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Could a cold home affect health and wellbeing? What ELSA tells us

Dr Cesar Messias de Oliveira

27 Apr 2023

The excess mortality associated with direct and acute effects of short-term exposure to extreme temperatures is among the most documented effects of climate on human health. The UK has more ill health and extra deaths in winter than colder European countries do. Two and a half million UK households have trouble heating their homes and have ‘fuel poverty’. This particularly affects people who are poor, older, or have bad health. Dr Cesar Messias de Oliveira explains how data from ELSA and the HEEEAT project are helping to examine the effects of housing energy policies on energy use, indoor temperatures, and older adults’ health.

One in 25 older people living alone in some areas of England and Wales have no central heating. Various government policies have tried to make people’s homes easier to heat. ‘Energy efficiency’ improvements include loft and wall insulation, new heating systems, preventing draughts, and double-glazing. Financial support includes cash payments and rebates to vulnerable households to reduce the costs of heating.


The HEEEAT project, funded by the Economic and Social Research Council, is conducted by the ELSA research team together with the UCL Energy Institute. HEEEAT explores the long-term impacts of indoor temperature on health, and the impacts of energy efficient home improvements and eligibility for fuel payments on indoor temperature, heating expenditure, and health.


We’re asking what types of interventions - energy efficiency improvements and/or financial - are most effective at improving indoor temperatures. Do the interventions benefit low-income households enough? Do people respond by improving the indoor temperature or by spending less on heating and releasing funds for food or other needs instead? What part does people’s age or wealth play in their decision making?  Are improved indoor temperatures associated with longer lives or fewer hospital admissions? Have policies reduced inequalities in health between poorer and richer families, or older people of different ages? We will also use our study to look at the recommended indoor temperatures for health for the general population and for people at greater risk.


Why this is important

Understanding the combined effects of physical and financial housing energy policy intervention is crucial for a wide range of users. Results of our study will help national and local government policymakers and practitioners, policy bodies and government agencies, NGOs and professional organisations decide which policies and measures work best to reduce people’s spending on energy and exposure to cold homes, and how this affects health, wellbeing, and quality of life.


Within the project, ELSA data will be used in two main ways. Indoor temperature was measured by a trained nurse when an ELSA participant’s blood pressure was measured in waves 2, 4, 6, 8 and 9. We will combine that with the outdoor temperature via Met Office data. This will also then be matched with information from the National Energy Efficiency Database (NEED), held by the government Department of Business, Energy and Industrial Strategy (BEIS). This database contains information on what energy efficiency improvements have been undertaken in participants’ homes and how much gas and electricity they have used. Our study will also analyse the effects of the different home energy measures by looking at people’s spending on heating their home and the actual indoor temperature. We will then use ELSA data linked to hospital and mortality records. We will look at the effects of indoor temperature on later health and examine people at different ages and at higher risk of disease.


Who will benefit from our findings?


The general population could benefit if authorities respond with interventions to improve energy efficiency measures  and financial support. In the longer term, taxpayers could benefit from reduced expenditure on ineffective programmes and the general public will benefit from improved health, and a wider understanding of home energy efficiency resulting in less fossil fuel use and lower greenhouse gas emissions. .


It is hoped the findings of the linked-data analysis will also contribute directly to government policymaking and targeting of energy efficiency retrofits and understanding of how older adults use winter fuel payments. Within government, we expect the research will contribute to policy planning and evaluation within the BEIS Fuel Poverty programme and the Home and Local Energy Analysis team, providing evidence on what impact retrofits have on energy, temperature, and health for households vulnerable to fuel poverty (low-income, elderly). We’d also like the research to support guidance on indoor wintertime temperatures for vulnerable households and the broader population.


Local government will have better evidence on which to base their interventions and to prioritise their limited funding towards more effective interventions in homes of population groups with greater potential for benefit and to reduce inequalities in thermal comfort and its health consequences.


Health and social care systems will benefit if these interventions reduce exacerbations of disease by cold weather, thereby reducing a major contributory factor to NHS winter pressures. Finally, researchers worldwide will benefit from the increased knowledge our study generates, to fill gaps in the evidence and to further extend our work.

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