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Hilary Thomson University of Glasgow
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Warmth improvements and health: evidence of possible pathways to long term health impacts
Hilary Thomson
MRC/CSO Social and Public Health Sciences Unit
Date
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Evidence synthesis of energy efficiency, health & socio-economic determinants of health
o Systematic review: published 2013 Very few (any?) more recent well conducted studies- conclusions still
stand
o Searched globally 39 databases, websites & expert consultation
Included qualitative & quantitative studies from any high income country
o Included studies which assessed change in any health outcome
measures to improve warmth & energy efficiency
Excluded MVHR: Mechanical Ventilation Heat Recovery
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
What the review found
o 19 studies mix of quantitative & qualitative
UK (15), New Zealand (2), Germany (1) & Denmark (1)
o Interventions covered by studies
• loft/cavity wall insulation, double glazing, central heating, lagging, flued heaters, energy advice…
o Evidence synthesis draws on better quality
studies n=11 studies with quantitative data (5 RCTs)
n=5 studies with qualitative data
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Summary of health impacts following warmth & energy efficiency improvements
o Best available evidence (11 studies)
o Mixed effects across studies
Some improvements in mental health, respiratory health, and general health
Greatest improvement in RCTs in New Zealand
Least improvement in UK studies
o Review conclusion: warmth improvements can lead to health improvements
especially when targeted at individuals with inadequate warmth & chronic respiratory disease
very little indication of adverse health impacts
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Why no/little health effect?
o Improvements not targeted at those who need them most
o Other effects may affect potential for health impacts and/or
exposure to warmth improvement
Use of new heating system
Skills, fear of bills
Impacts on housing costs
o Timescale for health impacts
Over optimistic to expect improved health in 6-12 months of evaluation?
o What are possible short term impacts which may be on the pathway to longer term health impacts?
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
What is the pathway from warmth to long term health impacts?
?
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Warmth & energy efficiency improvements: other impacts
o Reduced time off work/school due to illness
o Increased usable space at home
o Improved household relationships
o Increased control over home environment
o Increased entertaining at home
o Reduced fuel costs (sometimes)
o Increased rent costs- protected by welfare
provision
o Mechanisms for longer term health
impacts?
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Pathways to impacts following warmth & energy efficiency improvements
Possible long term
improvements in health
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
What is the pathway from warmth to long term health impacts?
?
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
What are the possible pathways from warmth to health impacts?
? •Increased thermal comfort
•Increased disposable income
•Increased usable space
•Increased control over & satisfaction with home
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Pathways, caveats & recommendation
Possible pathways to longer term health impacts
o Increased thermal comfort
o Increased disposable income
o Increased usable space
o Increased control over & satisfaction with home
Caveats
o May not always happen and not always in same direction
o Possible pathways/critical steps- needs further testing
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Pathways, caveats & recommendation
Possible pathways to longer term health impacts
o Increased thermal comfort
o Increased disposable income
o Increased usable space
o Increased control over & satisfaction with home
Caveats
o May not always happen and not always in same direction
o Possible pathways/critical steps- needs further testing
Recommendation
o Healthy housing investment should aim to provide affordable thermal comfort in housing of appropriate size & design to meet household needs