Objectivesin light of the acknowledged relationship between housing circumstances and health outcomes, the research explored the implications of the diversifying role of housing associations, considering the extent and form of engagement with the health sector and the potential repercussions for inequalities.Study designthe research was based on a single case study of the Manchester city-region, chosen to provide a way of considering the role of recently agreed devolved governance and funding arrangements in respect of housing and health.Methodsprimary qualitative data were assembled via a programme of semi-structured interviews with housing and health policy actors and direct observation of six quarterly meetings of a housing-health steering group established as part of new devolved governance arrangements.Resultsthe findings reveal a perception among housing managers that the reorientation of housing association services to offset the rationalisation of mainstream provision risks exacerbating inequalities. Interview and observational data suggest that the diversification of housing association activity may have begun to erode the sector's ability and willingness to provide affordable housing on a universal basis to those in need.ConclusionsThe growing non-landlord functions of some housing associations can act as a deterrent to the allocation of housing to applicants with complex (and expensive) needs. This reinforces the increased selectivity in housing association stock allocations, linked to marketization and the increasingly commercial outlook of some providers. Further inequalities may be engendered because while tenants can benefit from the extended housing associations services, others continue to depend on a weakened statutory sector.