Why is it important to act?

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General legal and policy context for action


The Government has proposed a target to ensure that as many fuel poor homes as is reasonably practicable achieve a minimum energy efficiency standard of band C, by 2030.1 This would replace the recently abolished target to eradicate fuel poverty by 2016.


The Home Energy Conservation Act (HECA) 1995 and the Warm Homes and Energy Conservation Act 2000 legally require local authorities to take action on fuel poverty, as far as reasonably practicable.


Landlords have a duty of care to minimise the effects of excess cold on their tenants. The Housing Health and Safety Rating System is a guidance document used by local authorities to assess risks to residents of rented properties, including excess cold.  The guidance was created as a result of the Housing Act 2004, which puts emphasis on any adverse effects to the occupants rather than the specific condition of the building itself.  The aim of any inspection is to identify and minimise any potential hazards that may pose a risk to health and wellbeing.  The Housing Health and Safety Rating System guidance specifically mentions excess cold as being such a risk and states the importance of adequate heating and insulation in rented homes to safeguard against this.


National guidance highlights that public health workers have a role to play in tackling fuel poverty. The UK Health Forum has produced guidance in association with several stakeholders, to inform both clinical and non-clinical staff in public health teams about the negative effects of cold homes on health.  The National Institute for Health Care and Excellence has also recently published a draft public health guideline on the health risks associated with cold homes.  Front line workers have a key role to play in identifying patients in or at risk of fuel poverty and taking steps to help them receive assistance. 



Health implications of cold homes


The Marmot review highlighted how cold homes can lead to health problems for their residents, especially children:

  • Cold housing increases the level of minor illnesses such as colds and flu and exacerbates existing conditions such as arthritis and rheumatism.
  • There is a strong relationship between cold temperatures and cardio-vascular and respiratory diseases.
  • Children are particularly vulnerable: those living in cold homes are more than twice as likely to suffer from a variety of respiratory problems, including asthma and bronchitis, than children living in warm homes.
  • Children living in damp and mouldy homes are up to three times more likely to suffer from coughing, wheezing and respiratory illness as their peers who live in dry homes.2


Fuel poverty causes excess winter deaths, especially affecting older people and those in ill health. Some 10% of excess winter deaths could conservatively be attributed directly to fuel poverty.3  Living at low temperatures, as a result of fuel poverty, is likely to be a significant contributor to the excess winter deaths that occur each year (a total of 27,000 each year over the last decade in England and Wales), which mostly affect older people.4


Circulatory and respiratory diseases are the largest causes of excess winter deaths. Circulatory diseases account for some 40% of excess winter deaths, while respiratory diseases count for around 30%. In contrast, hypothermia and influenza cause only a small proportion of excess winter deaths.5


Older people are more likely to be vulnerable to colder weather. Older people are more likely to have pre-existing medical conditions, as well as being vulnerable to hypothermia due to being less active than younger people and having less body fat. They are also likely to spend more time at home than other age groups and so need to heat their homes for longer.6


Cold homes are a cost to the health service and tackling fuel poverty could save money. The Chief Medical Officer estimated the annual cost to the NHS of treating winter-related disease due to cold private housing to be £859 million and suggested that investing £1 in keeping homes warm saved the NHS 42 pence in health costs.7  When all medical conditions that are aggravated by cold homes are also considered, the total cost to the NHS is even higher, at approximately £1.36 billion per year.8


Cold homes affect people’s mental health. The Marmot Review found evidence to suggest that adolescents living in cold housing are up to five times more likely to experience mental health problems than those that have always lived in warm homes, and that, among all age groups, mental health is negatively affected by cold homes and fuel poverty.9



Broader societal impacts


Fuel poverty affects more than a million children in England,10 and eradicating child poverty is a UK policy goal. The Child Poverty Act 2010 seeks to ensure that child poverty is eradicated by 2020.


Fuel poverty may affect children’s education. Health problems can lead to absence from school, or a cold home may mean there is no warm, separate room for children to do their homework.11


For adults, ill health can lead to enforced absences from work. Certain types of illness, such as respiratory disease, may also restrict choices of potential employment for those without work.12


Households experiencing fuel poverty are unduly penalised by policy costs on energy bills. People who experience fuel poverty usually use less energy and therefore have lower total carbon emissions than other households, meaning they contribute the least to climate change.  However, they still pay for carbon reduction policies through their energy bills13 despite making limited gains from doing so, leading to a triple injustice where they pay proportionately more of their income towards energy costs than higher income households, while benefiting less from policy measures and being less responsible for emissions.  Information on which households emit most carbon can be found here.


Groups who are likely to experience fuel poverty are also vulnerable to the impacts of climate change and extreme weather events (see Who is vulnerable?) They are therefore more likely to see disproportionate impacts on their health and wellbeing as a result of some of the same personal, environmental and social factors which help to explain patterns of fuel poverty. Information on who is vulnerable to the impacts of climate change and severe weather events can be found here.


Fuel poverty is part of wider poverty and so should be included as part of overall anti-poverty strategies locally and nationally.



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  1. DECC (2014). Cutting the cost of keeping warm. A new fuel poverty strategy for England.
  2. Marmot Review Team (2011) The Health Impacts of Cold Homes and Fuel Poverty.
  3. Hills J. (2012) Getting the measure of fuel poverty. CASE report 72. Centre for Analysis of Social Exclusion for Department of Energy and Climate Change (DECC), p.27 of full report, based on evidence from the Marmot review team (see footnote 60)
  4. Hills J. (2012) Getting the measure of fuel poverty. CASE report 72. Centre for Analysis of Social Exclusion for Department of Energy and Climate Change (DECC).
  5. Marmot Review Team (2011) The Health Impacts of Cold Homes and Fuel Poverty.
  6. Marmot Review Team (2011) The Health Impacts of Cold Homes and Fuel Poverty
  7. Annual Report of the Chief Medical Officer (2009)
  8. Butcher, J. (2014) Fuel Poverty: How to improve health and wellbeing through action on affordable warmth. A report published by the UK Health Forum and partners.
  9. Marmot Review Team (2011) The Health Impacts of Cold Homes and Fuel Poverty.
  10. Based on 1,027,000 families with dependent children in fuel poverty, in DECC statistics: DECC (2014) Fuel poverty detailed tables 2012.
  11. Marmot Review Team (2011) The Health Impacts of Cold Homes and Fuel Poverty.
  12. UK Fuel Poverty Strategy (2001) Chapter 1: The causes and effects of fuel poverty.
  13. Preston, I., White, V., Thumim J. and Bridgeman, T. (2013) Distribution of carbon emissions in the UK: implications for domestic energy policy. JRF, York.