Paul Pholeros, Director, Healthabitat - presentation at the Rockefeller Foundation's Bellagio Center on October 17, 2011 (View the video on YouTube-http://www.youtube.com/watch?v=GsS9Lg8C3pI)

1. Preface Why does improving housing for Indigenous people seem
to be such a long road?
Expanding - Housing for Health
Paul Pholeros
Director of Healthabitat
Bellagio Residency Presentation
October 2011

2. Preface
Why does improving housing for Indigenous people seem
to be such a long road?
We believed the publication of Housing for Health (1994)
was the proof that housing and health improvement were
possible. It not only described how to do it, but also
revealed how throughout the year long project, the local
Aboriginal people were involved in both the work and the
results.

3. Housing for Health projects, immediate change not policy promises
Why does improving housing for Indigenous people seem
to be such a long road?
We believed the publication of Housing for Health (1994)
was the proof that housing and health improvement were
possible. It not only described how to do it, but also
revealed how throughout the year long project, the local
Aboriginal people were involved in both the work and the
results.
Seventeen years later we’ve developed a robust
methodology for assessing houses and specifying
urgently needed works.

4. Preface
Why does improving housing for Indigenous people seem
to be such a long road?
We believed the publication of Housing for Health (1994)
was the proof that housing and health improvement were
possible. It not only described how to do it, but also
revealed how throughout the year long project, the local
Aboriginal people were involved in both the work and the
results.
Seventeen years later we’ve developed a robust
methodology for assessing houses and specifying
urgently needed works with a safety and health priority to
focus small amounts of money to improve existing
houses.
1985-2011
$7,500 av. per house

5. Preface
Why does improving housing for Indigenous people seem
to be such a long road?
We believed the publication of Housing for Health (1994)
was the proof that housing and health improvement were
possible. It not only described how to do it, but also
revealed how throughout the year long project, the local
Aboriginal people were involved in both the work and the
results.
Seventeen years later we’ve developed a robust
methodology for assessing houses and specifying
urgently needed works with a safety and health priority to
focus small amounts of money to improve existing
houses.
A large, skilled, national team has completed this work,
on over 7,000 houses.

6. Preface
Why does improving housing for Indigenous people seem
to be such a long road?
We believed the publication of Housing for Health (1994)
was the proof that housing and health improvement were
possible. It not only described how to do it, but also
revealed how throughout the year long project, the local
Aboriginal people were involved in both the work and the
results.
Seventeen years later we’ve developed a robust
methodology for assessing houses and specifying
urgently needed works with a safety and health priority to
focus small amounts of money to improve existing
houses.
A large, skilled, national team has completed this work,
on over 7,000 houses. Over 75 percent of this team are
Indigenous people from each local community.

7. Preface
Why does improving housing for Indigenous people seem
to be such a long road?
We believed the publication of Housing for Health (1994)
was the proof that housing and health improvement were
possible. It not only described how to do it, but also
revealed how throughout the year long project, the local
Aboriginal people were involved in both the work and the
results.
Seventeen years later we’ve developed a robust
methodology for assessing houses and specifying
urgently needed works with a safety and health priority to
focus small amounts of money to improve existing
houses.
A large, skilled, national team has completed this work,
on over 7,000 houses. Over 75 percent of this team are
1985-2011
Indigenous people from each local community.
The Housing for Health principles, informed and honed
by data gathered from over 180 projects nationally,

8. Housing and health
Yami
Lester
–
“Stop
people
ge=ng
sick”
1985
Uwankara
Palyanku
Kanyintjaku
1985-2011
0-­‐5
years
mid
teen
years
40
years
of
age
+
Ear
infec*on
Loss
of
hearing
capacity
Loss
of
hearing
capacity
Eye
infec*ons
Eyesight
loss
Eyesight
loss
Respiratory
infec*ons
and
Reduced
lung
capacity
Reduced
lung
capacity
Skin
infec*ons
Annoying
Increased
renal
failure
risk

9. Preface
Why does improving housing for Indigenous people seem
to be such a long road?
We believed the publication of Housing for Health (1994)
was the proof that housing and health improvement were
possible. It not only described how to do it, but also
revealed how throughout the year long project, the local
Aboriginal people were involved in both the work and the
results.
Seventeen years later we’ve developed a robust
methodology for assessing houses and specifying
urgently needed works with a safety and health priority to
focus small amounts of money to improve existing
houses.
A large, skilled, national team has completed this work,
on over 7,000 houses. Over 75 percent of this team are
Indigenous people from each local community.
The Housing for Health principles, informed and honed
by data gathered from over 180 projects nationally, are
described in the National Indigenous Housing Guide (3rd
edition 2007) and have been accepted and adopted by all
Australian governments since 1999.

10. Preface
So why isn’t this a happy
end to the story?

11. the last 25 years
Myths slow progress
“The problem is…
- damage by residents...’they’ destroy
houses”

12. Why is the fix work needed?
Damage? Faulty?
Installed incorrectly,
by the residents poor construction
Routine?
normal wear

13. National Fix work showing reason fix work was required, as reported
by licenced trades (All FHBH and HfH projects).
(All Housing for Health projects)
Damaged: overuse, Faulty: poor initial
misuse, abuse or construction,
vandalism incorrect product
9% or specification
21%
Routine: normal
wear and tear,
routine
maintenance
70%

14. the last 25 years
Myths slow progress
“The problem is………
• damage by residents….
• ‘they’ are hopeless and need our help

15. 2009-2010
931 Indigenous staff
60 trade teams
50 team leaders
17 managers
1 statistician
1 national manager
3 directors

17. the last 25 years
Myths slow progress
“The problem is………
• damage by residents….
• ‘they’ are hopeless and need our help
• change in Aboriginal health or housing is
simply not possible…..”

18. Housing, health and the evidence of consistent policy chaos
2004 = 2,701 houses
2011 = 7,308 houses
+ - - - - ? -

20. Washing people, clothes and bedding, removing waste Shower, Laundry & Toilet block design
Applied Research and
Development projects
Shower,
laundry
and toilet areas

21. Detail matters
50 R&D
Projects
2005-11

22. Reducing trachoma
In 1985 around 95% of
school age children
had active trachoma
By 2000 levels had
dropped to around 50%

23. Reducing trachoma

24. Mid 1980 s = 95%
trachoma
No environment change
With environment
change… trachoma
reduced
PIPALYATJARA EYE HEALTH PROJECT: Results
Reducing trachoma

25. NSW - Housing for Health NT – Strategic Indigenous Housing and
Infrastructure Program (SIHIP)
2,230 houses 200 houses (approx refurbs )
$11,000 per house (average) $75,000 per house
100 houses per year (average in NT over
2 years)
Baseline housing safety and health No agreed baseline housing data and no
function data with defined improvement available measure of defined
improvement
Over 75% of all program staff are local
indigenous people (planning, design, 36% local indigenous “on site”
tools, data, finance) employment (1 project) with the aim of
“20% indigenous employment”
No health measures for key
40% reduction in hospital environment related illnesses, and no
separations for key environmental agreed, defined house function tests
health related illnesses (acute at handover - as surrogate health
respiratory, gut, skin and ear infections) measures.

26. Housing for Health New York City
Paul Pholeros Director of

27. Survey Fix Day 1
Teams walking from the
Brownsville Partnership
office to various
apartments to start work

28. Locations of the 10 apartments for the Housing for Health pilot
The apartments were selected by the Brownsville Partnership and included a wide variety of building types within the area.
This 10 apartment trial was to enable the feasibility and costs to be assessed to improve 4,300 units in this area.

29. we need toilets….
the provision of toilets for 400 people in Bhattedande Village,
Nepal 2007- 2010 and new projects ongoing

30. Stage 1
Toilet design
+
Water ?
+
Gas $
=
Trees x
=
Erosion !
+
Smoke !!!

31. Start building two toilets first……..
Build a local, resilient team

32. Redesign and improve the
hardware

34. Toilet + light = wedding

35. $1800 = 1 toilet, biogas system
and help build a local team
Dispose of human waste safely - 58 toilets – with 28 bio gas and 30 septic
systems, for a village of 400+ people, with a full Nepali team. The work has now
moved to two new villages with the same needs.

36. “…an Australian Aboriginal problem….too hard to solve”
“…poverty is not natural…it is man-made and it can be overcome and eradicated
by the actions of human beings”
Nelson Mandela, University of Sydney, 2005
Expanding…
Housing for
Health

37. Expanding…Housing for Health
www.healthabitat.com
Thanks