Housing is one of the main determinants of health, but it’s not always straightforward to fix.
Keeping our houses dry, warm and draught-free may not be something that, when the sun is high in the sky and our winter clothing is packed away, many of us are busy thinking about. But for the team at AWHI Healthy Homes, work is already underway to prepare families across South Auckland and Waikato for the cold, wet winter months.
AWHI Healthy Homes helps whānau make their homes – owned and rented – warmer, drier and safer in an effort to address negative health outcomes, like rheumatic fever, that are caused by social inequities like poor housing. Poor housing is a direct expression of racism and colonialism seen through socioeconomic disparity, hence why poor housing and the negative health outcomes linked to it are more common in some areas and for some communities.
Set up in 2013 by the National Hauora Coalition, AWHI was a direct response to high levels of rheumatic fever in Counties Manukau. Damp, mouldy, cold and overcrowded housing has been linked to an increase in transmission of Group A Streptococcus. This bacteria can present as a somewhat innocuous “strep throat”. If left untreated, it increases the likelihood of rheumatic fever which can lead to rheumatic heart disease. Māori children are 46 times more likely to be hospitalised with acute rheumatic fever. Pacific children are 115 times more likely.
Housing is the most important risk factor for rheumatic fever in Aotearoa, and AWHI programme lead Priscilla Laita (Ngāti Kahu, Ngāpuhi, Te Ātiawa) says poor housing is one of the main determinants that directly impact people’s health. “We often don’t understand the impacts of [poor housing] until we’re actually informed or educated on it. The health of a home makes a huge difference, and some of our whānau don’t understand how closely it interrelates.”
In 2019, the government introduced a new set of standards for all rental properties in Aotearoa. These give landlords a clear minimum standard to achieve in areas such as home ventilation, insulation and heating, but there are still many homes, especially in lower socio-economic areas, that are far from meeting these benchmarks.
A 2022 study from the AWHI Healthy Homes initiative stated that “income inequality, which is perpetuated by structural racism and government policy”, has resulted in Māori and Pacific whānau being pushed to live in more deprived areas, and in cold homes, resulting in disproportionate exposure to housing-related illnesses. Draughty doors, missing or broken windows, improper drainage and lack of affordable heating options are all linked to poor health, so providing easy, accessible solutions is an important part of AWHI’s work.
Laita says overcrowding is also an issue – sickness spreads faster when an increased number of people are house-sharing and bed-sharing in order to save money. “We’ve seen more and more overcrowding with the changes to our economy. Lack of rental properties available and access for social housing, that’s really becoming more and more of a challenge for the whānau in our service.” Providing physical resources like beds, curtains and heaters is thus only the tip of a much larger iceberg of mahi the AWHI team carries out.
A huge amount of AWHI’s time and resource also goes into education, giving whānau the knowledge and tools they need to effectively advocate for themselves. “If they have a clear understanding of the system, it helps them to be able to take a strength based approach to get things done on their property on their own,” says Laita.
“Ensuring that they are receiving their full entitlements, their benefit entitlements, that they have an understanding of the Kainga Ora system, our social housing agency, knowing what they can do in the process when they’re needing interventions done” – these are all things the AWHI team helps their whānau with.
Healthy Homes Initiatives like AWHI have already had a big impact. A recent five-year outcomes evaluation showed these initiatives have supported over 200,000 referred whānau members and reduced hospital visits, trips to the GP and days of school missed. Housing related hospitalisations reduced by 18.6% and school absence for illness reduced by 5%. According to the evaluation, the benefits of these initiatives have also exceeded the cost to the government with a five year return on investment of 507%.
When Marion’s* son was in hospital with a severe case of asthma she overheard a nurse talking about AWHI. Marion then got in touch to see if there was support available for her and her family. That support came quickly.
“When we got discharged with my son, my caseworker Zion kept calling me… I was so pleased and thankful for Zion to come and walk around our house. She said that anything that was damaged or needed fixing, she would come and check it out.”
Marion says AWHI also helped her whānau to get better access to the benefits they were entitled to through WiNZ. “We had struggled. We had a lot of payments and loans to pay back… but [our caseworker] was pushing, telling WiNZ our situation, what we really needed,” she says.
“We only had one bed in the room. All of my four kids were using it and sometimes two would sleep with me in the other room… Zion called and found a free bunk bed for us. She also helped us get beds, pillow cases and a couch,” says Marion.
Families across Aotearoa are living in homes that don’t meet Healthy Homes standards. That’s why the AWHI team educates their whānau on cost effective ways to heat their houses, keep dampness out without using dehumidifiers, and stay on top of mould before it becomes a health risk. But they also educate whānau about the health risks themselves. “We provide the basic health literacy to help them understand the impacts of some of their homes that are in poor condition, how that can impact on their tamariki and their whānau health and wellbeing,” says Laita.
AWHI contracts various agencies to provide their frontline services. One of these agencies is Turuki Healthcare, a kaupapa Māori health service provider. Dottie Wilson (Tonga) is a team lead there and understands that many of the solutions – like bedding and heating – can be “band-aids” on a larger problem, so as well as teaching whānau practical skills often overlooked, like how to effectively clean mould, there’s a big emphasis on the “why”.
“To have an understanding of why curtains are important. Why it’s important to clean mould, what mould should mean to a family and how to kill the mould and create a warmer, dry environment for free, rather than rely on dehumidifiers, for example.”
Most of the referrals for AWHI’s services come through A&E and paediatric units at Waikato and Middlemore hospitals – who pick up on the links between sick tamariki and their living conditions. Families can reach out directly and other social service providers like Plunket and Well Child also refer to AWHI.
While the warmer weather is here, the team is working to get word out about their service, in hopes whānau access it before the cold hits. “We did a big waka ama regional event down in Hamilton a few weeks ago and we’ve got a community hauora event coming up as well,” Laita says.
Showing up within communities does a lot to build trust between AWHI and the families they work with, says Wilson. “The trust starts from that [first] moment of engagement. So they may not be in our service, but then they’ve already heard, seen our faces, know our team’s names and what our service provides. We really want to not just get to families when it’s about to get too hard for them. Let’s get them prepared. Let’s ensure they have the resources, the heaters, and the winter clothing for the babies now.”
When Marion’s son was admitted to hospital for a month, she worried about where she could turn for support. “I have no parents or sisters or brothers here, and neither does my husband.” She thinks many families in similar positions could benefit from the support of AWHI. “A lot of Island families don’t know what AWHI means, they don’t know they can help,” says Marion. “AWHI really helped us, especially the kids.”
While the mandate is that AWHI spends 12 weeks supporting each family to get their house to a more liveable standard, the team often supports families beyond that. “At the 12-week mark, they should be well equipped with resources and education… and we have really supportive funders at the National Hauora Coalition that allows us to create the programme that we want, that works for our whānau,” says Wilson. “A lot of families receive support with their health, housing, resources, money, and that’s because of all the work that our team puts in… We have been able to re-house many families and change their environment, from what they were previously living in.”
Housing is a fundamental human need and having warm, safe housing means that whānau can better focus on other parts of their life. Because of the help from AWHI, Marion and her whānau are now living in a healthier home. She thinks many families could benefit from AWHI, and wants people to know that AWHI is there to lean on if things get tough, like they did for her. “I was feeling like ‘I can’t do it’, but Zion was calling me everyday, checking in on me… I knew this was someone that could really help support me and my kids.”
As AWHI sees it, the prevalence of poor housing and associated health problems in particular communities is a direct consequence of systemic racism. These enduring effects of colonialism have created significant socioeconomic disparities and long-term inequities for Māori and Pacific whānau in Aoteaora. More housing and whānau focused solutions are needed to counteract these inequities. Whānau cannot be expected to face or fix them alone.
*First names only used for privacy
