1. Fuel poverty, cold homes and health
Dr Simon Dean

2. What is Fuel Poverty?
Warm Homes and Energy Conservation Act 2000: “a person is to be regarded as living “in fuel poverty” if he is a member of a household living on a lower income in a home which cannot be kept warm at reasonable cost”.

3. No central heating;

4. Whoever would study medicine … must consider the effects of the seasons of the year and the differences between them...(and) must study the warm and the cold winds common to every country... Hippocrates 400BC
The relationship between environmental temperature and health has been known for a very long time.
I don’t want to dwell on the extremes of heath effects: frostbite, hypothermia, heat stroke etc. I want to address the more widespread effect that a cold home has on an average population such as ours.

5. 15°c
25°c
A number of studies have suggested that mortality rates are lower when average temperature ranges between 15 and 25 deg C (these values can vary a bit between countries); mortality rises progressively as the ambient temperature becomes hotter or colder.
The greater mortality linked to heat occurs during the first few days after temperature increase; the effect of cold has been described as being prolonged for several weeks.

6. Elderly and those with impaired health most likely to suffer
Cardiovascular (heart, stroke) and respiratory causes of death are those most strongly associated with cold temperatures
Elderly and those with impaired health most likely to suffer
Nothing suprising here

7. How does a lower air temperature change our bodies?
Mild cooling air for 6 hrs
No change in core temperature
Whole blood viscosity increased by 21%
Increased platelet count
Blood pressure rose on average from 126/69 to 138/87
HDL and LDL Cholesterol increased
‘Could account for cardiovacular thrombosis increase seen in cold weather”.
What is the actual physiological change? May be a clue from this study:
1984 study at London Hospital Whitechapel ; 6 med students;
Rectal probe
Undressed
Fed and paid

8. …in the real world – heart attacks vs ambient temperature
2008 study; England & Wales
84,000 hospital admissions for heart attacks in 15 conurbations
Each 1°c fall associated with 2% increased risk of heart attack
This equates to 200 extra heart attacks for every 1°c fall in ambient temperature
Older people and those with previous heart disease most vulnerable
Those on aspirin less vulnerable

9. Effective home heating and children with asthma
2007, New Zealand study
Compared to the control group, children had 1.8 fewer days off school, 0.4 fewer visits to Doctor for asthma and significantly less asthma symptoms.
409 children aged 6-12 with existing asthma diagnosis
Installation of non-polluting more effective home heater before winter vs replacement heater at end of the trial for control group

10. Excess Winter Deaths (EWD)
Measure of the excess deaths December to March
Countries with cold winters (eg Finland, Germany) don’t have EWD
Heart, stroke and respiratory disease have higher winter death rates but cancer doesn’t
No clear association with influenza or with deprivation indices
Housing standards and socioeconomic conditions thought to be the most significant factors influencing EWD
The ONS standard method defines the winter period as December to March, and compares the number of deaths that occurred in this winter period with the average number of deaths occurring in the preceding August to November and the following April to July:
So therefore EWD is not a “we’re all getting older” effect
Conversely, countries with very mild winter temperatures in Southern Europe such as Portugal and Spain had very high rates of EWM. England and Wales both have higher than average EWM and exhibit high variation in seasonal mortality.
Central heating

11. 2014