Title: Health Effects of Energy Efficiency measures and Ambient Temperature (HEEEAT)
Funder: Economic and Social Research Council

Abstract: Our proposed research will analyse the effects of UK Government policies to reduce energy demand, reduce energy bills, and provide financial support for heating and to maintain adequate warmth, to tackle fuel poverty and cold homes. The physical and financial interventions were carried out under national housing energy policies through energy supplier obligations, fuel poverty programmes and fuel bill support schemes. The overall aim of the project is to determine the co-effects of physical and financial housing energy policy interventions in England on fuel expenditure, indoor temperature, and the short- and longer-term health of older adults. Objectives: 1. To assess the impacts of a range of energy efficiency retrofits and eligibility for fuel payments and rebates, separately and in combination, on indoor temperature, energy use and fuel expenditure in older adults overall and by age, income, wealth, geography and health status 2. To assess the associations between indoor room temperature and subsequent health outcomes in older adults (using self-reported health, mortality and hospital admission from any cause, cardiovascular disease, ischaemic heart disease, stroke and respiratory disease), adjusted for demographic, socio-economic, behavioural, health and biological factors 3. To assess the associations between interventions and subsequent health outcomes 4. To evaluate recommendations on indoor temperature for health for specific population subgroups (older people, those in poor health). Research questions: 1. To what extent do energy use, expenditure and energy performance levels affect indoor temperature, and how do health, education, income and wealth characteristics affect indoor temperature, given the external temperature? 2. To what extent do a) the installation of energy efficiency retrofits (loft and wall insulation, new heating systems, and double-glazing), b) eligibility for fuel payments and rebates to vulnerable households to reduce the burden of heating expenditure, and c) the two together, affect indoor temperature, given the external temperature? 3. What are the associations of indoor temperature with subsequent reported health, hospital admissions and mortality, adjusted for known predictors of ill health? Is there any evidence for 18oC being an important threshold for effects? Should there also be a recommendation for maximum indoor temperature?

Lay abstract: The UK has more ill health and extra deaths in winter than colder European countries do. Cold kills 18,000 to 30,000 people each year in the UK. Two and a half million UK households have trouble heating their homes and have 'fuel poverty'. Excessively hot temperatures are also detrimental to health. With global climate change, excess deaths in heatwaves are expected to increase. This particularly affects people who are poor, older, or have poor health. Various government policies have tried to make people's homes easier to heat. 'Energy efficiency' improvements include loft and wall insulation, new heating systems, stopping draughts, and double-glazing. Financial support includes cash payments and rebates to vulnerable households to reduce the costs of heating. Our study will examine the effects of these housing energy policies on changing energy use, indoor temperatures, and health of older people. For example, what types of interventions (energy efficiency improvements and/or financial) are most effective at improving indoor temperatures? Do they benefit low-income households enough? Do people respond by improving the indoor temperature or by spending less on heating, releasing funds for food or other needs? Does people's age or how poor/wealthy they are affect that? 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. We will use data from the English Longitudinal Study of Ageing (ELSA) in two ways. First, we are linking ELSA data (including indoor temperature) with information on what energy efficiency improvements have been undertaken in participants' homes and with the outdoor temperature. Our study will analyse the effects of the different home energy measures by looking at people's spending on heating their home and the actual indoor temperature. Secondly, we will use ELSA data linked to hospital and mortality records. We will look at the effects of indoor temperature on later health. We will examine sub-groups of people at different stages of their life or at higher risk of disease. No individual will be identifiable in the linked datasets. We have approval from an NHS Research Ethics Committee for this study. Results of our study will help national and local governments and other 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.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE