Pooran Desai OBE MA HonFRIBA and Dr. Jose Siri MPH, PhD


A key message of the COVID-19 crisis in the UK has been the need to “Protect the NHS” from excessive demand. Housing Associations (HAs or Registered Social Landlords, RSLs) can play a critical role in easing future crises—including future pandemcis and the health consequences of climate change—by designing their estates and engaging their tenants in ways which promote health, well-being and environmental sustainability. We urge Housing Associations to act now by harnessing the best science and digital technology.

The problem.

The World Health Organisation (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Yet, too often, our living environments do not promote health. Today, 40% of NHS spending is on disease caused by modifiable risk factors, and thus avoidable[1]; many of these factors result from not planning for health and wellbeing. Indeed, there is a mismatch between our human needs (physical, social, psychological, emotional, cultural and spiritual) and the way we design, manage, and inhabit the spaces where we live, revealing a massive opportunity for improvement.

Factors that affect health include diet, lifestyle, physical activity, social networks, housing and air quality—all of which can be influenced by Housing Associations through design, management and tenant engagement. Good health generally protects against illness, and those at highest risk for poor outcomes, including death, are those with pre-existing conditions. So, good health can increase resilience to health challenges; reducing pressure on the NHS during times of crisis and reducing social and economic impacts on society at all times.

Lesson from Covid19 for Tackling the Climate Crisis

The consequences of underlying poor health are laid bare by the COVID-19 crisis. Yet, while the scale of this threat is in many ways unprecedented, it will not be the last, nor, perhaps, the greatest. The WHO identified climate change as the single biggest risk to health in this century[2]. Climate change will increase pressure on all human systems—economic, social, technological and governance—and increase the likelihood of a wide variety of shocks—not only weather-related events, but even pandemics themselves[3]

In the UK, its impacts will mirror those of Covid-19, causing death among the highest risk, namely the elderly and those in poor health. Similarly, although climate change is a long-term issue with long-term societal effects, it will also produce acute crises that challenge the peak capacity of the NHS and other systems—heat waves already cause spikes in deaths in the UK,[4] and numbers of climate refugees, both home-grown[5] and from abroad[6], will surge in response to climate-related events. Of course, the social and economic impacts of climate change, like those of the current crisis, will be staggering.


Housing Associations are critical. Tenants of housing associations experience a higher incidence of modifiable disease than the population as a whole—including childhood obesity[7] and respiratory illness related to poor air quality[8]. Yet, housing associations are in a position to influence key determinants of health. They can do so by building or re-designing communities to feature health-promoting environments and encourage healthy behaviour, while reducing impacts on the environment. Key features of healthier communities that are good for people and planet include: high walkability; low car dependence; low air pollution; space for socialisation, physical activity, and play; a high mix of local economic activity that promotes local sufficiency; robust social networks; high energy efficiency; easy access to nature; and a healthy food culture based on widespread access to healthy food products.

Modern digital technologies can support design, management and tenant engagement to attain these goals. Key actions and effective monitoring would produce quantifiable health benefits today, while also increasing the resilience of communities to health shocks tomorrow. Communities that adopt such actions – promoting Health + Well-being + Sustainability – will reap major social and economic benefits and thrive from greater long-term stability; while also reducing pressure on the NHS and its precious resources.


We therefore call on HAs to implement health-based design and management solutions in existing and new properties, consulting tenants and other critical stakeholders. In so doing, HAs should engage with the latest digital technology to generate relevant health and environmental data, inform solutions, and catalyse rapid development and deployment. We ask government bodies, including Homes England, to facilitate and support this data-driven, health-based approach.


Pooran Desai has a degree in Physiological and Medical Sciences and has been working in sustainability for thirty years, including in the design, construction and management of healthy, zero carbon communities around the world. He is CEO of digital solutions provider,

Dr José Siri is a microbiologist and public health professional. He has worked to develop and apply systems approaches to urban health, focusing on leveraging science for healthy development, developing simple tools to catalyse better decision-making, and improving understanding of complex challenges. José is currently Senior Science Lead at the Wellcome Trust.

[1] British Medical Association ‘Prevention before cure

[2] World Health Organisation ‘Climate change and human health

[3] World Health Organisation ‘Climate change and infectious disease’

[4] BBC News Heat waves causing spike in deaths

[5] The Guardian UK’s first climate refugees?

[6] UNHCR ‘Climate change and disaster displacement’

[7] NHS Children from poorer backgrounds more affected by rise in obesity

[8] Defra Air Quality and Social Deprivation in the UK