Asthma Friendly Homes: When Housing Shapes Children’s Respiratory Health

Childhood asthma linked to housing conditions remains one of the most persistent and under-addressed challenges in urban social housing. In northeast London, between 30 and 50 per cent of children attending A&E for any reason report mould and damp in their homes. Yet clinical and housing practitioners are increasingly aligned on a central point: the condition is largely preventable, and housing providers are well positioned to intervene earlier. 

This is the context behind a new project led by the Healthy Homes Hub, currently under development in the London Borough of Tower Hamlets. Working with four major housing providers, Clarion, Gateway, Hyde and Riverside, alongside the local NHS integrated care board, the project will test a suite of playbooks designed to guide housing and health professionals in identifying and reducing childhood asthma risk linked to housing. 

The environment children live in 

Tower Hamlets presents a concentration of risk factors that makes it both a significant challenge and a meaningful test case. The borough has an estimated 27 per cent overcrowding rate in social housing, consistently places among the top ten councils for housing waiting list length, and records some of the highest levels of outdoor air pollution and child poverty in the country. 

Families in these circumstances face compounding pressures. Old housing stock, properties not designed for current occupancy levels, and limited financial headroom to manage indoor environments leave many residents with few immediate options. The conditions are not of their making, yet the consequences, particularly for children with respiratory conditions, are direct and measurable. 

Progress since Awaab’s Law 

The implementation of Awaab’s Law, now six months in, has produced observable changes in how reported damp and mould cases are handled. Surveyors are attending more promptly. Reporting pathways have been clarified across councils and housing providers. There is greater organisational acknowledgement that addressing poor indoor environments is a shared responsibility across health and housing. 

What the legislation has not resolved are the structural conditions that drive respiratory risk in the first place. Overcrowding cannot be remedied by faster repair responses. Non-functional extractor fans, a problem encountered routinely during home visits in the area, represent a practical and addressable issue, but systematic identification requires active engagement rather than reactive reporting. 

The Renters Reform legislation removes the fear of retaliatory eviction that historically deterred tenants from reporting problems early. This may encourage earlier disclosure, but the evidence base on how non-clinical interventions affect health outcomes remains limited, and building it is a stated objective of the Tower Hamlets project. 

An established model as the foundation 

The Asthma Friendly Homes project builds on work developed by Walsall Housing Group through its ACING asthma project. That model operates across three pillars: a structured housing and health partnership, a community champions approach using trained residents with lived experience, and a focus on the wider determinants of health, including fuel poverty and overcrowding, rather than clinical need alone. 

The community champion model is particularly significant. Residents with direct experience of childhood asthma, trained and supported by the housing provider, act as trusted intermediaries within their communities. The approach mirrors what the Asthma Friendly Schools programme has achieved in educational settings, reaching children and families who may have limited contact with tertiary health services. 

In Tower Hamlets, with its greater complexity, multiple housing providers and borough-level variation in existing pathways, the challenge will be adapting this model to a more fragmented operating environment. The project will test whether the playbooks can be configured to work across different providers while producing consistent outcomes. 

Building the case for prevention 

The NHS is moving towards neighbourhood health delivery and a prevention-centred approach. Clinicians working in children’s respiratory health report that housing letters and referral requests dominate clinic time, with limited practical effect where housing supply is constrained. The demand is shifting: not for individual clinical solutions, but for system-level change that reduces the volume of children requiring secondary and tertiary care. 

Children growing up in adverse housing conditions, with persistent exposure to damp, mould and overcrowding, face long-term respiratory consequences that extend into adulthood. The cohort affected now will not simply grow out of these conditions; they are more likely to develop complex respiratory illness or chronic obstructive pulmonary disease in later life. The cost of inaction is not confined to the present. 

The Tower Hamlets project is designed to generate local evidence that community and housing-led interventions can reduce hospital attendances and clinic referrals. If successful, it offers a model that could be adapted and applied nationally, scaling prevention in a way that individual housing providers cannot achieve in isolation. The Asthma Friendly Schools programme provides a precedent, a structured, accreditation-based approach that moved asthma management out of the clinic and into the community settings where children spend their lives. 

Practical steps for housing providers 

• Audit the condition of extractor fans across managed stock, particularly in bathrooms and kitchens, as an accessible early intervention with direct impact on indoor air quality. 

• Map existing reporting pathways for damp and mould to assess whether they are accessible to all residents, including those without reliable digital access. 

• Train frontline staff, repairs operatives and housing officers to identify indicators of childhood respiratory risk during routine visits, using structured prompts rather than clinical judgement. 

• Engage with local integrated care boards to establish or strengthen referral routes for families with children affected by housing-related respiratory conditions. 

• Review the Walsall Housing Group ACING asthma project and the Asthma Friendly Schools accreditation model as reference frameworks when designing a community champion approach within existing resident engagement structures. 

• Link housing management data, including adaptation requests, repair histories and overcrowding records, to asset planning conversations, so that health risk is considered alongside stock condition. 

• Monitor outcomes over 12 months to build local evidence of impact, supporting both governance reporting and the wider case for funding community-level prevention programmes.