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Abstract
Aims Children experiencing homelessness while living in temporary accommodation (TA) have a higher life-long risk of developing chronic conditions, repeated cycles of homelessness and adverse childhood experiences. The COVID-19 pandemic has disproportionally negatively impacted vulnerable populations. The study objective was to quantitively explore the distribution of the socio-political determinants of health inequalities during the pandemic for families with children under age five (under5s) living in TA in comparison to families not living in TA (non-TA) taking London Borough of Newham (LBN) as a case study. LBN has one of the most socially deprived and diverse populations in the UK: 1 in 2 children live in poverty, 1 in 11 children live in TA, over 100 languages are spoken, and LBN has the second highest COVID-19 mortality rate in England.
Methods A cross-sectional survey of families with under5s in LBN during the pandemic using validated measures. Snowball sampling was used to recruit families including parents/carers of under5s and expectant parents from September-December 2020. The LBN Public Health Team asked their child-facing services (midwives, health visitors, children centre staff, and voluntary sector) to distribute information sheets and links to a Qualtrics online survey in different languages via email/phone invitation to eligible participants. Participants were also recruited via promotion on LBN Council’s media outlets. Using descriptive and univariate analyses, socio-demographics, food security, and housing environment were compared between TA and non-TA families.
Results From the survey sample(n=2054), 2024 reported their housing status, of which 84(4.15%) households were currently living in TA, which was roughly similar to the wider population of LBN who live in TA(4.84%). 35.44% of the TA sample reported living in TA for 2 or more years, and 24.05% reported 12 months to 2 years.
Compared to non-TA families, TA families were of a lower socio-economic background, more likely to have no recourse to public funds (NRPF) and be unemployed, non-white British ethnicity, non-UK born, single-parent households, and food insecure. In housing, TA families were exposed to more environmental hazards including overcrowding, dampness/mould growth, pests/vermin. They reported the need for major house repairs, no digital connectivity, broken large electrical appliances, and no access to outdoor space (figure 1). TA families were less likely to access antenatal care and immunisation services (table 1).
Comparisons Between TA and Non-TA Families: Socio-political Determinants
Health care access: comparison of non-TA and TA families n (%)
Conclusion TA children were increasingly disadvantaged among multiple domains: socio-demographics, food insecurity, inadequate/poor housing, health service access. Therefore, the need is urgent to minimise the potential lifelong health impacts of these socio-political determinants of health experienced by this vulnerable group in addition to tackling the immediate risks arising from issues such as digital exclusion and poor housing conditions, which were likely exacerbated during the pandemic. The future of the pandemic is uncertain and future lockdowns are possible, so all families must have digital access now that many vital health services and schooling are online, even some exclusively. The time families spend in TA must be reduced, and the co-production of interim solutions and future policies to ensure a minimum set of housing standards for TA should be made a priority to address these inequalities and inequities.