Housing quality is essential for population health and broader well-being. The World Health Organization Housing and health guidelines highlight interventions that protect occupants from cold and hot temperatures, injuries, and other hazards. The COVID-19 pandemic has emphasized the importance of ventilation standards. Housing standards are unevenly developed, implemented, and monitored globally, despite robust research demonstrating that retrofitting existing houses and constructing high-quality new ones can reduce respiratory, cardiovascular, and infectious diseases. Indigenous peoples, ethnic minorities, and people with low incomes face cumulative disadvantages that are exacerbated by poor-quality housing. These can be partially ameliorated by community-based programs to improve housing quality, particularly for children and older people, who are hospitalized more often for housing-related illnesses. There is renewed interest among policy makers and researchers in the health and well-being of people in public and subsidized housing, who are disproportionately disadvantaged by avoidable housing-related diseases and injuries. Improving the overall quality of new and existing housing and neighborhoods has multiple cobenefits, including reducing carbon emissions.

Health is an important but inadequately assessed aspect of programs to renovate home energy efficiency. This study sought to determine if savings in healthcare costs might balance investments in the thermal renovation of energy-inefficient homes. This work is based on the "Housing Health and Safety Rating System (HHSRS)", a methodology developed in England and used to identify homes where energy inefficiency puts inhabitants' health at risk. It is possible to cross housing and health data in England and accordingly to estimate the probability of harmful health effects according to the risk of exposure to cold indoor temperatures and then calculate the corresponding medical costs. Applying this approach to the assessment of housing energy performance with data from the French national Phebus study shows that 3.5 million primary residences, or 13% of the French housing stock, are energy-inefficient from a thermal perspective. After adaptation to the French context, the healthcare costs associated with this residential energy inefficiency were estimated and compared with renovation costs. The results suggest that investment in an appropriate energy renovation program could generate economies for the healthcare system and that these savings would be highest for homes of households with the lowest incomes. Indeed, for low income households, the medical costs avoided and the renovation costs incurred would be of the same order of magnitude.

Over five million households in France are estimated to be in fuel poverty and so possibly exposed to low indoor temperatures. Such exposure is a threat to health. Besides the individual's suffering, negative health outcomes, ranging from mild respiratory conditions to death, create demands on the health sector and costs to society. The health costs associated with energy inefficient dwellings have been calculated in England using a method based on the Housing Health & Safety Rating System (HHSRS); a health-based risk assessment system, adopted in 2006 as the prescribed statutory method for appraising housing conditions in England and Wales. The aim of this study was to use the English approach to estimate the health costs attributable to energy inefficient dwellings and energy vulnerability in France, and to analyse the cost benefits of thermal upgrades. This article details the methodology used to match the English and French housing energy efficiency assessment to provide the foundation necessary for the estimation of costs. This work has demonstrated that it is practicable to adapt the English HHSRS based approach, so that it can be used in another country such as France.

In New Zealand, as in many other countries, housing in the private-rental sector is in worse condition than in the owner-occupier housing sector. New Zealand residential buildings have no inspection regime after original construction signoff. Laws and regulations mandating standards for existing residential housing are outdated and spread over a range of instruments. Policies to improve standards in existing housing have been notoriously difficult to implement. In this methods paper, we describe the development and implementation of a rental Warrant of Fitness (WoF) intended to address these problems. Dwellings must pass each of 29 criteria for habitability, insulation, heating, ventilation, safety, amenities, and basic structural soundness to reach the WoF minimum standard. The WoF's development was based on two decades of research on the impact of housing quality on health and wellbeing, and strongly influenced by the UK Housing Health and Safety Rating System and US federal government housing standards. Criteria were field-tested across a range of dwelling types and sizes, cities, and climate zones. The implementation stage of our WoF research consists of a non-random controlled quasi-experimental study in which we work with two city-level local government councils to implement the rental WoF, recruiting adjoining council areas as controls, and measuring changes in health, economic, and social outcomes.

High on the political and social agenda are the levels of domestic energy use, of carbon emissions, and of fuel poverty. Strategies to reduce these levels should ensure that the health and well-being of residents are protected and improved. Thermal discomfort in housing ranges from being uncomfortable to serious health impacts. Avoiding thermal discomfort maintains well-being and protects the health of, in particular, the most susceptible members of the population. This position paper defines thermal discomfort, examines how it can be measured, and looks at the health impacts of low and high temperatures. Factors that increase susceptibility to low and to high temperatures, both human and building related, are identified and discussed. This paper shows that there are similarities between some of these factors, and that tackling these together will provide protection for those most at risk from exposure to high and low temperatures. Strategies aimed at reducing susceptibility to both excess heat and excess cold are suggested.