Social inequalities

In NZ there is a growing gap between the rich and the poor - it's glaringly obvious to those who visit here infrequently.

You don't have to work very long taking care of poor people before you realize that the contents of our medical bag of tricks are often insufficient to improve their health status. One key contributor to ill health is the environment around the patient—do people smoke? Can the family afford healthy food? Is the home safe and warm?

The last of these is explored this week in a ground-breaking randomized controlled trial from New Zealand (doi: 10.1136/bmj.39070.573032.80). Philippa Howden-Chapman and colleagues randomized 1350 single family homes in low income communities to receive new insulation or not and measured changes in environmental and health outcomes over one year. As one might expect, they found significant increases in winter indoor temperature and decreased dampness (humidity) in the insulated homes, despite decreased energy consumption. But they also found that residents of the insulated homes reported significantly improved quality of life, decreased wheezing, and fewer GP visits and sick days from school and work.