Fuel Poverty Impacts on Human Health A Cross-Sectoral Approach Christine Liddell

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 NI Registrar General Annual Report 2010

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 30% of all EWD’s 417 deaths p.a. 189 deaths p.a. IrelandNorthern Ireland Across 11 EU countries 38,203 deaths p.a. attributable to cold homes Source: 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 WheezingFormaldehyde< 1% TuberculosisIndoor crowding5% Lung cancer deathsRadon2-12% Cardio/Resp. diseasePassive smoking1-23%

Medical symptom (MS)Home Hazard% of MS attributable to hazard Not FP-related WheezingFormaldehyde< 1% TuberculosisIndoor crowding5% Lung cancer deathsRadon2-12% Cardio/Resp. diseasePassive smoking1-23% FP-related Lung disease deaths/disabilitySolid fuel exposure0-15% Child asthma deaths/disabilityMould12% Child asthma deaths/disabilityDamp15% Excess winter deathsLow indoor temp.30%

Mental Health Impacts Keep the customer satisfied

Warm Front National Evaluation MeasureEffect 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 Findings MeasureEffect 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 National Evaluation MeasureEffectDose- response? Insulation installed Heating and insulation installed Draught-proofing installed Less condensation Warmer home Happy with home Coping with fuel bill Not what is done but how improvements make people feel

FP: The Coping Hierarchy 1. Reduce bills for non-essentials 2. Reduce bills for food 3. Reduce bills for heat and light 4. Borrow from friends/relatives 5. Start using savings 6. Sell valuable items 7. Go into debt 8. Borrow from loan agencies Source: Anderson et al. 2012

FP: The Coping Hierarchy 1. Reduce bills for non-essentials 2. Reduce bills for food 3. Reduce bills for heat and light 4. Borrow from friends/relatives 5. Start using savings 6. Sell valuable items 7. Go into debt 8. Borrow from loan agencies Source: Anderson et al “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 23 rd 2012 Indicators for the Wider Determinants of Health

19 Indicators for Wider Determinants of Health Child povertyHomelessness 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 stock ALL 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 Health Employment Training/Ed Environment Social Welfare Private Sector

Thanks for listening