Why has nothing changed since I was a kid living in a cold home?

During 1970s and 1980s I grew up in a cold home. On very cold mornings ice would be crusted on my bedroom window and I could play dragons with my breath. I remember things being a bit of a struggle and having to be done in a rush to avoid the cold. Not wanting to get out of bed, then once I was up rushing to get dressed, putting on cold almost damp feeling clothes or rushing downstairs to quickly warm them in front of the fan heater. In the evening venturing from the one warm room in the house was only done if necessary and involved dashing to the toilet or to quickly make a cup of tea. Bedrooms were no-go areas until you rushed upstairs to go to bed, and going to bed involved a nightly ritual of putting my hot water bottle in bed half an hour before bedtime then layering up in night clothes, socks, and loads of blankets only to wake up in a cold room once more.  

Forty odd years later it is saddening and shocking that millions of households are now living like this. I have been researching aspects of fuel poverty and cold homes for almost 30 years and the situation is worse now than it was then. The war in Ukraine, rising energy prices, and the cost-of-living crisis have driven millions more households into fuel poverty but, the enduring nature of the problem over these four decades has a lot to do with the poor condition of our housing stock – much of it is poorly insulated, draughty or hard to ventilate, inefficient, and hard to heat.

Yet, since I started my career, the range of health consequences of living in cold homes and fuel poverty has become more widely recognised and is now well documented.

We now know that living in fuel poverty and a cold home results in: a greater risk of cardiovascular disease and respiratory conditions (Institute of Health Equity, 2022); mental health problems such as anxiety, stress, and depression (Clair and Baker, 2022; Harris et al, 2010; Hernandez et al, 2016; Liddell and Guiney, 2015; Gilbertson et al, 2012; Middlemiss et al, 2019); an exacerbation of existing health conditions such as arthritis (Daniel et al., 2019; Howden-Chapman et al., 2011); a higher risk of infections like colds, influenza, and pneumonia; and an increase in the likelihood of home accidents and unintentional injury (Liddell and Morris, 2010; Marmot Review Team, 2011).

We now know that those at greatest risk of health difficulties include older people, babies and children, and people with a longstanding illness or disability. We know that these groups are often more susceptible to cold conditions (Barnes et al, 2008; Shiue, 2016; Institute of Health Equity, 2022; Gonzalez Pijuan, 2022) and are particularly vulnerable to indoor conditions as they often spend more time at home. For example, a child living in inadequate housing is at a greater risk of a range of adverse outcomes, particularly chest, breathing, asthma or bronchitis (Barnes et al, 2008). Young people in cold homes are unhappier than those living in warm homes, and children living in cold damp homes miss more school days due to illness and find it harder to study at home (Institute of Health Equity, 2022).

We now know that the comparatively high number of Excess Winter Deaths in the UK when compared to other European countries with colder winters is often linked to our poor and inadequately insulated housing combined with high levels of fuel poverty (Wilkinson et al, 2001), and that the energy efficiency of housing is an important determinant of vulnerability to cold-related health risks (NICE, 2015).  

We now know energy insecurity is one of the main contributors to chronic stress in low-income households (Hernandez et al, 2016; Liddell and Guiney, 2015) and that fuel poverty accompanies and exacerbates existing inequalities (Institute of Health Equity, 2022; Middlemiss, 2022). As well as enduring inadequate housing, those living in fuel poverty are much more likely to be experiencing other forms of deprivation all of which contribute to a cumulative burden on their health and generate further inequalities (Liddell and Guiney, 2015). For example, disabled people often face a ‘spiral of worsening energy poverty’ due to a combination of their disability, ill health and their reduced earning capacity (Cronin de Chavez, 2017; Ballesteros-Arjona et al, 2022; Snell and Thomson, 2023). In turn, people with poor mental health are far more likely to experience fuel related poverty (Harris et al, 2010). Being a single parent, experiencing a mental health problem and being out of work are all factors which have been found to be associated with moving into fuel poverty (Kearns et al, 2019; Gonzalez Pijuan, 2022).

Today people are contending with the more challenging context of higher energy prices and the cost of living crisis, as well as continuing to suffer the consequences of poor housing. Many more people and a wider range of social groups, who are already socially disadvantaged, are more likely to experience fuel poverty and endure the health consequences. These groups include low-income households, single parent families, students and younger people, ethnic minorities, disabled people and those with a longstanding illness, migrants, socially isolated people (Middlemiss, 2022). 

The child's hand draws a man on a frozen misted window in winter

Yet also today, there is more evidence demonstrating that addressing cold homes and fuel poverty by tackling inefficient and poorly insulated properties and providing suitable ventilation can benefit asthma, respiratory symptoms, mental health, and general health (Wang et al, 2022) and can lead to multiple benefits for society (IEA, 2014) including reducing energy use/carbon emissions (Hamilton et al, 2013). Improving home energy efficiency provides social and economic benefits to people living in them (Poortinga et al, 2018).

We now know that the most vulnerable individuals, such as older people and those with pre-existing health conditions, are likely to have ‘the clearest positive impacts on health’ of improving the warmth of their homes (Gibson et al., 2011). There are significant benefits for children, people in poor health and vulnerable groups, with those on low incomes benefiting most (Maidment et al, 2014). Targeted interventions for those living in cold homes with chronic respiratory disease can improve symptoms (Howden-Chapman et al, 2007; Poortinga et al, 2017) and is an effective way of benefiting health (Thomson et al, 2013), with lower humidity and increased warmth in winter helping cardiovascular health (Willand et al, 2015). Improving housing so that it is more efficient and affordable to heat improves health and social relations (Thomson et al, 2015) and can increase feelings of autonomy and social status (Willand et al, 2015) improve subjective wellbeing (Poortinga et al, 2018) and reduce psychological distress (Green and Gilbertson, 2008).

Recent studies have also shown that largescale home insulation programmes and programmes to upgrade homes to a national decent standard reduce hospital admissions (Rogers et al, 2018; Fyfe et al, 2020), something which would directly relieve current pressures on health services.

And so I ask, given all this evidence, why hasn’t that much changed since I was a kid living in a cold home?

This article featured in The Conversation.