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