Title: The Health Impacts of Structural Energy Performance Investments in Wales: An Evaluation of the Arbed Programme
Funder: Division for Social Care and Health Research (Wales)

Abstract: The research consists of 6 interlinked work packages:WP1: Secure Anonymised Information Linkage System (Lead: Lyons Rodgers): SAIL is used to retrospectively evaluate Arbed Phase 1 with routinely collected hospital and GP consultation data. SAIL is an ethically approved tool developed and hosted by Swansea University that anonymously links individual and property-based data to objective health service data. The system ensures that individuals remain anonymous while retaining the ability to make links between different datasets. The procedure involves the removal of names by a trusted third party who will replace them with an unidentifiable code. This procedure ensures that no-one sees all datasets together maintaining patient confidentiality. This WP will use multiple comparator groups i.e.: (a) 13000 household living in social housing in low-income neighbourhoods and (b) the whole Welsh population. Households that received Arbed 1 improvements will be excluded from both groups. We will evaluate admission and consultation rates for cardio-respiratory condituions for the intervention and comparator groups in the same periods before and after the Arbed 1 intervention. WP2: Community-Based Health Impact Study (Lead: Poortinga Palmer): A health impact study will be set up to evaluate Arbed Phase 2. The intervention will target private and social housing in low-income areas. In total 500 householders will be interviewed before and after the Arbed 2 intervention that will take place in 2014. Control households (n=500) in similar low-income neighbourhoods will be interviewed in the same before and after periods. Householders will be interviewed face-to-face by trained interviewers. Participants’ self reported respiratory conditions and the MCS of SF12 are the main outcomes. Secondary outcomes include reported health-related QoL (PCS of SF12) thermal comfort financial position fuel poverty and social isolation. Parts of the questionnaire are already developed as part of a health impact assessment of the Carmarthenshire Homes Standard programme led by the Principal Applicant. Ethical approval will be sought from the School Research Ethics Committee. Welsh Health Survey data collected in 2013-2015 is used to examine if the health status of the intervention group has improved relative to the whole Welsh population.WP3: Household Monitoring (Lead: Tweed): Detailed energy consumption and internal condition data will be collected and linked to experienced thermal comfort. The study will include a subset of dwellings undergoing Arbed improvements (n=50) a control group where no such improvements will take place (n=50). Detailed indoor temperature and relative humidity measurements will be made with Tinytag data loggers in the living room main bedroom and hallway. Recording will be made every 15 minutes over a 4 week period in the heating season to make a reliable assessment of average temperature and humidity. Energy use over the same period will be estimated by meter readings. The data will be adjustments for external meteorological conditions. The lead has developed a comfort survey method which allows occupants thermal comfort to be tied directly to physical measurements of environmental conditions. This WP will show whether the intervention improves thermal comfort and indoor environmental conditions and expands occupants’ living space all which may be part of the pathway to improved mental and cardio-respiratory health. It will make an objective assessment of fuel poverty using income and energy bill data.WP4: Health Economic Assessment Tool (Lead: Phillips): The HEAT for Housing tool is used to provide an economic evaluation of the energy efficiency investments. HEAT was initially developed to estimate the economic savings as a result of improved health due to regular cycling and walking. In the active NIHR-PHR project the tool is being adapted so it can be used for housing improvements. The approach will be a cost-consequences analysis (CCA) from the perspective of the public sector as a whole. The costs of delivering the Arbed programme will be compared to the cost savings associated as a result of reduced health service use. Comparisons in cost-consequences will be made between intervention and control areas; with future costs and benefits being discounted to bring them into present values. The HEAT for Housing tool is applied to data collected in the community-based study and by SAIL. Cost savings to the health service are calculated using hospital/GP admission and treatment data from SAIL while the cost utility of the intervention is calculated using QALYs obtained from SF6D utilities calculated from SF12 responsesWP5: Steering Board (Lead: Poortinga): We will convene an expert steering board for the project for advice and critical feedback on the design and direction of the research. The panel comprises both public policy and leading academics in housing and health research. The board will meet bi-annually throughout the research. Having members from Public Health Wales and the Welsh Government on board ensures that the research keeps sight of its policy relevance and the results will be directly communicated to relevant policy areas.WP6: Resident Engagement (Lead: Poortinga; Tweed): The research is informed resident engagement. Focus groups will be conducted in areas where improvements have been made i (n=2x7) and where they are expected to take place (n=2x7).Focus groups will discuss the resident experiences to improve WP2 survey design and where possible adjust the direction of research. A number of participants will be recruited to meet 3 times in an occupants panel. Second the results of the project will be made available to residents via presentations at central locations and an easy-to-understand key findings brochure.


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