Across Wales, thousands of people live in homes that are damp, mouldy, cold or poorly ventilated – conditions known to make people ill. Health services continue to treat the symptoms, but the housing conditions that drive those symptoms often remain unchanged. This article sets out what we know about how housing harms health, why this is a systemic policy failure, and what the Welsh Government has done so far to fix it.
Homes that actively worsen health
Poor housing is a direct and preventable driver of ill-health. Public Health Wales identifies several ways in which poor quality homes can harm both physical and mental wellbeing. These include overcrowding, which is linked to a range of health conditions in both children and adults; exposure to pollutants such as radon or tobacco smoke; and risks associated with poor building design, excess noise, or accidents within the home. These factors are associated with respiratory symptoms and infections, as well as lung cancer, coronary heart disease, stress, and wider mental health impacts.
The scale of the problem is substantial. In 2017-18, an estimated 238,000 dwellings in Wales contained at least one Category 1 hazard — around 18% of all homes. Category 1 hazards are the most serious risks to health and safety, including excess cold, damp and mould, and the risk of falls. This means that hundreds of thousands of households are living in conditions officially assessed as dangerous to health and wellbeing.
These hazards have predictable consequences. Respiratory illness, chronic pain, anxiety, depression, and persistent fatigue are all made worse — and in many cases directly caused — by cold, damp, or unsafe homes. Clinicians are seeing this daily in their work. The Royal College of Physicians reports that more than 70% of doctors are treating increasing numbers of patients whose conditions are worsened by social factors such as poor housing. This highlights the importance of addressing the causes of ill-health, not just treating the clinical symptoms.
Despite this, health services often respond to the symptoms in isolation, without addressing the housing conditions that perpetuate them. The Welsh NHS Confederation Health and Wellbeing Alliance (a coalition of 50 health and social care organisations) has warned that cold and mouldy homes are driving respiratory problems and that many of the root causes of illness lie outside the NHS. They argue that improving health in Wales requires coordinated action across housing, health and social care systems.
The human impact: children and vulnerable groups
Children are among the most affected. The Children’s Commissioner for Wales highlights extensive evidence that young people are living in homes with mould, damp, overcrowding, cold temperatures, unsafe locations, and cramped temporary accommodation. These conditions negatively impact children’s physical health, mental wellbeing, education, and sense of safety.
Families also report struggling to access adapted housing for disabled children, while neurodivergent children — who may have high sensory sensitivities — face environments that are noisy, unpredictable, or overstimulating, yet still judged suitable under existing criteria.
The latest data shows that around 2,400 children are living in temporary accommodation. Research published by the Bevan Foundation has highlighted the impact this can have on a child’s physical health, wellbeing and ability to develop and learn.
A system with no clear owner
According to Public Health Wales, one of the core structural problems is fragmentation. Housing‑related health harms fall between multiple systems:
- health boards can diagnose housing‑related illness;
- local housing authorities can identify housing hazards and enforce improvements; and
- social care can identify vulnerability.
Public Health Wales emphasise the need for integrated approaches, noting that poor housing imposes significant costs on the NHS and society — estimated at £1 billion per year. Their work calls for organisations to share information, pool resources, and take joint action to address housing as a determinant of health, rather than treating it as separate from public health strategy.
At the same time, wider structural challenges – including increases in housing costs and a shortage of social homes – also present significant challenges for policy makers seeking to address this issue.
What Is the Welsh Government doing?
The Welsh Government has several policy frameworks aimed at improving housing quality, though their coverage and impact vary.
Welsh Housing Quality Standard (WHQS)
The Welsh Housing Quality Standard (WHQS) sets the benchmark for the quality of social housing in Wales, requiring homes to be:
- in good repair;
- safe and secure;
- adequately heated, insulated and ventilated;
- fitted with modern kitchens and bathrooms; and
- suited to the needs of the household, including disabled residents.
Social landlords are required to meet and maintain the standard, and the Welsh Government monitors compliance annually. However, WHQS only applies to social housing, not privately rented or owner‑occupied homes — where many of the worst conditions are concentrated.
Renting Homes (Wales) Act
The Renting Homes (Wales) Act 2016 introduced a legal duty on landlords to ensure that the homes they let are ‘fit for human habitation’ and kept in good repair. This places responsibility on landlords to maintain properties as safe, healthy places to live, taking account of the 29 matters and circumstances set out in the accompanying regulations.
Local authorities are responsible for enforcing these health and safety standards. However, environmental health teams often have limited capacity to carry out inspections or take enforcement action. Tenants may also hesitate to report problems due to concerns about eviction, rent increases or the potential impact on their landlord relationship. Together, these factors constrain the system’s ability to identify and address hazards in rented homes.
Welsh Housing Conditions Survey (WHCS)
The Welsh Housing Conditions Survey (WHCS) provides data on housing conditions and hazards across all tenures in Wales. It identifies the scale of Category 1 hazards, energy inefficiency, and disrepair.
Although this is a strong national dataset, the survey is not conducted on a regular basis and the most recent full housing quality results date from 2017–18. The Welsh Government recently committed to commissioning a new Welsh Housing Survey which will gather information on the fabric and condition of homes. It expects that the first results will be published in 2028-29.
The lack of more up‑to‑date surveys limits the Welsh Government’s ability to track emerging issues such as mould linked to rising fuel poverty.
Where Action Falls Short
Public Health Wales has been a strong advocate for integrating housing and health policy, arguing for investment in safe, warm homes as a public health intervention. They have suggested the Welsh Government’s planned Housing and Regeneration Strategy could be an opportunity to address the systemic housing challenges which affect people’s health.
Community Housing Cymru, the representative body for housing associations in Wales, has also called for “a whole government approach” which focuses on prevention and early intervention to keep people well at home.
While the Welsh Government acknowledges housing as a determinant of health in its broader public health and social care strategies, there is no dedicated funded pathway for early health‑related rehousing or housing‑linked prevention. This gap means people often have to reach a crisis point — such as hospital admission or unsafe housing conditions — before qualifying for support.
Poor‑quality housing in Wales is not a marginal issue — it affects nearly one in five homes and costs the nation over a billion pounds a year. The health impacts are profound, predictable, and preventable. The Welsh Government and Public Health Wales have taken meaningful steps, particularly through the WHQS, but the system arguably remains too fragmented and under-resourced to address the full scale of the problem. Until this changes, people will continue to become ill in homes that should keeping them well.
Addressing housing as a public health priority will require sustained investment, system‑wide accountability, and a clear national strategy that treats safe housing as essential to wellbeing.
Article by Sarah Hatherley and Gwennan Hardy, Senedd Research, Welsh Parliament
