Housing, health and affordable warmth: an investigation into the link between fuel poverty risk and the health of older people

The research question addressed is whether a relationship can be shown between fuel poverty and the health of older people in Newham, using morbidity data. The aim is to help develop a methodology to measure effects of fuel poverty for evaluating outcomes of investment III domestic energy efficiency and affordable warmth: a complex, multi-disciplinary problem. First government references to fuel poverty were peripheral to environmentally driven energy conservation targets, designed primarily to reduce carbon dioxide emissions to meet national climate change commitments. However, these targets can militate against solving immediate needs of the fuel poor. Those who cannot afford sufficient fuel tend to 'take back' part of the gain from energy efficiency measures as increased comfort, so that minimal energy savings result from interventions to fuel poor homes. Potential cost savings from associated health benefits of environmental targets are disregarded, partly because there is currently no means of measuring them. This problem importantly contributes to the motivation behind the research. Here, as a new indicator for measuring health outcome of fuel poverty, an excess winter morbidity ratio is proposed, rather than the conventionally used ratio of excess winter mortality. Records of seasonal deaths are more easily accessible than disease episodes, but numbers are fewer and represent only extreme outcomes of cold-related health effects. Perhaps health gains could be more readily measurable in terms of reduced morbidity, over a shorter period, than from reduced mortality statistics, following energy efficiency improvements for a given population. An epidemiological approach was taken, using Newham borough as the research sample, but focussing on the population over 64 years old as the most vulnerable to cold homes. A small area index of Fuel Poverty Risk (FPR) was derived from the combined factors of low income, home energy ratings (a measure of energy efficiency), population age, household size and under-occupation of housing. This was mapped and compared with the incidence of emergency winter hospital admissions for cold-related disease in the older population, as indicated by the calculated Excess Winter Morbidity Ratio (EWMbR). A significant positive correlation was found between the FPR and the EWMbR, adding to the evidence-base of links between fuel poverty and health. The mapped analysis is illustrated using GIS software, which is helpful for presenting multidisciplinary data and is a common epidemiological tool. The proposed methodology could predict cost benefits to the health services of investment in domestic energy efficiency measures and be used in monitoring and evaluation. The FPR Index could help local authorities to identify areas of fuel poverty risk for prioritising action towards achieving affordable warmth in homes