Housing, Energy & Health
12 January 2012
Service des Etudes Médicales
Fuel Poverty
• The current UK definition ~
Where a household needs to spend more than 10%
of its income on energy to maintain reasonable
indoor temperatures (DECC)
• Questions ~
1. Although useful, can this definition apply
everywhere?
2. What are ‘reasonable indoor temperatures’?
‘Fuel poverty’ definition and Eastern
European countries
WHO LARES project
(2002-2003)
• 8 European cities
• 3,382 dwellings
• 8,519 individuals
Income
%age spent
on heating
>20 %
Cities
Vilnius
Budapest
Bratislava
Genève
Bonn
Angers
Forli
Ferreira
46%
26%
21%
1%
1%
4%
2%
1%
What are ‘reasonable temperatures?’
• WHO Recommendation ~
 ‘No demonstrable risk to health of healthy
sedentary people living in air temperatures between
18oC and 24oC’ (WHO-EURO, 1987)
• Thermal Comfort ~
– covered by WHO definition of Health ~ ‘A
A state of
complete physical, social and mental well-being and
not merely the absence of disease or infirmity’
– depends on: air temperature, radiant temp., relative
humidity, air velocity, clothing, level of activity
– its assessment is linked to surveys’ methodology (eg,
measurements and/or nature of questions)
WHO LARES study
‘Is there a problem with temperature in your dwelling
during winter, transient seasons or summer?
If yes, do you feel too cold, too hot or both?’
Problem with
temperature
Vilnius
Transient season
55%
33%
16%
50%
Of these, %age feeling
too cold
90%
69%
63%
20%
During winter
60%
32%
28%
75%
Of these, %age feeling
too cold
92%
76%
85%
98%
Bratislava Budapest
Ferreira
Causes of Fuel Poverty
are often combined and include ~
• Energy inefficient dwellings
• Cost of energy
• Social and/or economic factors
Service des Etudes Médicales
Some options for coping with Fuel
Poverty ~
• Decrease energy consumption by using
less energy than really needed for
heating, cooking, lighting, etc.
• Use other means for heating, cooking
and lighting
…with different consequences
Direct ~
– Insufficient appropriate energy for heating (air and
water), lighting, food storage (refrigeration) and
cooking
Indirect ~
– Inappropriate forms of ~
• heating (flueless gas or oil heaters)
• lighting (candles, oil lamps)
– Inadequate or no ventilation (blocking ventilators…)
– No hot water
– Food spoilage and contamination
– Low quality meals (avoiding cooking…)
…and effects on health and safety
• Low indoor temperature
• Respiratory and cardiovascular diseases
• Poor mental health, low self esteem, and social isolation
• Poor indoor air quality
• Dampness, mould growth
– Asthma and allergies
• CO poisoning (acute and chronic)
• Fire (and burn injuries)
• Accidental injury (falls, collisions…)
• Poor personal and domestic hygiene
• Food poisoning
• Unbalanced diet (poor nutrition/obesity)
…and effects on health and safety
• Low indoor temperature
• Respiratory and cardiovascular diseases
• Poor mental health, low self esteem, and social isolation
• Poor indoor air quality
• Dampness, mould growth
– Asthma and allergies
• CO poisoning (acute and chronic)
• Fire (and burn injuries)
• Accidental injury (falls, collisions…)
• Poor personal and domestic hygiene
• Food poisoning
• Unbalanced diet (poor nutrition/obesity)
Health effects of low indoor temperatures
24 ºC
21 ºC
18 ºC
16 ºC
12 ºC
6 ºC
Comfortable and healthy
Possible discomfort. No risk except
for the vulnerable (eg, elderly)
Uncomfortable. Risk of respiratory
conditions, and to mental health
Cardiovascular risk
Beyond 2 hours, risk of
hypothermia
Situation in England
• Estimated 4 million households in Fuel
Poverty in 2009 (DECC)
• Estimated that 2,700 excess winter deaths
related to Fuel Poverty ~ more than the
number of transport related deaths
(CASE Report 69)
These negative health outcomes result in ~
• Suffering for the individual and household
• Loss to the individual, and household ~
• Working days lost
• School days lost (under-achievement)
• Cost to society, including ~
• Increased demand on the health sector
Health Costs of Cold Homes
In England, it has been possible to ~
• Identify the number of Cold Homes
(energy inefficient dwellings)
and
• Using health outcomes associated with
fuel poverty calculate the cost to the health sector
This has been possible because ~
• English House Condition Survey (EHCS)
– A sample survey, providing data on the state and
condition of English housing, including energy efficiency
• Housing Health & Safety Rating System
(HHSRS)
– A risk based approach to assessing housing conditions
– Now used in the EHCS to assess housing conditions
The HHSRS ~
Introduced in 2006, it ~
shifts the assessment from dwelling defects
to
the potential threats to health and/or safety
attributable to any defects
The HHSRS identifies potential housing hazards,
including Excess Cold (ie, Cold Homes)
Cost of Cold Homes
Two figures necessary ~
1. Number of energy inefficient dwellings the number of dwellings given in the EHCS
where hazard of Excess Cold assessed as
unacceptable
2. Cost of diagnosing and treating health
outcomes associated with fuel poverty available on the UK National Health Service
web-site
Cost of Cold Homes
Health costs limited to the outcomes from
Excess Cold given for the HHSRS
Note ~ these do not include – All possible indirect outcomes
– Death (because of the widely conflicting values
given for death)
Cost of Cold Homes
• The health outcomes attributable to energy
inefficient housing in England are estimated to
cost the health sector
£750 million every year
• This annual cost to the health sector should be
compared with the one-off (single) cost of
improving energy inefficient housing
Nicol et al (2010) Quantifying
Cost of Poor Housing, BRE
Policies and Programmes
The EHCS data is used ~
• By central government to inform and
monitor its policies and priorities,
nationally and regionally
• By local authorities to inform and monitor
their programmes
This health cost data shows the cost
benefits of energy efficiency measures
Perspectives
• Currently, the HHSRS is unique as a national
housing assessment tool, however it ~
– was used to inform the development of the New
Zealand Healthy Housing Index
– is being developed as an assessment tool by the US
Department for Housing and Urban Development
– is central to a proposed project for developing a
European Housing Injury Prevention System
Linking the health and housing sectors
Several initiatives ~
• Where patient suffering from asthma (or other
condition associated with fuel poverty) referral
made for housing survey
– Conseiller Médical en Environnement Intérieur CMEI
(France) : Health advisor in indoor environment (‘free’
visit prescribed by MD)
– Green ambulances (eg, Brussels)
• Proposed intervention study to investigate both
underlying cause(s), and effect of energy
efficiency measures on indoor air quality
Mechanisms to tackle the problem
Two options ~
1. Short term ~ subsidies/social tariffs to
help those unable to meet the cost of
energy needed to maintain thermal
comfort
2. Long term ~ improve energy efficiency of
dwellings
Housing, Energy and
Thermal Comfort, WHO
(2006)
Conclusions and Perspectives
Improving energy inefficient dwellings ~
• Improves the social, physical and mental
health and well-being of households, and so
• Reduces demands on the health sector,
which means
• A reduction in the annual cost to society
Definition of Fuel Poverty
• Current UK definition ~
Where a household needs to spend more than
10% of its income on energy to maintain
reasonable indoor temperatures (DECC)
• Hills Fuel Poverty Review~
Includes a review of six possible alternative
definitions of Fuel Poverty (CASE Report 69)
Hills ~ Alternative Definitions
Include ~
Current UK definition, but after housing costs
Residual Income, households below the poverty
line after required fuel spending
Number of households in poverty and living in an
energy inefficient dwelling
Work in progress
• Energy Precariousness ~
When an adequate supply of clean energy for
space and water heating, for cooling, lighting,
food storage and cooking of food necessary to
protect the health and safety of the occupants is
not guaranteed or certain