Home thermal efficiency is a key component of housing quality that is increasingly put under pressure by global environmental challenges such as climate change. Thus, it is important to characterise home thermal efficiency at the city-level using epidemiological evidence to develop evidence-based housing policy. The overall aim of my MPhil is to develop a home thermal efficiency metric and estimate its associations with health, at the small-area level in London (i.e., Lower Super Output Area (LSOA)).
No single agreed-upon definition of housing quality exists. In the first part of this thesis, I summarised housing quality literature and tools to identify recurring themes. Using this insight, I developed a housing quality and health framework which is composed of 13 housing domains, meta-characteristics and interacting factors. In the second half of this thesis, I conducted a case study based on one housing quality domain, i.e., thermal comfort, in London. I first developed a mean LSOA home thermal efficiency metric using the Battese-Harter-Fuller model and then estimated the association between this metric and selected health outcomes.
My framework allows cities to comprehensively understand areas of housing quality that are relevant for their populations and also identify appropriate data sources to measure housing quality. The development of the thermal efficiency metric highlighted that mean thermal efficiency score is higher (i.e., better) in LSOAs near central London and generally decreases with distance from the city centre. Overall, there was an increased risk for all hospital admissions, all cardiovascular admissions, and all respiratory admissions with decreasing LSOA home thermal efficiency scores. Similar but weaker associations were observed when adjusting for income instead of smoking.
My thesis highlights the need for robust and accessible housing quality data, as well as the importance of taking health outcomes into consideration when building, renovating and retrofitting homes.