"Take away the greed of the private landlord housing market … because that is killing people": Examining the political economy of housing and health inequalities in four English coastal towns.

Health inequities are avoidable and unjust differences in health arising from how society and the economy are structured. These inequalities are driven by vertical political and economic systems that prioritise economic growth over wellbeing. Yet, empirical research on health inequalities often focuses horizontally on people, places, and their inter-relationships. This research adopts a vertical lens to examine the structural processes driving geographical inequalities in health, framing housing as an extractive industry that contributes to ill-health and inequality. Drawing on comparative ethnography aross four English coastal towns, Hartlepool, Blackpool, Hastings, and Torbay, where deprivation, health and social inequalities are among the most severe in the country, the research involved 4-6 weeks of immersive fieldwork in each site during 2023. Data collection involved in-depth interviews, walking interviews, and focus groups with 140 people living/working in these towns, supported by participant observation, field notes, documentary analysis, and photography. This paper will focus on participants discussions around housing as a major determinant of poor health and inequalities in their towns. Findings highlight vertical mechanisms such as 'Right-to-Buy legislation, extractive wealth practices of private landlords, substandard housing conditions, financial strain, and housing insecurity in driving physical and mental ill-health. By highlighting the intersection of housing, the political economy, and health inequalities this study demonstrates the importance of 'scaling-up' our analyses to identify vertical processes which undermine horizontal efforts to reduce inequalities in health. Further examination of these dynamics, covering other determinants of health, is necessary to support the development of policies that go beyond mitigating health inequalities but also tackle the vertical structures that sustain them.