Rationale and impact
- Prioritising indoor air quality in local strategy or plans
- Referrals for a housing assessment
- Raising awareness of poor indoor air quality in the home
- Advice and information for the general population
- Healthcare professionals
- Regulators and building control teams
- Architects and designers
- Builders, contractors and developers
- Rental properties
These sections briefly explain why the committee made the recommendations and how they might affect practice. They link to details of the evidence and a full description of the committee's discussion.
Poor indoor air quality is a risk to everyone's health. But evidence showed that some groups are more at risk than others (see box 1).
For example, people living in poor-quality housing – including housing with damp or with inadequate heating due to fuel poverty or housing that may need remedial work – are at increased risk. They may not have the resources to carry out the necessary work or may have to wait a while for landlords or property managers to carry it out. This could leave them exposed to pollutants for longer.
Good evidence showed that homes with damp and those in need of repair are both linked to an increased risk of health problems. (Homes with serious damp and mould are likely to be classified as having a category 1 hazard by the Ministry of Housing, Communities and Local Government's housing health and safety rating system.)
There was no evidence on the effect of poor indoor air quality on older people. But the committee agreed, based on their experience, that older people may spend longer than average at home and so may be at increased risk of exposure. People with existing health problems such as asthma or chronic obstructive pulmonary disease (COPD) are also more likely to be affected by poor indoor air quality.
Pregnant women, those who have recently given birth, and pre‑school children are also at increased risk from damp and other indoor pollutants. This is partly because pregnant women and those who have recently given birth may have compromised immune systems, and pre‑school children are likely to spend more time at home.
The committee agreed that location is a risk factor because if the property is near a busy road, for example, then opening windows to improve ventilation may be counterproductive. It is also important to consider other pollutant sources associated with building location, such as nearby open fires, bonfire and firework events, agricultural sources, industrial sources or railway lines, as outlined in the government clean air strategy 2019.
Evidence also showed that overcrowding increases moisture in the air from everyday activities such as cooking and washing. This creates damp conditions. In addition, in properties where rooms are used for both living and sleeping (for example, in bedsits or studio flats), poor indoor air quality can have a greater impact. That is because residents are exposed to it for a greater proportion of time and smaller dwellings have less space in which to dilute pollutants. Local authorities should assess crowding and space using the housing health and safety rating system of the Housing Act 2004.
Heating and ventilation can help to maintain good air quality. The committee agreed to stress that the balance has to be right, and remedial or maintenance works for any property should be assessed individually. For example, insulating the home to prevent cold without thinking of ventilation might lead to increased humidity and condensation, which in turn results in damp. But the committee concluded that because buildings vary so much (for example, in terms of age, type, location and state of repair), it wouldn't be practical to make any specific recommendations in this area.
There was evidence on the benefits of home visits by healthcare professionals to prevent or reduce indoor air pollution. The committee were also aware of examples of shared decision making on health and funding in England.
There was a lack of evidence on the benefits of joint working and local inspection protocols to prevent or reduce indoor air pollution. But the committee agreed to recommend these actions because:
Staff who visit vulnerable people in their homes are ideally placed to report on poor housing conditions, particularly if there are inspection protocols in place.
Sharing this information, subject to local data-sharing arrangements, would speed up the process of assessment and remedying the poor housing conditions.
Based on their knowledge of current practice in England, the committee agreed that local authorities would benefit from working with local home improvement agencies who provide home improvement grants to vulnerable groups. The committee also considered the benefits of working with professional organisations such as the Chartered Institution of Building Services Engineers, the Chartered Institute of Environmental Health, the Royal Institute of British Architects, the Chartered Institute of Architectural Technologists and the Royal Town Planning Institute. These organisations would be able to provide practical information to support home improvements, which may include information on grants available. Not only would it free up resources, but it would also allow them to work with local partners to emphasise the importance of maintaining good air quality in the home.
Based on their experience, the committee agreed that it would be helpful if local authorities regularly checked existing and new strategies to ensure air quality in the home is being given priority.
This could include monitoring buildings for signs of poor indoor air quality and checking whether data collected during home visits and local inspections identify vulnerable people and other neighbouring or similar types of properties that may be at risk.
Local authorities regularly update their strategies. But additional resources (in terms of staff time and meetings) may be needed to include indoor air quality in an existing strategy and ensure it is implemented.
Because making indoor air quality a public health priority will improve people's health, this will lead to resource savings elsewhere. For example, by reducing the need for enforcement teams to intervene. There may also be additional economic benefits to the local economy and wider social benefits including improved educational outcomes and contributing to the achievement of government policies supporting policies such as Best Start in Life.
Local health and wellbeing boards are already in place to review current and future health and social care needs. So the costs of staff time and meetings associated with multi-agency working are expected to be minimal. Also, increased collaboration with home improvement agencies could mean that local authority resources set aside for issues related to indoor air quality could be reallocated.
Staff who visit people in their homes may need training to identify problems with indoor air quality and give advice on how to prevent or resolve such problems. Incorporating this training into existing continuous professional development could help minimise costs. But the visits may take longer if staff give advice and they may also result in additional enforcement activities.
Using building control or enforcement teams to collect and use performance data may have resource implications. For example, staff time, communication, and meetings for cross-team working. But improved health outcomes and resource savings elsewhere in the system (for example, by reducing the need for enforcement teams to intervene) might offset costs. The committee also considered the impact of not taking action. This may increase the risk of any future litigation arising from 'unhealthy' homes.
There were limited data on the link between someone who was at high risk and their level of exposure, so the committee had to estimate this.
Some benefits that were identified could not be quantified. So the overall benefits are likely to have been underestimated. The committee concluded that interventions could offer good value for money, but that this will depend on local factors.
Tenants in housing association housing can follow their complaints procedure and can contact the Housing Ombudsman or Environmental Health.
Tenants in private rented properties can contact Environmental Health or take action themselves.
Private homeowners can also contact the local authority for advice if they are worried about the condition of their home. In the committee's experience, many people – including professionals working in housing services – don't know about these processes.
The committee also agreed that health and social care staff who visit people in their homes, and healthcare professionals who have concerns, need to be able to help people request a housing assessment. This is especially important for people who may be particularly vulnerable to ill health as a result of exposure to poor indoor air quality due to their housing conditions (see box 1). There was no evidence on how effective this would be. But the committee agreed it would ensure staff can make every contact count and could improve people's health.
Based on their experience, the committee agreed that there might be barriers preventing tenants from requesting a housing assessment. For example, they might be concerned about eviction, or about a possible increase in rent due to maintenance and repairs of heating and ventilation systems.
Housing assessment pathways already cover some of the causes of poor indoor air quality. For example, professionals such as heating engineers are given instructions on how to identify signs of poor ventilation (see NICE's guideline on winter deaths and illness and cold homes).
Minimal additional resources would be needed to extend this to health and social care professionals and public service staff (for example, fire and rescue service professionals, ambulance service staff) who visit people in their homes. Healthcare professionals may need training on how poor air quality affects health, how to identify poor indoor air quality and how to take steps to mitigate its effects. This could be incorporated within existing training pathways, including professional training and accreditation examinations.
If more professionals are made aware of how to make referrals, this could lead to more housing assessments and more remedial work or legal actions. But local authorities have budgets for regular maintenance and upkeep of their properties. In addition, if legal action is taken to enforce standards in private properties, these costs will be recovered if the action is successful.
Good evidence showed that exposure to poor indoor air quality is linked to a range of health problems. This includes respiratory conditions such as a cough, wheezing or asthma, and allergic symptoms such as a runny nose or eye irritation. Certain groups are more vulnerable, either because of their personal circumstances or because of where they live. Because poor indoor air quality is a hidden health threat, raising awareness is a first step in reducing the risk of long-term health issues, especially for vulnerable groups.
In the committee's experience, professionals such as care workers and health visitors, and the public, are generally unaware of the factors affecting indoor air quality. The same applies to private and social landlords, and those who regulate them.
Similarly, the committee agreed that not all professionals who see people in their home know who is likely to be most vulnerable to poor indoor air quality. And they will not necessarily know how to get help for those who cannot afford repairs or modifications.
Evidence showed that advice given on sources of poor indoor air quality could reduce people's risk of exposure. This includes general advice on using ventilation systems, barriers to heating and ventilation, and more specific advice about particular situations and activities, including how to get a housing assessment.
The committee noted that people on a low income, particularly in poorly insulated homes, may not be able to afford effective heating and may try to make their homes airtight to keep heat in. This, in turn, can mean the ventilation is less effective. They also may not be able to afford to heat all rooms to a constant temperature, or may only use heating occasionally (for example, when expecting a home visit). Both approaches can cause damp and condensation.
The committee were also aware of the increased risk for those who cannot afford remedial work or have to rely on landlords or property managers to do the work. In both cases, this could leave them exposed to pollutants while they wait for it to be done. The committee pointed out that there are enforcement powers that local authorities can use to ensure compliance with regulations. (See the recommendation on using existing building regulation enforcement activities in the section on regulators and building control teams and also the Ministry of Housing, Communities and Local Government's Housing health and safety rating system operating guidance.)
Most of the evidence focused on homes where a problem had already been identified. The committee agreed that research is needed on how to give people information on identifying the sources of the problem in the first place. Also, the committee considered that further research on the health impact of pollutants, alone or in combination with each other, would help identify the pollutant or combination of pollutants that have the largest impact on people's health. This research would also provide useful information to help raise awareness around indoor air pollutants. (See the research recommendations on the health impact of air pollutants at home, effective interventions to improve indoor air quality in the healthy population, air exchange rate and good air quality, health impact of building materials, and effective strategies for raising awareness.)
The government clean air strategy 2019 already outlines how the government and local authorities need to raise awareness of poor indoor air quality. These recommendations support the strategy and should have minimal additional impact.
Resident satisfaction from improved health outcomes should result in resource savings elsewhere in the system and will offset costs. For social landlords, improved tenant satisfaction reduces both the time properties are left vacant and the likelihood of compensation claims.
It is not expected that any extra resources would be needed. Staff may need training on raising awareness of poor indoor air quality and in giving advice in a language the tenant understands. But incorporating this into existing general training and continuous professional development could minimise costs. Improved health outcomes leading to potentially fewer hospital visits, GP visits, or visits from community nurses should result in resource savings elsewhere in the system and will offset costs.
The committee looked at evidence for specific interventions such as air filtering systems or air purifiers. But they agreed that buildings vary so much that it wouldn't be practical to make any specific recommendations in this area.
Evidence showed that giving people advice on specific pollutants and their sources can help them reduce the pollution levels in their homes and improve their health. Evidence also showed that giving people advice on how to reduce or prevent indoor air pollution is cost effective for people who are already ill, because it can prevent their condition worsening. So this can lead to savings for the NHS.
The committee agreed that local authority staff are in a good position to give this advice because they are in contact with members of the public who use their services, including social housing. (They also have a regulatory responsibility for privately rented properties.)
There is clear evidence of a link between gas cookers and increased levels of nitrogen dioxide, and between open solid-fuel fires and increased levels of particulate matter. Exposure to these is linked to poor health, especially if there isn't sufficient ventilation to prevent the build‑up of pollutants.
Based on their experience, the committee agreed that rooms should be well ventilated when cooking to prevent moisture and condensation. The committee also agreed that gas cookers should not be used for heating rooms because this can result in the build‑up of moisture and indoor air pollutants (for example, nitrogen dioxides).
Although there was no evidence on candles, the committee, based on their experience, extrapolated from the evidence on particulate matter from other combustion sources and from the Chief Medical Officer annual report 2017: health impacts of all pollution. This stated that candles were one of a number of large combustion sources of pollutants alongside heating, cooking and open solid fuel fires. The committee therefore agreed that candles should not be used unless the room is well ventilated.
There was insufficient evidence on the health effects of indoor air pollutants in the home. The committee agreed that research on the relative health impact of individual pollutants alone or combined with each other, would help give people better information to understand and avoid harms associated with indoor air pollution (see the research recommendation on the health impact of air pollutants at home).
Evidence showed that poor housing in need of repair (for example, houses with damp) puts people's health at risk. Again, the committee agreed it was important to emphasise the significance of ventilation not only when washing or cooking, but also during other moisture-producing activities, for example, air-drying clothes indoors. The committee agreed that it is important for the local authority to take action if landlords do not carry out repairs or improve ventilation.
Evidence shows that paraffin heaters are linked with respiratory symptoms such as wheezing. These appliances are not in widespread use in England. But the committee agreed, based on their experience, that it was important to avoid using them at all indoors. They also agreed that paraffin heaters are more harmful than open solid-fuel fires, for example, because the latter are flued so that any harmful fumes should, in theory, be extracted outdoors.
Based on their experience, the committee were aware that many people do not know how and when to use ventilation systems. Ensuring a room is adequately ventilated is usually a key part of reducing exposure to volatile organic compounds (VOCs) especially while painting, renovating or decorating and using household products such as cleaning sprays and aerosols. The committee noted that there is a labelling scheme for paints in the UK. Although newer paints have a lower VOC content than older paints, the product advice is still to ensure good ventilation when using these products. The committee also agreed that people should be reminded to read the manufacturer's instructions and increase ventilation during these activities.
The evidence showed that flooring and furniture are often sources of VOCs or formaldehyde. Based on the evidence, the committee agreed it was important to highlight these dangers, because both can damage people's health.
Smoking and environmental tobacco smoke are always a health risk. The committee agreed it was important to encourage people not to smoke in their homes, and so they referred to NICE's guidance on smoking.
The committee agreed that research is needed on ways to improve indoor air quality for people who do not have pre‑existing health conditions that put them at risk from poor indoor air quality (see the research recommendation on effective interventions to improve indoor air quality in the healthy population).
Local authorities will need to develop or update existing practice to provide people with information on how to improve indoor air quality and where to go for help. Staff might need training but incorporating this into existing continuous professional development could help minimise costs.
Improved health outcomes leading to higher resident satisfaction should result in resource savings elsewhere in the system and will offset costs. For example, by reducing the need for enforcement teams to intervene if a problem develops.
Healthcare professionals frequently see people with pre‑existing health conditions and women who are pregnant or have young children. The committee agreed that this puts them in an ideal position to give advice on how indoor air pollutants, as well as damp and mould, can affect their health.
Evidence showed that people with respiratory or cardiovascular conditions or allergies are particularly affected by poor indoor air quality, including pollutants from damp and from open solid-fuel fires.
Good evidence showed that exposure to poor indoor air quality is linked to a range of health problems. These include respiratory symptoms and conditions such as a cough, wheezing or asthma, and allergic symptoms such as a runny nose or eye irritation.
Evidence showed that allergen barriers like mattress and pillow covers can reduce exposure to house dust mite allergens. Evidence also showed that second-hand mattresses were associated with increased levels of house dust mites.
Women who are pregnant or who have given birth in the past 12 months and partners and people who live with them
Good evidence showed that damp homes and those in need of repair are both linked to an increased risk of health problems. (Homes with serious damp and mould are likely to be classified as having a category 1 hazard by the Ministry of Housing, Communities and Local Government's housing health and safety rating system.)
Pregnant women, those who have recently given birth, and young children are at increased risk from damp and other indoor pollutants. This is partly because these groups may have compromised or undeveloped immune systems, and also because young children are likely to spend longer than average at home. So the committee agreed that it was important to make sure they are living in a 'healthy' home that is well ventilated.
Women who are pregnant and babies under 12 months may be particularly vulnerable to pollutants such as VOCs. In addition, evidence suggested that exposure to VOCs during pregnancy was linked with coughing, wheezing and other health issues in the first years of the child's life. VOCs are found in products like aerosol sprays and glue.
Women who are pregnant and babies under 12 months may also be particularly susceptible to the effects of particulate matter – released from, for example, open solid-fuel fires. Based on this evidence, the committee agreed that using proper ventilation to disperse these pollutants is very important – as is reducing use of such appliances when this is feasible.
The committee did not look at evidence on environmental tobacco smoke because any level is considered unsafe. Instead they agreed to adapt recommendations from and cross-refer to NICE's guidance on smoking during pregnancy.
There was a lack of evidence on how indoor air pollutants affect people without pre‑existing health conditions and how to improve air quality in their homes. So the committee made a research recommendation on this group (see the research recommendation on effective interventions to improve indoor air quality in the healthy population).
Most healthcare professionals might need training on how poor indoor air quality affects health and how to mitigate it. Incorporating this training into existing general training and continuous professional development could help minimise costs.
Asking about housing conditions and helping people request a housing assessment may increase consultation times. But this will be offset by future healthcare savings.
There are no national regulations or guidelines to determine 'safe' levels of indoor air pollutants. But based on their experience, the committee agreed that standards such as the World Health Organization or Public Health England guidelines could be used.
Building regulations are generally used to enforce standards in new housing. Other local standards may be used for existing homes, for example, standards on repairs and property condition or room size. Using these regulations will ensure existing and new buildings meet air quality standards.
The committee noted that enforcement and prosecution practice may vary across local authorities. Reasons for this variation include capacity for follow‑up visits and time taken to confirm non-compliance. They agreed to highlight the importance of meeting the government Building Regulations 2010 legislation and housing health and safety rating system operating guidance because this can improve people's health.
Increased use of building control or enforcement teams may have resource implications. For example, staff time for inspection, communication, follow‑up and meetings. But improved health outcomes and resource savings elsewhere in the system (for example, by reducing the need for enforcement teams to intervene) might offset costs.
Using existing international guidelines will minimise the resource impact of developing new standards or updating existing ones.
Evidence showed that some building materials can emit high levels of pollutants. There was no evidence on building materials and products that emit a low level of VOCs and formaldehyde. The committee agreed that specifying low-emission materials could help protect people's health. But because of the lack of evidence, they could only suggest professionals consider their use on a case-by-case basis when drawing up specifications.
The committee also noted that there are no national labelling schemes for building materials or consumer products in England (apart from a scheme for paints). They also noted government plans to set up a voluntary labelling scheme in England, as outlined in the government's clean air strategy 2019.
The committee noted the Department for Education's Building bulletin BB101: ventilation, thermal comfort and indoor air quality 2018 and considered that its recommended performance levels could also be applied to homes.
Evidence showed that open solid-fuel fires emit particulate matter and are a major cause of poor indoor air quality. This evidence was limited, but the committee agreed that designing heating options that avoid them will help protect people's health.
Evidence showed a clear link between cooking with gas and pollutant levels – these are higher in the kitchen when cooking using gas than outdoor pollutant levels unless there is an air quality alert.
Evidence also showed that some causes of poor indoor air quality, such as condensation, are the result of poor thermal performance, high moisture levels combined with poor ventilation. The current focus on draught proofing and energy efficiency can add to the problem.
Because buildings vary so much, the committee were unable to recommend specific types of ventilation or heating strategies. But they agreed it is important that design strategies achieve the correct balance between ventilation, energy efficiency and heating.
Outdoor pollutants entering through windows can contribute substantially to poor indoor air quality. This is particularly the case in deprived areas where housing is likely to be close to busy roads (see the government's clean air strategy 2019). The committee agreed that if opening windows is not safe or lets in more outdoor pollutants (for example, if the window faces a busy road) then other methods of ventilation or methods of preventing pollutant ingress without resorting to opening windows are needed. This includes mechanical systems with filtration to protect against outdoor pollutants including intelligent ventilation systems.
Building or refurbishing homes to improve heating without taking ventilation into consideration can affect the health of people who live in them. So the committee stressed the importance of balancing the need for heating and ventilation, and taking into account all factors affecting indoor air quality.
They noted that the British Standards Institute standards for domestic retrofits and energy efficiency could be a useful source of information for architects and designers.
The committee agreed that more research is needed about the benefits and harms of different air exchange rates, and the health risks associated with pollutants released from building materials over time in lived‑in home environments. This would improve understanding of the minimum ventilation thresholds and appropriate building materials that designers and builders should use. (See the research recommendations on air exchange rate and good air quality and health impact of building materials.)
The recommendations will reinforce current best practice. Architects and building designers should already be aware of the potential risks of the products and materials that they specify.
Balancing ventilation, insulation and heating is already best practice to maintain good air quality so there should be no additional resource impact.
In the UK, materials specified for use by builders, contractors and developers have to comply with existing building regulations and should be used according to the manufacturer's instructions. The same is true for heating and ventilation systems. Based on their collective experience, the committee felt that compliance with regulations and instructions can be variable, so they agreed it was important to highlight them.
There are regulations on pollutant threshold levels but information on the level of emissions from different materials is limited. Few regulations exist to guide the choice of materials according to their effect on indoor air quality.
In the committee's experience, it is common practice for builders to use substitute materials if the specified ones are not available. Members agreed that emission levels need to be taken into account in such cases, whether working on a new building or a refurbishment.
Evidence showed that people's health is affected if best practice and standards are not complied with during home renovations. This is most likely during works that do not require building regulation approval.
In the committee's experience, building regulation enforcement may vary across local authorities. The committee stressed the particular need for enforcing compliance with heating and ventilation regulations, because any imbalance can have a disproportionate effect on indoor air quality.
The committee also highlighted that heating and ventilation systems in the home should be installed by a recognised competent installer, so as to avoid issues of poor-quality installation, in ways that make them easily accessible for regular checks and maintenance.
The recommendations reinforce current best practice and will help local authorities meet their obligations to improve people's health and reduce health inequalities. Ensuring compliance will lead to cost savings in healthcare, because it will reduce the number of homes with poor indoor air quality and, in turn, improve residents' health.
Building regulations and standards already exist for enforcement teams. But building control teams may need to monitor their activities more closely, unless building work is under the control of an approved inspector. This may incur costs for local authorities and homeowners, particularly if issues are identified that need to be fixed. (Only local authorities have the power to enforce standards if things go wrong.)
Training on specifications and compliance will involve costs and time away from work. Incorporating this training into existing continuous professional development could help minimise costs. For small contractors and companies that do not run continuous professional development programmes, the cost will be offset by reducing the risk of future litigation that may arise from building 'unhealthy' homes.
Local authorities have a responsibility for public health, improving wellbeing and reducing inequalities, and a duty of care to ensure public sector homes are maintained to a decent standard. This duty extends to private housing with hazards considered to be a serious and immediate risk to a person's health and safety (category 1 hazards). Homes with serious damp and mould, excess cold or excess heat are likely to be classified as having a category 1 hazard by the Ministry of Housing, Communities and Local Government's housing health and safety rating system. Local authorities can also take action for hazards that are less serious or less urgent (category 2 hazards).
Local authorities have a range of enforcement options (see Ministry of Housing, Communities and Local Government's housing health and safety rating system enforcement guidance: housing conditions). The most commonly used enforcement option is an improvement notice, which requires work to be carried out within a defined time period to remove a category 1 or category 2 hazard. If the works are not carried out, the local authority may prosecute for not complying with the notice, and/or carry out the works itself and charge the owner.
The committee were aware that it is best practice to have heating and ventilation systems that meet performance requirements and are regularly maintained, which should include checking the airflow rates of extractor fans. The committee emphasised that some pollutants (such and damp and mould) and some hazards associated with poor indoor air quality (such as excess cold and excess heat) can only be dealt with if a problem has been identified and by ensuring that appropriate heating and ventilation systems are in place. But they agreed that this does not always happen – and so this needs to be stressed to all landlords as part of local authority advice to the public (see the section on advice and information for the general population) and implemented, if a housing assessment has identified a problem that may contribute to poor indoor air quality.
The committee agreed that best practice also involves repairing any water damage and removing its cause as soon as possible, to prevent mould and damp developing. Local standards may be used for existing homes, for example, landlord legislation or standards on repairs and property conditions or room size.
The committee were also aware of the increased risk for tenants who cannot afford remedial work or have to wait for landlords or property managers to do repairs (including to heating and ventilation systems). This could leave them exposed to pollutants while they wait for the work to be done.
Based on their experience, the committee agreed that if properties are properly equipped and maintained, this will control and reduce sources of indoor air pollution.
But they were concerned that property managers and landlords might not be aware of how mould, damp and other indoor air pollutants affect people's health. So they made a recommendation to advise on this and their general responsibilities to safely maintain their properties.
The evidence showed that flooring and furniture that contain flame retardants are often sources of VOCs or formaldehyde. Based on the evidence, the committee agreed it was important that these dangers were highlighted to property managers and landlords, because both can damage people's health.
The recommendations will reinforce current best practice and the need to use existing regulatory powers to ensure homes are safe (see the government's advice on renting out your property [England and Wales]) and the Ministry of Housing, Communities and Local Government's housing health and safety rating system operating guidance. Because many people on a low income live in rented accommodation, this will help address health inequalities. It will also help improve the health of other vulnerable groups and others who live in rented accommodation.
These recommendations will reinforce current best practice.
Property managers are legally obliged to carry out maintenance checks and the following have to be embedded in tenancy agreements:
checks and maintenance of ventilation systems (including airflow rates of extractor fans)
gas and electricity safety checks.
So, the impact on practice and resources should be minimal, although there may be costs for repair of any problems found during the checks.
Housing has an important effect on health and health inequalities, particularly when properties need repairs. These recommendations will help meet local authorities' obligations to tackle health inequalities.