He Kainga Oranga: reflections on 25 years of measuring the improved health, wellbeing and sustainability of healthier housing.

This paper reflects on the influences and outcomes of He Kainga Oranga/Housing and Health Research Programme over 25 years, and their impact on housing and health policy in Aotearoa and internationally. Working in partnership particularly with Maori and Pasifika communities, we have conducted randomised control trials which have shown the health and broad co-benefits of retrofitted insulation, heating and remediation of home hazards, which have underpinned government policy in the Warm Up NZ-Heat Smart programme and the Healthy Homes Standards for rental housing. These trials have been included as evidence in the WHO Housing and Health Guidelines and led to our designation as a WHO Collaborating Centre on Housing and Wellbeing. We are increasingly explicitly weaving Maori frameworks, values and processes with traditional Western science.

Post-housing first outcomes amongst a cohort of formerly homeless youth in Aotearoa New Zealand.

This paper explores the government service interactions for a cohort of formerly homeless youth in Aotearoa New Zealand, using linked administrative data. We report the rates of service interactions pre- and post-housing for a cohort of 69 youth, aged 18-25 years old, who received housing and support from a Housing First provider. 60.9% were women, and 69.6% were Maori. Very high rates of service interactions were seen both before and after they were housed. The evidence shows promising potential improvements in young people's lives when housed. The most significant changes we saw in the one and two years post-housing were in incomes from both wages/salaries and social welfare benefits; there was a significant increase in total income for our cohort. There was also a promising reduction in hospitalisations and emergency deparment admissions. Overall, Housing First shows promising outcomes for youth.

Service usage of a cohort of formerly homeless women in Aotearoa New Zealand.

PURPOSE: The aim of this paper is to explore government service usage across the domains of health, justice, and social development and tax for a cohort of formerly homeless people in Aotearoa New Zealand, focusing specifically on the experiences of women. The Integrated Data Infrastructure is used, which links our de-identified cohort data with administrative data from various Aotearoa New Zealand Government departments. RESULTS: Of the cohort of 390, the majority (53.8%) were women. These women were more likely to be younger (57.1% were aged 25-44), indigenous Maori (78.6%), and have children (81.4%). These women had lower incomes, and higher rates of welfare benefit receipt, when compared to men in the cohort and a control group of women from the wider population. CONCLUSIONS: The cohort were primarily female, younger, Maori, and parents. They earned much less than their non-homeless counterparts, and relied heavily on government support. The neoliberalisation of the welfare state, high rates of women's poverty, and the gendered nature of parenthood means that women's homelessness is distinct from men's homelessness.

Well Homes Initiative: A Home-Based Intervention to Address Housing-Related Ill Health.

BACKGROUND: Six thousand children are hospitalized each year in New Zealand with housing sensitive conditions, and 86.2% of these children are rehospitalized during childhood. The Healthy Homes Initiative, set up by the Ministry of Health, and implemented in Wellington through Well Homes, carries out housing assessments and delivers a range of housing interventions. METHOD: Housing assessments were carried out by trained community workers. Philanthropic funding was received for the interventions through a local charitable trust. RESULTS: Well Homes saw 895 families. Mold in the home was the most commonly recorded area of poor housing quality, in 836 homes (93%). Partial or complete lack of insulation was also common, with 452 records (51%) having a documented need for further assessment and either an upgrade or full installation. Eighty-three percent of homes had insufficient sources of heating. A total of 5,537 interventions were delivered. Bedding, heaters, and draft stopping were delivered over 90% of the time. In contrast, insulation and carpets were only delivered 40% of the time. Interventions were least likely to be delivered in private rental housing. DISCUSSION: Targeted interventions using social partnerships can deliver housing improvements for relatively little health spending. Well Homes provides immediate and practical interventions, education, connection with social agencies, and advocacy for more substantial structural home improvements to help families keep their home warmer, drier, and healthier. This approach will be strengthened when combined with a new regulatory framework to raise the standards of private rental housing.

Evidence base for a housing warrant of fitness.

Substandard housing is a major public health issue in New Zealand. Approximately, two-thirds of the housing stock is uninsulated and many homes are inadequately heated, with an average indoor temperature of 14.5°C. Cold, damp, and mouldy housing results in poor health; each year, respiratory hospital admissions are 74% higher during winter, and excess winter mortality is 20% higher than other seasons. The relationship between injury and housing conditions is also well established. Each year, 500,000 New Zealanders suffer falls requiring medical treatment in their homes. As a step towards improving the quality of existing housing, an evidence-based warrant of fitness has been developed. This article outlines the evidence base to each criterion in the warrant of fitness. We conclude that introducing and properly enforcing a housing warrant of fitness will ensure that basic minimum standards are met, which could mitigate the disease burdens and injuries associated with, or caused, by poorer quality housing. In addition, there are potential fiscal and economic advantages of the scheme, including reduced hospitalisations and increased productivity.

A principles framework for taking action on Maori/Indigenous Homelessness in Aotearoa/New Zealand.

OBJECTIVE: The objective of this research was to develop a principles framework to guide action on Maori/Indigenous homelessness in Aotearoa incorporating Rangatiratanga (Maori self-determination), Whanau Ora (Government policy that places Maori families at the center of funding, policy and services) and Housing First. METHOD: Three pathways were identified as creating opportunities for action on Maori homelessness: Te Tiriti o Waitangi/Treaty of Waitangi is the Maori self-determination pathway; Whanau Ora, a government-sponsored policy supports whanau/family as the pathway for Maori wellbeing and disparities reduction; and Housing First, an international pathway with local application for homelessness that is being implemented in parts of Aotearoa. The potential opportunities of the three pathways shaped interviews with authoritative Maori about Maori principles (derived from the three pathways) for addressing Maori homelessness. Twenty interviews were conducted with Maori experts using Kaupapa Maori research processes, eliciting advice about addressing Maori homelessness. A principles framework called Whare Oranga was developed to synthesise these views. RESULTS: Addressing Maori homelessness must be anchored in rights-based and culturally aligned practice empowered by Maori worldviews, principles and processes. Te Tiriti o Waitangi, which endorses Maori tribal self-determination and authority, and Whanau Ora as a government obligation to reduce inequities in Maori homelessness, are the foundations for such action. Colonisation and historical trauma are root causes of Maori homelessness. Strong rights-based frameworks are needed to enact decolonisation and guide policy. These frameworks exist in Tino Rangatiratanga/Maori self-determination and Whanau Ora. CONCLUSION: Whare Oranga: An Indigenous Housing Interventions Principles Framework was developed in Aotearoa/New Zealand to end Maori homelessness. Future research is needed on the practical application of this framework in ending Maori homelessness. Moreover, the use value of the Whare Oranga Framework as a workable approach to ending homelessness in other indigenous populations is yet to be considered.

Service usage by a New Zealand Housing First cohort prior to being housed.

BACKGROUND: The Ending Homelessness in New Zealand: Housing First research programme is evaluating outcomes for people housed in a Housing First programme run by The People's Project in Hamilton, New Zealand. This baseline results paper uses administrative data to look at the scope and duration of their interactions with government services. METHODS: We linked our de-identified cohort to the Integrated Data Infrastructure (IDI). This database contains administrative data on most services provided by the New Zealand Government to citizens. Linkage rates in all datasets were above 90%. This paper reports on the use of government services by the cohort before being housed. We focus on the domains of health, justice and income support. RESULTS: The cohort of 390 people had over 200,000 recorded interactions across a range of services in their lifetime. The most common services were health, justice and welfare. The homeless cohort had used the services at rates far in excess of the general population. Unfortunately these did not prevent them from becoming homeless. CONCLUSION: These preliminary findings show the homeless population have important service delivery needs and a very high level of interaction with government services. This highlights the importance of analysing the contributing factors towards homelessness; for evaluation of interventions such as Housing First, and for understanding the need for integrated systems of government policy and practice to prevent homelessness. This paper also provides the baseline for post-Housing First evaluations.