Fuel poverty: could rising energy bills put added strain on the NHS?

The energy regulator Ofgem recently announced that the energy price cap will surge to £1,971 from April, adding almost £700 to the average household energy bill.

And gas prices aren’t the only thing that are rising – food is getting more expensive, the cost of petrol and diesel has jumped by around a quarter compared to a year ago, and national insurance contributions are set to rise by 1.25 percent in April.

With the cost of living rapidly increasing, millions of households across the country will see their budgets stretched to the limits, and it is estimated that more than a quarter of British households will be pushed into fuel poverty.

With more people struggling to make ends meet, Rebecca McDonald, Senior Economist at the Joseph Rowntree Foundation, says families across the UK will be presented with “completely impossible choices” such as living in a cold home or restricting the food they buy.

But these choices do not come without consequences, and cold homes are recognised as a source of both physical and mental ill health.

How does fuel poverty affect health?

While few people self-identify as living in fuel poverty, it is a problem faced by millions of families living on low income “in a home which cannot be kept warm at a reasonable cost”.⁹ It can lead to making stark choices between energy and other essentials or falling into debt. For some, this means living in a cold home, which has a negative impact on health and wellbeing.

As Lakasing and Johnson write in their article Fuel poverty: significant cause of preventable ill health¹, no single illness or syndrome is exclusively caused by fuel poverty; rather, it is a factor in causing or exacerbating the relative risk of several common conditions.

Older people are particularly vulnerable to fuel poverty and the illnesses that come with it. For example, diabetic complications, peptic ulcer disease, osteoarthritis and hip fractures are all associated with cold exposure.

Cold homes can also exacerbate circulatory disease, respiratory disease and mental health problems, while food poverty (which can be a by-product of gas price hikes) can have a range of adverse health effects, including on the muscular system, the immune system and psycho-social function.

Circulatory disease

Mortality from coronary heart disease and cerebrovascular disease is more likely in cold temperatures, and there are pathophysiological responses that explain this. One study² demonstrated that cold is a significant factor in the total burden of hypertensive disease, while another³ demonstrated that a 1-degree C lowering of room temperature raised blood pressure by 1.3mmHg.

Respiratory disease

Other research has demonstrated that significant respiratory disease is strongly linked to cold and damp housing, for example, Hajat et al⁴ found that GP consultations for respiratory tract infection rose by 19% for each degree drop below 5 Celsius. This is also reflected in markedly increased hospital admission rates.

Mould, which is common in cold, damp housing, is another hazard which must be considered, as it can cause or exacerbate asthma and aspergillosis, the latter being an easily-missed diagnosis particularly important to consider in patients with atypical or prolonged coughs, particularly when more obvious explanations have either been excluded or treated.⁵

Mental health

Fuel poverty can also affect mental health, with one study⁶ finding that anxiety and depression were strongly associated with cold homes. The research found that bedroom temperatures of 21 degrees were associated with a 50% reduction of anxiety and depression relative to temperatures of 15 degrees.

Social isolation consequent upon a reduced ability to leave the home (due to illness) or to welcome visitors into it has also been identified as a significant issue which can impact upon mental health.⁷

Fuel poverty can lead to poor food choices

Fuel poverty and food poverty are closely linked, as when money is tight, many have to make the choice between good quality food and heating their home (the ‘heat or eat’ dilemma). This increases the risk of malnutrition and weight loss which further exacerbate the effects of the cold and in older people, can lead to increased falls and fractures.

Research shows that food poverty can also increase the risk of cardiovascular problems, with one global study estimating that food poverty contributes to 50% of all coronary heart disease deaths.⁸

Warmer homes help to protect the health of those most vulnerable

With inflation at its highest rate in 30 years, millions of households are likely to be living in colder homes and making poorer food choices. This will in-turn lead to an increase in physical and mental health problems, putting added strain on an NHS which is already struggling to cope.

This time last year, the government posted its strategy Sustainable Warmth – Protecting Vulnerable Households in England,⁹ which aims to create warmer homes for families across the UK.

The report acknowledges that warmer homes have the potential to reduce the frequency and severity of health problems and therefore help to protect the health of the most vulnerable (including the older population).

They note that this is particularly relevant now, given the impact that Covid-19 can have on respiratory systems, where symptoms may make individuals more vulnerable to cold exacerbated ill-health.

The strategy aims to ensure that as many fuel poor homes as ‘reasonably practicable’ achieve a minimum energy efficiency rating of Band C by 2030. This means ensuring homes have sufficient insulation and are equipped with central heating systems to ensure homes are as efficient as possible.

Energy efficient homes can save people thousands of pounds a year, and research has shown that improving a home with a Band G energy rating to Band E can save the average household an estimated £1,600 per year.⁹

For this reason, it is now more important than ever that this target is reached in a timely manner, particularly for low income households who are particularly vulnerable to the effects of a cold home.

If it is not, there is a real risk that the NHS could see a significant increase in patients seeking treatment. With six million people in the UK currently awaiting routine operations and treatment and a staffing crisis looming overhead, the NHS cannot risk being further over-burdened with avoidable illness.

What can health professionals do?

As Lakasing and Johnson¹ say, while it is not reasonable for the medical profession to assume responsibility for a largely social problem, from a clinical perspective, it is worth bearing it in mind as a potential ‘red flag’ in certain cases, such as frequent exacerbations of asthma or COPD.

In practice, it is most likely to be community-based clinicians such as GPs, district nurses and community matrons who flag this up, and there are agencies which may help.

In some parts of the country, GPs can become part of ‘warmth on prescription’ schemes through which they refer patients to public health and housing services that can deliver interventions. Such referral schemes can be provided by local authorities, public health and housing functions or third sector organisations.

Lakasing and Johnson emphasise the importance of funding these core services, as “since they are not a statutory duty, their number and scope has been reduced during the recent years of local authority austerity.”

Government must ensure everyone can live in a warmer home to protect the NHS

Ultimately, while health professionals can help individuals by signposting them to potentially helpful agencies, the responsibility for reducing the impact of fuel poverty on the NHS falls on the government.

While the Chancellor Rishi Sunak has announced a one-off repayable £200 discount off energy bills and a rebate on council tax, Rachel Reeves, the shadow chancellor said this will be “of little comfort to many.”

A vital part of the long-term plan to tackle fuel poverty is ensuring that existing homes are made more fuel-efficient, and with individuals and the NHS hit hard by the pandemic, it is now more important than ever everyone has the ability to live in a warm home.

References

Lakasing and Johnson (2019) Fuel poverty: significant cause of preventable ill health, GM Journal, available online at: https://www.gmjournal.co.uk/fuel-poverty-significant-cause-of-preventable-ill-health
Wilkinson P, Pattenden S, Armstrong B et al. Vulnerability to winter mortality in elderly people in Britain: population based study. BMJ 2004; 329 (7467): 647-651
Shiue I, Shiue M. Indoor temperature below 18 C accounts for 9% population attributable risk for blood pressure in Scotland. International Journal of Cardiology 2014; 171(1): e1-e2
Hajat S, Kovacs RS, Lachowycz K. Heat-related and cold-related deaths in England and Wales: who is at risk? Occupational and Environmental Medicine 2007; 64(2): 93-100
Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 2002; 110: 685-692
Green G, Gilbertson J. Warm front: better health: Health impact evaluation of the Warm Front Scheme.
Lawlor DA. The health consequences of fuel poverty: what should the role of primary care be? British Journal of General Practice 2001; 51(467): 435-436
Yusuf S, Hawken S, Ounpuu S et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 364(9438): 937-52.
Department for Business, Energy & Industrial Strategy (2021) Sustainable Warmth Protecting Vulnerable Households in England, available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/960200/CCS207_CCS0221018682-001_CP_391_Sustainable_Warmth_Print.pdf