Housing, Fuel Poverty and Health: A Pan-european Analysis

HOUSING, FUEL POVERTY AND HEALTH: A PAN-EUROPEAN ANALYSIS Jonathan Healy Ashgate Publishing 2004, 249 pp, US$99.95 ISBN 0 7546 4218 6This is a very important book. Housing is a basic human right, embedded in the Universal Declaration of Human Rights (UN 1948), and in major international human rights treaties such as the International Covenant on Economic, Social and Cultural Rights (UN 1966). More recently, the Ottawa Charter blueprint for health promotion identified the prerequisites for health as being peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity (WHO 1986). It is against this backdrop of international law and governance that the author tells the story of inequity in a basic necessity for health: adequate housing.The book embraces primarily housing-related, structural, and material determinants of health, but contextualises the observations within cultural and social policy considerations; describing how these upstream conditions shape (beneficially or otherwise), housing related matters and subsequently, health. Specifically, using a comparative framework, it sets out to examine, for Europe, the relationship between domestic energy efficiency, fuel poverty and related health impacts. The Republic of Ireland is used as a specific country context case study on the premise that it has high rates of fuel poverty, excess winter mortality, energy inefficient housing, high domestic energy consumption, and greater environmental emissions. While the introductory chapter rationalises the approach taken throughout the book, no explicit working definition is given for fuel poverty. Just as food poverty encompasses a number of domains including nutritional, social and health connotations, it would have been useful to make clear, upfront, the constituents of fuel poverty. Following from this, the book would benefit from a conceptual framework at the beginning, providing a heuristic device from which to consider the various ways fuel poverty and related socio-environmental factors affect health.The book makes excellent use of existing dataseis from a diversity of sources to illustrate systematic inequalities in key components of housing related socio-environmental determinants of health, both between countries and within countries. Chapters two to nine explore the empirical data, demonstrating marked gradients across Europe in housing conditions, levels of deprivation, affordability and general satisfaction with housing. The book highlights data limitations within the European countries, but is not unduly constrained by them. A key message from the book is the usefulness and necessity for harmonisation of public health related data and development of multilevel surveillance systems. In Chapter three, a new approach to measuring fuel poverty (and hence its definition) provides the mechanism by which to quantify and demonstrate the severity of fuel poverty within Europe. In an economically rich country such as Ireland, a remarkable 17% of households were found to be fuel poor.The final results chapter combines the various risk factors, explored until now in singular fashion, and assesses their impact on seasonal mortality, specifically excess winter mortality. It is hard to imagine that the inhabitants of Portugal - a country which provokes images of hot summers and unexceptional winters - experience the highest seasonal variation in mortality across the EU, with a winter increase of 28%. However, using a collection of datasets from 1988-97, Healy demonstrates that relative excess winter mortality is highest in southern Europe, Ireland and the UK. …