1,721,034 research outputs found
Household crowding
No full textHousehold crowding is a condition where the number of occupants exceeds the capacity of the dwelling space available, whether measured as rooms, bedrooms or floor area, resulting in adverse physical and mental health outcomes (72, 73). Crowding is a result of a mismatch between the dwelling and the household. The level of crowding relates to the size and design of the dwelling, including the size of the rooms, and to the type, size and needs of the household, including any long-term visitors. Whether a household is “crowded” depends not only on the number of people sharing the dwelling, but on their age, their relationship and their sex. For example, a dwelling might be considered crowded if two adults share a bedroom, but not crowded if those adults are in a relationship (74–76). Crowding relates to the conditions of the dwelling as well as the space it provides: people may crowd into particular rooms in their home to avoid cold or uninhabitable parts of the dwelling or to save on heating and other costs (54).Fil: Howden Chapman, Philippa. University Of Otago; CanadáFil: Rojas, Maria del Carmen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Investigaciones Geohistóricas. Universidad Nacional del Nordeste. Instituto de Investigaciones Geohistóricas; Argentin
Improving Pacific Health and Reducing Health Inequalities: Policy Implications
No full textPacific people migrated to New Zealand in search of a better life. However, despite making important social, sports, cultural, and economic contributions in New Zealand, they continue to face challenges in other areas such as health, education, employment, housing, and the justice system. The level of health inequalities between Pacific and non-Pacific people had become a major
concern by the late 1990s and became a policy focus of the incoming Labour-led Government in 2000. The ambitious health reforms led by this government meant a significant change in tide for the entire health sector.
The principal purpose of this thesis is to analyse the Pacific health sector experience during the 2000 health reforms, which established District Health Boards (DHBs) and required, for the first time, an explicit focus on improving Pacific health and reducing health inequalities, but built on earlier strategies and policies. It is a qualitative piece of research undertaken by an ‘insider’, which aims to capture the stories and experiences, voices and viewpoints of those trying to paddle the popao (canoe) to improve Pacific health and reduce health inequalities during this period of intensive reform.
It is an exploratory study about how DHB model was working (2000-2005) with a view to develop further to ensure there is a strong focus on Pacific health issues and appropriate service delivery for Pacific peoples.
The goal and aims of this thesis:
To identify the factors that support, and the factors that provide barriers to progress, in the early stages of the DHB model, with respect to improving Pacific Health and further developing services to more appropriately meet the needs of Pacific peoples.
Aims:
• To describe the structures and processes established by DHBs in respect of Pacific Health.
• To describe the experiences of Pacific and non-Pacific senior staff and Pacific providers during the health reforms with respect to those structures and processes.
• To provide recommendations to inform future work on the impact of implementing policies to reduce health inequalities.
A combination of Pacific and Tongan frameworks, metaphors, and proverbs are used to frame the study, as well as inform analysis and presentation of ideas. The three data collections approaches were: (1) Talanoa (sharing or telling stories) – face-to-face interviews; (2) Lalanga (weaving) – textual analysis of strategic documents; and (3) Siofi (observation) – participant observation. Three-week placements were carried out with four DHBs and with three Pacific providers funded by those DHBs. The four DHBs studied were chosen because of their large Pacific populations, and also to provide a range of geographical perspectives. Overall, participants were overwhelmingly generous with their time. This willingness to engage highlighted the effectiveness of the talanoa (sharing stories) method, as it provided an open space for sharing experiences and eliciting the rich views of the participants.
Factors that enabled and acted as barriers to implementing policies related to Pacific health are discussed in detail in this thesis. In particular, the study found that having Pacific people participating in decision making at the governance level was critical to pushing the reducing inequalities agenda forward in institutions that were not ready for change. Participants strongly advocated for more inclusion of Pacific cultural values at all levels of decision making within the health sector. In addition, health workers being fakatoukatea, or able to operate in both Pacific and non-Pacific worlds, was seen to be a vital enabling factor. This research documents the complexities of working in a DHB environment where there are many tides and currents operating. The local needs, community demands, organisational requirements and agendas of DHBs, and broader political currents and influences did not necessarily flow in the same direction. In addition, the study describes a complex, but important relationship between Māori and Pacific communities.
The popao (canoe) was developed as the interpretive and analytical framework to describe the existing organisational structure of the DHB, acknowledging the desirability of moving to a kalia, a more stable double-hulled canoe. This thesis argues that health inequalities will continue until there is a renewed emphasis on social and economic determinants and DHB structures and processes move beyond the popao and develop the structural support of a kalia, where Pacific values are given enough space to co-exist, and Pacific people have real input into navigation. The study uses the popao and kalia as guiding metaphors to analyse the existing organisational structure of the DHB and possibilities for the future. In addition, the study utilised the Pacific Policy Framework ‘Alamo’ui: Pathways to Pacific Health and Wellbeing (MOH, 2014) to guide and to elaborate the discussion of results and findings. Effectively improving the health of Pacific peoples and reducing inequalities in this context of competing demands is challenging. This study provides an insider account of those at the forefront of paddling the popao for change in a complex environment
Evaluating the impact of social housing remediation and regeneration on tenants’ wellbeing: Health, social connections and safety
No full textBackground – Adequate housing is a basic human right. Despite this, much of New Zealand’s housing stock is in poor condition. Notably, there has been a substantial underinvestment in renewing New Zealand’s social housing infrastructure. In part this is because the contribution of good quality social housing to tenants’ wellbeing has been undervalued. There is a need to remediate the social housing stock in New Zealand and address inequalities in quality housing.
Against a general trend, internationally and nationally, Wellington City Council and Tāmaki Regeneration Company invested in their social housing stock. Evaluating the impact of these initiatives on tenants’ wellbeing is important, to build a robust evidence base and improve knowledge about the benefits of social housing.
Wellbeing refers to a person’s welfare, quality of life, or utility, at the individual, community and societal level. It encapsulates elements of life that people value and the degree to which people can live consistently with their desires and aspirations. Various domains influence wellbeing, as outlined in wellbeing frameworks developed by the Organisation for Economic Co-operation and Development and New Zealand Treasury. This thesis focuses on a subset of domains: housing, health, social connections and safety.
Aim – The aim of this thesis was to provide a framework for measuring the impact of social housing remediation on tenants’ wellbeing at three levels:
1. Housing level: interventions made to the indoor environment of discrete units, e.g. draft stopping intervention at Marshall Court, an already upgraded Wellington City Council housing complex with 27 units
2. Complex level: interventions include changes to the physical fabric/infrastructure of units and/or environment, e.g. rebuild of a section of Arlington, Wellington City Council’s largest social housing complex, with 269 units
3. Community level: interventions include changes to the environment/urban landscape of the neighbourhood, social services for general use and social systems, e.g. remediation of 2,500 social units in three suburbs of Tāmaki, Auckland, by Tāmaki Regeneration Company.
This thesis also aimed to test the application of the frameworks and inform the debate around the New Zealand Healthy Homes Guarantee Act 2017, which proposed a minimum temperature for rental properties. Therefore, indoor temperature was a particular focus.
Methods – This thesis developed robust evaluation frameworks, informed by literature, which can be generalised and utilised across the three levels of intervention. To evaluate the natural experiment at each level and promote causal attribution, I proposed a quasi-experimental before-and-after approach using control groups.
The housing level evaluation provided a field test of the initial framework, which proved the viability of the approach. The framework was expanded for the complex level evaluation and baseline data were collected. An even larger framework was developed for the community level intervention, which has a 15–25 year construction estimate; baseline data collection is ongoing at present. Frameworks were refined and contextualised in consultation with stakeholders. Follow-up, post-intervention data collection and analysis of the complex and community levels are anticipated to be undertaken as part of a future research programme.
As the level of intervention increases in scale, an expanding range of methods and tools are recommended to evaluate the impact. At a minimum this includes surveying tenants and monitoring the physical performance of housing including temperature, humidity and energy use. Administrative data are useful to obtain health and safety information on health care utilisation, victimisation and injuries. Site specific reports such as crime prevention through environmental design, urban design and maintenance reports are also useful sources to provide context, especially with respect to understanding social connections and safety.
Results – A literature review was conducted on evaluations of physical social housing interventions. This indicated that interventions generally led to tenants having increased satisfaction with their home, improved indoor conditions, health, social connections and safety. However, it was difficult to compare project evaluations. While they had a common goal, there was no consistent framework utilised.
For this thesis, cohesive evaluation frameworks and methodologies are presented across all three levels of intervention of interest at the housing, complex and community level. In practice a number of challenges were confronted when undertaking the evaluations, particularly at the complex and community level. This thesis also addresses how these were handled.
Key results from the housing level intervention showed meaningful indoor temperature increase was possible through minor interventions. Units were 1.36°C warmer on average after the draught stopping intervention, adjusting for outdoor temperature. Tenants’ diary entries also claimed units were warmer and more comfortable post-intervention.
Baseline results from the complex and community level showed a real need for warmer units, as pre-intervention units were on average 14.9°C and 16.7°C respectively; colder than the World Health Organization recommended minimum indoor temperature of 18°C.
Conclusion – The frameworks developed in this thesis can be applied when evaluating social housing interventions with respect to tenants’ wellbeing. The importance of housing interventions, with particular regard to indoor temperature, was demonstrated, and evidence developed was used in the development of the guidelines under the Healthy Homes Guarantee Act 2017. This will ideally be used to identify effective interventions, improve wellbeing and address inequalities going forward
Post-disaster housing recovery and community resilience: the case of the Canterbury earthquakes of 2010 and 2011
Full text linkBackground:
After a major natural disaster like the Canterbury earthquakes of 2010 and 2011, western democracies like New Zealand tend to enact top-down recovery statutes and regulations that are thought to enable a nimble response to national emergencies, save lives, and restore social order. But these statutory changes in governance not only determine the sustainability of the natural and built environments. They can also affect the wellbeing of those impacted, impairing their democratic ability to have a say and actively participate in the urban renewal processes taking place around them. What does this mean in terms of community action and resilience? This project is a case study of post-disaster housing recovery in Christchurch after the Canterbury earthquake of 2010 and 2011.
Aims:
In this qualitative study, I analysed the statutory framework governing the process of post-disaster housing recovery in Christchurch and its impact on local democracy. I also explored the role of communities and the third sector in housing and urban renewal. This aim was to contribute to the development of a critical theoretical understanding of community resilience as an inherently political concept. Community resilience is influenced by causal factors or generative mechanisms that impact upon the relations between people in a particular social context. I undertook this empirical study to develop a critical realist approach to understanding community resilience.
Methods:
I completed a narrative synthesis of textual data, derived from a thematic analysis of in-depth interviews with key informants, related policies, media, and fieldwork.
Results:
I found that a centralisation of government authority over housing recovery resulted in an erosion of democracy and representative government at a local level. This centralisation had a major impact on communities and their voice in the process of post-disaster housing recovery. Communities, however, never relented and worked tirelessly among themselves and with other social sectors to make a positive impact to post-disaster housing and urban recovery against difficult odds and stretched resources. This immense social capital and inspiring sense of community must be fostered and given the opportunity to democratically participate in the development of recovery policy as a key element of community resilience
Causal inference and the design of clinical trials in the community environment: a pilot study of allergen-reduction for the amelioration of childhood asthma.
No full textThis thesis tested the hypothesis that it was possible to successfully adapt to the New Zealand community setting, the study design of an American allergen-reduction trial. The American study reported by Morgan and colleagues translated the gold-standard scientific method for testing causal associations, so that it could be taken from the ideal world of the laboratory, and applied in the ‘real life’ American community domestic environment. This thesis elucidates the key components of the scientific proof of a causal association, and outlines the issues involved in the adaptation of the American study in order to incorporate these key components, and take account of the relevant differences between America and New Zealand (such as, the kinds of allergens, nature of domestic houses, and cultural differences). The major adaptation was the development of placebo interventions because Morgan and colleagues did not take account of the placebo effect.
A systematic review of allergen-reduction trials in childhood asthma is presented, and an assessment is made of the degree to which the key components of the scientific proof of causality were able to be included without compromising their integrity, in both the New Zealand adaptation, and similar studies reported in the literature. The thesis concludes that because of flaws in the designs of research performed to date (such as absence of a control group, or lack of a placebo, or inadequate randomisation protocols) there is insufficient evidence for or against the allergen-reduction hypothesis. This thesis makes a contribution by outlining the key study-design components that any future study must posses in order to scientifically test the allergen-reduction hypothesis.
In the process of reviewing the literature, and critically analysing it, it became apparent that it was necessary to take a step back, to take a wider view of concepts and assumptions that lie prior to, and underpin, the American study and allergen-reduction research in general. This thesis explores logic and causality and their role in scientific studies of allergen-reduction, and points to reasons why research has been unable to provide definitive answers, and identifies the key features that any future study must possess, in order for it to conclusively accept or reject the allergen-reduction hypothesis once and for all. Research in this field to date has paid too little attention to theory, and this thesis makes a contribution by explicating the relevant theories of logic, causality, and immunology which must inform the design of a study if it is to have any chance of delivering interpretable and useful results.
The outcomes of the pilot study of the New Zealand adaption of the study design of Morgan and colleagues are outlined, along with a critical discussion about the lessons learned from the pilot.
The thesis concludes that extensive changes are needed to the pilot study design in order for it to have scientific validity, and to ensure it is acceptable to the study-participants and to the asthmatic children in the community to whom the results of the study should be applied
Anyone can live in a boarding house can't they? The advantages and disadvantages of boarding house residence
No full textResearch indicates that housing and tenure type influence well-being. Traditionally, boarding houses are an important type of accommodation, but there is a paucity of knowledge about these dwellings in New Zealand. International studies and a small number of New Zealand studies have shown that boarders staying in the poorest condition boarding houses experience high levels of poverty, poor health and disability and are vulnerable to eviction. Due to inadequate tenancy protection and a lack of privacy, boarders can be considered to be essentially homeless. Some boarders cycle between boarding houses, other forms of temporary accommodation, and sleeping rough.
This qualitative thesis explores the advantages and disadvantages of boarding houses in Wellington, New Zealand. Constructivist grounded theory and semi-structured interviews with nine participants, consisting of two boarders, three health workers, and four landlords and managers are used to understand the drivers for boarding house use, gain insight into the realities of living in these dwellings, and to seek ways to improve boarding house conditions for those with poor health and disabilities.
The analysis indicates a lack of affordable housing, debt, and housing discrimination are key drivers of boarding house use. Others drivers include the lack of connection between health and housing policy and recognition of housing needs when people on low incomes are discharged or released from institutional care.
Results also show that the boarding house market is segmented and that all boarding houses are not equal. The experience of living in a boarding house varies depending on whether the house is in the upper, middle or lower part of an evident hierarchy of boarding houses. Those in the lower part of the hierarchy have the worst physical standards, least safe social environments, and poorest management practices.
Current building legislation is poorly enforced and the complaint-based mechanism to protect boarders from these issues fails due to weak tenancy protection. Weak tenancy protection also denies health workers the ability to advocate for improved housing conditions for people using the service. The study found more can be done to improve the physical standards of dwellings, increase the choice of affordable, quality housing and the provisions of health and social support to vulnerable boarders and to prevent the eviction of boarders due to unmet health needs and disability.
More proactive enforcement of building regulations and the provision of stronger tenancy protection to protect boarders from eviction is required. Landlords and managers that house vulnerable boarders also need better support from health and social services to be able to provide sustainable housing. Boarding houses are not a suitable form of accommodation for some and there is a need to increase the provision of affordable, quality housing for the most vulnerable, as stated in the aims of the New Zealand Disability Strategy (2001)
Evaluating the impact of social housing remediation and regeneration on tenants’ wellbeing: Health, social connections and safety
No full textBackground – Adequate housing is a basic human right. Despite this, much of New Zealand’s housing stock is in poor condition. Notably, there has been a substantial underinvestment in renewing New Zealand’s social housing infrastructure. In part this is because the contribution of good quality social housing to tenants’ wellbeing has been undervalued. There is a need to remediate the social housing stock in New Zealand and address inequalities in quality housing.
Against a general trend, internationally and nationally, Wellington City Council and Tāmaki Regeneration Company invested in their social housing stock. Evaluating the impact of these initiatives on tenants’ wellbeing is important, to build a robust evidence base and improve knowledge about the benefits of social housing.
Wellbeing refers to a person’s welfare, quality of life, or utility, at the individual, community and societal level. It encapsulates elements of life that people value and the degree to which people can live consistently with their desires and aspirations. Various domains influence wellbeing, as outlined in wellbeing frameworks developed by the Organisation for Economic Co-operation and Development and New Zealand Treasury. This thesis focuses on a subset of domains: housing, health, social connections and safety.
Aim – The aim of this thesis was to provide a framework for measuring the impact of social housing remediation on tenants’ wellbeing at three levels:
1. Housing level: interventions made to the indoor environment of discrete units, e.g. draft stopping intervention at Marshall Court, an already upgraded Wellington City Council housing complex with 27 units
2. Complex level: interventions include changes to the physical fabric/infrastructure of units and/or environment, e.g. rebuild of a section of Arlington, Wellington City Council’s largest social housing complex, with 269 units
3. Community level: interventions include changes to the environment/urban landscape of the neighbourhood, social services for general use and social systems, e.g. remediation of 2,500 social units in three suburbs of Tāmaki, Auckland, by Tāmaki Regeneration Company.
This thesis also aimed to test the application of the frameworks and inform the debate around the New Zealand Healthy Homes Guarantee Act 2017, which proposed a minimum temperature for rental properties. Therefore, indoor temperature was a particular focus.
Methods – This thesis developed robust evaluation frameworks, informed by literature, which can be generalised and utilised across the three levels of intervention. To evaluate the natural experiment at each level and promote causal attribution, I proposed a quasi-experimental before-and-after approach using control groups.
The housing level evaluation provided a field test of the initial framework, which proved the viability of the approach. The framework was expanded for the complex level evaluation and baseline data were collected. An even larger framework was developed for the community level intervention, which has a 15–25 year construction estimate; baseline data collection is ongoing at present. Frameworks were refined and contextualised in consultation with stakeholders. Follow-up, post-intervention data collection and analysis of the complex and community levels are anticipated to be undertaken as part of a future research programme.
As the level of intervention increases in scale, an expanding range of methods and tools are recommended to evaluate the impact. At a minimum this includes surveying tenants and monitoring the physical performance of housing including temperature, humidity and energy use. Administrative data are useful to obtain health and safety information on health care utilisation, victimisation and injuries. Site specific reports such as crime prevention through environmental design, urban design and maintenance reports are also useful sources to provide context, especially with respect to understanding social connections and safety.
Results – A literature review was conducted on evaluations of physical social housing interventions. This indicated that interventions generally led to tenants having increased satisfaction with their home, improved indoor conditions, health, social connections and safety. However, it was difficult to compare project evaluations. While they had a common goal, there was no consistent framework utilised.
For this thesis, cohesive evaluation frameworks and methodologies are presented across all three levels of intervention of interest at the housing, complex and community level. In practice a number of challenges were confronted when undertaking the evaluations, particularly at the complex and community level. This thesis also addresses how these were handled.
Key results from the housing level intervention showed meaningful indoor temperature increase was possible through minor interventions. Units were 1.36°C warmer on average after the draught stopping intervention, adjusting for outdoor temperature. Tenants’ diary entries also claimed units were warmer and more comfortable post-intervention.
Baseline results from the complex and community level showed a real need for warmer units, as pre-intervention units were on average 14.9°C and 16.7°C respectively; colder than the World Health Organization recommended minimum indoor temperature of 18°C.
Conclusion – The frameworks developed in this thesis can be applied when evaluating social housing interventions with respect to tenants’ wellbeing. The importance of housing interventions, with particular regard to indoor temperature, was demonstrated, and evidence developed was used in the development of the guidelines under the Healthy Homes Guarantee Act 2017. This will ideally be used to identify effective interventions, improve wellbeing and address inequalities going forward
Individual and collective action for healthy rental housing in New Zealand: an historical and contemporary study
No full textSubstandard, insecure, and unaffordable housing affects health, contributing to the spread of infectious disease, susceptibility to respiratory illness, and to feelings of stress and anxiety. In New Zealand, people who rent are most likely to experience health problems related to housing. This study explores the connections between power and housing as social determinants of health by investigating the ability of New Zealand tenants to individually and collectively represent their interests in order to obtain healthy housing.
The first part of the study is based on archival records and chronicles the five key phases of New Zealand tenant protest, during which tenants organised for affordable, secure and quality housing through political advocacy, tenant support services, and direct action. Tenant protest groups worked for rent controls in 1916 and 1920, against evictions during the Depression, for better quality and lower rents in the 1970s, against market rents for state housing in the 1990s, and against the redevelopment of state housing communities in the 2010s. Such groups helped individuals retain, gain or improve their housing, and contributed to policy and law change that helped people access healthy housing. However, tenant groups faced common challenges which meant that their actions were small scale and intermittent. In addition, state promotion of homeownership meant tenants were more likely to try to leave the rental sector rather than work towards its improvement. In discussing the results, I draw on Albert Hirschman’s exit-voice framework, Kemeny’s housing typologies, and the literature on collective action and social movements.
The second part of the study consists of a survey of tenants and interviews with tenant advocates, which explore how tenants are able to represent their interests at an individual level, in relation to their landlord or the courts. Key issues facing tenants were insecurity, affordability, and poor quality housing. When tenants were able to represent their interests, often with the assistance of a tenant advocate, they could improve their housing. However, tenants often chose against representing their interests due to a lack of knowledge of or confidence in asserting their rights, as well as the high costs of doing so in terms of time and effort, the experience that reporting housing problems does not lead to their resolution, and the fear of risking their tenancy. In discussing the results, I draw on Hirschman’s exit-voice framework and Steven Lukes’ work on hidden dimensions of power.
This thesis shows that tenant representation can support health by helping tenants access secure, affordable, and quality housing. But tenants are limited in their ability to represent themselves. The health disadvantages of tenants are inextricably linked to their power disadvantages. At an individual level, housing insecurity makes asserting their rights, as the legislation requires them to do, a risky endeavour, especially for low-income people. At the political level, group representation by tenants is limited by resource constraints and policies that make home-ownership the rational option for anyone who can afford to. The thesis makes the case that improving tenant health requires interventions that account for power disparities, and suggests that tenants are important allies in working towards healthier housing
Power and Control: A multiphase mixed methods investigation of prepayment metering and fuel poverty in New Zealand.
No full textFuel poverty, (the inability to afford adequate household energy services, including healthy indoor temperatures) is a significant public health problem currently estimated to affect 25% of households in New Zealand and the cost of electricity is a key driver. Despite widespread international recognition, fuel poverty is not officially defined, measured, or explicitly targeted by government policy in New Zealand.
Prepayment metering is an electricity payment method used predominantly by low-income consumers. It carries the risk of users not crediting their electricity meter or ‘self-disconnecting’, which may have serious health implications. Official figures suggest around 3% of households may be using prepayment metering, although there is no routine collection of data.
This thesis examines the relationship between prepayment metering, in its present form, and fuel poverty in New Zealand through four discrete phases of research. This multiphase mixed methods programme of research draws from pragmatism, translational research, and socio-technical systems theories.
A price comparison analysis found that using prepayment metering for electricity was always more expensive than other payment methods in four cities.
A national-level postal survey of 768 electricity prepayment metering consumers was conducted in 2010 (response rate 48%). The survey found that households using prepayment meters are typically on low-incomes, Māori and Pasifika households are over-represented, and 54% of include children. Major findings were that 52% of respondents self-disconnected at least once in the past year; of concern, one third of these respondents were without electricity for ≥12 hrs, and 17% self-disconnected six or more times.
A follow-up postal survey with the same cohort in 2011 (n 324, response rate 61%) investigated patterns of self-disconnection over time and home heating practices of
this vulnerable group. Key findings were that self-disconnection remained problematic over time, that prepayment metering encouraged restriction of space heating in already cold homes, and over two thirds experienced shivering indoors at least once during the winter.
An integrative analysis of the survey results compared the outcomes for households with and without children, responding to policy discussion. This found that households with children experienced greater hardship and were significantly more likely to restrict grocery expenditure in order to afford prepayment meter credit.
A final study used qualitative description to explore household management of electricity expenditure and consumption through in-depth longitudinal interviews with 12 households. Extensive descriptions of advantages and disadvantages of prepayment metering, budgeting for electricity and of electricity end-uses, and socio-technical interactions between householders and their prepayment meters were attained.
Overall, this research shows prepayment metering consumers are at greater risk of fuel poverty than the general population. Rationing electricity consumption below requirements for maintaining health and wellbeing is a significant problem; yet despite this, self-disconnection remains a consequence of fuel poverty for many households. Government intervention could reduce the risks and capture the benefits of prepayment metering. Other policies could enhance housing energy performance and reduce fuel poverty. An approach to defining and measuring fuel poverty is indicated. Policy recommendations for reducing fuel poverty, with particular attention to prepayment metering, are developed from this research
Causal inference and the design of clinical trials in the community environment: a pilot study of allergen-reduction for the amelioration of childhood asthma.
Full text linkThis thesis tested the hypothesis that it was possible to successfully adapt to the New Zealand community setting, the study design of an American allergen-reduction trial. The American study reported by Morgan and colleagues translated the gold-standard scientific method for testing causal associations, so that it could be taken from the ideal world of the laboratory, and applied in the ‘real life’ American community domestic environment. This thesis elucidates the key components of the scientific proof of a causal association, and outlines the issues involved in the adaptation of the American study in order to incorporate these key components, and take account of the relevant differences between America and New Zealand (such as, the kinds of allergens, nature of domestic houses, and cultural differences). The major adaptation was the development of placebo interventions because Morgan and colleagues did not take account of the placebo effect.
A systematic review of allergen-reduction trials in childhood asthma is presented, and an assessment is made of the degree to which the key components of the scientific proof of causality were able to be included without compromising their integrity, in both the New Zealand adaptation, and similar studies reported in the literature. The thesis concludes that because of flaws in the designs of research performed to date (such as absence of a control group, or lack of a placebo, or inadequate randomisation protocols) there is insufficient evidence for or against the allergen-reduction hypothesis. This thesis makes a contribution by outlining the key study-design components that any future study must posses in order to scientifically test the allergen-reduction hypothesis.
In the process of reviewing the literature, and critically analysing it, it became apparent that it was necessary to take a step back, to take a wider view of concepts and assumptions that lie prior to, and underpin, the American study and allergen-reduction research in general. This thesis explores logic and causality and their role in scientific studies of allergen-reduction, and points to reasons why research has been unable to provide definitive answers, and identifies the key features that any future study must possess, in order for it to conclusively accept or reject the allergen-reduction hypothesis once and for all. Research in this field to date has paid too little attention to theory, and this thesis makes a contribution by explicating the relevant theories of logic, causality, and immunology which must inform the design of a study if it is to have any chance of delivering interpretable and useful results.
The outcomes of the pilot study of the New Zealand adaption of the study design of Morgan and colleagues are outlined, along with a critical discussion about the lessons learned from the pilot.
The thesis concludes that extensive changes are needed to the pilot study design in order for it to have scientific validity, and to ensure it is acceptable to the study-participants and to the asthmatic children in the community to whom the results of the study should be applied
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