Fuel poverty poses a distinct societal and healthcare burden. Official fuel poverty statistics show that around 11% of households in England are affected. These health and housing inequalities persist despite the knowledge that cold homes increase the risk of damp- and cold-related morbidity and mortality. This has been articulated in a number of landmark publications such as the 1980 Black Report, the 1998 Acheson Report and the 2010 Marmot Report, which called for improved household energy efficiency across the social gradient. Well-designed home energy efficiency improvements (e.g.

A range of factors (e.g. rising house prices) are leading to a rapid growth in the number of households living in privately rented properties. Previous research has highlighted the disproportionate share of inferior-quality and older housing, as well as the concentration of low-income households, in this sector. As a result, energy efficiency levels are often poor.

Previous research has pointed to a strong link between living in fuel poverty and a range of health problems including respiratory issues and mental illness, as well as other negative social outcomes. Given that a significant proportion of households living in fuel poverty are families with children, maximising the take-up of financial assistance and other forms of support such as advice and guidance available to families is vital.

Households on low incomes are known to be vulnerable to fuel poverty. People with disabilities are often excluded from the labour market and reliant on welfare benefits, which places them at an increased risk of being fuel poor. Measures to alleviate fuel poverty, including advice and guidance on energy efficiency, are widely promoted, but the reach of these programmes among home occupants with disabilities is not known. People with learning disabilities often face extra barriers to accessing such resources.

Although solid wall insulation (SWI) is known to have a positive impact on domestic energy efficiency, its installation is technically demanding and, in practice, disruptive to residents. The introduction of the national ‘Green Deal’ and Energy Company Obligation schemes from 2012 brought significant emphasis on the installation of energy efficiency measures in domestic properties, particularly where the household was at risk of fuel poverty or the building was eligible for improvement.

To date, government initiatives aimed at tackling rising levels of fuel poverty have largely focused on managing household demand by reducing consumption through improving the energy performance of domestic properties (e.g. grants for insulation) or offsetting costs (e.g. Winter Fuel Payments). Less attention has been paid to how household power generation can play a part in addressing the issue.

Earlier research by Thrive, an initiative of Church Action on Poverty working in the borough of Stockton-on-Tees, carrying out action research and developing solutions to poverty and exclusion, indicated that financial exclusion and debt posed serious challenges for a segment of the population living in deprived neighbourhoods. Despite the presence of advice and support agencies in the area (e.g. Citizens Advice, credit unions, etc.), these households were not being reached. Research also suggested limitations and gaps in the current provision.

Over the first decade of this century, the issue of fuel poverty has gained increasing prominence, and central government has established dedicated initiatives focused on delivering warmer homes. There is evidence that living in a cold property has serious consequences for both an individual’s wellbeing and the resulting demand placed on health and social care services.

Despite considerable work around the take-up of fuel poverty alleviation programmes, prior to this project work had generally focused on or drawn upon evidence from frontline managers and other stakeholders. In comparison, research drawing on the insights of end users had been minimal.  

The Warm Front programme was introduced in 2000 as the central plank in the UK Government’s policy to tackle fuel poverty through practical measures to increase energy efficiency in domestic housing. However, rural and urban homes may present different challenges for such schemes owing to dissimilarities in property type, household demographics and access to energy supplies.

The introduction of legal requirements and regulations associated with Decent Homes, fuel poverty, Warm Homes and energy conservation has created a clear demand for effective ways to measure the energy efficiency of domestic properties. Since the 1990s, the Standard Assessment Procedure (SAP) has offered a way to estimate the energy performance of a property.

It is widely accepted that tackling fuel poverty is likely to have positive health benefits for households that receive practical interventions to make their homes warmer or more energy-efficient. In mapping the exact nature of that association, it is important to understand in detail the drivers and how such benefits are manifested. Being able to observe a process from start to finish offers valuable opportunities to catalogue the relationship and inform future policy, practice and research.

A significant proportion of housing research seeks to influence government policy on health inequalities. While previous studies have suggested there is a link between substandard housing and health deficiencies, identifying causality among a range of other contributory factors is often challenging.

Cold homes are believed to be a significant factor in excess winter deaths recorded in the UK, and low internal and/or external temperatures are associated with ill health, but it has often been a challenge to demonstrate a causal link because of the complex variables involved and the prohibitive expense of dedicated research. It is often assumed that low-income households are at a high risk in this respect, being less able to afford to heat their homes or pay for improvements and more likely to live in properties in poor repair.

Evidence from the National Association of Citizens Advice Bureaux (NACAB) suggested that fuel poverty was a major issue among their clients, many of whom struggled with multiple debts. There was an assumption that not only did fuel costs form a significant proportion of the overall sums owed among clients in debt, they were also a driver of debt in other areas. Furthermore, there appeared to be an association between fuel poverty and problems in other areas such as health.  

There are approximately a million visually impaired people in the UK, but preliminary research suggests that their energy advice needs have been entirely overlooked. While some information resources could be requested in accessible formats (such as large print), these options were not produced as standard and only related to a proportion of the full range of material. As a result, a significant subsection of the population may have been missing out on energy efficiency opportunities, reducing the potential impact of programmes.

It has long been known that there is a strong relationship between poor housing conditions and poor health outcomes. Householders in fuel poverty are more likely to be living in cold, draughty and/or damp homes, which are physically harder to heat and have unsatisfactory heating systems.

Chronic obstructive pulmonary disease (COPD) is a significant cause of ill health, hospitalisation and death in England and Wales. It is known that damp conditions in housing aggravate the symptoms of asthma sufferers owing to a greater volume of inhaled airborne allergens, but while the pathology of COPD is also largely concerned with disrupted lung function, it has a number of different underlying traits. It is known that the symptoms are worse the lower external and internal temperatures become.