Assessing the role of housing association activity in tackling health inequalities in Greater Manchester

Abstract

This thesis examines the role of housing associations in relation to health inequalities. Many housing associations in England are diversifying their business activities, and taking an increasingly active role in providing non-housing support services. Such services may function as either a direct or indirect determinant of health, yet empirical data on these activities is lacking. By investigating the experiences of housing providers in Greater Manchester, which is the only city-region in England to have had its budget for health and social care devolved from central government, the research assesses the interaction between housing association services and the city-region’s population health approach. A group of Greater Manchester Housing Providers (GMHP) sits formally within the city-region’s devolution structure, presenting a research opportunity that makes a contribution to both housing studies and the social determinants of health scholarship. Using a multi-level case study of Greater Manchester and data from elite interviews with housing and health sector professionals, this research considers whether housing associations, as independent businesses that have retained a public service function, can offer a suitable, sustainable solution to housing-related health inequalities. A critical realist approach to population health is employed to demonstrate the interdependencies and complexities between housing association services and the wider populations, governance structures and policy contexts they operate within. In this thesis, housing association activity is shown to be diverse, variable and inconsistent, and susceptible to numerous external pressures. As a sector, housing associations offer only a fragmented solution to the pervasive and entrenched health inequalities which disadvantage whole social gradients. In one sense, the diversifying housing association offer is shown to be more comprehensive, and to be engaging with health in an increasingly holistic way. Yet against the backdrop of continued statutory retrenchment, austerity and welfare reform, the activities of housing associations are shown in this thesis to be increasingly exclusionary, contributing to regressive gaps in the safety net and social contract, which are ill-suited to tackling the universal issue of health inequalities.

Date of Award	31 Dec 2021
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Iain Deas (Supervisor) & Mark Baker (Supervisor)