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What can a special issue on sustainable and healthy housing contribute to the widespread ongoing debate? Well, there is a need for good examples, for successful strategies and for “stepping stones”, meaning that better practices are based on acquired experience. Also, the young generation has to be prepared for state-of-the art sustainable principles and products and not to treat them as innovations.

After ten years of development, the English government adopted the Housing Health and Safety Rating System (HHSRS) as the prescribed method for assessing housing conditions. Prior to 2006, the assessment was based on the condition of the building and the presence of necessary facilities. Being ‘building focussed’, the basis of the severity of the condition was the extent and cost of any remedial works considered necessary to make the dwelling ‘fit for human habitation’. The HHSRS shifts the focus to the potential threat to health and safety from any defects and deficiencies. The assessment takes account of the likelihood of a hazardous occurrence, and the probable severity of harm that could result from such an occurrence. This approach acknowledges that defects that would be relatively inexpensive to deal with can pose a serious threat to health and/or safety.

Work on the development of the HHSRS included matching data on housing conditions with data on health outcomes. The analyses of the matched database provided information on, among other factors, the range and severity of harm outcomes associated with particular hazards. As the health data used was that available from hospitals and general practitioners, it meant that the health outcomes were those serious enough for the victim to seek medical attention. It has now been realised that it is possible to compare the one-off cost of works to remove or reduce housing hazards with the estimated annual saving to the health service. Using this approach, it has been estimated that poor housing in England is costing the health service around £600 million a year. This cost to the health service is estimated to be around 40% of the total cost of poor housing to society.