Excess Cold And Fuel Poverty Environmental Sciences Essay
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In the winter period December to March 2008/09 there was a sharp increase in England and Wales of excess winter mortality EWM. Appendix. A. This excess figure quoted is for deaths over and above the average for the year. There are a number of estimates quoted for these mortality rates and different interpretations of what constitutes excess winter mortality can vary. This is in part due to mortality rates as a result of excess cold not being known until after the event which may be between 3-12 days after hospital admittance and as a result of health problems developing.
The office of national Statistics (ONS) stated that compared to the previous accounting period 2007/08 this was an increase of around 49 % with the most vulnerable being the elderly over 75 years of age, which accounted for around 29,400 additional deaths. (ONS11/09) These figures include for all factors of ill health but were predominately caused by either respiratory or cardio vascular problems with cases of hypothermia being rare.
Causal factors.
The link between EWM and poor housing in respect inadequate or inefficient heating has been recognised for some time and these findings were highlighted in the Independent Inquiry into Inequalities in Health report (Acheson 1998). The report provided recommendations to address these concerns and was based on evidence from a number of studies between 1988/97. Appendix B
A further study by the School of Hygiene and Tropical Medicine, (SHTM 2001) showed that there was a definite link to poor housing and EWM, and that this percentage increase in mortality was predicted to be higher in homes with no adequate heating provision or thermal insulation, and that "substantial public health benefits can be expected from measures that improve the thermal efficiency of dwellings and the affordability of heating them" In addition the predicted outcomes were also influenced by the age of the property, with properties built before 1850 being of the highest risk with properties built up to and including 1980 being of lower risk.
Irrespective of the heating and thermal efficiency provision of the dwelling it became apparent that the ability to heat it to suitable comfort levels was one of affordability. This inability to adequately heat a home was identified under the heading of fuel poor or as it is now widely known fuel poverty, a term coined by Dr Brenda Boardman of the Centre for Sustainable Energy (CSE) in 1988.The definition at that time of what constituted fuel poverty was that a household needed to spend more than 10% of its total income on fuel to maintain adequate heating and for other purposes.
Legislative background
In order to address these concerns the Warm Homes and Energy Conservation Act 2002 came in to force which further specified fuel poverty as; "a person is to be regarded as living in fuel poverty" if they are "a member of a household living on a lower income in a home which cannot be kept warm at reasonable cost" and it required under Section 2 of the act that the government set out a strategy to eradicate fuel poverty and included the timescale for achieving this. It also required that there was consultation with energy suppliers, local authorities, health authorities and other public health professionals in the formulation of the strategy.
This Inter-Ministerial strategy required that fuel poverty was to be eradicated in all vulnerable households with elderly, infirm or containing children by 2010, with further improvements to all households by 2016. At the time it was estimated that approximately 4 million homes were in fuel poverty with EWM of around 25,000 persons.
Following the adoption of the strategy, between the periods from 2001/04 there were real improvements, with the numbers in fuel poverty falling substantially from the numbers recorded in 1999/2000. However the mortality figure since 2004 has increased significantly despite measures to improve heating and insulation to homes. The main cause for this increase has been attributed to the substantial rise in fuel costs nationally which were in excess of rises in income from all sources for the same period.
The strategy also considered the complex issues surrounding fuel poverty and also the wider impacts such as social isolation the exacerbation of existing illness and the affects of increased demands on health and social care and the cost to society in general.
What is the real cost to society?
Whilst the most severe outcome of excess cold will lead to an increase in mortality, other health factors in the most vulnerable groups relate to the associated increased GP referrals and hospital admission for cardio vascular diseases e.g. heart attacks and strokes, and increased risk of respiratory diseases, chronic obstructive pulmonary disease, (COPD) bronchitis and with further increases of asthma particularly in young children. The onset of respiratory disease in all ages is in general exacerbated by damp and mould which is also more prevalent by the lack of inadequate heating and which is one of the most common sources of dissatisfaction with housing conditions among tenants of both social and private landlords. Other negative social factors include the long term affects of education on young persons due to extended periods of illness, and social isolation by all ages from either the reluctance to interact with the community or to invite others into their home. What is clear however is that excess cold, fuel poverty and its accompanying health stressors encompasses a wide range of the Social Determinants of Health and inequalities associated with them.
Whilst there is no individual figure of the financial cost to the National Health Service (NHS) for the affects of cold homes, the Chartered Institute of Environmental Health (CIEH) commissioned, in conjunction with the Building Research Establishment (BRE) the "Good housing leads to Good health" toolkit (CIEH 2008), which included a cost calculator with median costs taken from the English Homes Condition Survey (EHCS) 2005/06 data. These figures reflect the cost to benefit ratio for works carried out to eliminate or mitigate the relevant hazard. Appendix C
It is estimated however that the cost of to the NHS due to poor housing in general is around £600m annually, and that the total cost to society is around £1.5 billion. (M Davidson et al 2009)
What interventions are in place?
Within the last ten years a number of initiatives e.g. the Energy Efficiency Commitment Scheme (EEC) 2005/08 were introduced to improve the energy efficiency of homes and reduce the impact of fuel poverty through various measures such as the Warm Front Scheme administered by the eaga partnership which is in part funded by energy suppliers and central government. This scheme offered assistance and advice on various energy reduction measures and provided grant funding to support them, and is specifically aimed the most vulnerable and/or households in receipt of certain benefits and within certain criteria i.e. age, income. These improvements range from energy efficient light bulbs to full gas or oil heating installations. From an enforcement perspective local authorities can actively enforce the Housing Health and Safety rating System (HHSRS) for Excess cold and promote the Warmfront initiative where this may be an acceptable option.
Is the Strategy working?
As an example within the scope of this initiative it is widely accepted that simple measures such as loft and cavity wall insulation are the most cost effective measures to reduce energy costs and improve thermal insulation, and that there have been a large number of beneficiaries to the scheme however measures such as cavity wall insulation may only be suitable for newer properties where cavities exist, thereby excluding a large number of properties which fall within the higher risk categories. In addition these older properties are more likely to have larger room sizes which would imply that the cost of installing a heating system would be in excess of the grant funding available, currently £3500,(average grant 2008/09 £1701) with the occupier being required to top up the cost of the installation. The number of client contributions for heating installations in 2008/09 was approximately 24% (Hansard 04/09) Given the criteria for eligibility for grant funding, any heating provision which would require a top up is not likely to go ahead. This scenario would apply to both owner occupiers and private sector tenants whereby the property owner would incur additional costs. The non eligibility for grant funding does not make the occupier any less vulnerable. This would also indicate that only properties of a more modern construction which are of a smaller size and probably a lower risk category would benefit from the scheme.
Another factor in the application of the Warm front scheme is how and when it is accessed. In general excess cold problems are only highlighted by the most vulnerable when there is a problem during the highest risk periods e.g. boiler failure in the heating season 1 October -31 April. The Warm front website states that the installation of insulation can take up three months to install with heating installations up to six months with demand outstripping the funding available. (Warmfront accessed 16/01/10) This delay in carrying out the works would therefore reduce the effectiveness of the measures at a time when it was most needed.
The most recent initiative in promoting energy efficiency is the boiler scrappage scheme announced in December 2009, this scheme aims to replace existing G rated boilers of which it is estimated there around 125,000 with far more efficient A rated appliances, however whilst this may promote savings in respect of energy usage for the individual, the numbers are limited and the main drivers behind this scheme is to secure jobs in manufacturing, sustain installers and reduce carbon emissions. In the present period of recession whilst these are welcome measures, the promotion of this scheme is more aligned to the reduction of CO2 emissions than in reducing fuel poverty. It could be argued that the beneficiaries of the scheme may not necessarily be fuel poor, and could be borne out by the announcement that the demand is so great that the funding could run out by March 2010. (EST)
How does the private rented sector compare to Social Sector landlords?
In general social sector landlords perform better in regard to energy efficiency of homes through programmes of improvement carried out under the under Decent Homes Standard of the Housing Act 1985 (as amended by the 1989 Local Government and Housing Act), whereby under the revised definition and guidance, update 2006, Criterion d: it states that a dwelling "to have both efficient heating; and effective insulation" Appendix D-E. These standards have been in place for a number of years and it is true to say that most social sector landlords have been installing an "A" rated heating appliances and improving insulation levels for some time. It was from this Decent Homes Standard that the (HHSRS) was developed and introduced in 2006 to replace the fitness standard as the statutory element and to enable more targeted assessment of hazards of which Excess Cold is one of the most common hazards along with Damp and Mould.
In comparison there is still a large number of private sector housing whose energy efficiency is well below reasonable levels of comfort. When considering the Standard Assessment Procedure (SAP) which provides an energy efficiency rating for the dwelling, the "Social sector homes are on average much more energy efficient than those in the private sector (55.2 compared to 44.1 respectively) and are improving at a faster rate". (CLG 2007).
Private sector housing however has been slow to appreciate the benefits' of improved energy efficiency and the possible availability of grant subsidies. In reality, what interest does a landlord have in improving the energy efficiency of a property where the cost of heating is paid for by the potentially transient tenant?
In addition how many landlords provide Energy Performance Certificates (EPC's), which has been a requirement since October 2008 for new tenancies? Whilst most landlords on the whole are responsible, some may see this as another piece of bureaucracy and an unnecessary additional burden if they are even aware of their responsibilities. If tenancies were decided on the energy efficiency of the property one would assume that prospective tenants would opt for the most efficient property. In reality landlords advertising privately probably do not provide these to prospective tenants and they largely ignored, as there is no real enforcement taking place for domestic EPC's, and tenants are probably not aware of the requirement to be provided with a copy of the EPC.
Conclusion.
It is clear from the above discussion and examples that there are some major concerns and obstacles in defeating fuel poverty and the associated inequalities in health. It could be argued that the strategies put in place by government, although admirable in their aims are now largely ineffective. It is evident also that organisations involved in achieving these aims are far too numerous. What is their motivation is it altruism or are they all vying for a piece of the very large cake? Also apparent is the blurring of the original focus, which was very clear, improving the energy and thermal efficiency of a dwelling so that it would be cheaper to heat adequately and at an affordable cost to the most vulnerable in society. Consideration should therefore be given to trying to understand the drivers behind these initiatives; the EEC scheme, of which phase 2 has now come to an end is now the EEC-CERT (Energy Efficiency Commitment/Carbon Emissions Reduction Target) thereby indicating a shift away from the real purpose of improving energy efficiency and reducing fuel poverty to one of emissions reduction. No one can argue that climate change from increased CO2 emissions is of paramount global importance, however there does need to be a balanced approach, with neither side suffering when a balance shift is required.
In order to get back on course there needs to be a refocusing of the original motivation, i.e. reducing deaths, and improving health and wellbeing. Landlords need further education of the problem of fuel poverty and how they can contribute in eradicating it. Social marketing and promotion of grant funded heating installations and thermal insulation should be targeted in the spring/summer period when the detrimental health affects are minimized and only then will the spectre of EWD be removed.
