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.