Transcript Document

UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Maintaining Health through fuel
poverty reduction
some issues raised by the «Warm
Homes Project»
Nick Merleau-Ponty Research Officer NEA
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Warm Homes Project
Collaboration between
NEA, University of Northumbria, City University, North Tyneside MBC,
funded by H&Social Research within Community Fund
Teresa Allan (City University)
Barbara Harrington (University of Northumbria)
Prof. Bob Heyman (City University)
Nick Merleau-Ponty (NEA, Newcastle)
Helen Stockton (NEA)
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Background to the Study
Limited evidence (1999) re: relationships
between fuel poverty, energy efficiency, health
& well-being, tho’ some elements in possible
causal pathway understood
Even evidence about effects of EE improvement
on attained temperature lacking
In particular, need for randomised controlled
trial
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Intervention systems - policies, procedures, resources …………………….
Insulation, Heating system,
Ventilation, Appliances, Fuels,
building build, location…
user
interface
household
Beliefs
Habits
Expectations
Priorities
Conflicts
Housing History
Income
Fuel Poverty
Controls
Feedback
Behaviour
external
factors
internal
atmosphere
Temperature
Humidity
Air change &
"draughts"
pathogens
(many) other
factors
Health
outcomes
physical, socialpsychological
time, dose,
preventative,
palliative,
iatrogenic…….
Erosion/improvement
Possible Effects model
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Warm Homes Project
Main elements:
•Logistical Regression study of Fuel Poverty, Energy
Efficiency & Health relationships at household level
•Randomised Controlled Trial of EE impact on measures
of Health
•Qualitative and descriptive studies
•Modelling of a simpler set of energy, health and housing
relationships at aggregated area level [abandoned owing to
lack of accurate energy data at district level]
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
HS & other tools for Log reg and RCT
Energy Audit data (yr 1 and updates)
Improvement Protocol constructed
Winter Temperature monitoring + meter readings
HS items:
Household Characteristics
Inventory of Health self-report measures
Heating Satisfaction
Energy Behaviour
Housing & expenditure priorities
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Sample: h/hs in North Tyneside
Wave A
Semi-random recruitment by phone, using “home
always warm” and “high fuel costs” filter questions,
with offer of free measures to the “eligible”.
Wave B
Similar filter via doorstep contact in targeted areas in
N Tyneside believed to contain poor housing and
lower income households.
RCT: 250 (appx 125 EXP and CONT) Households in or
near fuel poverty [all cases where FPI > 7.5%]
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
HS= Household Survey
Qualitative Interviews: Pilot, Cycle 1, Cycle 2
HS 2
Mar 01
HS Wa
Mar 00
HS Wb
Oct 00
Energy
Audits
N=541
EXP
N=335
Fuel Poverty Assessment
Matching EXP and CONTROL,
Maintaining Comparator nonFP
group
HS 3
Mar 02
N=275
Intervention
April - Sept
Overview of prospective RCT
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Nick Merleau-Ponty
CON
HS 4
Mar 03
N=210
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
LR findings: Significant odds ratios
Age (*6)
Other sources of
variation
General
Deprivation
(*2)
Locus of
Control
(*4)
Global
Health
Score
SAP
Rating
(*1.03/ pnt)
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Nick Merleau-Ponty
Acute
Illness
Score (*3)
Use of Health
Services Scores
Prescriptions (*6)
Visits (*3)
Heating
Satisfaction
(*2)
LR
Models:
Yr 1&1
Yr 1&2
etc
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Other Log Reg key issues
Energy efficiency (as measured by SAP) a highly
significant intervening variable in the Health and
Housing relationship – complementary at household
level to Paul Wilkinson’s findings (Cold Comfort) at
aggregated area level.
Fuel Poverty did not enter the LR models as a
significant term when income and EE terms present.
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
RCT Preliminary Findings
NB Preliminary Findings
subject to the usual issues
of interpretation and
possible modification in
the light of review and
further analysis (ongoing|)
Using Health change scores yrs 2-3:
Temperature (except Zone I pm) improvements and
range of health improvements in year 3 EXP
relative to CONTROL but not stat. significant
But differences reached s.s. [notably for global health
measure, SF36: EV, MH, Pain, GH] when removing
zero-improvement cases & selecting:
i)
Homes where critical mean temperatures
rose/heating satisfaction improved
ii) Small households
iii) Households in fuel poverty
iv) Similar using 2-4 pre-post comparison (physical
functioning significant, gh no longer significant)
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Other findings:
Sig. Correlations between temperature
variables, FPI scores [disposible income]
and household size except Zone I evening.
Significant inter – correlations between:
change in heating satisfaction, temperature
improvement and overall health change
Sig diffs. dichotimised heating sat. change and
self-rep. health changes 2-3 on EV, MH,
and social functioning
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Other Findings (2)
Importance of Housing history. Little housing choice –
most now gave warmth & fuel bills higher priority
where choice available (method of recruitment?)
h/h warmth central to meaning of “home” [bar small
minority] - little evidence of v low temps living
rooms evening. But evidence underheating in Zone
II esp with smaller households and those in FP
High propensity (70%) to save money rather than
achieve higher temperatures
Highly sig. improvement SF36 physical functioning with
PPV (selective sub-sample)
Warmth mainly seen as part of dependent care, rather
than as determinant of well-being but some saw
cold home as leading to depression
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Some policy and organisational issues:
1. In spite of small sample and limited intervention (12 SAP
points mean), study adds weight to role of energy efficiency
work in health improvement.
2. Suggests effect maximised in smaller and older households
and those in fuel poverty where temperatures lower
(temperature monitoring important) but…
3. FPI found to be volatile over time and not an ideal targeting
guide; but persistent fuel poverty (long-term econ inactive,
older, disabled) probably v. important
4. “Fuel Poverty” still a useful shorthand for monitoring, and as
shorthand for low income/high fuel cost combination
5. Support for value of ppv for improved physical health in
damp homes/reported respiratory illness combination
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Policy and organisational issues (2):
6. Passive characteristics of home energy system important as
many h/h’s don’t control systems in way expected. But
reported control difficulties, lack of health risk knowledge,
high propensity to save on bills rather than take higher
temperatures suggest greater temperature (and health?)
improvement possible with: better health and energy
education, attention to interface design
7. Access to: energy info about home (sellers pack*), tenant
empowerment (at whim of landlords), knowledge about
health risks of cold and badly-ventilated homes, and grants
(eligibility gaps* much in evidence in the study) are
important issues.
8. Experience of recruitment to study adds to evidence that
many take-up* issues remain.
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Nick Merleau-Ponty
UKIEG Housing & Health Conference 19 Oct 2004
Maintaining Health through Fuel Poverty Reduction – some issues raised by the «Warm Homes Project»
Main Publications:
Logistical Regression study: to be
published in Housing Studies
Qualitative study: to be published in Health
& Social Care in the Community
RCT paper: in preparation
NEA report on whole project: Jan 05
Contact: nick.merleau-ponty @ nea.org.uk
NEA, 90-92 Pilgrim St, Newcastle upon Tyne, NE1 6SG tel: 0191 261 5677
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Nick Merleau-Ponty