Tackling Fuel PovertyChristina Marriott, NHS England

December 2013

Health and Fuel Poverty• Excess Winter Deaths

• What we know about cold homes

• How does fuel poverty link to health inequalities – a model

• What can we do – and how do we integrate?

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Excess Winter Deaths

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Excess Winter Deaths• The additional number of people who die during the winter

months, defined as December to March

• An estimated 31,100 EWD (Eng. and Wales) - 29% up

• As in previous years, there were more excess winter deaths in females and the majority of deaths occurred among those aged 75 and over. There were 25,600 75+ cf. 5,500 in people under the age of 75. (of course, related)

• Cold winter – and hard flu strain

• But not just absolute temperature – cold countries vs. warmer

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Excess Winter Deaths

PHE

Excess Winter Deaths - Trend

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PHE

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Excess Winter Deaths – Causes • Clinically: Diseases of the cardiovascular system, such

as stroke and heart attack and

• Respiratory diseases, in particular the flu

• PHE “The causes of death are complex and interlinked with cold weather, fuel poverty, poor housing and health inequalities, as well as infectious diseases such as flu and norovirus, and the extent of snow and ice.”

• Relative risk relates to age of home – post 1965

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Cold Homes

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Cold Homes and Health

• It has been shown that a low indoor temperature is associated with higher EWM from cardiovascular disease in England

• A colder home temperature with increased blood pressure

• Another study found that cold causes the blood to become thicker, which could lead to blood clots (thrombosis)

• The cold also lowers immune resistance to respiratory infections

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But Not Just Mortality - Children• Cold homes also associated with:

• Reduced weight gain in infants

• Asthma in young children

• Impeded ability to learn in older children

• Social embarrassment – children

• Various and often multiple mental health problems in adolescents

• Long term health inequalities

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But Not Just Mortality• Cold homes also associated with:

• Increased incidence of colds and flu

• Exacerbation of rheumatism & arthritis

• Depression and dementia

• Chronic lung diseases

• Heart attacks

• Strokes in older people

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2013 Cochrane Review

• Impact of housing improvement

• A small evidence base – including on wellbeing and mental health

• Significant impacts for 14 of 23 tests (60%)

• Small to moderate effect sizes

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Model of HowProfessor Christine Liddell

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How do these associations come

about?

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What Can We Do?

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What Can We Do?• Plan - identify who

• Refer – social presc

• ribing, CVS, integrate

• Tackle – Liverpool Healthy Homes and HH on Prescription – integrate social and health, lever all sectors

• Mitigate risk – flu vaccinations

Contact

• Email: Christina.marriott@nhs.net

• Twitter: chrismarriott6

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