'That house was a home': Qualitative evidence from New Zealand on the connections between rental housing eviction and poor health outcomes.

ISSUE ADDRESSED: Eviction, or a forced move from rental housing, is a common experience for New Zealand renters, yet we know very little about its effects. This research investigated how eviction affects people's lives and health. METHODS: We conducted semi-structured interviews with 27 people who had experienced eviction. We coded the transcripts and grouped them into themes using template analysis. RESULTS: Participant experienced grief at the loss of the home. Moving out and searching for a new home was highly stressful on participants and on their relationships. After being evicted, people became homeless, often staying with family and friends and lived in poor quality or unaffordable housing. They reported health issues as a result of these circumstances. CONCLUSIONS: Eviction harms health through causing stress, grief and a move to a risky living situation. Increasing the supply of housing and funding wide-ranging support services can help minimise the harm caused by eviction. SO WHAT?: Reducing the incidence and impact of eviction should be a priority for health promotion.

Promoting health through housing improvements, education and advocacy: Lessons from staff involved in Wellington's Healthy Housing Initiative.

ISSUE ADDRESSED: Improving the conditions of housing through programs that trigger when children are hospitalised has the potential to prevent further ill-health and re-hospitalisations. Exploring the attitudes and beliefs of staff involved in such a program assists in understanding the advantages and challenges of this approach. METHODS: We interviewed 21 people involved in a regional initiative to improve the health outcomes of children through referral to a housing program. Interviews were recorded and transcribed. Transcripts were subsequently subjected to qualitative thematic analysis. RESULTS: Participants identified a number of factors that were key to the success of the program, such as: visiting the home, having health and energy organisations work together, and an integrated approach that includes interventions as well as education and advocacy. Key challenges to the program's aim of improving health outcomes for children were landlords' reluctance to implement improvements, homeowners' inability to afford improvements, limitations to staff resources, and client stress and income constraints, which meant that some interventions did not necessarily lead to housing improvements. CONCLUSIONS: Efforts to improve health outcomes through housing interventions should be supported by funding and regulatory initiatives that encourage property owners to implement recommended interventions. SO WHAT?: This program represents an encouraging step towards health promotion through housing interventions and education. However, the initiative cannot fully counter structural challenges such as poor quality housing, and lack of housing and energy affordability. This study highlights the potential for a holistic approach to health promotion in housing, which integrates health initiatives with advocacy for regulatory support.

"You're so powerless": Takatapui/LGBTIQ+ people's experiences before becoming homeless in Aotearoa New Zealand.

Little is known in Aotearoa New Zealand about experiences of homelessness amongst Takatapui/LGBTIQ+ identifying people, despite growing international literature regarding LGBTIQ+ homelessness. Using data from semi-structured interviews with eight people who identified as Takatapui/LGBTIQ+ and had experienced homelessness, this paper explores their experiences prior to becoming homeless. These experiences are placed into the categories of: the pervasiveness of instability (especially in regards to family relationships, finances, and housing), having to grow up fast due to social and material conditions, experiences of looking for housing in stressed markets, and systems failures that resulted in a lack of autonomy. These results show that instability and systems failures are key contributors to Takatapui/LGBTIQ+ people becoming homeless in Aotearoa New Zealand.

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.

Public Housing and Well-Being: Evaluation Frameworks to Influence Policy.

BACKGROUND: A robust evidence base is needed to develop sustainable cross-party solutions for public housing to promote well-being. The provision of public housing is politically contentious in New Zealand, as in many liberal democracies. Depending on the government, policies oscillate between encouraging sales of public housing stock and reducing investment and maintenance, and large-scale investment, provision, and regeneration of public housing. AIM: We aimed to develop frameworks to evaluate the impact of public housing regeneration on tenant well-being at the apartment, complex, and community levels, and to inform future policies. METHOD: Based on a systems approach and theory of change models, we developed a mixed methods quasi-experimental before-and-after outcomes evaluation frameworks, with control groups, for three public housing sites. This evaluation design had flexibility to accommodate real-world complexities, inherent in evaluating large-scale public health interventions, while maintaining scientific rigor to realize the full effects of interventions. RESULTS: Three evaluation frameworks for housing were developed. The evaluation at the apartment level confirmed proof of concept and viability of the framework and approach. This also showed that minor draught-stopping measures had a relatively big impact on indoor temperature and thermal comfort, which subsequently informed healthy housing standards. The complex and community-level evaluations are ongoing due to longer regeneration timeframes. CONCLUSION: Public housing is one of central government's larger social sector interventions, with Kainga Ora - Homes and Communities the largest Crown entity. Evaluating public housing policies is important to develop an evidence base to inform best practice, rational, decision-making policy for the public as well as the private sector.

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.

LGBTIQ+ Homelessness: A Review of the Literature.

Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ+) people's experiences of homelessness is an under-explored area of housing and homelessness studies, despite this group making up 20-40% of homeless populations. Despite this, much of the existing literature focuses on specific elements of LGBTIQ+ homelessness, and often does not consider the intersections of these elements, instead placing them into individual siloes. Our approach is an intersectional one; this paper identifies the key themes in the existing research, and analyses how these themes interact to reinforce the discrimination and stigma faced by LGBTIQ+ people who experience homelessness. This intersectional-systems thinking approach to LGBTIQ+ homelessness can be used to develop well-informed, culturally sensitive support programmes.

Why don't owners improve their homes? Results from a survey following a housing warrant-of-fitness assessment for health and safety.

OBJECTIVE: To assess homeowners' intentions to make voluntary improvements to their homes following a warrant-of-fitness (WOF) assessment to highlight health and safety issues. METHODS: We recruited 83 homeowners, including nine landlords, in Taranaki, New Zealand, who agreed to have a WOF assessment carried out on their homes. We interviewed 40 of the homeowners to ascertain what improvements they planned to make, and barriers to improving their homes. RESULTS: Of the 83 properties, 76 (92%) failed the WOF. Of the 40 interview participants, 31 (76%) had addressed or planned to address at least one of the identified issues with the home. Participants were least likely to address identified issues with security stays on windows, and absence of ground vapour barrier. Reasons for not addressing identified issues included cost, and a belief that making the improvement would not benefit health and safety. CONCLUSIONS: Information about housing defects appears insufficient to encourage people to make improvements to their homes to meet a specified health and safety standard. Implications for public health: Better understanding of how particular housing defects pose a risk for health and safety, and provision of funding support in some cases, may encourage people to invest in safer, healthier homes.

Mapping interactions between the sustainable development goals: lessons learned and ways forward.

Pursuing integrated research and decision-making to advance action on the sustainable development goals (SDGs) fundamentally depends on understanding interactions between the SDGs, both negative ones ("trade-offs") and positive ones ("co-benefits"). This quest, triggered by the 2030 Agenda, has however pointed to a gap in current research and policy analysis regarding how to think systematically about interactions across the SDGs. This paper synthesizes experiences and insights from the application of a new conceptual framework for mapping and assessing SDG interactions using a defined typology and characterization approach. Drawing on results from a major international research study applied to the SDGs on health, energy and the ocean, it analyses how interactions depend on key factors such as geographical context, resource endowments, time horizon and governance. The paper discusses the future potential, barriers and opportunities for applying the approach in scientific research, in policy making and in bridging the two through a global SDG Interactions Knowledge Platform as a key mechanism for assembling, systematizing and aggregating knowledge on interactions.

Setting Housing Standards to Improve Global Health.

Developing World Health Organization international guidelines is a highly formal process. Yet the resulting guidelines, which Member States are encouraged, but not required to adopt, are a powerful way of developing rigorous policy and fostering implementation. Using the example of the housing and health guidelines, which are currently being finalised, this paper outlines the process for developing WHO guidelines. This includes: forming a Guidelines Review Group that represents all regions of the world, and ensures gender balance and technical expertise; identifying key health outcomes of interest; commissioning systematic reviews of the evidence; assessing the evidence; and formulating recommendations. The strength of each recommendation is assessed based on the quality of the evidence, along with consideration of issues such as equity, acceptability, and feasibility of the implementation of the recommendation. The proposed housing guidelines will address: cold and hot indoor temperatures, home injuries, household crowding, accessibility and access to active travel infrastructure.

Using Twitter to Explore (un)Healthy Housing: Learning from the #Characterbuildings Campaign in New Zealand.

While increasingly used for research, Twitter remains largely untapped as a source of data about housing. We explore the growth of social media and use of Twitter in health and social research, and question why housing researchers have avoided using Twitter to explore housing issues to date. We use the #characterbuildings campaign, initiated by an online media platform in New Zealand in 2014 to illustrate that Twitter can provide insights into housing as a public health and social problem. We find that Twitter users share details of problems with past and present homes on this public platform, and that this readily available data can contribute to the case for improving building quality as a means of promoting public health. Moreover, the way people responded to the request to share details about their housing experiences provides insight into how New Zealanders conceive of housing problems.

Towards an agreed quality standard for rental housing: field testing of a New Zealand housing WOF tool.

OBJECTIVE: Report on a field test of a rental housing warrant of fitness (WOF) to assess its practicality and utility for supporting improved quality of housing. METHODS: Five councils each recruited at least 25 rental houses to undergo a WOF assessment. The assessment included housing features that, based on a combination of research and practicality, were considered to have an important impact on health, safety and energy efficiency. Assessors were interviewed to get their feedback on the process. Landlords representing 81% of the rental properties were interviewed on their attitudes to the WOF. RESULTS: Of the sample of 144 houses, 94% failed at least one of 31 criteria. The most common reasons were: unsafe water temperature; no security stays; no smoke alarms; no fixed heating; and unsuitable handrails/balustrades. If items that required little (