Master Template for acetates and OHP

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Maintaining Health through fuel poverty reduction
some issues raised by the Warm Homes Project
Nick Merleau-Ponty Research Officer NEA
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Warm Homes Project
Collaboration between NEA, University of
Northumbria, City University, North Tyneside MBC,
funded by HSocial Research within Community Fund
Teresa Allan (City University) Barbara Harrington
(University of Northumbria) Prof. Bob Heyman
(City University) Nick Merleau-Ponty (NEA,
Newcastle) Helen Stockton (NEA)
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Background to the Study
Limited evidence (1999) re relationships between
fuel poverty, energy efficiency, health
well-being, tho some elements in possible causal
pathway understood Even evidence about effects of
EE improvement on attained temperature lacking In
particular, need for randomised controlled trial
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Intervention systems - policies, procedures,
resources .
Insulation, Heating system, Ventilation,
Appliances, Fuels, build, location
Controls Feedback Behaviour
Temperature Humidity Air change
"draughts" pathogens
physical, social-psychological time, dose,
preventative, palliative, iatrogenic. Erosion/i
mprovement
Beliefs Habits Expectations Priorities Conflicts H
ousing History Income Fuel Poverty
Possible Effects model
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Warm Homes Project

• Main elements
• Logistical Regression study of Fuel Poverty,
  Energy Efficiency Health relationships at
  household level
• Randomised Controlled Trial of EE impact on
  measures of Health
• Qualitative and descriptive studies
• Modelling of a simpler set of energy, health and
  housing relationships at aggregated area level
  abandoned owing to lack of accurate energy data
  at district level

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HS other tools for Log reg and RCT
Energy Audit data (yr 1 and updates) Improvement
Protocol constructed Winter Temperature
monitoring meter readings HS items Household
Characteristics Inventory of Health self-report
measures Heating Satisfaction Energy
Behaviour Housing expenditure priorities
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Sample h/hs in North Tyneside
Wave A Semi-random recruitment by phone, using
home always warm and high fuel costs filter
questions, with offer of free measures to the
eligible. Wave B Similar filter via doorstep
contact in targeted areas in N Tyneside believed
to contain poor housing and lower income
households. RCT 250 (appx 125 EXP and CONT)
Households in or near fuel poverty all cases
where FPI gt 7.5
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HS Household Survey
HS Wa Mar 00 HS Wb Oct 00 Energy Audits N541
Overview of prospective RCT
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LR findings Significant odds ratios
LR Models Yr 11 Yr 12 etc
Global Health Score
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Other Log Reg key issues

• Energy efficiency (as measured by SAP) a highly
  significant intervening variable in the Health
  and Housing relationship complementary at
  household level to Paul Wilkinsons findings
  (Cold Comfort) at aggregated area level.
• Fuel Poverty did not enter the LR models as a
  significant term when income and EE terms
  present.

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NB Preliminary Findings subject to the usual
issues of interpretation and possible
modification in the light of review and further
analysis (ongoing)
RCT Preliminary Findings

• Using Health change scores yrs 2-3
• Temperature (except Zone I pm) improvements and
  range of health improvements in year 3 EXP
  relative to CONTROL but not stat. significant
• But differences reached s.s. notably for global
  health measure, SF36 EV, MH, Pain, GH when
  removing zero-improvement cases selecting
• Homes where critical mean temperatures
  rose/heating satisfaction improved
• Small households
• Households in fuel poverty
• Similar using 2-4 pre-post comparison (physical
  functioning significant, gh no longer
  significant)

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Other findings

• Sig. Correlations between temperature variables,
  FPI scores disposible income and household size
  except Zone I evening.
• Significant inter correlations between
  change in heating satisfaction, temperature
  improvement and overall health change
• Sig diffs. dichotimised heating sat. change and
  self-rep. health changes 2-3 on EV, MH, and
  social functioning

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Other Findings (2)

• Importance of Housing history. Little housing
  choice most now gave warmth fuel bills higher
  priority where choice available (method of
  recruitment?)
• h/h warmth central to meaning of home bar
  small minority - little evidence of v low temps
  living rooms evening. But evidence underheating
  in Zone II esp with smaller households and those
  in FP
• High propensity (70) to save money rather than
  achieve higher temperatures
• Highly sig. improvement SF36 physical functioning
  with PPV (selective sub-sample)
• Warmth mainly seen as part of dependent care,
  rather than as determinant of well-being but some
  saw cold home as leading to depression

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Some policy and organisational issues
1. In spite of small sample and limited
intervention (12 SAP points mean), study adds
weight to role of energy efficiency work in
health improvement. 2. Suggests effect maximised
in smaller and older households and those in fuel
poverty where temperatures lower (temperature
monitoring important) but 3. FPI found to be
volatile over time and not an ideal targeting
guide but persistent fuel poverty (long-term
econ inactive, older, disabled) probably v.
important 4. Fuel Poverty still a useful
shorthand for monitoring, and as shorthand for
low income/high fuel cost combination 5. Support
for value of ppv for improved physical health in
damp homes/reported respiratory illness
combination
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Policy and organisational issues (2)
6. Passive characteristics of home energy system
important as many h/hs dont control systems in
way expected. But reported control difficulties,
lack of health risk knowledge, high propensity to
save on bills rather than take higher
temperatures suggest greater temperature (and
health?) improvement possible with better health
and energy education, attention to interface
design 7. Access to energy info about home
(sellers pack), tenant empowerment (at whim of
landlords), knowledge about health risks of cold
and badly-ventilated homes, and grants
(eligibility gaps much in evidence in the study)
are important issues. 8. Experience of
recruitment to study adds to evidence that many
take-up issues remain.
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Main Publications
Logistical Regression study to be published in
Housing Studies Qualitative study to be
published in Health Social Care in the
Community RCT paper in preparation NEA report on
whole project Jan 05
Contact nick.merleau-ponty _at_ nea.org.uk NEA,
90-92 Pilgrim St, Newcastle upon Tyne, NE1 6SG
tel [phone]