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Feature Patient Advocacy

The doctor forcing landlords to act on mouldy homes

BMJ 2023; 380 doi: (Published 30 March 2023) Cite this as: BMJ 2023;380:p698

Linked Opinion

Safer housing for better health

  1. Chris Baraniuk, freelance journalist
  1. Belfast
  1. chrisbaraniuk{at}

The tragic death of 2 year old Awaab Ishak raised questions about the medical community’s role in health problems related to housing. Advocating for patients and information sharing is key—and one doctor is taking that role particularly seriously, finds Chris Baraniuk

Sometimes the mould is visible, in the background, on video call appointments. Or patients show him pictures on their phones of the black splodges blighting their walls. Ian Sinha, a consultant respiratory paediatrician at Alder Hey Hospital in Liverpool, will explain that those splodges are why their child keeps getting sick, why they have that telltale wet cough, for example, that won’t go away. Ultimately, he knows, the mould could kill these children.

The parents attending Sinha’s “clean air clinic” often explain that they’ve made all the lifestyle adjustments they can. But if they ask their landlord or housing association to do something about the mould, they hit a barrier. That’s when Sinha writes one of his letters (box 1)—typically more than a dozen pages in length, they are more like clinical reports that help these parents argue their case. The letters contain detailed evidence of the mould in question, information about how it can harm tenants’ health, and an insistence that it gets sorted quickly.

Box 1

Letters to landlords—a possible structure

The details that Ian Sinha, consultant respiratory paediatrician at Alder Hey Hospital, includes in letters to landlords when he sees a patient affected by mould in the home include:

  • Interval symptoms when well, list of exacerbations or acute episodes, family and social history, immunisation history

  • Assessment of height and weight

  • List of medical investigations, including chest radiology, full blood counts, bronchoscopy results (including cytology), immune work-up, allergies, sweat test

  • Description of issues at home

  • Map of house in relation to main roads and industrial sources of air pollution

  • Local data on air pollution …

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