Jeff Standen, Behnoosh Khalaj, Wayne Smith, Aboriginal Environmental Health Unit, NSW Health
I’d like to tell a story today about Housing for Health. To start with I would like to acknowledge the Wongatha people for the warm welcome to Country and I also want to acknowledge my co workers; Benoosh Khalaj who is a statistician who has done a lot of the analysis for this project and Professor Wayne Smith my supervisor who has provided a lot of the academic guidance, particularly around the methodology for some of the more complicated parts of the project.
Housing for Health is a project we have been running in NSW for 10 years now. It has been part of the Aboriginal Health Strategic Plan since 1999 and it’s all about creating environments that support good health, in particular, creating a home environment that supports good health. We have been running Housing for Health in NSW in partnership with the Department of Aboriginal Affairs. And we have also, at times, received funding from the Commonwealth through their Fixing Houses for Better Health Program, a parallel program which uses the same methodology as Housing for Health, only the funding source and funding amounts differ.
What is Housing for Health?It is a methodology for surveying and fixing the houses which gives priority to safety and health. We buy the methodology ‘off the shelf’ as a tool to do assist us to do our job, much like we would buy Microsoft Office. It is a methodology that we believe, based on the evidence available, is a good approach to improving health in the home and in NSW we have been running the program for over 10 years now. The methodology has been used right across Australia and, more recently, internationally.
The fixing component is an important part of the licence agreement with Housing for Health. It forms an ethical component of the project, and there is a condition that there is “no survey without service”. As a result the survey teams carry took boxes and fix basic things that they can safely fix, and tradespeople are attached to the project as well so that serious electrical and plumbing jobs, which can only be fixed by qualified trades, get fixed immediately.
All the work we do to the houses are strictly prioritised in terms of getting a health benefit and safety as well.
Stages of Housing for HealthThere are five main stages to Housing for Health.
The first stage is Community Consultation and Feasibility. It is very important to be clear about the project at this stage because we don’t fix everything in the houses and care is taken to explain to the people what we are not going to as well as what we are going to do so as not to set up any false expectations. We don’t paint houses, we generally don’t do guttering, and we don’t build fences or carports etc. All the work we do is focussed on getting a maximum health benefit. If the community agree to the project we also do a feasibility study to arrange the logistics of running the project. At this stage we include all the community people.
Once the community agree to it, and the project is considered feasible, we then set aside a week for training and surveying houses. This week is the Survey-Fix 1 (SF1) stage of the project and involves a technical person such as an EHO doing training with the community team members in how to carry out the survey assessments. The team members then go out in groups with a team leader - a technical trained person - and they test about 240 items in each house; every light switch, every power point, every drain, every tap etc. All of these items are very methodically tested, and there is a standard test for each item. If they identify a problem and they can safely fix it, they do. For example if a shower rose needs replacing we have a box of shower roses and tools to replace it. It is a very intrusive process taking around 45 minutes to an hour, but by the time the team has finished there is some tangible benefit to the householder.
The data that the survey teams record goes back to a temporary office we set up somewhere in the community, where it is entered into a database. We then produce almost straight away a list of works for each of the trades; particularly plumbers and electrical trades, who go out and immediately start fixing all the urgent problems. The level of community involvement at this stage and the delivery of an immediate and tangible change to people houses immediately builds respect and relationships with the community. Even though we have promised that the trades will be coming to fix the urgent works identified, there is usually some scepticism and community members are often surprised when the tradies turn up about a half a day later. It’s on the back of that relationship and trust that NSW Health can start to talk about other issues in the houses, and delivering other services as well.
Once we have done the urgent jobs we enter a Capital Upgrade Stage where we do the larger, less urgent jobs, such as replacing hot water systems, installing safety switches, or sometimes we might have to re-wire a whole house. We sometimes find we have to fix bathrooms; we come across quite a lot of leaking showers and if the leaks affect other rooms in the house then that can compound crowding issues.
The fourth stage is Survey-Fix 2 (SF2), where we go back and do exactly the same survey, re-doing the training with the survey teams (many who participated in SF1). By doing exactly the same survey again it gives us the opportunity to evaluate the project; ensures that there are no outstanding items, and also gives the community an opportunity to audit our work. The involvement of the community in the project ensures the community has an understanding of what work has been done.
Then we report back to the community and funding providers and close the project.
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Housing for Health PrioritiesThe Housing for Health priorities are also outlined in the National Indigenous Housing Guide. They are firstly about ensuring safety as top priority. This includes electrical safety, fire, gas and sometimes structural issues. In terms of structural safety, we are limited by the project budget, so for example, if there are white ants throughout a whole house it may be beyond our project but where we can, we deal with those smaller structural issues.
The next priorities are about providing a healthy living environment and many of you are familiar with this work over the last 20 years. They are outlined in the box below. Being able to wash people, particularly children, is the highest healthy living priority, followed by washing clothes and bedding, then removing waste. Improving nutrition through being able to prepare, cook and store food in the house reduces people dependency of having to go down to the store for a meal every day.
There are another five priorities (listed below in blue). These are important and we do address some of these but it really depends on how far the dollars stretch; if we had unlimited dollars we could go through and do everything but we don’t have unlimited dollars. The top four are the critical ones.
Housing for Health priorities:
- Safety First (electrical, fire, gas, structural)
- Providing a Healthy Living Environment
- ability to wash people (especially children)
- ability to wash clothes/bedding
- removing waste
- improving nutrition and food safety
- reducing impact of crowding
- reducing impact of pests, animals & vermin
- controlling dust
- temperature control
- reducing trauma
In NSW, we have now been doing this for 10 years and we have a broad range of projects across the state. We have been doing projects in hot climates and in cold climates. We have done them in remote areas, in urban areas and in between. We have done projects in discrete Aboriginal communities and we have done Indigenous housing in mainstream towns as well. We have done houses in fairly good condition right though to houses that are in very poor shape. We have done work in a diverse range of houses from nearly half the Community Indigenous Housing in NSW.
For more informationJeff Standen
Manager, Aboriginal Environmental Health Unit
GPO Box 798, Gladesville, NSW 1675
Ph: 02 9816 0586 Email: email@example.com