Title: Fuelling health equity? The impact of the Winter Fuel Payment on the health of UK households
Funder: Chief Scientist Office (Scotland)

Abstract: The use of financial payments to encourage behaviours governments find useful is becoming common. The logic for these payments is that they may encourage small changes in behaviour which have potentially large benefits to the individual and society (e.g. Higgins et al. 2012; Promberger Dolan & Marteau 2012). Policy based on traditional economics has focused on the direct behavioural effects of incentives and the provision of information. Recent insights from behavioural economics suggest that how cash transfers are labelled may affect how this money is spent. This is because people appear to allocate the cash transfer income to a relatively non-fungible mental account that is directly linked to the transfer label. An example of this type of cash transfer policy is the Winter Fuel Payment (WFP). The WFP was initiated to combat fuel poverty and the related excess winter mortality and morbidity among older households in the UK. This winter morbidity is associated with cold indoor climates generally believed to be caused by insufficient heating of the home. The WFP provides households that include a member over the age of 60 years (in the qualifying week of a given year) with a lump sum annual payment in November with the goal that it will be put towards increased energy use and lead to warmer indoor temperatures. Recent research (Beatty et al. 2011) suggests that recipients spend 41% of the transfer on fuel much higher than the 3% expected increase if the payment were treated as cash.Although the WFP has the objective of enhancing the health and well-being of the fuel poor research has not yet evaluated this possibility. The proposed programme of work will treat the WFP as a natural experiment and employ a regression discontinuity design to estimate the potential causal effect of the WFP on household temperature circulatory (e.g. blood pressure coronary symptoms) and respiratory (e.g. lung function) health and the presence of infection (e.g. raised C-reactive protein levels.). Health variables which react quickly to cold and can gauge the presence of upper respiratory tract infections have been selected for this study. We also capitalize on the sharp eligibility criteria for the WFP to test whether the payment improves perceptions of physical health and mental health and well-being ratings.To do this we will utilize three large scale population health databases; the English Longitudinal Study of Ageing the Health Survey for England and the UK Biobank study. Each of these studies contain rich measures provided by participants sampled consistently throughout the year making this data ideal for producing comparisons between those who turn 60 before (recipients) and after (non-recipients/comparison group) the eligibility cut-off date for the WFP. The proposed programme of research brings together an interdisciplinary team working in areas of behavioural economics environmental economics epidemiology and behavioural medicine who together will build an evidence base for assessing the potential health benefits of the WFP and whether these are located principally amongst those on low incomes. We will estimate the role of the WFP in making homes warmer and attenuating the Winter excess in morbidity. In addition we will gauge how these potential effects differ by income groups. This research will provide key insights into how the labelling of a key Government transfer may have health effects.


Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: GENERIC HEALTH RELEVANCE