April 17,2004.173 Staley, Heather and Philippa Howden-Chapman,A Healthy Return from Investing in Insulation,presentation to Government officials, Wellington, 25February 2004.174 Isaacs, Nigel and M. Donn, Housing and health -seasonality in New Zealand mortality, AustralianJournal of Public Health, 17: 68-70, 1993.175 Howden-Chapman, Philippa, Louise Signal andJulian Crane, Housing and Health in Older People:Ageing in Place, Social Policy Journal of NewZealand, 13, 14-30, 1999.176 Platt et al, 1989; Brunekeep, 1989; Miller,1992, cited in Howden-Chapman et al, Housing andHealth: The relationship between research andpolicy.177 Ibid.178 ‘Alatini, Housing and Related Social Condi-tions of the Tongan Community living in Otara, p121.179 Howden-Chapman et al, Housing and Health:The relationship between research and policy.180 British Medical Association, Housing andHealth – Building for the future, p 35.181 Howden-Chapman et al, Housing and Health:The relationship between research and policy.182 Howden-Chapman, Philippa, Julian Crane,Michael Baker, Chris Cunningham and AnnaMatheson, Reducing Health Inequality ThroughImproving Housing – He Kainga Oranga/Housingand Health Research Programme, in Housing andHealth – Research Policy and Innovation, PhilippaHowden-Chapman and Penelope Carroll, (eds),Steele Roberts, Wellington, 2004.183 Evans, J, S Hyndman et al, An epidemiologicalstudy of the relative importance of damp housing inrelation to adult health, Journal of Epidemiologyand Community Health, vol 54, 677-686, 2000,cited in Howden-Chapman et al, Housing AndHealth: The Relationship Between Research AndPolicy.

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184 Lynch, Healthful Housing, p 21.185 Butler, Sarnia et al, Problems with damp andcold housing among Pacific families in NewZealand, NZMJ, vol 116, no 1177, 2003.186 Howden-Chapman et al, Housing and Health inOlder People: Ageing in Place.187 British Medical Association, Housing andHealth – Building for the future, p 30.188 He Kainga Oranga/Housing and HealthResearch Programme, The Housing, Insulationand Health Study - Preliminary results, 2003,www.wnmeds.ac.nz/Academic/Dph/research/housing/publications.html, downloaded April 17,2004.189 British Medical Association, Housing andHealth – Building for the future.190 Ibid.191 Ibid.192 Howden-Chapman et al, Housing and Health:The Relationship Between Research and Policy.193 Butler, Sarnia et al, Problems with damp andcold housing among Pacific families in NewZealand.194 Otara Housing and Health Local SolutionsProject, Action on Housing and Health in Otara.195 Otara Health, Our Home Our Place – Reporton the Otara Housing Hui, 2001.196 Butler et al, Problems with damp and coldhousing among Pacific families in New Zealand.197 Most figures in this section are from Safekids,Safe as Houses? Recommendations for ChildsafeHousing New Zealand Homes, Auckland, 1996.198 British Medical Association, Housing andHealth – Building for the future, p 32.199 Manukau City Council, The CollaborativeAction Plan on Child Poverty in Manukau.200 Mercy House Women’s Advocacy Group,Healthy Housing: A Child Health and SafetySurvey of Glen Innes Housing New ZealandHomes, p 5.201 Safekids, Safe as Houses? Recommendationsfor Childsafe Housing New Zealand Homes.202 Lynch, Healthful Housing.203 ‘Alatini, Housing and Related Social Condi-tions of the Tongan Community living in Otara, p121.204 Safekids, Safe as Houses? Recommendationsfor Childsafe Housing New Zealand Homes.205 British Medical Association, Housing andHealth – Building for the future, p 33.206 CHR, Accommodation Options for OlderPeople in Aotearoa/New Zealand, p 142.207 Te Puni Kokiri, Regional Housing Issues –Feedback from Maori.208 CHR, Accommodation Options for OlderPeople in Aotearoa/New Zealand.209 Saville-Smith, Kay, Critical Issues in Housing:Research challenges and responses, in Housing andHealth – Research Policy and Innovation, PhilippaHowden-Chapman and Penelope Carroll, (eds),Steele Roberts, Wellington, 2004.210 Maori Women’s Housing Project, For the

Sake of Decent Shelter, p 41.211 Ibid; Te Puni Kokiri, Regional Housing Issues –Feedback from Maori; HNZC, NZ HousingStrategy - Reports from stakeholders.212 Reid, Papaarangi, Challenging Knowledge,Challenging Practice, Making the Connections,papers from the sixth conference of the HealthPromotion Forum, Health Promotion Forum,Auckland, 2002.213 Hoskins, Rau, New Perspectives on MaoriHousing Solutions, in Housing and Health –Research Policy and Innovation, Philippa Howden-Chapman and Penelope Carroll, (eds), SteeleRoberts, Wellington, 2004.214 Ibid, p 114.215 Milne et al, Housing status and health implica-tions for Pacific people in New Zealand.216 He Kainga Oranga/Housing and HealthResearch Programme, Tokelau CommunityHousing, www.wnmeds.ac.nz/Academic/Dph/research/housing/tokelau.html, downloadedNovember 5, 2003.217 Ministry of Pacific Island Affairs, ScopingReport on Status of Housing for Pacific Peoples,Wellington, 1999.218 Otara Health, Our Home, Our Place.219 Maori Women’s Housing Project, For theSake of Decent Shelter.220 Durie, Mason, Whaiora: Maori HealthDevelopment, second edition, Oxford UniversityPress, Auckland, 1998.221 Joint NGO submission, Housing in NewZealand, p 16222 Johnson, Room For Improvement, p 5.223 Durie, Mason, A Maori Perspective of Health,Social Science and Medicine, vol 20, no 5, p 484,1985.224 Milne et al, Housing status and health implica-tions for Pacific people in New Zealand, p 81.225 Maori Women’s Housing Project, For theSake of Decent Shelter, p 17.226 Fleming, Robin, with Julie Taiapa, Anna Pasikaleand Susan Kell Easting, The Common Purse –Income sharing in New Zealand families, AucklandUniversity Press, 1997, p xix.227 Ibid, p 12.228 Ibid, p 15.229 Ministry of Pacific Island Affairs, ScopingReport on Status of Housing for Pacific People, p13.230 Lynch, Healthful Housing, p 22.231 CHR, Accommodation Options for OlderPeople in Aotearoa/New Zealand.232 Maori Women’s Housing Project, For theSake of Decent Shelter, p 15.233 Ibid, p 17.

Notes (continued)

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REFERENCES‘Alatini, Moses Ngaluopea, Housing and RelatedSocial Conditions of the Tongan CommunityLiving in Otara/Ko e Fale Nofo’anga’ pea mo ‘eneFekau’aki mo e Mo ‘ui ‘a e Käinga Tonga Nofo ‘iOtara, Master of Arts thesis, University ofAuckland, 2004.

Auckland, Christchurch, Dunedin, Hamilton,Manukau North Shore, Waitakere and Welling-ton City Councils, The Quality of Life in NewZealand’s Eight Largest Cities, 2003.

Auckland Regional Council, Auckland RegionalAffordable Housing Strategy, Regional GrowthForum, 2003.

Baker, Michael, Jasminka Milosevic, Tony Blakelyand Philippa Howden-Chapman, Housing,crowding and health, in Philippa Howden-Chapmanand Penelope Carroll, (eds) Housing and Health -Research, Policy and Innovation, Steele Roberts,Wellington, 2004.

Business and Economic Research Limited,Affordable Housing in the Auckland Region;Issues, mechanisms and strategies, Wellington,1999.

British Medical Association, Housing and Health– Building for the future, Board of Science andEducation, UK, 2003.

Butler, Sarnia, Maynard Williams, ColinTukuitonga and Janis Paterson, ‘Problems withdamp and cold housing among Pacific families inNew Zealand’, NZMJ, vol 116, no 1177, 2003.

Centre for Housing Research/Kainga Tipu,Changes in the Structure of the New ZealandHousing Market, Wellington, 2004.

Centre for Housing Research/Kainga Tipu,Accommodation Options for Older People inAotearoa/New Zealand, Wellington, 2004.

Centre for Housing Research/Kainga Tipu,Housing Costs and Affordability in New Zealand,Wellington, 2004.

Cheer, Tarin, Robin Kearns and Laurence Murphy,Housing policy, poverty and culture: ‘Discounting’decisions among Pacific peoples in Auckland, NewZealand, Paper presented to the annual meeting ofthe American Association of Geographers, NewYork, March 2001.

Department of the Environment and Heritage,Technical Report No. 9: Unflued Gas Appliancesand Air Quality in Australian Homes, ACT, 2004.

Dunn, James, Michael Hayes, David Hulchanski,Stephen Hwang and Louise Potvin, Housing as aSocio-economic Determinant of Health: A Canadianresearch framework, in Philippa Howden-Chapmanand Penelope Carroll, (eds) Housing and Health –Research Policy and Innovation, Steele Roberts,Wellington, 2004.

Durie, Mason, Whaiora: Maori Health Develop-ment, second edition, Oxford University Press,Melbourne, 1998.

Durie, Mason, ‘A Maori Perspective of Health’,Social Science and Medicine, vol 20, no 5, p 483-6,1985.

Field, Adrian and Karen Witten, ‘Who gets to what?Access to community resources in two New Zealand

cities’, Urban Policy & Research, Issue 22, (inpress).

Fleming, Robin, with Julia Taiapa, Anna Pasikaleand Susan Kell Easting, The Common Purse –Income Sharing in New Zealand Families,Auckland University Press, 1997.

Grant, Joy, Long-Stay Accommodation inCaravans and Mobile Housing, Auckland RegionBackground Report, Auckland Regional Authority,1982.

Gray, Alison, Definitions of Crowding and Effectsof Crowding on Health – A literature review,Ministry of Social Policy, Wellington, 2001.

Habitat for Humanity, http://www.habitatnz.co.nz,downloaded October 2004.

He Kainga Oranga/Housing and HealthResearch Programme, The Housing, Crowdingand Health Study, www.wnmeds.ac.nz/Academic/Dph/research/housing/hnzcohort.html, downloadedNovember 5, 2003.

He Kainga Oranga/Housing and HealthResearch Programme, The Housing, Insulationand Health Study - Preliminary results, 2003,www.wnmeds.ac.nz/Academic/Dph/research/housing/publications.html, downloaded April 17,2004.

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References (continued)

Documents

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