Fuel Poverty (Target, Definition and Strategy) (Scotland) Bill and Fuel Poverty Strategy: health impact assessment

Health Impact Assessment on the policy development of the Fuel Poverty (Target, Definition and Strategy) (Scotland) Bill and Fuel Poverty Strategy.

9. Effects on health and wellbeing of energy efficiency interventions

The relationship between housing quality and health outcomes is a complex one, and poor housing conditions often co-exist with other socioeconomic circumstances which are independently associated with poor health. Nonetheless, there is some evidence to suggest that making housing warm, dry and energy efficient can have a beneficial effect on people's health and wellbeing, especially for those most at risk to the adverse impacts of cold and damp homes. It should be noted however, that there is also some evidence that highlights the negative impacts of improvements to the energy efficiency of housing.

Mental Wellbeing

Living in cold and damp housing contributes to a variety of different mental health stressors, including persistent worry about debt and affordability, thermal discomfort, and worry about the consequences of cold and damp for health.

Improvements to energy efficiency are often associated with improvements in mental well-being and the impacts affect both physical and mental health.

Some studies ( e.g. of Warm Front) find that the effects are more prominent on mental health than physical health.

In their review of evidence on fuel poverty and health, Liddell & Morris (2010) find that mental health effects on adults emerge as significant in most studies. Mental health outcomes relate to the experience of anxiety, depression and stress.

Reductions in chronic stress, anxiety and depression have been attributed to reduced perceived financial strain and reduction in self-reported difficulty in paying fuel bills ( e.g. Warm Front). However, in other studies participants reported anxiety or worry about increased fuel bills (for those who previously did not have a functioning heating system) or about the fuel bills themselves i.e. not understanding the bills (Curl & Kearns, 2016).

Green G and Gilbertson J. (2008) Warm Front, Better Health: Health impact evaluation of the Warm Front scheme. Sheffield: Sheffield Hallam University.

Liddell, C., & Morris, C. (2010). Fuel poverty and human health: A review of recent evidence. Energy Policy.

Curl, A., & Kearns, A. (2016). Housing improvements, fuel payment difficulties and mental health in deprived communities. International Journal of Housing Policy.

Wellbeing and psychosocial outcomes

Wellbeing outcomes are understood to be intermediary in that they provide a pathway for improved mental health (Grey et al, 2017; Willand et al, 2015).

  • Increased satisfaction with home
  • Reduced social isolation and enhanced social status (increased satisfaction with home means occupant more likely to socialise in the home)
  • Reduced spatial shrink (using more rooms in the home due to increased warmth/comfort)
  • Increased subjective wellbeing (likely to be linked to above outcomes)
  • Reduced work/school absence due to illness

Physical health

Reported benefits include:

  • Better mobility and activity, related to arthritis/rheumatism relief
  • Fewer colds/flu
  • Reduction in wheezing
  • Increased life expectancy
  • Higher weight - under 3 year olds in low income households

Physical health benefits are likely to result from an improvement in housing condition i.e. greater thermal comfort, reduced dampness and mould, lowered relative humidity, better ventilation.

There is however, also a risk for individuals living in low energy buildings of adverse health impacts from overheating, due to a combination of poor design, effective heat retention and occupant behaviour (Aether, 2017).

Aether (2017). Evidence Review of the Potential Wider Impacts of Climate Change Mitigation Options: Built Environment Sector. Report to the Scottish Government.

In addition, air quality is a key health issue affecting people, homes and energy efficiency. While improvements in energy efficiency can lead to improvements in health outcomes, particularly for older people and those with respiratory and other chronic diseases, there is the potential for unintended consequences adversely affecting air quality in a home.

In February 2004, the Global Initiative for Asthma ( GINA) 5 reported that 18.4% of Scots suffer from asthma. This compares with 15.3% in England, 10.9% in the United States, 6% in Belgium, 4.5% in Italy and 2.3% in Switzerland. Over the past 25 years, the incidence of asthma episodes has increased by a factor of three to four in adults and six in children. Although allergic disease is on the increase across the developed world, what factors are unique to Scotland and the UK that can be identified as key causal mechanisms driving these differentials?

This could be due to a number of factors however poor ventilation can lead to poor indoor air quality, and in some cases problems can be exacerbated by:

  • modern design ( e.g. more airtightness; reduced air movement due to fire doors; chemical components in modern construction);
  • insulation (by increasing air-tightness or creating cold spots); and
  • the behaviour of occupiers ( e.g. closing vents to reduce heat loss, closing windows due to security concerns, low recognition of health impacts of air quality).

However, a draughty home is not necessarily a well-ventilated home and may be harder to heat and have higher carbon emissions.

The study of the Welsh Government NEST intervention targeted at those in fuel poverty found that compared to the control group, for those for whom a respiratory event was recorded in the winter prior to the intervention, there was a statistically significant decrease (3.9%) in the average number of respiratory GP Events in the winter after the intervention. Asthma GP events also decreased (6.5%). Other findings e.g. in relation to infections and emergency hospital admissions were inconclusive (Welsh Government, 2017).

A study of the 'Heatfest' intervention in the Easterhouse area of Glasgow to supply measures (insulation, double glazing, central heating) to flats experiencing significant problems with cold, damp and mould found that statistically significant falls in systolic and diastolic blood pressure were identified for the intervention versus control group, with self-reported general health improvements, reduced heating costs, medication use and hospital admissions.

Lloyd E, McCormack C, McKeever M and Syme M. The effect of improving the thermal quality of cold housing on blood pressure and general health: a research note. Journal of Epidemiology and Community Health. 2008;62:793-797.

A subsequent randomised controlled trial of mainly elderly COPD patients in Aberdeen found that many study participants would not take up energy efficiency measures (insulation, central heating) when offered amid concerns about costs, loans and disruption. However, significant respiratory health improvements were identified for recipients of the intervention outwith original randomisation although this was thought not to be associated with increased indoor warmth but with psychosocial benefits from reduced fuel costs impacting on health.

Osman L M, Ayres J G, Garden C, Reglitz K, Lyon J and Douglas J G. A randomised trial of home energy efficiency improvement in the homes of elderly COPD patients. Eur Respir J. 2010;35(2):303-9.

Home Energy Efficiency Programmes: Area Based Schemes Wall Insulation Evaluation, South and East Ayrshire – Retrospective Report June 2017

The purpose of this evaluation project was to evaluate the impacts of external and internal wall insulation upgrades in relation to improvements in energy efficiency, the health of occupants and any other significant benefits. There was some anecdotal evidence of improved health outcomes in relation to respiratory conditions, mobility issues and mental wellbeing.


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