Health Effects of Energy Efficiency measures and Ambient Temperature (HEEEAT)

The UK has more ill health and extra deaths in winter than colder European countries do. Cold kills 18,000 to 30,000 people each year in the UK. Two and a half million UK households have trouble heating their homes and have 'fuel poverty'. Excessively hot temperatures are also detrimental to health. With global climate change, excess deaths in heatwaves are expected to increase. This particularly affects people who are poor, older, or have poor health.

Various government policies have tried to make people's homes easier to heat. 'Energy efficiency' improvements include loft and wall insulation, new heating systems, stopping draughts, and double-glazing. Financial support includes cash payments and rebates to vulnerable households to reduce the costs of heating.

Our study will examine the effects of these housing energy policies on changing energy use, indoor temperatures, and health of older people. For example, what types of interventions (energy efficiency improvements and/or financial) are most effective at improving indoor temperatures? Do they benefit low-income households enough? Do people respond by improving the indoor temperature or by spending less on heating, releasing funds for food or other needs? Does people's age or how poor/wealthy they are affect that? Are improved indoor temperatures associated with longer lives or fewer hospital admissions? Have policies reduced inequalities in health between poorer and richer families, or older people of different ages? We will also use our study to look at the recommended indoor temperatures for health for the general population and for people at greater risk.

We will use data from the English Longitudinal Study of Ageing (ELSA) in two ways. First, we are linking ELSA data (including indoor temperature) with information on what energy efficiency improvements have been undertaken in participants' homes and with the outdoor temperature. Our study will analyse the effects of the different home energy measures by looking at people's spending on heating their home and the actual indoor temperature. Secondly, we will use ELSA data linked to hospital and mortality records. We will look at the effects of indoor temperature on later health. We will examine sub-groups of people at different stages of their life or at higher risk of disease. No individual will be identifiable in the linked datasets. We have approval from an NHS Research Ethics Committee for this study.

Results of our study will help national and local governments and other organisations decide which policies and measures work best to reduce people's spending on energy and exposure to cold homes, and how this affects health, wellbeing and quality of life.

Who will benefit?
Understanding the co-effects of physical and financial housing energy policy intervention in England on fuel expenditure, indoor temperature, and the health of older household occupants is relevant to a wide range of users. Results of our study will help national and local government policy-makers and practitioners, policy bodies and government agencies, NGOs and professional organisations decide which policies and measures work best to reduce people's spending on energy and exposure to cold homes, and how this affects health, wellbeing and quality of life.
Nationally, the UK Government will benefit, in particular the Department of Business, Energy and Industrial Strategy (BEIS) and the Ministry of Housing, Communities & Local Government (MCLG). The applicants have close working contacts with the BEIS Fuel Poverty Team who have commissioned several studies into modelling the health impact of energy efficiency measures. For the first time, our study will provide detailed information based on 11,391 individuals' health and indoor temperature reading to ascertain the actual impacts of energy performance, fuel use, fuel expenditure, and indoor temperature and of different fuel poverty strategies, including payments and different energy efficiency retrofits. BEIS is an active stakeholder of the project and member of the Advisory Board. More broadly, the general population in England, particularly those in or at risk of fuel poverty, older people and those in poor health, will benefit in the shorter term from evidence about the relative efficacy of different energy efficiency strategies. Our proposed user impact plan ensures findings will be disseminated to many users in the UK and internationally, as it is likely to be informative to other developed countries with excess winter deaths.

How will they benefit?
BEIS have emphasised the importance of specific co-effects (temperature and health) in policy development. In the Clean Growth Strategy BEIS highlighted how energy efficiency initiatives include the objective to support health and wellbeing. The results of the linked-data analysis will contribute directly to government policymaking and targeting of energy efficiency retrofits and understanding of how older people use winter fuel payments. Within government, the research will contribute to policy planning and evaluation within the BEIS Fuel Poverty programme and the Home and Local Energy Analysis team, providing evidence on what impact retrofits have on energy, temperature and health for households vulnerable to fuel poverty (low-income, elderly). The research will also support guidance from organisations such as Public Health England (PHE) on indoor wintertime temperatures for vulnerable households and the broader population.
Health and social care systems will benefit if these interventions reduce exacerbations of disease by cold weather, thereby reducing a major contributory factor to NHS winter pressures.
Local government will have better evidence on which to base their interventions and to prioritise their limited funding towards more effective interventions in homes of population groups with greater potential for benefit and to reduce inequalities in thermal comfort and its health consequences.
The general population will benefit from increased evidence supporting local and national interventions to improve affordable thermal comfort through energy efficiency interventions and financial support. In the longer term, tax-payers could benefit from reduced expenditure on ineffective programmes and the general public will benefit from wider understanding of home energy efficiency that could result in less fossil fuel use and lower greenhouse gas emissions, reducing the adverse impacts of climate change.
Researchers will benefit from the increased knowledge our study generates, to fill gaps in the evidence, and from extending our work later.