Fuel PovertyImpacts on Human Health

A Cross-Sectoral Approach

Christine Liddell

2010-2012 Update

• Excess winter deaths

• Physical health impacts

• Mental wellbeing

• New road maps in England

Excess Winter Deaths Update

Notes of caution

Excess Winter Deaths in NIRegistrar General

Annual Report2010

Excess winter deaths NI: Last 37 years

Source: Morris & Liddell 2011

No significant trend over time

Region-wide EWD’s 2000 to 2008

Source: Morris & Liddell 2011

Excess winter deaths are volatile because they have many causes

• Outdoor Temperatures are colder

• Indoor Temperatures are colder

• Air Quality is poorer

• Influenza is primarily a winter illness

How important is indoor temperature?

1987 & 2007

Keatinge (2000) 50%

Rudge (2011) 30%

40% of all EWD’s

No one knows for sure

Contributors to EWD (Rudge, 2011)

Implications

FP is responsible for only some EWD’s

Average in last decade @ 30% of all EWD’s

417 deaths p.a. 189 deaths p.a.Ireland Northern Ireland

Across 11 EU countries 38,203 deaths p.a.

attributable to cold homesSource: Rudge 2011

Which cause of EWD is the most preventable?

• Cold outdoor temperatures

• Poor Air Quality

• Influenza

• Indoor Temperatures

Physical Health Impacts

More are emerging

Hospital Admissions: New Zealand

Strong age effect

0- 4 years and 60+ years

Source: Telfar Barnard 2010

Out of hospital: European cities

New illnesses associated with FP

Stress-related • Gastric and duodenal ulcers

• Migraines

Source: Ormandy & Ezratty 2012

Health impacts of FP compared with other environmental risks

2011

Studies with a cast of millions

Medical symptom (MS) Home Hazard % of MS attributable to hazard

Not FP-related Wheezing Formaldehyde < 1%

Tuberculosis Indoor crowding 5%

Lung cancer deaths Radon 2-12%

Cardio/Resp. disease Passive smoking 1-23%

Medical symptom (MS) Home Hazard % of MS attributable to hazard

Not FP-related Wheezing Formaldehyde < 1%

Tuberculosis Indoor crowding 5%

Lung cancer deaths Radon 2-12%

Cardio/Resp. disease Passive smoking 1-23%

FP-related Lung disease deaths/disability Solid fuel exposure 0-15%

Child asthma deaths/disability Mould 12%

Child asthma deaths/disability Damp 15%

Excess winter deaths Low indoor temp. 30%

Mental Health Impacts

Keep the customer satisfied

Warm Front National EvaluationMeasure Effect

on mental health?

Dose-response?

Insulation installed?Heating+insulation installed?Draught-proofing installed?Less condensation?Warmer home?Happier with home?Coping with fuel bill?

Source: Grimsley et al. 2012

Warm Front: The FindingsMeasure Effect

on mental health?

Dose-response?

Insulation installed?Heating+insulation installed?Draught-proofing installed?Less condensation?Warmer home?Happier with homeCoping with fuel bill

Source: Grimsley et al. 2012

Warm Front National EvaluationMeasure Effect Dose-

response?Insulation installedHeating and insulation installedDraught-proofing installedLess condensationWarmer homeHappy with homeCoping with fuel bill

Not what is done

but how

improvements make

people feel

FP: The Coping Hierarchy1. Reduce bills for non-essentials2. Reduce bills for food3. Reduce bills for heat and light4. Borrow from friends/relatives5. Start using savings6. Sell valuable items 7. Go into debt8. Borrow from loan agencies

Source: Anderson et al. 2012

FP: The Coping Hierarchy1. Reduce bills for non-essentials2. Reduce bills for food3. Reduce bills for heat and light4. Borrow from friends/relatives5. Start using savings6. Sell valuable items 7. Go into debt8. Borrow from loan agencies

Source: Anderson et al. 2012

“Heat or Eat”

is optimistic

New road maps

Possibly time for a small cupcake

Public Health departments

Statutory duty to protect us from preventable illness and death

•Air pollution•Contaminated water

•Harmful additives in food•Serious communicable diseases

England:January 23rd 2012

Indicators for theWider Determinants of

Health

19 Indicators for Wider Determinants of Health

Child poverty Homelessness

Road accidents Youth criminal justice

Fuel poverty

New road maps

Reframing the status of Fuel Poverty.

Designated public health risk

With Indicator status

Fixing it in the English Housing Stock€20B

Who should pay?

€20B with a 15 year lifespan Returns from improvements to health

Retrofitting English Housing Stock

Returns from health improvements€ 660M per annum

Pays for itself in 30 years

Upgrading the housing stockALL society benefits

Retrofitting English Housing Stock€ 20B

Returns from all impacts on society€ 1.7B per annum

Retrofitting pays for itself in 12 years

Who should contribute?Cross-sectoral beneficiaries

€ 20B spend benefits private sector

•Referral and Advisory teams•Surveyors

•Manufacturers•Installers

•Inspection teams•Clerical agencies

•Auditors

?

Who should contribute?Cross-sectoral beneficiaries

€20B spend benefits public sector

• Housing • Health

•Social Welfare• Employment

• Training & Education• Trade

• Environment

?

Who owes money?Cross-sectoral beneficiaries

€20B spend benefits public sector

• Housing • Health

•Social Welfare• Employment

• Training and Education• Trade

• Environment

Trade

Tackling FP

Housing

HealthEmployment

Training/Ed

Environment

Social Welfare

Private Sector

Thanks for listening