1. Tackling Fuel Poverty Christina Marriott, NHS England December 2013

2. Health and Fuel Poverty Excess Winter Deaths What we know about cold homes How does fuel poverty link to health inequalities – a model What can we do – and how do we integrate? 2

3. NHS | Presentation to [XXXX Company] | [Type Date]3 Excess Winter Deaths 1

4. The additional number of people who die during the winter months, defined as December to March An estimated 31,100 EWD (Eng. and Wales) - 29% up As in previous years, there were more excess winter deaths in females and the majority of deaths occurred among those aged 75 and over. There were 25,600 75+ cf. 5,500 in people under the age of 75. (of course, related) Cold winter – and hard flu strain But not just absolute temperature – cold countries vs. warmer 4

5. Excess Winter Deaths 5 PHE

6. Excess Winter Deaths - Trend 6 PHE

7. Excess Winter Deaths – Causes Clinically: Diseases of the cardiovascular system, such as stroke and heart attack andcardiovascular systemstroke Respiratory diseases, in particular the fluflu PHE “The causes of death are complex and interlinked with cold weather, fuel poverty, poor housing and health inequalities, as well as infectious diseases such as flu and norovirus, and the extent of snow and ice.” Relative risk relates to age of home – post 1965 7

8. NHS | Presentation to [XXXX Company] | [Type Date]8 Cold Homes 2

9. Cold Homes and Health It has been shown that a low indoor temperature is associated with higher EWM from cardiovascular disease in England A colder home temperature with increased blood pressure Another study found that cold causes the blood to become thicker, which could lead to blood clots (thrombosis) The cold also lowers immune resistance to respiratory infections 9

10. But Not Just Mortality - Children Cold homes also associated with: Reduced weight gain in infants Asthma in young children Impeded ability to learn in older children Social embarrassment – children Various and often multiple mental health problems in adolescents Long term health inequalities 10

11. But Not Just Mortality Cold homes also associated with: Increased incidence of colds and flu Exacerbation of rheumatism & arthritis Depression and dementia Chronic lung diseases Heart attacks Strokes in older people 11

12. 2013 Cochrane Review Impact of housing improvement A small evidence base – including on wellbeing and mental health Significant impacts for 14 of 23 tests (60%) Small to moderate effect sizes 12

13. NHS | Presentation to [XXXX Company] | [Type Date]13 Model of How Professor Christine Liddell 3

14. How do these associations come about? How do these associations come about?

21. NHS | Presentation to [XXXX Company] | [Type Date]21 What Can We Do? 4

22. Plan - identify who Refer – social presc ribing, CVS, integrate Tackle – Liverpool Healthy Homes and HH on Prescription – integrate social and health, lever all sectors Mitigate risk – flu vaccinations 22

23. Contact Email: Christina.marriott@nhs.net Twitter: chrismarriott6 23