Background Fuel poverty – whereby households are unable to keep warm at reasonable cost – is an on-going problem within the UK. There are known health impacts of living in cold homes, and a number of free or subsidised interventions are available to help address fuel poverty. There is however concern that such interventions are not being taken up by those in greatest need. A Health Impact Assessment (HIA) was therefore conducted to explore barriers and solutions to take up of interventions to address fuel poverty in England, in order to make policy recommendations to the Department of Energy and Climate Change (DECC).
Methods In line with the HIA steps of screening; scoping; profiling; evidence gathering and appraisal; and making recommendations; we formed a steering group of staff from the Department of Health and DECC to set the scope of the HIA. We used data from the 2010 English Housing Survey to explore the socio-demographic profile of fuel poor households, and reviewed the evidence on the health impacts of fuel poverty on different population sub-groups. We conducted a literature review to explore barriers and potential solutions to take up of fuel poverty interventions, and used the findings from the HIA to develop policy recommendations.
Results While there are known health impacts of outdoor and indoor cold, the relationship between fuel poverty and health is complex, with a lack of evidence for specific impacts on population sub-groups such as those with disabilities and the elderly. Barriers to take up of existing fuel poverty interventions include lack of perception of need; lack of knowledge about options and their benefits; difficulty accessing further information; and unwillingness or inability to take action. A number of initiatives have tried to promote take up of interventions, however none have been robustly evaluated, meaning little is known about which are most effective.
Conclusion The findings from the HIA led to policy recommendations for improving the understanding of the relationship between fuel poverty and health, including the relationship between fuel poverty and excess winter deaths; improving the match between fuel poor households and those who are eligible for interventions to address fuel poverty; collecting data on the characteristics of households that do not take up interventions they are eligible for; addressing the known barriers to take up of interventions to address fuel poverty; evaluating the effectiveness of programmes that aim to address low take up of interventions; and ensuring on-going cross-government working.
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