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

2. 2010-2012 Update Excess winter deaths Physical health impacts Mental wellbeing New road maps in England

3. Excess Winter Deaths Update Notes of caution

4. Excess Winter Deaths in NI Registrar General Annual Report 2010

5. Excess winter deaths NI: Last 37 years Source: Morris & Liddell 2011 No significant trend over time

6. Region-wide EWD’s 2000 to 2008 Source: Morris & Liddell 2011

7. 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

8. How important is indoor temperature?

9. 1987 & 2007 Keatinge (2000)50% Rudge (2011) 30% 40% of all EWD’s No one knows for sure

10. Contributors to EWD (Rudge, 2011)

11. 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. IrelandNorthern Ireland Across 11 EU countries 38,203 deaths p.a. attributable to cold homes Source: Rudge 2011

12. Which cause of EWD is the most preventable? Cold outdoor temperatures Poor Air Quality Influenza Indoor Temperatures

13. Physical Health Impacts More are emerging

14. Hospital Admissions: New Zealand Strong age effect 0- 4 years and 60+ years Source: Telfar Barnard 2010

15. Out of hospital: European cities New illnesses associated with FP Stress-related Gastric and duodenal ulcers Migraines Source: Ormandy & Ezratty 2012

16. Health impacts of FP compared with other environmental risks 2011 Studies with a cast of millions

17. 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%

18. 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%

19. Mental Health Impacts Keep the customer satisfied

20. 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

21. 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

22. 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

23. 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

24. 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 “Heat or Eat” is optimistic

25. New road maps Possibly time for a small cupcake

26. Public Health departments Statutory duty to protect us from preventable illness and death Air pollution Contaminated water Harmful additives in food Serious communicable diseases

27. England: January 23 rd 2012 Indicators for the Wider Determinants of Health

28. 19 Indicators for Wider Determinants of Health Child povertyHomelessness Road accidents Youth criminal justice Fuel poverty

29. New road maps Reframing the status of Fuel Poverty.  Designated public health risk  With Indicator status

30. Fixing it in the English Housing Stock €20B Who should pay?

31. €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

32. 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

33. Who should contribute? Cross-sectoral beneficiaries € 20B spend benefits private sector Referral and Advisory teams Surveyors Manufacturers Installers Inspection teams Clerical agencies Auditors ?

34. Who should contribute? Cross-sectoral beneficiaries €20B spend benefits public sector Housing Health Social Welfare Employment Training & Education Trade Environment ?

35. Who owes money? Cross-sectoral beneficiaries €20B spend benefits public sector Housing Health Social Welfare Employment Training and Education Trade Environment

36. Trade Tackling FP Housing Health Employment Training/Ed Environment Social Welfare Private Sector

37. Thanks for listening