Good housing is a prerequisite for good health. When he was constructing the welfare state, William Beveridge named squalor—which he said resulted from a shortage of good houses—as one of the five giants standing in the way of social progress. There is a growing body of evidence which shows a correlation between poor housing and ill health. Warm, dry, and secure accommodation is associated with better health outcomes and improving housing and living conditions remains high on the public health agenda. So I was fascinated to hear that in Stoke on Trent you can buy a house for £1 .Yes, £1. 

The scheme was set up in 2013 in a run down area of the city around Portland Street with the aim of regenerating a deprived part of the city and helping the economy.

Known as the Clusters of Empty Homes Programme the initiative by Stoke City Council was developed to bring empty homes back into use as a catalyst to improving the social, economic, and environmental wellbeing of the area. By bringing in economically active people into a depressed area the council hoped to change the rhythm of the area; to make it a busy, thriving, growing locality. As well as encouraging movement back into empty housing, and attracting the New Homes Bonus and Council Tax income, the scheme has broader public health aims of creating healthier and safer environments. To quote from a paper to the housing committee: “Health and housing are intrinsically linked; a home which is free from hazards and provides modern amenities will keep residents in good health; whilst the condition of those with poor health will worsen if they live in a property which is in a poor state of repair and lacks basic modern amenities.”

The scheme is obviously not as simple as a £1 downpayment. Applicants need to take a low interest loan of £30K for property renovation, as well as be in paid employment, be a first-time buyer, and be able to demonstrate that they have a good credit rating and savings for renovation. They also have to commit to living in the area for five years. In a paper to the council proposing extension to the scheme, the initial scheme is hailed as a success.

So is this claim justified? It is just that sort of question that the organisation, The Centre for Health and Development(CHAD), of which I am chair, wants to be able to answer.

CHAD is a unique collaboration between Staffordshire County Council, Stoke-on-Trent City Council, and Staffordshire University, and is dedicated to the pursuit of reducing health inequalities and improving the health and wellbeing of the population of Staffordshire and Stoke-on-Trent. Its longer term future depends on responding to the challenge of showing what interventions and approaches might successfully reduce health inequalities in areas such as Portland Street. Not a simple thing to do and not aided by the “rules” of academe.

Community projects take time, their funding streams are precarious, statutory agencies have less and less lee way to support them and innovation is tough in this austere and uncertain political climate.
But there is an unfinished story to be celebrated and a reason why such initiatives must flourish and must be evaluated.

And that reason is not just the overall benefit to the community but to recognise the important role of local community champions who want to make a difference. Take Karen, a community spokesperson in the Portland St area. She puts her energy into the community. As we walk around she tells us about the dumped rubbish—sofas, fridges, carpets, the lot—in the narrow back alleys when she first moved into the area and the awareness campaign she and local residents ran as part of their efforts to upgrade the environment. She seems almost disappointed that our walkabout uncovered only one old fridge rather than the piles that used to exist. Last summer she and others in the area ran an arts programme in the empty dilapidated pub, supported by some of the £1 house owners. Now they need some council support to convert the space on a more permanent basis to create a community centre—then they could bring in child health clinics, older people’s exercise classes, more pottery classes [it is Stoke!] and develop their community programme. She proudly showed us the gardening space, created by getting the council to clear trees on some waste land, and tells of plans to get local children growing vegetables and of raised beds for older people.

In another part of the city we sit round the kitchen table drinking tea with Amelia as her young son and black kitten play together on the floor. She tells us that she has moved into the area because her house was affordable. Middleport pottery is down the road and much of the ongoing local regeneration activity emanates from the support by the Prince’s Regeneration Trust, which is primarily an initiative to keep the pottery alive and create jobs. Amelia is concerned about the lack of local community activities and the social isolation faced by both older people and new mums coming into the area. Whilst the café at the pottery provides a place to meet and the company supports local community events in kind, more could be done to engage the newly built GP surgery in community activity. The population size of the area means it is too small for a permanent GP presence and rooms often lie empty rather than being used for chair based exercise classes for older people or groups for postnatal mums suffering from depression. The authorities are giving what support they can. But it is the women and their colleagues who will are essential to making a difference. Both Amelia and Karen are unofficial community champions—motivated by their own sense of wanting to see things done that will make their own communities better places to live, healthier places to be.

Despite all the problems they face, my visit left me inspired and desperately hoping that despite financial challenges CHAD, and organisations such as My Community Matters who had set up the visits, will be able to continue to contribute to making the case for the support and recognition community champions such as Karen and Amelia need and deserve. Without them and others like them working with statutory agencies, health inequalities will continue to grow. Projects such as those in Stoke which focus on local regeneration and community development demonstrate how individuals can make a difference, but also how important it is that they are supported by the statutory sector.

Sian M Griffiths, Institute of Global Health Innovation, Imperial College London.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.