We finished last month’s blog with a book review urging that more be said about some of our great public health pioneers like Dr Christopher Addison. For someone who achieved so much, there is surprisingly little written about him although the Bodleian Library has catalogued his papers and speeches are available via Hansard.
I first came across ‘Addison houses’ when writing the first edition of Environmental Health and Housing (Stewart, 2001) but didn’t then appreciate his significant contribution to state funded council housing. Addison had started his career as a medical doctor but believed he could do more by entering politics to tackling the effects of poverty on health – what we would now refer to as ‘the social determinants of health’. He was then a Liberal (but later joined the Labour Party) and because of his medical background, was involved in the National Insurance Bill in 1911 and then focused on children and welfare. At the outbreak of the first world war he became Parliamentary Secretary to the Ministry of Munitions and there was widespread recognition that workers needed good housing to have security and to be productive workers, in other words, ‘War Socialism’. In practice this meant state subsidy of workers’ housing design to include suitable space standards, kitchen and bathrooms alongside good external layouts based on the principles of the garden cities. There was also a strong emphasis on what workers would be realistically able to afford to pay in rent. What was key was that government accepted that the private sector was unable or unwilling to provide such housing: there was a new recognition that the state had a role to play in house building and management.
Many will know of the Royal Arsenal at Woolwich (maybe more due to football connection than its local housing) and the Well Hall / Progress Estate was built during the first world war to house munitions workers, something that still amazes me. Architect Frank Baines designed the estate which still feels calm and established, and in a strange way relatively new. Its forethought, success and longevity is such that it is now a Conservation Area. See adjacent photo of Arsenal Road.
Toward the end of the war, Addison was charged with developing plans for reconstruction as part of the Homes fit for Heroes campaign. By 1919 he was the first Minister for Health with a portfolio for a range of social policies. The Housing and Planning Act 1919 (the Addison Act) provided the basis for state funded council housing reflecting the standards required by the Tudor Walters Committee. This was a fundamental move forward in tackling poor living conditions and providing new housing and showed incredible foresight. By the early 1920s some 200,000 state funded houses had been built, but far more were needed to replace the slums.
Funding was cut. Addison resigned in 1921. In The Betrayal of the Slums, you can feel his despair that housing would not be prioritised; his disbelief that despite the clear social and economic – not to mention health – arguments favouring the government investing in housing, they chose to spend money elsewhere. His frustration is palpable as he demonstrates in detail the need to fund housing and points out that if we do not, this will be at our peril.
Addison was ahead of his time: he calculated the social and economic cost that arose if government did not intervene in housing. He compared for example the costs of proposed grant to redemption of slums with the costs of treating tuberculosis and how much was meanwhile spent on war service (see illustration). The Betrayal of the Slums provides painstaking detail about how people were having to live for lack of alternative, the effects on their health and quality of life – and what must be done about it.
What is also refreshing and humane about his commentary is the concern not just with numbers, but with the effects of poor housing on its occupants, both adults and children and he highlights those who had served in the war who were still being ‘betrayed’.
Addison tells us: “For years past thinking and patriotic people of all parties have been seriously disquieted by the fact that in England and Wales alone there are nearly a million dwelling places — so-called homes — which consist of not more than two rooms. People are compelled to live in them, because no other habitations are available. In these places, as well as in vast numbers of others which contain more than two rooms, the processes of deterioration are necessarily constant and rapid … Homes of this kind are a perpetual hindrance throughout life to the people who have to live in them. They allow no privacy, afford little or no quiet or rest, even for the child, they give no opportunity for the mind and provide a continual poison for the body. The physical consequences are disastrous to the inhabitants and involve costly burdens on the rest of the community.”
There are streets called Addison, and many of these will be after Christopher Addison, such as our picture shows, with its attractive street layout, variations in housing design and general arts and crafts feel to them, like the garden city ideals.
There continue to be enormous and unnecessary social and economic costs associated with people who continue to live in poor housing. In 2009 the Building Research Establishment (BRE) (Davidson et al, 2010) estimated that the health cost of poor housing in England was over £600 million annually and the total cost to society may exceed £1.5 billion per year. More recently the BRE calculated that the new estimate to the NHS of the cost poor housing was £1.4bn (Nicol, Roys and Garratt, 2015).
In addition to this there are compelling social and economic arguments to build council / social housing, not to mention that it is simply the right thing to do so that people have somewhere decent, secure and affordable to live. The multiple costs will be felt elsewhere if we do not invest in housing, not just for housing benefit to private sector landlords. Municipal Dreams is well worth a read about what council housing has achieved and could achieve again and since its publication, the council borrowing cap has been removed but we are yet to see what what will be delivered.
Despite policy links to housing and health in the past, it is relatively recently that housing and health are again (politically) recognised as fundamentally interrelated once again. We could really do with a modern day version of The Betrayal of the Slums to provide new impetus in the common sense of providing enough state funded and supported housing. I think it would be an excellent subject as the basis for a PhD! Just look at the photos of Addison Close (above and right) to see what can be achieved when there is political will.
Davidson, M., Roys, M., Nicol, S., Ormandy, D. and Ambrose, P. (2010) The real cost of poor housing, Bracknell: IHS BRE Press.
Hatchett, W. (2017) Christopher Addison: Health visionary, man of war, Parliamentarian and practical pioneer (pp. 96-105), in J. Stewart (2017) Pioneers in Public Health, Routledge Focus
Nicol, S., Roys, M. and Garrett, H. (2015) BRE Briefing Paper: The Cost of Poor Housing to the NHS, Watford: BRE Trust.
Stewart, J. (2001) Environment Health and Housing, Clay’s Library of Health and the Environment, Spon Press
Stewart, J. (2016) Housing and Hope: the influence of the interwar years in England, (available at the iTunes Store)
Stewart, J. (2017) Tackling the Slums: Inspectors of Nuisance and the Sanitary Inspectors: Part 1, 1848-1914 Municipal Dreams Blog
Stewart, J. (2017) Tackling the Slums: Addison and the Sanitary Inspectors: Part 2, 1914-1939 Municipal Dreams Blog
Stewart, J. and Lynch, Z. (2018) Environmental Health and Housing: Issues for public health (2nded), Routledge