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Fuel PovertyImpacts on Human Health
A Cross-Sectoral Approach
Christine Liddell
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2010-2012 Update
• Excess winter deaths
• Physical health impacts
• Mental wellbeing
• New road maps in England
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Excess Winter Deaths Update
Notes of caution
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Excess Winter Deaths in NIRegistrar General
Annual Report2010
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Excess winter deaths NI: Last 37 years
Source: Morris & Liddell 2011
No significant trend over time
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Region-wide EWD’s 2000 to 2008
Source: Morris & Liddell 2011
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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
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How important is indoor temperature?
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1987 & 2007
Keatinge (2000) 50%
Rudge (2011) 30%
40% of all EWD’s
No one knows for sure
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Contributors to EWD (Rudge, 2011)
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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.Ireland Northern Ireland
Across 11 EU countries 38,203 deaths p.a.
attributable to cold homesSource: Rudge 2011
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Which cause of EWD is the most preventable?
• Cold outdoor temperatures
• Poor Air Quality
• Influenza
• Indoor Temperatures
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Physical Health Impacts
More are emerging
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Hospital Admissions: New Zealand
Strong age effect
0- 4 years and 60+ years
Source: Telfar Barnard 2010
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Out of hospital: European cities
New illnesses associated with FP
Stress-related • Gastric and duodenal ulcers
• Migraines
Source: Ormandy & Ezratty 2012
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Health impacts of FP compared with other environmental risks
2011
Studies with a cast of millions
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Medical symptom (MS) Home Hazard % of MS attributable to hazard
Not FP-related Wheezing Formaldehyde < 1%
Tuberculosis Indoor crowding 5%
Lung cancer deaths Radon 2-12%
Cardio/Resp. disease Passive smoking 1-23%
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Medical symptom (MS) Home Hazard % of MS attributable to hazard
Not FP-related Wheezing Formaldehyde < 1%
Tuberculosis Indoor crowding 5%
Lung cancer deaths Radon 2-12%
Cardio/Resp. disease Passive smoking 1-23%
FP-related Lung disease deaths/disability Solid fuel exposure 0-15%
Child asthma deaths/disability Mould 12%
Child asthma deaths/disability Damp 15%
Excess winter deaths Low indoor temp. 30%
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Mental Health Impacts
Keep the customer satisfied
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Warm Front National EvaluationMeasure Effect
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
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Warm Front: The FindingsMeasure Effect
on mental health?
Dose-response?
Insulation installed?Heating+insulation installed?Draught-proofing installed?Less condensation?Warmer home?Happier with homeCoping with fuel bill
Source: Grimsley et al. 2012
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Warm Front National EvaluationMeasure Effect Dose-
response?Insulation installedHeating and insulation installedDraught-proofing installedLess condensationWarmer homeHappy with homeCoping with fuel bill
Not what is done
but how
improvements make
people feel
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FP: The Coping Hierarchy1. Reduce bills for non-essentials2. Reduce bills for food3. Reduce bills for heat and light4. Borrow from friends/relatives5. Start using savings6. Sell valuable items 7. Go into debt8. Borrow from loan agencies
Source: Anderson et al. 2012
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FP: The Coping Hierarchy1. Reduce bills for non-essentials2. Reduce bills for food3. Reduce bills for heat and light4. Borrow from friends/relatives5. Start using savings6. Sell valuable items 7. Go into debt8. Borrow from loan agencies
Source: Anderson et al. 2012
“Heat or Eat”
is optimistic
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New road maps
Possibly time for a small cupcake
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Public Health departments
Statutory duty to protect us from preventable illness and death
•Air pollution•Contaminated water
•Harmful additives in food•Serious communicable diseases
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England:January 23rd 2012
Indicators for theWider Determinants of
Health
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19 Indicators for Wider Determinants of Health
Child poverty Homelessness
Road accidents Youth criminal justice
Fuel poverty
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New road maps
Reframing the status of Fuel Poverty.
Designated public health risk
With Indicator status
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Fixing it in the English Housing Stock€20B
Who should pay?
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€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
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Upgrading the housing stockALL society benefits
Retrofitting English Housing Stock€ 20B
Returns from all impacts on society€ 1.7B per annum
Retrofitting pays for itself in 12 years
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Who should contribute?Cross-sectoral beneficiaries
€ 20B spend benefits private sector
•Referral and Advisory teams•Surveyors
•Manufacturers•Installers
•Inspection teams•Clerical agencies
•Auditors
?
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Who should contribute?Cross-sectoral beneficiaries
€20B spend benefits public sector
• Housing • Health
•Social Welfare• Employment
• Training & Education• Trade
• Environment
?
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Who owes money?Cross-sectoral beneficiaries
€20B spend benefits public sector
• Housing • Health
•Social Welfare• Employment
• Training and Education• Trade
• Environment
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Trade
Tackling FP
Housing
HealthEmployment
Training/Ed
Environment
Social Welfare
Private Sector
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Thanks for listening