Although a significant body of work has developed on the relationships between cold, inefficient and damp homes and poor health, no detailed overview has been produced. As major investment and strategic policy on tackling fuel poverty gather pace in the UK, it is essential to have a clear insight into the main themes emerging from this research in order to shape and influence national and local approaches and also to identify future research priorities.
Key research Question
The report is a scoping paper intended to inform the future direction of research around fuel poverty and health. As such, it presents an overview of the existing evidence on the topic in the UK (with reference to one European study), with particular reference to the links between cold homes and poor health. It also considers policy and programmes devised to tackle fuel poverty by health agencies and local authorities to gain a broader understanding of new approaches.
Summary of activity
A review of secondary data including quantitative measurements of fuel poverty (e.g. the 1991 English House Condition Survey).
The report concludes that a significant body of research has accumulated over the previous decade but that important gaps remain. Research findings are categorised into three themes: fuel poverty, cold homes and health, and policy initiatives.
Fuel poverty: Various studies have indicated the factors that contribute to fuel poverty, including low incomes, housing conditions and fuel prices (including a lack of access to cheaper energy). The poor efficiency and insulation of older, in comparison with newer, housing are noted, as is the significant proportion of vulnerable groups, such as older people with ill health, living in the worst-performing homes. The latter may also require extra warmth, as may people with disabilities, families with young children and those without employment. The review found very few fuel poverty studies that focused on other European countries.
Cold homes and health: The levels of excess winter mortality in the UK appear to be disproportionately higher than those in other comparable countries, and this largely occurs among older people and lower social classes. Evidence suggests that exposure to external cold and insufficiently heated and/or damp properties are contributory factors. The rise in central heating use is likely to be behind a decline in excess winter deaths, although establishing exact causal relationships between housing and health is complex.
Policy initiatives: There have been relatively few specific policies on fuel poverty, energy efficiency and health, and limited coordination across government; however, the growth of a ‘New Public Health’ agenda and a new government may offer an opportunity to develop more strategic approaches. Examples of projects occurring at a more local level are listed, and these are driven mainly by local authorities and health organisations, but their extent is largely unknown. Analyses of the cost to the NHS of inferior housing are limited.
The report recommends that comprehensive mapping of local health and housing initiatives would be valuable and the resulting learning should be disseminated, particularly regarding the benefit of capital spend on housing improvement. The development of robust methodologies for estimating the health costs of poor housing is recommended, with the caveat that non-economic costs (and benefits) should also be recognised.
Further research is proposed around three themes to address key gaps in the literature, of which the first theme is fuel poverty. Recommendations include an improved secondary analysis of large datasets such as the English House Condition Survey to understand the complex drivers of fuel poverty, as well as to assess the robustness of their methodology. A comparative analysis of fuel poverty in the UK and elsewhere in Europe should be undertaken, and the resulting learning should be shared. Further work on the theoretical framework of fuel poverty is proposed in order to recognise structural and behavioural factors and the impact of housing improvements.
Under the second theme of cold homes and health, research is suggested on the following topics: variations within the UK, poor housing and mental health, and the potential risk that housing improvements will exacerbate problems such as humidity. It is noted that the Department of Health is conducting research into the health impact of indoor pollutants and it is recommended that research should focus on any gaps in this programme.
The third theme (evaluating initiatives) calls for better evaluation of government schemes such as the Home Energy Efficiency Scheme. A review of projects being delivered at a local level is advocated in order to assess their performance and collate good practice for dissemination.