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Otago Uni study estimates over-crowding causes over 1,300 hospital admissions a year and some deaths; Professor calls for programme to build thousands of affordable homes

Otago Uni study estimates over-crowding causes over 1,300 hospital admissions a year and some deaths; Professor calls for programme to build thousands of affordable homes

By Bernard Hickey

A major University of Otago study has estimated over-crowding is responsible for more than 1,300 hospital admissions a year and some deaths from infectious diseases such as pneumonia, meningococcal disease and tuberculosis.

The Ministry of Health-funded study included a world-first systematic review of global literature combined with New Zealand housing and census data since 1991 and university research on hospital admissions in New Zealand hospitals over the last two decades.

It estimated one in 10 hospital admissions for such infectious diseases were now the direct result of household over-crowding and this over-crowding had risen dramatically over that time.

That proportion jumped to one in 5 for admissions by Maori and Pacifica, and was a particular risk factor for children. 

The study was based on a review of almost 10,000 published studies from which researchers selected the most relevant and highest quality 350 reports.

The study's lead investigator Professor Michael Baker said the studies provided consistent evidence that household over-crowding was an important risk factor for nine major categories of infectious disease — gastroenteritis, hepatitis A, Helicobacter pylori infection, pneumonia and lower respiratory infections, upper respiratory infections, Haemophilus influenzae disease, bronchiolitis, meningococcal disease and tuberculosis. 

“Most of the diseases in the study have especially high rates in children. Children are more susceptible to meningococcal disease, gastroenteritis, pneumonia and most other infectious diseases, and our analysis shows that their risk is strongly associated with exposure to household crowding," Professor Baker said.

The research found over-crowding was estimated to be responsible for 5% of admissions by Pakeha New Zealanders, while the proportion for Asian New Zealanders was 13%. This rose to 17% for Maor and 25% for Pacifica.

“Fundamentally what it reveals is a very real and urgent need to lower household crowding as a first step to reducing these serious diseases among our most vulnerable populations,” Professor Baker said.

Interventions such as Housing New Zealand’s Healthy Housing Programme in Auckland, Northland and Wellington, which focused on reducing crowding, improving housing conditions and linking households to health and social services, was successfully lowering hospitalisation rates for children in those areas, he said.

The budget announcement to add 3,000 new state house bedrooms and 500 new homes was promising, but considerably more social housing was needed to have a significance impact on infectious diseases, he said.

Professor Baker said New Zealand faced a severe shortage of affordable housing with about 45% of Pacifica children and 28% of Maori children living in crowded houses, compared with 8% for Europeans and others.

"New Zealand needs a large scale programme to construct thousands of additional social and affordable houses if it wants to reduce household crowding and prevent many cases of serious infectious disease.”

Professor Baker said the study was likely to be an undersestimate of the total effect of over-crowding on serious infectious diseases because the study had not been able to look at some infectious diseases such as skin infections and rheumatic fever because of a lack of high quality published studies on those diseases.

“Although household crowding is likely to be important for such diseases as rheumatic fever and skin infections, we cannot currently put a figure on the likely number of cases of these diseases caused by this exposure.”

The issue of a lack of affordable housing is already a major economic issue. It is cited as a factor driving house price inflation in Auckland and Christchurch at double digit rates, which the Reserve Bank has warned is becoming a risk to financial stability. It has also been a hot topic of political debate in recent months as the government moves to bring in Special Housing Areas with faster and easier building consent rules. 

Political reaction

Referring to the University of Otago study, Labour's Housing spokesperson Phil Twyford said too many kids were dying preventable deaths because of overcrowding and sub-standard housing. 

This was a direct result of the country's housing crisis, which was caused by the failure of the housing market and the Government's refusal to increase the stock of social housing.

"National's response has been at best half-hearted. Cutting back the home insulation subsidy, blaming Councils and planning regulations for the shortage of affordable housing, and tutu-ing around with a pilot warrant of fitness scheme in state houses, just won't cut the mustard," Twyford said.

He said adding modular bedrooms onto 1,000 state houses was a good start, but was a tiny response.

"It won't do a thing for the half of all children living in poverty who live in private rental housing," he said.

Twyford called for minimum standards for heating and insulation for private rentals. Labour planned a 'Healthy Homes Guarantee' and would amend the Residential Tenancies Act to make it mandatory for landlords to insulate and heat their rental properties, he said.

"Labour believes only the failure of the housing market requires bold action by Government. Labour will tackle the shortage of affordable housing by working with the private sector and Councils to build 10,000 affordable starter homes each year for a decade," he said.

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Interesting though when you drive through a predominantly state housing area, lots of expensive looking 4WD,s sitting in driveways, sky dishes on nearly every house and lots of kids wearing brand name sneakers. But it's the government's problem.

So from your observation this is not such problem? That if only parents did not spend money on transport, entertainment and clothing they could afford warmer larger houses for there families.
Yeah right!

I would suggest the social pressure to look successful has and will do us severe damage...thank the marketeers....

Good on this for following up on this issue after they bravely published the social problems of unaffordable housing at the begginning of this year.

This shows, clearly, the problem with Universities. In this particular instance, We have Harlene Hayne at the top, and I suspect she would be in general support of the report.
But - at the same University, I can go to lectures which point out that ever-increasing housing, infrastructure, indeed population - are impossible on a finite planet. Those lectures point out that we are in species-overshoot now; something the learned Prof could learn about by walking one block, along to Zoology.
I call their failure 'Interdisciplinary Genuflection' - the 'I won't comment on your patch, old boy' thing.
More housing houses more mothers who produce more offspring - in a species which is in overshoot. That's lunacy - putting out the fire with gasoline - and if the Prof failed to walk as far as the Physic Department, it wasn't his only failure. (In calling for housing, he is out of his sphere, and therefore should have conferred with the relevant expertises; energy-studies being the obvious one).
Ultimately, Harlene Hayne is the 'buck stops here' person responsible, for what I see as a prima facie academic  failure. She recently lauded inter-disciplinary communication, and is smart enough to use 'vibrant' while avoiding 'economic growth'. Her problem, perhaps,  is that her edifice is geared to endless research, whereas society needs to act on answers, at a point in time.
That point was passed, when Will Catton wrote Overshoot in 1980. Whether it be  Interdisciplinary Genuflection, cognitive dissonance, denial, or failure-to-scope, this report is only useful if we paste it into the bigger picture. Exponential growth vs finite planet being the backdrop. Hayne, being also on the Board of Treasury, will be able to impart the immediacy of the problem to the appropriate people, and  - given that it is a short walk to the site of the knowledge - she has no excuse for procrastination.
Overcrowding is a symptom, not a cause.

Correct.....less population = no overcrowding = no problem.  So what we actually need is free fertility control and the education on why.

PDK I agree that it would be helpful for society if our Universities participated in the public debate of how to solve our problems.
Otherwise I respectfully disagree that housing affordability is a symptom of 'overshooting' resources. There is some evidence evidence that we are approaching 'overshoot', in that many resources that were cheap are no longer, such as oil being $100 a barrel not $20. But to say that is the cause of our current housing boom is lacking evidence. If a shortage of resources was the problem, then everywhere experiencing the rise in resource prices would experience unaffordable housing. But that is not the case, the Demographia housing affordability surveys shows that is not true. There is massive differences in affordability in markets expericing the same rise in resource costs. Secondly you would expect the construction component of housing to be rising rapidly if the major problem was resource shortages. Wheras it is the land component of housing that is rising the fastest. So there must be another explanation.

When you look at the rise in component prices for housing, well Im sorry but from here they have indeed risen significantly. 15 years ago I used to do large DIY projects but the costs outweighed the gains, it made no sense to continue on anything but maintenance and essential upgrades eg im building a new kitchen myself.
Also of course the factors effecting prices are very much impacted by the state of the economy...right now DIY and building outside chch doesnt look to be doing well, staff at some of the big DIY stores tell me its been very quitet for 18+months....
I think Belle commented on the petrol costs of her son whose self-employed. I know quite a few similar ppl and they all say the same thing...but they have a hard time putting up prices as ppl cant or wont pay. 
So sure artificial land restrictions play some part in the specualtive component but that cost bears no resemblence to what it costs for the lnad but rather the price the seller thinks the buyer will pay. 
What I have yet to see is any explanation from Hugh or say yourself on how we remove all the choke points to get land prices down.  ie sure move the residental zone out say 2km, but really then you move the choke point to the land banker who will in turn artifially restricts supply, net result diddly I suspect.
Of course we also have all sorts of ther factors impacting costs, eg councils are squeezed for $s so look for anywhere that has the ability to pay and up's those costs as much as possible, that of course distorts the market and the view of it...
PS there has been enough comment on the demographica "work" to doubt its robust and reliable, especially when you add that its being pushed by those with very libertarian points of its dubious.

I think the best explanation is the Hugh/Best explanation. That the urban plans that prevent 'sprawl' do not take into account human behaviour. They give monopoly power to a select few land bankers and property owners who greedily exploit it to increase land/house prices for their benefit but at the cost to the most vulnerable in society as detailed in the above report.
This is not the perfect anology, maybe someone can think of a better one. But imagine in response to cold houses we had some 'green' legislation that mandated double or triple glazed windows for all NZ and a doubling of wall, ceiling and floor insulation. So winter heating is no longer a problem. But now houses overheat in the summer and people use just as much energy to cool there houses as they did to heat them.
Then there is a backlash against the 'greens' and a demand to return to our older easily constructed houses. But the correct response would be for everbody to acknowledge they did not take into account all the factors and human behaviour. That they will go back to the drawing board and think how New Zealand houses can be designed so they meet peoples desire not to hot or cold.
PDK I think you should go outside kick the fence post, get a bit pissed off that 'green' plans are not working. And then come back and design something better.

I dont see how its the Green's fault...
plus the Green's support is 11%? hardly a reversal when its grown from 7% ish...
plus I see no back lash for "simpler", though that is I suggest what green's would want (I certainly do)  ie get rid of complex roofs etc.
Insulation makes you hot in summer? lol shows how clueless you are in terms of engineering....The insulation isolates you from the heat sources in summer.  If you want to mitigate that further you use passive cooling techniques (which my Engineering degree is on btw) but that costs....
In terms of human behaviour its actually moot, ie nature and the laws of thermodynamics win everytime...and they are about to make that win obvious in a most painful way.
The green's plans (in terms of the party party)  are actually almost of no impact thus far into the late game.....
It seems you are destined to wear your political blinkers until nature knocks them off.

A did not refer to Greens as in the party but to 'greens' meaning those who have supported the various anti sprawl urban plans. In my opinion support for these plans has declined.
But this blame thing which is not how I see it means there is a possibility of throwing the baby out with the bathwater. The way I see it is these plans were first generation attempts to confront big issues of sustainability etc. But they have not work that well. Which is to be expected for first generation stuff. Simply this needs to acknowledged and to move on to the next attempt.
If problems are not acknowledge then support for 'greens' could be lost forever.
Alternative models to consider would be for urban plans that allow environment villages outside the rural urban boundary. This would be the splatter sprawl that gives the supply vent which PhilBest/Hugh talks about but be similiar to what PDK is trying to set up in the Kilmogs. Another model would be instead of trying to keep all development within a ring. Have designated transport/service corridors radiating out and around the urban areas. That within a certain distance of those corridors have higher density and then further away no limts on density. But the developer has to pay to connect (roads and services) to the corridor.  
And by the way a well insulated housing with too much west facing glazing could easily overheat in NZ, if it is poorly designed from a shading, ventilating point of view. And it was just an analogy which you seem to have made no attempt to try to understand

maybe use the term nimbies then......but really Green isnt the appropriate wording IMHO.
and yes alternatives need to be thought about, outside the boundary earthship's for instance need no water in, no sewerage out and generate their own power....hence there is no need for the council to charge obscene amounts for somethign they will never use.  The problem is the likes of HughP only push one model, the failed surburbian one.
I did my degree in passive heating and cooling and well understand solar gains...typically a 900mm overhang made out of any cheap durable material for north facing would eliminate most window gains in summer yet allow solar gains in winter as the sun is lower. Then use thermal mass which gives a time delay to your advantage...and especially as NZ tends to have high solar gains yet a relatively low air temperature, making it ideal.
Its not rocket science and I actually used a very advanced design system that took all the variables into account....sadly it was highly proprietry and I think the code was lost with the author...

oh and in terms of cooling in summer that is also the time when solar panels are at their best so actually using them to drive chilling plant isnt that bad. I think German utilities are suffering lost profits because the huge amount of solar instalations has robbed them of peak and daytime charging.

Brendon (note: this will be above, but posted aprez, the below comments).
re Green - agreed, we're on the same page.
It it was an analogy, then no, I didn't understand. Took it at face value. An open window more than compensates, in our 2-storey open-plan structure, for the fact that it's sun-facing.
You raise a valid point re the way forward. LA's are typically scared of development cost biting them in the bum, later. I was on one, saw it first hand. You get an enthusiast - say, for analogy :) a composting-toilet enthusiast. They look after it, tinker, give no off-site problems. Maybe the next owner is good too. But - sooner or later, a suburban type with no knowledge, no wish to know, and an expectation to no-limit indulge (they go hand-in-hand, more often than not) and there is a problem. Who does the Council 'blame', and how can it avoid getting into that corner? So they legislate for the controllable, which is the least environmentally friendly, most water-using option.
I think a set of quality bottom-lines might have done the trick in easier times, but there isn't the energy in the system to 'pay' for the monitoring now. I also think the 'rules' will be eroded from both ends - the Hughey/PB types and the 'inability to comply but need to live types'
Agree re transport thinking..

Brendon - you're familiar with nursing, right? Do you suggest to someone coming out of oncology with bad news " you need to design something better"? No. You help them work through the available options, help them make the most of their reality.
Your prima facie failure, is to project what you want (which is, I presume, a cheap house for you and yours) and then to reject anything that points to why this is increasingly unlikely.
A common secondary failure, is to assume a 'normal' house as the object of desire. If that doesn't apply, good on you. I know folk living quite happily in small houses, house-trucks, boats, corners of industrial buildings, a caravan in a rural barn, all sorts of spaces.
I've put this up before:
and known that the folk who I've addressed it to, will baulk at reading it, then more likely than not, will reappear saying the same things. Just think about the length of time it takes to pay off a mortgage, google 'limits to growth double resources', and overlay. That's two planets, just in case the maths was a bit wrong re one.
Don'y worry, a Professor ignored it, so you're in august company.

Many ppl fall into the trap of a cheap house as the first cost, over its life of course the total cost of ownership is far more important....its just not so obvious.  And lots of commercial properties are terrible in this respect.

Oh -and you need to read up on passive solar housing. The sun is lower in winter - 22 deg above the w/solstice horizon in my case - and higher in summer. You design with overhead eaves, which prevent the summer sun getting in. You also design thermo-paths (my approach is low and high windows East and West, so that the prevailing wind can enter low, go up with the heat-flow, and exit downwind. You need to do some homework, this is 1970's stuff.    :)
There are already backlashes - fart taxes, efficient shower-heads, ightbulbs. They were all 'something better'.

powerdown .. answer me this ..
The housing affordability issue has been a hot topic for a long time now .. it has been discussed up hill and down dale .. the underlying causes are many .. some of the less important ingredients have had more air time than the more important .. the lever-pullers have finally decided to be seen to be doing something .. anything .. and the winner is .. the growth lobby .. more .. more .. growth .. growth .. have you wondered why?

Why, for me its because there is no other game in town....I tend to assume its hard wired in DNA to re-produce and grow...after that 10,000 years of conditioning, quite a challenge to change. yet because we can think, it should be possible.

Icono - yes, there last few years, I've though about that more and more, whereas the answers - which are obvious - I'v needed to think about less and less.
I think Brendon epitomises the problem. He's had enough posted here, by my reconing, to 'get it', yet by his comments above, he doesn't. Maybe you need a brain wired (I'm not saying 'better', I'm saying 'different') in a physics/math/big-picture way. Possibly, it's even in an exponential-grasping way. The fact that so many folk swallow the paying of mortgages, and collectively 'paying' the banks for 'renting fiat-issued money, suggest there may be such a cranial missing-circuit in the ,majority. Perhaps it wasn't required for survival, wasn't seen as a desirable gene for mating-with?
So these people put up with being screwed by those who are 'richer', on the basis that they believe they'll be richer themselves, someday. They therefore vote for whatever will deliver short-term 'betterment'. Politicians will go down the gurgler if they offer anything else (Clark made a 'sustainability' speech, then silence. I suspect the polls nosedived). The media is hand-in-glove with those who push the myth, indeed need it to perpetuate to perpetuate their business models.
It wasn't, however, sustainable. Choices were hitting the wall full-noise, or attempting control. I'm about advocating the latter, but it won't happen. Too many small/immediate/self type thinkers, and too many others playing on that.

Finally someone nails it. NZ housing is a national disgrace. The quality and quantity and affordability of the housing stock is just bloody awful. It is always the powerless in society who suffer most when things are messed up - the very young and the very old.

RW - interesting that you needed to say that, there.
Sure, the vulnerabe suffer first. Step back one, and Bangladesh, Nigeria, the Middle East, suffer first - well before our 'poor'. Your comment therefore lacks relativity, and ignores mine above. You might like to wonder why.

They didn't "nail it" they wacked their thumb with the hammer Roger..simple to see...provide modern high quality affordable housing for all and what you get is ....even more unwanted children...never ending nightmare.
What would help is funding to teach thrift and self control, family planning and why it pays off in the long run.

So the gormless are stuck on the treadmill, stop population growth and the problem solves itself.
Build more houses and ppl will just breed to fill them.....

Lots of our new houses are problems.  Light constuction etc.  Useful life of about 15 years IMHO.  Gee in Auckland there are houses being built on tanalisied piles.  With particle board floors.  Unbelievable.  And then we have people who think buses and steel containers will do.  PDK ?
We need to be building real houses.  Stone and big beams like an old german farmhouse.  Some of those are 400 years old and still going strong.  Lifetime cost in dollar terms very cheap.  And resource use, ecological impact, very low, in related to the of the use and benefit they give. 

Actually no, you need to look at the total life cost over say 150 years.  I think there was some interesting total cost of ownership discusions / models around making the floor plate, yes last several hundred years but building the house to only last  50. You then completely replaced that every 50 years as that was less expensive, lowest ecology / environmental impact over that 150 years.  Now I'll admit I have not closely followed this stuff for 15 years and things could be different...
PS I used hardwood t&g on my extension,  economically <2 carpet changes and the difference was paid for, but I prefer polished wood anyway.

Not one mention of  the un-touchables: .. report June 2011 .. out of sight .. out of mind
A report obtained under the Official Information Act shows 14 people, including three children, were listed at one household in Papatoetoe. Collectively it was getting over $4000 a week net in benefit payments - adding up to $224,000 a year. Another home in Mangere had 18 people listed as living there, including 11 children. Benefit payments to those in the household totalled almost $2300 a week.

Then these should be checked as accurate and true. 

Over-crowding - April 2013 - 19 people in one state house

Density of people is just a transfer mechanism and is not the cause of disease.  Malnutrition, likely correlated to some degree, is the prime culprit.

How many posters here are looking at the density of people through their own cultural perspective.  How many, including the writers of the report give acknowledgement of the cultural values of intergenerational homes?
What some see as 'over crowding', others may see as 'family living'.

I agree Labour should apologise for the housing bubble they created.
I am totally unimpressed with Twyfords comments on this issue. To my thinking Labour knew and understood full well that there was a housing shortage when they were in power and used that housing shortage for advantage to sell to the public that NZ'ers were doing well because their houses were worth more.
The horrible part of this is that deaths have occured from over-crowding and some people will have health problems for life. Political and Bureaucratic herd drovers want to confine people to limited pastures within certain designated boundaries and have failed to take in to account basic human needs.
I would like to know how many RMA applications for subdivisions and other buildings related to residential housing have been denied and/or delayed since 2000 across NZ?
Who were the submitters who opposed the applications for the above RMA applications?
Maybe those people who have opposed applications for any type of residential housing should consider that they have blood on their hands.

Well, well, well, they got 'em out of all the paddocks; back, fromt and home.
Must be quite a fluster, in certain quarters?
Next we'll have Ruth Richardson doing the hammer-throw, followed by.........
Actually, you, Notaneconomist, have blood on your hands. We all do, but some of us seek to change things. Time, perhaps, you faced facts. Every western user-of-Third-World labour does, no matter how much in denial they may be. Local 'poverty' and 'overcrowding' are nothing - don't even rate - against what we do to the majority on this planet, so that we can live as we do. Not just their slave-labour in crappy conditions with no safety-margin, but we rape them of their resources too.
Our IMF and World Bank types force their Governments to borrow, to pay attention to ratings (because those determine the extent of the payback blackmail) and to toe the line. Coups are financed, democracies overthrown (of course, they were communist, terrorist, rebel, or whatever - yeah right) drones flown, oil/resource containing nations invaded (think; Nigeria, Iraq) and how many killed?
All so you can shop for a bargain. And you have the nerve to write what you did above? Pot calling kettle. Twyford and Labour are probably a notch more humanitarian, and they could do precious little about the collective greed colliding with peak oil, although this:
Hon Dr MICHAEL CULLEN: I have to confess that, for once, the
member has floored me; I do not understand what is meant by the
term 'peak oil'.

suggests they were being disingenuous too. Doesn't excuse you from your responsibility, though. Or the current Govt. We need a more mature approach than blame-shifting rhetoric, from all Parties; and those who can't raise their game should leave the paddock. Oh, one already has.

If people can't afford to live in Auckland they should go somewhere cheaper.
Can't see why taxpayers and ratepayers should pay for poor people to live in expensive areas. And have way too many kids they can't afford.
Building more houses  is like trying to cure alcoholism with alcohol, with resultant environmental and social degradation due to too much demand on limited environmental , health, education and financial resources.
More houses=more people, sadly with no evidence overcrowding and health outcomes will be better by one iota. A bit simplistic to think that more housing = better health, bit like thinking more houses = cheaper houses.
Len Brown, and the Govt , and the Green Party (well, the whole world needs to control population through political/cultural means or war starvation and disease will solve it for us if we don't) should be discouraging population growth, especially when we do not have the infrastructure to support the current population, let alone the future million predicted for Auckland.
Here is biologist explaining why poor people tend to have more children -- all about evolution.
Get them out of poverty then problem is solved. How to get them out of poverty? They have two hands and a brain, right?

Your biologist is correct, but given that poverty or the lack of it, is a case of having access to resources or not, becoming 'rich' was obviously only going to be a temporary option if we overshot the resource base.
Which we have.
Which suggests that we may not have as much collective brain as you imagine. It has been hypothesised, that our brains were developed at the beginning of our resource-consuming, and that there is no precedent for overshoot, therefore no hard-wiring to deal with it. The hypothesis goes on to surmise that if our species doesn't get it right on this planet (if we go right on past the inflection-point over-consuming, and crash, having unrestrictedly expended the only massed store of energy) then probably no emergent/dominant species, on any planet, ever will.
An interesting thought, not often thought, which is food for thought.

Perhaps we better hurry up - after all the worlds' human population expands by 80 million EVERY YEAR at the moment.........

The link is verging on Evolution Psychology. Here is the thing, while populations may show a relatyionship between women's life expentancy and age of first child, if you shift an individual between richness and poverty (described in the link as the correlation with maximum age) and their birth pattern changes, it is not genetic and not evolution.
For that matter, once you cancel out the effects of childhood mortality even in poor societies most women have the same number of child bearing years as rich societies. Again, not suggesting a genetic basis.
What is generally known, and is one of the strongest correlations there is in demographics in this area, is the negative association with years of education and birth rate. This is the case even in unequal societies where women would seem not to be able to take advantage of that education to have their own inpendent means of support. It is also a major factor in the various long term population trends eventgually topping out then decreasing- that over time the proportion of women receiving a high school equavalent level of eduation is increasing.