Prepayment meters strongly associated with economic and health deprivation: an observational, cross-sectional study
Authors: Ding Xuejie , Akimova Evelina , Zhao Bo , Dederichs Kasimir , Mills Melinda C. 
Published: December 2022

AbstractObjectivesTo examine to what extent pre-payment meters (PPMs) are associated with multiple measures of structural economic and health deprivation.DesignCross-sectional, observational.SettingEngland and Wales.Data sourceExperimental Lower Layer Super Output Area (LSOA) prepayment electricity meter consumption 2017 is used to map the percentage of PPMs for each LSOA. Number of domestic prepayment meters and meters for 33,332 LSOA regions across England and Wales are linked with multiple sub-national LSOA deprivation and Middle Layer Super Output Area (MSOA) health measures. Smart meters operating in prepayment mode are not included.Outcome measuresPrevalence of PPMs for electricity bills per LSOA, associated with multiple national deprivation measures. In England: fuel poverty; income deprivation children and older people; living environment; barriers to housing and services; crime; health and disability; education, skills and training; employment; income; overall Index of Multiple Deprivation (IMD). In Wales: physical environment; community safety; housing; access to services; education; health; employment; income; overall Welsh Index of Multiple Deprivation (WIMD). Additional outcomes of Tenure Type of Housing (rented social, private; owned) and emergency hospital admissions for chronic obstructive pulmonary disease (England) and all respiratory diseases (Wales).ResultsPPM prevalence is strongly correlated (0.62 to 0.63) with fuel poverty, with similar patterns in England and Wales. In England, PPM prevalence was strongly associated with virtually all deprivation indicators, including: lower income (−0.83 [−0.83 to −0.82]), receipt of employment-related benefits (−0.76 [−0.77 to −0.76]), educational disadvantage (−0.70 [−0.70 to −0.69]) and higher levels of health deprivation (−0.65 [−0.65 to −0.63]). Higher PPM prevalence is concentrated in low-income families with children and older individuals, strongly associated with income deprivation affecting children (−0.8 [−0.81 to −0.80]) and older people (−0.79 [−0.80 to −0.79]), social rent (0.67 [0.66 to 0.68]), hospital admissions for respiratory diseases (England 0.69 [0.68 to 0.70]; Wales 0.64 [0.58 to 0.70]), indicating a heightened risk of illness.ConclusionsInstead of blanket policies, interventions on households with PPMs offers an immediate solution to avoid a health crisis and shield vulnerable households from a ‘heat or eat’ dilemma and further exacerbating existing inequalities.Strengths and limitations of the studyThis is the first analysis linking structural economic and health inequality to pre-payment meters (PPM) in the current energy crisis.PPMs are a similar to standard measures of fuel poverty, but a more straightforward proxy for a rapid targeted intervention to avoid a surge in hospital emergency admissions this winter as the most vulnerable households face a ‘heat or eat’ dilemma.PPMs are concentrated in vulnerable households (children, elderly, out of employment) and highly correlated with socioeconomic deprivation and emergency hospital admissions for respiratory diseases.PPMs do not include smart meters operating in prepayment mode, underrepresenting the observed level of poverty.The study includes only England and Wales. Care should be taken when generalising to other areas. We call for the release of PPM data in Scotland and Northern Ireland, to include payment methods in social surveys to evaluate risk for focused interventions.