Cost of living crisis: the health risks of not turning the heating on in winter

People in the UK might be tempted to keep their heating turned off to offset the large increases in energy bills this winter. A recent YouGov poll, revealed that 21% of respondents would not turn their heating on until at least November. Could the health of these people be endangered?

Before COVID, an average of 25,000 extra deaths occurred between December and March compared with any other four-month period of the year. Even if COVID did not exist, the cost of living crisis could result in the toll from the coming winter being worse than usual.

The Marmot review (a report investigating the effects of cold homes and fuel poverty) estimated that 21.5% of all excess winter deaths could be attributed to the coldest 25% of homes in the UK population.

This would suggest that 5,000 extra deaths occur in winter because people live in cold homes. But this does not mean the cold homes cause the deaths. People who live in cold homes may have other disadvantages, making them less able to survive winter.

Would it make any difference whether they leave their heating on or off? Studies suggest temperatures should be kept to at least 18℃ to minimise the risk to health, but how easy is it to maintain this if homes are poorly insulated?

Research into what is best for people’s health ideally relies on randomised controlled trials to tell us about cause and effect. But it would be unethical to conduct a trial where some people were told to leave their heating off and others were told to keep it on to see if it had any effect on mortality. Instead, we have to rely on what are known as “longitudinal studies” where people are followed over many years and respond regularly to questionnaires.

In one such study in the 1970s, the British Regional Heart Study recruited thousands of men, then in middle age, from across Great Britain. In 2014, around 1,400 of these men, then aged 74-96 years, answered a questionnaire that included questions on home heating.

One question asked whether, during the previous winter, the respondent had: “Turned off the heating, even when you were cold because you were worried about the cost?” One hundred and thirty men (9.4%) said yes. These men seemed no more likely to die in the following two years than men who had replied no.

A larger study would have given a more robust answer. And in the absence of other direct evidence, we have to draw conclusions from indirect evidence, such as this.

The most vulnerable

Recently, researchers in Sweden tried to assess a range of questions about the effects of energy use, fuel poverty and energy efficiency improvements on people’s health. They systematically reviewed all the relevant studies on the topic. One of their findings showed consistently across four studies the link between fuel poverty and premature death.

The British Regional Heart Study showed that fuel poverty was more likely to be found among people who were single, poor and working class. This suggests that people who are the most financially vulnerable will be those most likely to leave the heating off. As with climate change, the poorest are hit hardest.

So far I have only discussed effects on health in terms of death, which in the UK concerns mainly older people. The winter deaths that occur are usually the result of heart disease, stroke and respiratory disease. Yet increasing attention has also been paid to the strong effects of the cold on mental health.

The Marmot review quoted studies that drew attention to the depressive effect of living in a cold home. Children in adolescent years may seek respite and privacy away from home, with consequent exposure to mental health risks. The misery caused by financial pressures only add to this burden.

Because the most financially vulnerable people are also the most vulnerable in their health, it should follow that interventions at government level are urgently needed to offset the likely health crisis looming from increased energy costs.

The most vulnerable will need the most help. Yet a common paradox seen in public health is that interventions applying to the whole population will lead to more lives saved than those targeted only to those at greatest risk.

This is because there are far more people in the population at moderate risk than at high risk. Only a modest proportion of people at moderate risk will benefit. Yet because this group is so much larger than the high-risk group, more lives may be saved among those at moderate risk.

Buildings in the UK clearly need to be better insulated, but these sorts of interventions will come too late for this winter. Mitigating the rising costs of energy must be the only way forward to allow homes to be heated to a comfortable level and prevent a tidal wave of excess winter deaths.The Conversation


This blog is written by Cabot Institute for the Environment member Richard Morris, Honorary Professor in Medical Statistics, University of Bristol

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Richard Morris

Watch Richard speak more about this issue in our Cabot Conversations video on Heatwaves and Health.






Sharing routine statistics must continue post-Brexit when tackling health and climate change

Post-Brexit vote, we are posting some blogs from our Cabot Institute members outlining their thoughts on Brexit and potential implications for environmental research, environmental law and the environment.  

It has been argued that one of the EU’s major contributions has been its legislation regarding environmental protection. Some of these bear directly on human health (for example, concerning air pollution levels). Looking forwards, moves to adapt and mitigate the effects of climate change may be greatly facilitated by sharing data on emerging trends across Europe.

An excellent example is provided by analysis carried out on “excess winter deaths” across Europe. Every country in the world displays seasonal patterns of mortality whereby more deaths occur in winter than at other times of year. However the extent of this excess varies between countries even within Europe. Intuitively one might have expected the excess to be greater in countries where winter temperatures are more extreme, yet this is not so. Healy (2003) used data from 14 European countries to demonstrate that in 1988-97, the relative Excess Winter Deaths Index (EWDI) was greatest for Portugal, where the mean winter temperature was highest. Conversely Finland with the lowest mean winter temperature showed the lowest EWDI. Data on mortality were available from the United Nations Statistics Databank and the World Bank, as well as some macro-economic indicators, but Healy also availed himself of the European Community Household Panel survey on socioeconomic indicators and housing conditions. This revealed that high EWDI was associated with lower expenditure on public health per head of population, as well as income poverty, inequality, deprivation, and fuel poverty. Furthermore, several indicators of residential thermal standards appeared to carry influence, whereby countries where houses had better insulation experienced lower EWDI.

A similar study was reported in 2014 by Fowler et al, partly as an update of Healy’s work, this time on 31 countries across Europe for the years 2002-11. The same geographic pattern still seemed to be present, with southern European countries faring worse in terms of winter deaths. However a few countries such as Greece, Spain and Ireland demonstrated a reduction in their EWDI. It is possible that Healy’s study had highlighted the need for improvement in those countries. All 27 countries who by that time were members of the European Union were included in analysis, and use was made of the Eurostat database.

In view of the projected increases in global temperature in coming decades, it might be hoped that the problem of excess deaths in winter will gradually disappear from Europe. Yet the greater susceptibility of warmer European countries to winter deaths compared with colder countries suggests such an assumption may be mistaken. It will be important for carefully collected routine data to be analysed, to investigate any changes in the patterns previously seen in Europe.

My colleagues and I were led to consider whether relatively low temperatures were more threatening to older people than absolute temperature level, and whether this might hold for individuals, as well as at a national level as highlighted by Healy’s and Fowler et al’s studies. We carried out analyses of two European cohort studies, of around 10,000 people aged 60 or over, followed over 10 years. Using daily temperature data for the localities of where these participants lived, we investigated weather patterns experienced by those who suffered major heart attacks and strokes. There was some evidence that cold spells (cold in relation to the month of the year) increased people’s risk over a 3-4 day period. We hope to replicate this finding in other datasets.

Reflecting on the data used by Healy and Fowler et al, it is noticeable that most (though not all) came from EU countries. Some of the data in Healy’s study was held by the United Nations or World Bank. Yet the Eurostat database was a major contributor to these enlightening analyses. Eurostat was established as long ago as 1953, initially to meet the requirements of the Coal and Steel Community. Over the years its task has broadened, and when accessed on 29 June 2016 displayed detailed comparative data on many domains including aspects of health.

It would be deeply disappointing as well as surprising if the UK were in future to withhold such valuable information, or conversely if such pan-European data were to become unavailable to UK-based researchers. This would seem unlikely, as Eurostat seems to draw upon data from EFTA nations as well as the EU, and advertises its data as freely available. It behoves the UK research community to continue to use these valuable data in a collaborative way with EU-based partners, and also to encourage continuing provision of UK data so that our EU-colleagues (both academics and policymakers) may benefit from this common enterprise.

This blog is by Professor Richard Morris, from the University of Bristol’s School of Social and Community Medicine.  Richard’s research focuses around statistics applied to epidemiology, primary care and public health research.