Fran Monticelli: Housing is a healthcare crisis

Over 200 healthcare professionals call on the government to end insecure tenancies

Protecting and promoting population health is achieved by reducing health inequalities. Addressing homelessness should be at the forefront of the public health agenda because these inequalities are exacerbated for homeless people. [1] As a public health student I worry about the public health impacts of Section 21, a legislation from the 1988 Housing Act, which allows landlords to carry out no-fault evictions. This leads to renters having insecure tenancies, and this has a knock on effect on their personal sense of security and wellbeing.

In the past five years, homelessness, of which evictions are a leading cause, has risen by 168%. [2] There are numerous causes—austerity related cuts to services, the current housing market, or simply ineffective housing policies. Whatever the reason, campaigning to help tackle homelessness feels more relevant than ever.

The mortality rate for homeless people is alarming. On average, homeless men, have a life expectancy of 47, whereas homeless women tend to live to 43; roughly 30 years less than the average population. This, coupled with the excessively high percentage rise in homelessness shows the gravity of the situation.

It is clear that living with the stress of potential no-fault evictions will inevitably have a negative impact on renters’ physical and mental health. Imagine being afraid to lodge a complaint about the damp and mouldy house you live in for fear of being kicked out by your landlord. It is often, and inevitably, the most marginalised in society who feel the impact of insecure housing the greatest as it is compounded by precarious wages and diminishing social security support. In 2016, 20% of homes failed to meet the Decent Homes Standard and it is estimated that leaving people in the poorest housing conditions costs our NHS £1.4 billion a year for the first year alone. [3, 4].

The link between no-fault evictions and homelessness is a public health concern. Those who are homeless have higher rates of chronic health conditions that coexist with other disorders and these individuals are sometimes unable to access care when needed most, due to both structural and personal barriers. Homeless people in rural areas often lack of transport  which means they have limited access to health services. These barriers to treatment can aggravate chronic conditions which then affect re-housing status and income stability. [5]

Last week, Medact London, delivered an open letter signed by over 200 healthcare professionals to James Brokenshire, Secretary of State for Housing, calling for the abolition of Section 21 of the Housing Act 1988. Together with our friends at Generation Rent, we are campaigning to protect the rights of renters to enable more people to have access to good quality, secure housing. We demand more policies that protect renters and have renters in mind. A petition on this issue from Generation Rent was signed by more than 50 000 people. Together we’re prescribing James Brokenshire a solution for safer, more secure housing for renters, to help prevent homelessness and to improve health outcomes. If you are a health professional who is interested in campaigning on health inequality, you can get involved with your local Medact group.

Fran Monticelli is a Public Health student at King’s College London. She is a member of the Medact London group, part of the global health charity Medact.


[1] Amanda Stafford and Lisa Wood Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants, Int J Environ Res Public Health. 2017 Dec; 14(12): 1535.

[2] Housing Justice, Rough sleeper count shows street sleeping continues to rise, Niamh Costello

[3] Nicol S, Roys M, and Garrett H, (2015), The cost of poor housing to the NHS, Briefing paper, Watford: BRE Trust, available at

[4] Roys M, Nicol S, Garrett H, and Margoles, S, (2016), The full cost of poor housing, BRE Report FB 81, Bracknell: IHS BRE Press

[5] Fransham, M. and Dorling, D. (2018) Homelessness and public health, The British Medical Journal, January 30th, BMJ 2018;360:k214 doi: 10.1136/bmj.k214