A link restored for now

Originally written as a column for Inside Housing.

We routinely talk about the relationship between health and housing but have we forgotten just how close it once was?

That was the intriguing question posed by Al Story, professor of inclusion health at University College London, in the final session of this year’s Housing Studies Association conference.

As he traced how the relationship between public health, homelessness and housing developed from the 19th century to the present day, he outlined a sometimes surprising history with a striking contemporary relevance in the wake of Covid-19.

It’s a story that starts with the 19th century Vagrancy Act (now finally scheduled for repeal) but also the gradual realisation of the links between overcrowding, poor housing, contaminated water and disease.

A system of workhouses, poor law infirmaries and shelters developed with features such as the penny sit-up (a bench with no sleeping allowed), two penny hangover (a rope to lean on) and four penny coffin (a coffin-shaped box to sleep in).

Although the workhouse model was finally abolished in 1930, much of the concept and many of the buildings still survive: communal casual wards became modern day night shelters and cellular casual wards became hostels.

Public health concerns drove increased help for homeless people. Workhouse infirmaries were responsible for half of all deaths from TB but these were significantly reduced by segregation of consumptives even before treatments were available.

The contemporary relevance of all this is not just that homeless people still have the highest rates of TB even in the 21st century but also that the disease is spread via aerosol transmission – the same as with Covid-19.

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Shrinking the state

What would it mean if George Osborne succeeds in cutting public spending to its lowest level since the 1930s?

The scale of the cuts for the rest of this decade implied by the deficit reduction targets in the Autumn Statement takes us into territory uncharted since the war. Many people believe Osborne has moved from the realms of the unlikely to the realms of fantasy and it’s not hard to see why. If the chancellor missed the deficit targets he set out in 2010 by a wide margin, why should we accept what he says in 2014? Especially when he says he can cut taxes at the same time.

Osborne must have hoped that all the headlines would be about stamp duty reform. Instead, news coverage has instead been dominated by the Office for Budget Responsibility’s projections of what further austerity would mean for the public sector. This graph on government consumption as a proportion of GDP sums it up:

1930s

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Happy birthday welfare state

This Friday marks the 65th anniversary of one of the greatest moments in British history. With some justification, it has been called ‘our second Finest Hour’.

But as the welfare state and the National Health Service reach retirement age are both of them being pensioned off by a government intent on austerity and endless rounds of welfare and public sector ‘reform’?

Monday, July 5, 1948 was known as The Appointed Day. It marked not just the start of the NHS but also full implementation of the Beveridge plan for social security. A comprehensive system of national insurance now complemented earlier measures including family allowances and industrial injuries compensation.

NHS-Launch-Leaflet

The NHS launch leaflet, July 1948

Personal testimonies of the time range from the touching to the gruesome and the comical to the romantic. One young GP remembered going to see a family where he’d left medicine for a sick child. As he was leaving he heard coughing and asked the mother if she wanted him to go up. ‘I’m sorry, doctor, we can’t afford it,’ she said, explaining that it was another child who was ill. ‘Today, July 5th, it’ll cost you nothing, I was able to tell her,’ he said. ‘And I’ve never forgotten it.’

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