Participating in Housing for Health

By June 12, 2019 No Comments

I’ve been asked to reflect on my first experience participating in a Housing for Health project for the Healthabitat blog. After more than 220 projects across Australia and internationally, the potential for novel insights into Housing for Health is somewhat narrow, especially from a first-timer. This is a tried and tested survey and fix methodology, refined across three decades, and shown by NSW Health (2010) to reduce hospital separations. Very few housing or public health programs could evidence such a claim about proven impact, reputation, and longevity. Indeed, in the Remote Housing Review (2017), published in advance of the conclusion of the National Partnership Agreement for Remote Indigenous Housing (NPARIH) in June 2018, the authors acknowledge the significance of repairs and maintenance work to government-owned Indigenous housing provision and the Housing for Health approach specifically: “the first priority for governments has to be to protect their investments and increase the longevity of houses by maintaining the housing already delivered. The key is an increased emphasis on planned cyclic maintenance, with a focus on health-related hardware and houses functioning.” In this moment, the challenge remains how to incorporate this proven methodology into state and territory housing departments beyond NSW Health.

The fact that the Housing for Health methodology has been well documented over a long time reduced the likelihood of any major surprises or upset expectations. Despite the complex logistics of coordinating multiple teams to survey over 100 houses, while employing and catering for about 25 staff, the work was rolled out incredibly smoothly. In this instance my perspective only captured stage 4 – Survey-Fix One – which follows the prior stages setting up the project – project planning; community negotiation; and feasibility report and budget preparation – and precedes the more extensive fix-work and capital upgrades, Survey-Fix Two, and reporting back to the community. Survey-Fix One is perhaps the “main event”, where team members including community residents and environmental health officers donned our yellow hats and surveyed the health hardware of houses included in the project, fixing items as we went. A dynamic approach was required, with word-of-mouth determining our crisscrossed path through town depending on who was at work or at home. The participation of community members is not simply ideal but fundamentally necessary to the success of the project: as educators to those of us from elsewhere, as familiar faces to and translators for other residents, for their technical skills for fixing health hardware, and for their knowledge about where we should head to next.

Healthabitat’s data set and its image archive provide broadly accurate representations of the condition of the houses in this project. As in all communities, houses were highly variable, with some passing almost all the over 250 items assessed within the checklists and others requiring more significant attention. Working through our sheets, we tested and identified blackened or sparking powerpoints, replaced light bulbs and marked failed light fixtures for the electrician to attend to both in the subsequent days. We checked drainage, hot water systems, taps and faucets, cisterns, laundry tubs, and all those other items which determine residents’ abilities to enact critical healthy living practices such as washing people, washing clothes and bedding, and removing wastewater safely. We variously identified instances of mould, rust, leaks, and rot, as well as absent insulation, broken stoves, missing smoke detectors, and exposed wires. Instances of bathroom PVC piping draining straight under houses or hot water system relief values cut dangerously high were not uncommon – anecdotal instances resembling Healthabitat’s findings for the key reasons for health hardware dysfunction: poor initial construction and a lack of routine maintenance. As Stephen Graham and Nigel Thrift (2007) write, “Architectures are morphogenetic figures forged in time, tacking against a general entropic tendency.” Over time, things wear out, break, fall apart. Without careful mediation, this process accelerates.

The Housing for Health Incubator, partnered with Healthabitat, is exploring the barriers to seeing the Housing for Health methodology incorporated into state and territory approaches to the management of public housing stock, replacing housing repair programs that are not evidenced for improving health outcomes, less extensive, and applied inconsistently or reactively. Although the positive health and infrastructural impacts of planned, recurrent R&M have been clearly demonstrated, government housing programs often prioritise new builds and major refurbishments. Tess Lea and I call this the “assembly fetish”, a perspective that reduces housing crises to the problems of new builds and land release, and in which attention to codes and standards is inconsistent – it is at the planning, promising, and pre-handover stages that construction is scrutinised, while from the post-occupancy stage householders become the objects of surveillance and superintendence. Maintaining a house that allows residents to enact healthy living practices is not an easy feat, contending with environmental, political, and institutional factors that coalesce to pull housing assemblages apart. For me, participating in a Housing for Health project demonstrated directly the ongoing fixwork required to maintain functional health hardware, the need to arrest major failures before they occur, and that the HFH methodology deserves further promotion for wider take-up. – Liam Grealy

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