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The Englishman's castle
PUBLIC
HEALTH
The Journal of the Society of Medical Officers of Health Vol. LXXVII
January 1963
No. 2
THE ENGLISHMAN'S CASTLE WmcI~ aspect of public health work has shown least advance during the past twenty-five years ? We strongly suspect that if this question were to be put to medical officers of health who were in office in the nineteen-thirties a substantial majority would answer "housing". 1937 was, indeed, a year of hope. Though the Housing Act of i 936 was a consolidating measure, containing nothing really new, recently acquired novel powers, including the concept of redevelopment areas and the first formal definition of overcrowding, with powers to abate it, had been added to clearance procedures and measures for dealing with individual unfit houses, and the assault on slum conditions had received considerable impetus. Health Departments, without any prodding from the central government, were thinking ahead and planning their anti-slum programmes for the next ten or twenty years. Yet now, a quarter of a century later, there are medical officers of health who are more or less resigned to tolerating for another five or ten years the continued existence of some of the very houses which figured in not-too-remote phases of their pre-war clearance plans. Hitler and Goering are by no means free from blame. True, the Luftwaffe cleared more than a few slums--in the phrase of the time, Jerry knocking down what Jerry builtwbut a fair number of houses destroyed by enemy activity were good, sound ones. Perhaps more important was the suspension of normal building programmes and the suspension also of normal building maintenance work on houses which, though not yet decrepit, were certainly middle-aged. Furthermore, the war created a shortage of material and human resources which inevitably lasted for some years after the arrival of peace. In spite of the difficulties of the situation, a promising start was made on house-building and health departments, accepting the fact that any house was better than no house, declared a virtual moratorium on slum clearance until the over-all situation improved. At this point, however, M a m m o n moved in. The shortage had created a seller's market and a hovel could now be sold for what had been the price of a sound house pre-war. (Paradoxically, mansions were a drug on the market and sold cheaply, but they could make no serious contribution to solving the problem.) Political pressures were brought to bear to shift the burden of new housing provision from the non-profit-making local authori65
66
PUBLIC
HEALTH
VOL.
LXXVII
NO.
2
ties to private enterprise and to end rent controls. For the latter there was some justification. There were small landlords living in poverty while newly wealthy tenants paid derisory rents which were quite inadequate to keep the houses in decent repair. There were, however, poor tenants living in houses owned by affluent trusts and individual landlords, and whatever the "free market" in housing may have achieved one of its effects has certainly been to make a substantial section of the under-privileged pay rents higher than they can afford, live in dwellings inadequate for their needs, or, not infrequently, both. "Houses in multiple occupation", as the new legislation calls them, have become a new bane to the health departments. Get-rich-quick landlords have bought up large, elderly properties, installed a minimum of junk furniture and let at inflated rents accommodation not much better than that of the old common lodging houses. Old houses have been carved into minuscule "flats", let furnished at quite extravagant figures. Basements, attics and boxrooms have been pressed into service as bedrooms and the owners have laughed at the planning authorities, knowing that the enforcement of either planning or overcrowding legislation would result in families being dispossessed and that blind eyes would of necessity be turned in their direction. The situation has certainly not been improved by the fact that some useful by-law powers have been either taken away or put into cold storage for the time being. The advent of new legislation to deal with "multiple occupation" was eagerly awaited, but when it arrived the occasion turned out to be hardly one for loud and prolonged cheers. In the sense that limited powers are better than none at all it was an advance, but there was a strong official suggestion that it was intended only to act to remove the more squalid blots on the housing picture and we do not consider it unfair to suggest that up to the moment the local authorities have been enjoined rather to survey the situation than to do anything much about it. The Minister of Housing has promised the biggest slum clearance drive ever undertaken. Certainly the need is for a "biggest ever" operation, but we find the official promises and proposals still unsatisfying. The clearance rate is to be "doubled or trebled" in "some of the areas where the slum blight lies heaviest". This kind of phraseology can mean much or little and experience suggests that it is precisely the kind of wording which politicians use when they wish to imply that little is much. It would delight us to find that we have misjudged the Minister, but when one comes to look at actual figures the prospect is hardly encouraging. The Minister talked of 500,000 as the number of slum houses still standing; the public health inspectors' organization estimates it as more like 750,000 and there are those who regard the latter figure as still too low. Since there is no national standard of obsolescence an absolute figure is hard to come by, but we do not expect that the local authorities in making their estimates have been over-idealistic. If it is assumed, optimistically, that "doubling or trebling" in "some of the areas" may result in an overall doubling of the national rate of clearance, then
EDITORIAL
67
the present annual number of 60,000 houses closed or demolished will rise to 120,000 and existing slums might be cleared in about seven years. But the country is now reaching a point at which a great deal of housing in working class areas which were developed in the latter part of the nineteenth century is coming up to its hundredth birthday. The Ministry of Housing estimates the average life of a house at 100 years. This may be a fair guess for the more soundly built properties but it is undoubtedly an over-estimate for many of those which were run up in the expanding towns in the eighteen-sixties and -seventies. Even if the figure were accurate, it would mean that some 150,000 houses were reaching slum standard every year, so that by the time the present 750,000 have been cleared a further million will be ripe for clearance. "Trying to fill a bath with the plug-hole open" is the trite but inevitable metaphor! And, speaking of baths, the country has still four million houses without them, to say nothing of a million without inside sanitation; is official policy thinking of houses in which people can really live or merely of houses in which they can exist ? In his article in this issue, Dr. McGregor takes an admirable and timely look at housing as a current public health problem. As he points out, the relationship between housing and health is hard to define. One can rarely demonstrate that a particular death is due to bad housing or even that a particular illness is caused by it. Yet it may exacerbate illness or make the life of an ill person more of a burden than it need be. It may intensify the evil effects of a complex of stress factors, and in saying this we are mindful that the emotional stresses consequent on bad housing are not to be ignored in a time when the importance of mental ill-health and its prevention are being at long last recognized. From the beginning, British housing legislation has been, inevitably, sensitive to the interests of the property owners and the rights and privileges which have been by degrees granted to tenants have been limited and not easy to exercise. (We would instance the brevity of security of tenure granted to those who complain to rent tribunals and the procedure which must be followed to obtain certificates of disrepair as two recent examples.) The battle between the profit-making builder, whether building houses for sale or contracting to build for local authorities, and the direct labour building organisations of local authorities is still being bitterly fought at both local and national levels. Even the Minister's present modest proposals will need the development of a new approach, both in administration and in construction techniques, to the provision of new houses. We are not at the moment arguing the merits of private enterprise versus public enterprise, for all the nation's resources of every kind are going to be needed to do the job. But we do insist that, whatever methods may be used to achieve it, the provision of decent housing to give the average man and woman living standards of twentieth century quality is a question of urgent public service to the public health, no less important than the building of new establishments for the practice of curative medicine or the reorganisation of medical care services.
HEALTH
The Journal of the Society of Medical Officers of Health Vol. LXXVII
January 1963
No. 2
THE ENGLISHMAN'S CASTLE WmcI~ aspect of public health work has shown least advance during the past twenty-five years ? We strongly suspect that if this question were to be put to medical officers of health who were in office in the nineteen-thirties a substantial majority would answer "housing". 1937 was, indeed, a year of hope. Though the Housing Act of i 936 was a consolidating measure, containing nothing really new, recently acquired novel powers, including the concept of redevelopment areas and the first formal definition of overcrowding, with powers to abate it, had been added to clearance procedures and measures for dealing with individual unfit houses, and the assault on slum conditions had received considerable impetus. Health Departments, without any prodding from the central government, were thinking ahead and planning their anti-slum programmes for the next ten or twenty years. Yet now, a quarter of a century later, there are medical officers of health who are more or less resigned to tolerating for another five or ten years the continued existence of some of the very houses which figured in not-too-remote phases of their pre-war clearance plans. Hitler and Goering are by no means free from blame. True, the Luftwaffe cleared more than a few slums--in the phrase of the time, Jerry knocking down what Jerry builtwbut a fair number of houses destroyed by enemy activity were good, sound ones. Perhaps more important was the suspension of normal building programmes and the suspension also of normal building maintenance work on houses which, though not yet decrepit, were certainly middle-aged. Furthermore, the war created a shortage of material and human resources which inevitably lasted for some years after the arrival of peace. In spite of the difficulties of the situation, a promising start was made on house-building and health departments, accepting the fact that any house was better than no house, declared a virtual moratorium on slum clearance until the over-all situation improved. At this point, however, M a m m o n moved in. The shortage had created a seller's market and a hovel could now be sold for what had been the price of a sound house pre-war. (Paradoxically, mansions were a drug on the market and sold cheaply, but they could make no serious contribution to solving the problem.) Political pressures were brought to bear to shift the burden of new housing provision from the non-profit-making local authori65
66
PUBLIC
HEALTH
VOL.
LXXVII
NO.
2
ties to private enterprise and to end rent controls. For the latter there was some justification. There were small landlords living in poverty while newly wealthy tenants paid derisory rents which were quite inadequate to keep the houses in decent repair. There were, however, poor tenants living in houses owned by affluent trusts and individual landlords, and whatever the "free market" in housing may have achieved one of its effects has certainly been to make a substantial section of the under-privileged pay rents higher than they can afford, live in dwellings inadequate for their needs, or, not infrequently, both. "Houses in multiple occupation", as the new legislation calls them, have become a new bane to the health departments. Get-rich-quick landlords have bought up large, elderly properties, installed a minimum of junk furniture and let at inflated rents accommodation not much better than that of the old common lodging houses. Old houses have been carved into minuscule "flats", let furnished at quite extravagant figures. Basements, attics and boxrooms have been pressed into service as bedrooms and the owners have laughed at the planning authorities, knowing that the enforcement of either planning or overcrowding legislation would result in families being dispossessed and that blind eyes would of necessity be turned in their direction. The situation has certainly not been improved by the fact that some useful by-law powers have been either taken away or put into cold storage for the time being. The advent of new legislation to deal with "multiple occupation" was eagerly awaited, but when it arrived the occasion turned out to be hardly one for loud and prolonged cheers. In the sense that limited powers are better than none at all it was an advance, but there was a strong official suggestion that it was intended only to act to remove the more squalid blots on the housing picture and we do not consider it unfair to suggest that up to the moment the local authorities have been enjoined rather to survey the situation than to do anything much about it. The Minister of Housing has promised the biggest slum clearance drive ever undertaken. Certainly the need is for a "biggest ever" operation, but we find the official promises and proposals still unsatisfying. The clearance rate is to be "doubled or trebled" in "some of the areas where the slum blight lies heaviest". This kind of phraseology can mean much or little and experience suggests that it is precisely the kind of wording which politicians use when they wish to imply that little is much. It would delight us to find that we have misjudged the Minister, but when one comes to look at actual figures the prospect is hardly encouraging. The Minister talked of 500,000 as the number of slum houses still standing; the public health inspectors' organization estimates it as more like 750,000 and there are those who regard the latter figure as still too low. Since there is no national standard of obsolescence an absolute figure is hard to come by, but we do not expect that the local authorities in making their estimates have been over-idealistic. If it is assumed, optimistically, that "doubling or trebling" in "some of the areas" may result in an overall doubling of the national rate of clearance, then
EDITORIAL
67
the present annual number of 60,000 houses closed or demolished will rise to 120,000 and existing slums might be cleared in about seven years. But the country is now reaching a point at which a great deal of housing in working class areas which were developed in the latter part of the nineteenth century is coming up to its hundredth birthday. The Ministry of Housing estimates the average life of a house at 100 years. This may be a fair guess for the more soundly built properties but it is undoubtedly an over-estimate for many of those which were run up in the expanding towns in the eighteen-sixties and -seventies. Even if the figure were accurate, it would mean that some 150,000 houses were reaching slum standard every year, so that by the time the present 750,000 have been cleared a further million will be ripe for clearance. "Trying to fill a bath with the plug-hole open" is the trite but inevitable metaphor! And, speaking of baths, the country has still four million houses without them, to say nothing of a million without inside sanitation; is official policy thinking of houses in which people can really live or merely of houses in which they can exist ? In his article in this issue, Dr. McGregor takes an admirable and timely look at housing as a current public health problem. As he points out, the relationship between housing and health is hard to define. One can rarely demonstrate that a particular death is due to bad housing or even that a particular illness is caused by it. Yet it may exacerbate illness or make the life of an ill person more of a burden than it need be. It may intensify the evil effects of a complex of stress factors, and in saying this we are mindful that the emotional stresses consequent on bad housing are not to be ignored in a time when the importance of mental ill-health and its prevention are being at long last recognized. From the beginning, British housing legislation has been, inevitably, sensitive to the interests of the property owners and the rights and privileges which have been by degrees granted to tenants have been limited and not easy to exercise. (We would instance the brevity of security of tenure granted to those who complain to rent tribunals and the procedure which must be followed to obtain certificates of disrepair as two recent examples.) The battle between the profit-making builder, whether building houses for sale or contracting to build for local authorities, and the direct labour building organisations of local authorities is still being bitterly fought at both local and national levels. Even the Minister's present modest proposals will need the development of a new approach, both in administration and in construction techniques, to the provision of new houses. We are not at the moment arguing the merits of private enterprise versus public enterprise, for all the nation's resources of every kind are going to be needed to do the job. But we do insist that, whatever methods may be used to achieve it, the provision of decent housing to give the average man and woman living standards of twentieth century quality is a question of urgent public service to the public health, no less important than the building of new establishments for the practice of curative medicine or the reorganisation of medical care services.