Transcript Angela Mawle Chief Executive, UKPHA From national to local

UK Public Health Association
Angela Mawle
UK Public Health Association
Dublin February 2012
Fuel Poverty – the UK Perspective
National Context – UKPHA
The UKPHA is an independent, UK wide voluntary
association, which brings together individuals and
organisations from all sectors, who share a common
commitment to promoting the public’s health.
The UKPHA is a membership organisation which aims to
promote the development of healthy public policy at all
levels of government and across all sectors, and to
support those working in public health either
professionally or in a voluntary capacity.
UKPHA Priorities
• Combating health inequalities
– working for a fairer, more equitable and
healthier society
• Promoting sustainable development
– ensuring healthy environments for future
generations
• Challenging anti-health forces
– promoting health-sustaining production,
consumption and employment
The Health Effects of Cold
Cardio-vascular disease:
 The cold increases blood pressure.
 Increased risk of heart attacks and strokes.
 Responsible for approximately 40% of excess winter
deaths (over 37,000 in the UK last year)
Respiratory Illness:
 The cold lowers resistance to respiratory infections.
 Coldness impairs lung function and can trigger bronchoconstriction in asthma and COPD.
 Dampness is associated with cold houses; damp increases
mould growths, which can cause asthma and respiratory
infections.
 Responsible for approximately 30% of excess winter
deaths
The Health Effects of Cold
Mild Hypothermia
• A study showed incidence peaks of hypothermia in A&E patients
over 65 from relatively deprived postcodes, coinciding with periods
of cold weather
Cold houses affect mobility and increase falls and non-intentional
injuries
Mental and social health
• Damp, cold housing is associated with a 4 fold increase in
depression and anxiety
• Some people become socially isolated as they are reluctant to invite
friends round to a cold house.
• In cold homes where only one room is heated, it is difficult for
children to do homework, affecting educational and long-term work
and health opportunities.
Thermal Comfort
Recommended by WHO:
• 21ºC
Recommended minimum daytime
temperature for main rooms
• 18ºC
Recommended minimum bedroom
temperature at night
World Health Organization (1987) Health Impact of Low Indoor Temperatures: Report
on a WHO meeting. Copenhagen: World Health Organization.
Available at: http://tinyurl.com/3ghblbm
Excess Winter Deaths
• The Office for National Statistics calculates excess winter deaths as
the difference between the number of deaths in December – March
and the average of deaths in the preceding August – November and
the following April – July.
• If a two month period is taken instead of the four months, the peak
of excess winter deaths is consistently more than 40% higher than
the summer trough
• Each centigrade degree reduction below 18°C in temperature in the
UK corresponds with an extra 3500 deaths .
Sequence of Health Impacts
Excess Winter Deaths
Diseases of“ the circulation – including heart attack
and stroke – account for around 40% of excess
winter deaths.
Around one third of excess
winter deaths are due to respiratory illness…”
[Chief Medical Officer Report, 2009]
Excess Winter Deaths
We could prevent many of the yearly excess
winter deaths – 35,000 in 2008/09 – through
warmer housing...
[Public Health White Paper, England, 2010]
Excess Winter Deaths
• The elderly are subject to the greatest
increase in deaths in winter, with 20,200
more deaths in the UK among those aged
over 75 years during the winter of 2005/06
compared with levels in the non-winter
months
Why are the elderly vulnerable?
• Older people are more likely to be vulnerable to cold weather, partly
because they are more likely to have existing medical conditions.
• their temperature control is weaker because of less subcutaneous
fat, making them vulnerable to hypothermia
• a 1°C lowering of living room temperature is associated with a rise
of 1.3mmHg blood pressure, due to cold extremities and lowered
core body temperature
• Older people are more likely to be fuel poor, as they are likely to
spend longer in their homes than other people and therefore require
their houses to be heated for longer periods .
Michael Marmot Review of health impacts of cold homes
• Countries which have more energy efficient housing have lower
EWDs.
• There is a relationship between EWDs and low SAP rating/low
indoor temperature.
• EWDs are almost three times higher in the coldest quarter of
housing than in the warmest.
• 21.5% of all EWDs are attributable to the coldest quarter of housing,
because of it
• Around 40% of EWDs are attributable to cardio-vascular diseases.
• Around 33% of EWDs are attributable to respiratory diseases
Michael Marmot Review of health impacts of cold homes
Michael Marmot Review of health impacts of cold homes
Michael Marmot Review of health impacts of cold homes
Finland
Germany
Netherlands
Sweden
Norway
Denmark
Belgium
France
Austria
Greece
UK
Ireland
Portugal
CSVM
0.10
0.11
0.11
0.12
0.12
0.12
0.13
0.13
0.14
0.18
0.18
0.21
0.28
Cavity wall
insulation
(% houses)
100
24
47
100
85
65
42
68
26
12
25
42
6
Roof
insulation
(% houses)
100
42
53
100
77
76
43
71
37
16
90
72
6
Floor
insulation
(% houses)
100
15
27
100
88
63
12
24
11
6
4
22
2
Double
glazing
(% house)
100
88
78
100
98
91
62
52
53
8
61
33
3
Michael Marmot Review of health impacts of cold homes
 Significant effects on the physical health of the young were evident,
especially in terms of infants’ weight gain, hospital admission rates,
and caregiver-rated developmental status, as well as self-reported
reduction in the severity and frequency of children’s asthmatic
symptoms.
 Mental health impacts emerged as extremely strong amongst both
adults and adolescents.
 After improvements have been made to homes, health
improvements for adults were measurable, although modest, and
mostly related to perceptions of physical well-being and selfassessed general health.
 Large-scale studies suggest that impacts of cold temperatures as a
function of poor housing on mortality and morbidity are almost
certain across the whole population.
Michael Marmot Review of health impacts of cold homes
30
2007/08
2008/09
2009/10
26.0
24.6
23.6
23.4
24.5
22.9
23.0
23.3
22.7
19.7
20
17.8
16.9
16.6
17.3 17.2
17.2
17.1
15.7
17.0
16.7
15.5
14.8
17.9
17.4
15.9
14.5
15
15.4
14.9
13.4
13.0
10
5
North East
Yorkshire and
Humber
London
East Midlands
South West
North West
West Midlands
East
South East
0
ENGLAND
Excess winter deaths index
25
Benefits of
housing improvements
• Improving housing conditions can lead to
significant improvements in health and wellbeing
(Howden-Chapman et al, 2007)
Better self-rated health
Fewer days off school
Fewer days off work
Fewer visits to GP
50%  in fair/poor health
51% 
38% 
27% 
• A recent study showed that investing £1 in keeping
homes warm could save the NHS up to 42p in
health costs
(Liddell, 2008)
Cold Weather Plan
Summary of Plan
What is the CWP?
• The CWP is a public health plan
• Aim = to avoid the adverse health effects of
winter by raising public awareness and
triggering actions by those in contact with people
most at risk
• Sets out what needs to happen before and
during periods of severe winter weather in
England
• CWP was launched on 1st November 2011
Who is the CWP for?
• The CWP sets out a series of clear, co-ordinated
actions to be taken by the NHS, social care and
other public agencies and professionals who
interact with those most at risk from cold
weather
• The CWP is also intended to mobilise
individuals and communities to help protect
their neighbours, friends, relatives and
themselves against avoidable health problems in
winter
How does it link with existing winter actions?
• Builds on established national and local actions
by creating a co-ordinated, strategic approach
• Provides strategic guidance and a framework
which local organisations can incorporate into
their winter planning arrangements
‘Warm Homes, Healthy People’
• To support the aims of the CWP, the Department
of Health is establishing the ‘Warm Homes,
Healthy People’ fund
• A major new initiative to support local
authorities and their partners in reducing death
and poor health due to cold housing
• Fund of up to £20 million for winter 2011-12
• Will be inviting bids from local government and
the voluntary sector for innovative local
proposals
Key findings of the UKPHA FPI
Data mapping and overlay
between PCTs and local
authorities
Health Data – Data Source Table
The table below shows the health data available to PCTs
Measure
Geographical Level
Data Indentified
National / SHA Area
/ PCT Area / LA
Area / Practice
Level / Part Post
code
Age & Age Band,
Gender, Ethnicity
Prevalence of
diseases in the
community
National / SHA Area
/ PCT Area / LA
Area / Practice
Level
Number &
Percentage of
condition, males,
females
Yearly (Pooled)
Yes (Publicly
Available)
Death Rates
National / SHA Area
/ PCT Area / LA
Area
Males, Females &
People
Yearly
Yes (Publicly
Available)
National / SHA Area
/ PCT Area / LA
Area / Practice
Level / Post code
Age & Gender
Monthly
Only available by
PCTs
National / SHA Area
/ PCT Area / LA
Area / Practice
Level
Number &
Percentage of
condition
Yearly (Pooled)
Yes (Publicly
Available)
numbers of
patients admitted
to hospital
Clinical IndicatorBlood pressure,
COPD rates
Frequency
Availability
Updated Monthly
Every PCT should
be able to retrieve
data about their
own PCT
Housing Data – Local Authority Data
The table below shows the local authority data sets
Measure
Data Source
Geographical
Level
Data Indentified
Frequency
Availability
Domestic housing
attributes e.g.:
Year built
Built form
Type & level of insulation
Central heating system
3-5 yearly, some
will be updated
annually
depending on
LA
Every LA
should hold
data about
their own LA
Standard Assessment
Procedure (SAP) Rating
Updated
regularly by
local officer
Every LA
should hold
data about
their own LA
Yes (Publicly
Available)
Every LA
should hold
data about
their own LA
Domestic Housing
Attributes
Private Sector
Stock Condition
Survey
Authority / Ward /
SOA / Street /
Postcode /
Dwelling
Standard
Assessment
Procedure Rating
Private Sector
Stock Condition
Survey
Authority / Ward
/SOA / Street /
Postcode /
Dwelling
Fuel Poverty
Centre for
Sustainable Energy
– Fuel Poverty
Indicator
LSOA / Ward
Number and percentage of
population in fuel poverty
Based on the
2003 English
House Condition
Survey (EHCS)
and 2001
Census
Compound
Measures
Local Energy
Efficiency
Database, e.g. UNO
Authority / Ward /
SOA / Street /
Postcode /
Dwelling
E.g. annual domestic
heating running costs per
year
Updated
regularly by
local officer
Contextual Data – Other Sources
The table below shows other contextual data that can be used
Measure
Income
Income
Dataset
Pay check
Labour Market
Statistics online
Data Source
CACI
ONS
Lowest Level
Data Indentified
Frequency
Availability
Postcode
Household Income:
Mean income
Median income
Mode income
Annual
License
City
Number of jobs per
thousand
Mean income
Median income
Annual % change
Annual
Yes (publicly
available)
Quarterly
Yes (publicly
available)
Annual
Publicly
Available
Income
Individual
Benefits
Department of Work
and Pensions (DWP)
LSOA
Attendance
Allowance
Disability Living
Allowance
Incapacity
Benefit/Sever
Disablement
Allowance
Income Support
Job Seekers
Allowance
Pension Credit
State Pension
Deprivation
Index of
Multiple
Deprivation
Communities and
Local Government
(CLG)
LSOA
Indication of levels of
Deprivation by
area/ward
Geo
Demographic
Mosaic
Experian
Post Code
Geo Demographic
segmentation
Licence
Geo
Demographic
Acorn
CACI
Post Code
Geo Demographic
segmentation
Licence
Licence
Licence
Using the Data – Stepping through the Process
Does energy inefficiency correlate with CHD and areas of deprivation
Summary
Data Sources Used:
•Emergency Admissions for CHD from
SUS
•SAP rating from UNO
•Deprivation data from ONS
The darker blue areas on the map
highlight housing that has a low SAP
rating and therefore are energy
inefficient.
The greener areas highlight areas of
higher deprivation.
The Red markers indicate higher
numbers of emergency admissions due
to CHD.
Geo-Demographic Segmentation
Higher than expected Hypertension rates correlated with Heating running costs
Summary
Data Sources Used:
• SUS Admitted Patient Care (Hypertension
Spells)
• Mosaic Population Segmentation
• ONS Mid Year 2008 Population Estimates
• Heating running costs – Salford LA
Calculating who to target:
• SUS – all Hypertension spells between 2008
and 2009
• Mosaic groups attributed to each spell based
on the patient’s postcode
• Dividing the admissions by segment
populations enables an expected rate of
admission to be calculated for each Mosaic
segment
• The average rate for the population is 1
• Using the average rate, comparisons were
made with the actual admission rates for
each Mosaic segment. For example, if a
segment’s rate was 3 then there were 3
times as many spells than expected. This is
the higher than expected rate of
Hypertension.
Overlaying PCT Data
GP IT Referral Systems
GP IT Referral Systems
GP IT Referral Systems
GP IT Referral Systems
Beating or creating the system??
• GP referral systems now up and running in
Hampshire and Kent
• Greater Manchester work expanding
• Liverpool set to integrate the central
clearing house hub model with the GP
referral systems
Beating or creating the system?? – The Liverpool Story
• Liverpool's Healthy Homes Programme (HHP) was launched to
prevent premature death and ill-health due to poor housing
conditions and accidents in the home. It is mainly aimed at the
rented sector and is helping many of the most vulnerable residents
in Liverpool
• National estimates, show that poor housing conditions are believed
to be a significant contributor in up to 500 deaths and around 5,000
illnesses needing medical attention in Liverpool each year. Liverpool
has one of the highest rates of excess winter deaths in the UK.
• Liverpool City Council was commissioned by Liverpool Primary Care
Trust to assist in the reduction of health inequalities to improve
morbidity and mortality statistics. The programme pro-actively
targets and survey a large number of the worst properties, housing
the most vulnerable occupants.
SSpread the word and the practice!!!
Visit our website to download
the toolkits!!!
www.warmerhealthyhomes.org.uk
LiLiverpool Healthy Homes Programme
Through the removal of hazards exposure and other interventions the
programme is designed to:
•
•
•
•
•
Prevent up to 100 premature deaths
Reduce GP consultations and hospital admissions by 1000 cases
Improve clinical understanding of poor housing on local health
Reduce reliance on secondary and tertiary treatment
Increase community capacity to support housing improvements
Liverpool Council won the Municipal Journal Public Protection
Achievement of the Year Award 2011 for its strategic use of regulatory
powers to improve housing conditions and reduce health inequalities
Referrals to Partner Agencies
Patient advice
and Liaison
Service
Roy Castle
Fag Ends
Age
Concern
Pension
Service
Careline
Social Care
LCC
Energy
Efficiency
Sure Start
City Safe
Taste 4
Health
Healthy
Homes
English
Churches
Housing
Active
City
Addiction
Services
Next
Step
CAB
Fuel Poverty
Fire
Service
Benefit
max
PCT
Health
Trainer
Progress - April 09 to November 11
 18,599 properties visited
 13,637 surveys completed
 17,179 referrals to partners
 3,379 HHSRS inspections carried out
 2,317 Cat 1 hazards identified
 £3.56M Private sector investment
Harm / prevalence
Housing inspections
Fire (421)
Excess cold (643)
-inhalation of smoke/fumes (mild to
fatal), burns (mild to fatal)
- cardiovascular conditions, respiratory
diseases, rheumatoid arthritis,
hypothermia
Falls (339)
-physical injury (cuts, swellings,
fractures, death), deterioration in
general health for elderly
Electric (71)
- shock mild to fatal
Falling elements (64)
- Minor bruising to death
Damp and Mould (300)
- respiratory disease, allergic
symptoms, infections, depression and
anxiety
Hygiene (184)
- gastro-intestinal disease, asthma
and allergic rhinitis, emotional
distress, depression and anxiety
Crowding (23)
Collision&entrapment(29) Hot surfaces (27)
psychological distress, poor hygiene,
-physical injury (cuts, piercing,
- burns and scalds,
increased risk of accidents, spread of
trapping, crushing)
psychological distress
contagious disease
CO (9)
-headaches to death,
Entry by intruders (58) – emotional
damage to nervous system
stress, injuries from aggravated burglary
Acute
Chronic
Time / Exposure
Generational
Unique collaborative across the public private and voluntary
sectors
Permission is being sought from Ofgem to enable substantial
funds to be released from Scottish Power to establish a long term
partnership between UKPHA, ScottishPower and Liverpool City
Council to train Health Professionals and Local Authorities to
implement and roll-out the GP Referral system to:
• accelerate the identification of the vulnerable fuel poor
• deliver joined up rapid and efficient services
• Demonstrate health improvement and the reduction of health
inequalities
Carpe Diem! Building on opportunities and grasping the nettle!
The development of processes of data share and referral both
individually (at the patient-GP interface) and at population level
(through data-overlay mapping between local authorities and
[currently] PCTs which enables evidence based targeting at a
Unitary (or equivalent population size) wide level fits perfectly with:
-
Localism’ and ‘Big Society’
the ambition and the required outcomes of the
NHS and Public Health White Papers.
the fact that energy companies within their
competitive markets will be seeking more
targeted, efficient and cost effective methods of
delivering solutions to their customers to both
meet carbon and fuel poverty targets
The organised efforts of Society?
‘The Strategic Review of Health Inequalities in England – Post 2010’
Sir Michael Marmot – February 2010
“Rise up with me against the organisation of
misery”
Pablo Neruda
UK Public Health Association
Angela Mawle
UK Public Health Association
Dublin February 2012
Fuel Poverty – the UK Perspective