Better home, better health

Urban regeneration improves not just the homes people live in, says Peter Ambrose, it also improves their health. Its downside, however, is that it makes life costlier, he tells Anne McHardy.

Peter Ambrose is unashamedly political. His findings on the long-term effects of one of the government's key programmes for tackling social deprivation are likely to cause controversy, particularly with a general election on the horizon.

Last year, Ambrose published a report showing a sevenfold improvement in personal health as a result of housing regeneration. But a follow-up report due for publication in late February shows the downside of single regeneration budget redevelopment -some participants were pushed deeper into the poverty-and-benefits trap by increased housing costs.

Ambrose says: "I am not just an academic. I am overtly political. I don't know what the term would be. Radical? Not old Labour. But not new Labour either. I try to carry out my work objectively. But I am not afraid to say what I feel needs to be said. Nobody is objective about this issue. It is shot through with value judgements."

Some 30 years of area-based initiatives to relieve deprivation have "only moved the poverty around", Ambrose says. He would like to see a coherent national redistribution approach using taxation and more investment in jobs and key mainstream programmes. This would be delivered according to an overall strategy, rather than the present piecemeal approach.

Ambrose's research on the regeneration of the Ocean and the Limehouse estates in Stepney, areas housing predominantly Bengali families, was commissioned by the London borough of Tower Hamlets. The estates have some of the worst deprivation in the United Kingdom. Ambrose's task was to assess the health effects of redevelopment.

He broadened the remit to look at the effects on the rest of the borough and on other budgets, such as that of the National Health Service. He says surrounding areas appear to gain no positive benefits and can, in some ways, seem worse off.

As a 67-year-old visiting professor at Brighton University, Ambrose has no fear of being outspoken. "Nobody can sack me. Nobody can lean on me. Not that they ever did much. But nobody can now. I think the arguments against area-based regeneration initiatives go back years to (Peter Townsend's ground-breaking reports on poverty in the UK) and beyond.

"Poverty is a difficult issue. Some people say there is no poverty any more - but there is no objective standard. There are people who describe themselves as 'poor', who have state-of-the-art televisions. In Stepney, poverty might mean being unable to afford a flight to Bangladesh to arrange a family marriage. But because their society depends on that marriage, poverty is real.

"On the right you would say it is 'lifestyle'. On the left, I am not sure what you would say - but in my view, deprivation has got to do with horizons and aspirations. It is a personal view."

Having spent decades looking at urban deprivation, Ambrose, who co-founded the urban studies degree at Sussex University with Peter Dickens, is clear that decent housing is essential.

Last year's report, A Drop in the Ocean , showed that regeneration could deliver health gains, greater feelings of security and fewer concerns about crime. It was the first report to quantify health change from an area's redevelopment. The findings confirmed previous research, comparing white residents on a redeveloped estate in Paddington, west London, with Stepney, before redevelopment.

The report showed that, before rehousing, Stepney residents felt ill, on average, one day in three. After rehousing, they felt ill just a day and a half each month. That has a phenomenal effect on adults' ability to work and on children's to attend school, Ambrose says.

He and his team were amazed. "We were expecting a gain, but we were staggered that it came up sevenfold. The health gain is good for the people, and it clearly saves money for the NHS - although it will be a big task to put a figure on that."

On Ocean and Limehouse, 525 people were interviewed over four months in the winter of 1995-96, before the redevelopment; then 2 of them in the winter of 1999-2000, a year after moving into new housing. The drop in numbers reflects a range of factors, such as people moving out of the area.

Ambrose and research officer Dee MacDonald say, however, that the health gain was partly offset by the effects of increased household costs, such as higher rents and council tax charges, and higher, metered, water charges.

It was a roundabout route that landed Ambrose in the field of urban studies. Brought up in Peckham, London, by " nouveau riche " parents, he left school to work in the City, for the Bank of New Zealand, and did national service in the Royal Air Force before winning a place at King's College, London, to read geography.

At King's Ambrose just missed a first, but he was awarded a Commonwealth scholarship for an MA at McGill University in Montreal. He was about to embark on his PhD when he was offered a junior lectureship by the newly founded Sussex University. He accepted and stayed until 1998, teaching geography, urban studies and, later, social policy.

Sussex encouraged the development of courses outside the majors. "It was a wonderful place to spread across disciplines," he says. But the university did not give him a chair. When he reached retirement, Sussex offered him an honorary visiting readership - but Brighton University offered him a visiting professorship.

The end of the cold war led indirectly to his present work. The Foreign Office "Know How" fund provided money to help former Soviet bloc countries adjust to market conditions. Ambrose was asked to form a team of housing experts to advise the Bulgarian government on housing.

"We beavered away for two years. In my team were Ken Bartlett and Stephen Hill." Bartlett is one of Britain's most experienced housing experts, and Hill is a respected regeneration specialist. On the way home from Bulgaria, they concluded that the UK's housing was due for an examination.

"We decided we should do a study in the UK to focus attention on the costs to the economy generated by all this dreadful housing. We started to look at the interactions between bad housing, bad health, disaffected kids at school, a high incidence of crime and low self-esteem - and what all that costs."

It is a complex topic, but it is also one that needs open debate, Ambrose says. He has influential platforms, such as the King's Fund, which ran a seminar in November to launch A Drop in the Ocean , and he hopes to keep the issue on the public agenda for some time to come - health permitting. "I am keeping my fingers crossed," he says.