Home Energy Efficiency Scheme Research Articles

A Comparison of The Health Impacts of Individual Level and Area Based Welsh Government Fuel Poverty Schemes

IntroductionLiving in a cold and/or damp house is known to increase the risk of morbidity, mortality and excess winter deaths. To reduce fuel poverty in Wales, the Welsh Government developed schemes to provide energy efficiency improvements to those most likely affected by fuel poverty.
 We explored the relative impacts on health of an individual-level scheme, Warm Homes Nest, and an area-based scheme, Arbed.
 Objectives and ApproachOverall aim: to evaluate the health impacts of Welsh Government funded schemes designed to reduce fuel poverty. Presented objective: to investigate the relative impact of the individual-level and area-based schemes on the health of recipients. A longitudinal dataset was created using the anonymised residence that received improvements linked to residents’ health measures using routine health records held in the SAIL Databank at Swansea University.
 We used difference-in-difference (DID) estimations to compare any changes in recipient health before and after intervention with any concurrent change in health in those yet to receive the intervention.
 ResultsAn analysis of the Warm Homes Nest Scheme, published in 2017 and presented at the IPDLN 2018 conference found a positive impact of the scheme on the health of recipients.
 This presentation will describe the further analysis comparing the area-based Arbed scheme with both the recipients of the individual-level Nest scheme and groups in comparable need that had not yet received the intervention. We will present results focussing on the relative impacts of the two schemes on respiratory health, infection prescribing and mental health.
 Conclusion / ImplicationsProviding home energy efficiency interventions has the potential to benefit population health, however there is a scarcity of evidence comparing different methods of implementing schemes. Our findings will inform more effectively focussed home energy efficiency schemes and potentially thus improve the health and wellbeing of people living in Wales.

Fuel Poverty Data Linking Project

Background with rationaleIn Wales, a household is considered to be in fuel poverty if it needs to spend more than 10% of its net income on maintaining a satisfactory heating regime. Addressing fuel poverty is particularly important to Wales with an estimated 29% of households in fuel poverty compared with 17% in the UK overall.
 To tackle fuel poverty in Wales, the Welsh Government implemented two fuel poverty schemes. Warm Homes Nest is a demand-led scheme and Warm Homes Arbed an area-based scheme. Both schemes provide free home energy efficiency measures e.g. home insulation or boilers.
 Main AimTo use linked administrative data to evaluate the impacts of Welsh Government home energy efficiency schemes for low income households. The findings will inform future fuel poverty schemes in Wales.
 Methods/ApproachIndividual-level data from both schemes was anonymously linked to routine health records, using the SAIL (Secure Anonymised Information Linkage) Databank, to examine the health service use of recipients.
 We used difference-in-difference estimations to compare any changes in the health of recipients before and after intervention with any concurrent change in health in those yet to receive an intervention.
 ResultsResults published in 2017 indicated positive effects for the Nest scheme, including positive impacts on respiratory health and general health.
 We will report results comparing the health impacts of the Arbed and Nest schemes. The study will be the first to directly compare the health impacts of a demand-led and an area-based energy efficiency scheme.
 Conclusion Providing home energy efficiency interventions has the potential to benefit population health; however, there is a scarcity of evidence comparing different methods of implementing schemes. Our findings will inform more effectively focussed home energy efficiency schemes and potentially improve the health of people living in Wales.

Evaluating the impacts on health outcomes of Welsh Government funded schemes designed to improve the energy efficiency of the homes of low income households: A comparison of individual level and area based schemes.

IntroductionLiving in a cold and/or damp house can damage health. To reduce fuel poverty in Wales, the Welsh Government developed domestic energy efficiency schemes - an individual-level scheme, Warm Homes Nest and an area-based scheme, Warm Homes Arbed. Both schemes provide improvements to those most likely affected by fuel poverty.
 Objectives and ApproachOverall aim: to evaluate the health impacts of Welsh Government funded schemes designed to reduce fuel poverty. Presented objective: to investigate the relative impact of the individual-level and area-based schemes on the health of recipients.
 A longitudinal dataset was created using the anonymised residence that received improvements linked to residents’ health measures (hospital admissions, GP prescriptions and clinical diagnoses) using routine health records held in the SAIL Databank at Swansea University.
 We used difference-in-difference (DID) estimations to compare any changes in recipient health before and after intervention with any concurrent change in health in those yet to receive the intervention.
 ResultsAn analysis of the Warm Homes Nest Scheme, published in 2017 and presented at the IPDLN 2017 conference found a positive impact of the scheme on the health of recipients.
 This presentation will describe the further analysis (concluding shortly) comparing the area-based Arbed scheme with both the recipients of the individual-level Nest scheme and groups in comparable need that had not yet received the intervention. We will present results focussing on the relative impacts of the two schemes on cardiovascular, respiratory and general health.
 Conclusion/ImplicationsProviding home energy efficiency interventions has the potential to benefit population health; however, there is a scarcity of evidence comparing different methods of implementing schemes. Our findings will inform more effectively-focussed home energy efficiency schemes and potentially thus improve the health of people living in Wales.

Evaluating the impacts on health outcomes ofWelsh Government funded schemes designed to improve the energy efficiency of the homes of low income households: A comparison of individual level and area based schemes.

BackgroundTo reduce fuel poverty and its adverse health effects in Wales the Welsh Government developed programmes to improve the energy efficiency of homes. This includes the fuel poverty scheme: ‘Warm Homes Nest‘. The scheme was available to low income and vulnerable households in Wales from 2011 to 2015, and provided energy efficiency measures e.g. insulation and heating upgrades such as a more efficient boiler, aimed to maintain warmer homes.
 ObjectivesThe overall aim was to evaluate the health impacts of Welsh Government funded schemes designed to reduce fuel poverty through the use of existing data linked to the routine health records held in the SAIL Databank at Swansea University.
 MethodWe created a longitudinal dataset of individuals living in residential dwellings in receipt of home energy efficiency improvements, then linked to their health records to create a summary of their health utilization measures.
 We used difference-in-difference (DID) estimations to compare any changes in recipient health before and after intervention against any concurrent change in health in those yet to receive the intervention.
 FindingsWe have built upon our previous work presented at the ADRN 2017 conference where we reported a positive impact of the Nest scheme on the respiratory health of recipients. We will show a significant impact on respiratory conditions leading to a change to the eligibility criteria for the successor scheme. We will discuss our ongoing work analysing the impacts of the Nest scheme on mental health outcomes. This will include the findings from the literature search demonstrating the need for more evidence using objective outcome measures, and on selecting and utilizing validated codes developed for administrative data to investigate any changes in common mental health issues such as depression and anxiety.
 ConclusionsProviding home energy efficiency interventions has the potential to benefit population health. Our findings will inform more effectively-focussed home energy efficiency schemes and potentially thus improve the health of people living in Wales.

Evaluating the impacts on health outcomes of Welsh Government funded schemes designed to improve the energy efficiency of the homes of low income households.

ABSTRACTBackgroundLiving in a cold and/or damp house is known to increase the risk of morbidity, mortality and excess winter deaths. To reduce fuel poverty and its adverse health effects in Wales the Welsh Government developed programmes to improve the energy efficiency of homes. These included the Home Energy Efficiency Scheme (HEES) and subsequent Warm Homes NEST scheme. Both schemes supported those most likely to be affected by fuel poverty, including low income and vulnerable households from 2000 to 2015. The energy efficiency measures provided included insulation and heating upgrades, such as a more efficient boiler.
 AimThe overall aim of the project is to evaluate the health impacts of Welsh Government funded schemes designed to improve the energy efficiency of the homes of low income households through the use of existing data (HEES and NEST linked to the routine health records held in the SAIL Databank at Swansea University).
 MethodsA longitudinal dataset was created using the anonymised residential dwelling that has received home energy efficiency improvements linked to a summary of their health measures (hospital admissions, reason for the admission, GP prescriptions and clinical diagnoses).
 Cohorts will be constructed of people who have already received the intervention to compare those who have not yet received the intervention but who went on to receive it two years later. We will use a stepped wedge design to construct an intervention and control cohort for each year of the study period. We will apply statistical techniques to conduct difference in difference (DID) estimations. This will allow us to compare any changes in the health of people before and after the intervention with any concurrent change in health in those who may require, but have yet to receive, the intervention.
 ResultsWe anticipate concluding the analysis in June in order for the results to inform the redesign of the successor scheme to Warm Homes NEST, due to be consulted on during 2016 and in place from April 2017. Our results will compare specific interventions for their impacts on health. We will show whether particular population groups e.g. those suffering from particular health condition, gain particular benefit from interventions.
 ConclusionOur findings have the potential to inform more effectively focussed home energy efficiency schemes in order to reduce the numbers of people living in fuel poverty and thus improve the health and wellbeing of people living in Wales.

Fuel poverty, affordability, and energy justice in England: Policy insights from the Warm Front Program

Millions of homes around the world suffer from “fuel poverty,” commonly defined as the necessity to spend more than 10 percent of their income paying energy bills. This article first discusses how home energy efficiency schemes, such as those that pay to weatherize doors and windows, install insulation, and give free energy audits, can significantly reduce the prevalence of fuel poverty. It then examines the “Warm Front” program in England, which over the course of 2000–2013 saw 2.3 million “fuel poor” British homes receive energy efficiency upgrades to save them money and improve their overall health. Warm Front not only lessened the prevalence of fuel poverty; it cut greenhouse gas emissions, produced an average extra annual income of £1894.79 per participating household, and reported exceptional customer satisfaction with more than 90 percent of its customers praising the scheme. This study details the history, benefits, and challenges of the program, and it teases out six noteworthy lessons for energy analysts, planners, and policymakers.

Evaluating fuel poverty policy in Northern Ireland using a geographic approach

Recent audits have shown that anti-fuel poverty policies in the UK depend on loosely defined targeting and cannot accurately identify fuel poor households. New methods of targeting are necessary to improve fuel poverty policy. This paper uses Geographic Information System (GIS) techniques to evaluate the targeting of a home energy efficiency scheme small area level in Northern Ireland, based on the level of need. The concept of need is modelled using an area-based, multi-dimensional fuel poverty risk index. The characteristics and spatial distribution of household retrofits are explored. Policy activity and expenditure are compared with the level of need in an area. Results indicate that policy activity is only weakly associated with the level of need in an area, although policy appears to be well targeted in a few areas. Contrary to existing evidence, rural areas appear to be well served by policy, receiving above average numbers of retrofits and expenditure. There are typically two types of retrofit (major and minor). Most retrofits are minor and may not reduce fuel poverty. These results evidence the limitations of the current targeting system and suggest that there may be scope for improved policy implemented via a more proactive, area-based approach.

Psychosocial routes from housing investment to health: Evidence from England's home energy efficiency scheme

Over the past decade the Warm Front Scheme has been the English Government's principal programme for improving domestic energy efficiency and reducing fuel poverty. This paper reports on a cross-sectional survey of low income householders participating in the Warm Front Scheme in five urban areas of England. Surveys were conducted of 2685 individuals, before and or after intervention. Pathways to self reported health were modelled by logistic regression. Of all the dimensions of health examined, only self reported mental health is directly associated with Warm Front measures. Intermediary variables associated with Warm Front intervention were shown to be significantly correlated with more dimensions of self reported health status. Higher temperatures, satisfaction with the heating system, greater thermal comfort, reductions in fuel poverty and lower stress were significantly correlated with improved health. Alleviating fuel poverty and reducing stress appeared to be the main route to health. We conclude there are complex and indirect relationships linking energy efficiency measures to outcomes on all dimensions of health which contribute to significant material and psychosocial benefits. The impact of the Warm Front Scheme cannot be fully understood by a limited analysis which merely relates indoor temperature and property characteristics to physiological health outcomes.

Living in cold homes after heating improvements: Evidence from Warm-Front, England’s Home Energy Efficiency Scheme

Objective To investigate explanatory factors for persistent cold temperatures in homes which have received heating improvements. Design Analysis of data from a national survey of dwellings and households (in England occupied by low-income residents) that had received heating improvements or repairs under the Warm Front Scheme. Methods Over the winters of 2001–02 and 2002–03, householders recorded living room and main bedroom temperatures in a diary. Entries were examined for 888 households, which had received high level heating interventions. Two hundred and twenty-two households were identified as occupying cold homes, with mean bedroom temperature below 16 °C or mean living room temperatures below 18 °C. Binary logistic regression was used to model dwelling and household features and then occupants’ behaviour and attitudes in the ‘cold homes’ sub-set compared with the remainder of the high intervention group. Seventy-nine supplementary, structured telephone interviews explored reasons given for lower temperatures. Using graphical and tabular methods, householders preferring cooler homes were distinguished from those who felt constrained in some way. Results Cold homes predominate in pre-1930 properties where the householder remains dissatisfied with the heating system despite major improvements funded by Warm Front. Residents of cold homes are less likely to have long-standing illness or disability, but more likely to experience anxiety or depression. A small sample of telephone interviews reveals those preferring lower temperatures for health or other reasons, report less anxiety and depression than those with limited control over their home environment. Their ‘thermal resistance’ to higher temperatures challenges orthodox definitions of comfort and fuel poverty.

Home is where the hearth is: Grant recipients’ views of England's Home Energy Efficiency Scheme (Warm Front)

This paper reports the results of research carried out as part of the national health impact evaluation of the Warm Front Scheme, a government initiative aimed at alleviating fuel poverty in England. Semi-structured interviews were carried out in a purposive sample of 49 households which received home energy improvements under the Scheme from five urban areas (Birmingham, Liverpool, Manchester, Newcastle, Southampton). Each household had received installation, replacement or refurbishment of the heating system and, in some cases, also insulation of the cavity wall or loft or both, and draught-proofing measures. Most householders reported improved and more controllable warmth and hot water. Many also reported perceptions of improved physical health and comfort, especially of mental health and emotional well-being and, in several cases, the easing of symptoms of chronic illness. There were reports of improved family relations, an expansion of the domestic space used during cold months, greater use of kitchens and improved nutrition, increased privacy, improved social interaction, and an increase in comfort and atmosphere within the home. Greater warmth and comfort also enhanced emotional security, and recipients were more content and at ease in their homes. However there was little evidence of substantially lower heating bills. These results provide evidence that Warm Front home energy improvements are accompanied by appreciable benefits in terms of use of living space, comfort and quality of life, physical and mental well-being, although there is only limited evidence of change in health behaviour.

Mould and Winter Indoor Relative Humidity in Low Income Households in England

This paper examines the extent to which variation in heating-season, indoor relative humidity (RH) and mould occurrence in English households is explained by dwelling and household characteristics. It is based on analysis of data from a national study of England's Home Energy Efficiency scheme ( Warm Front) which provides grants for energy efficiency improvements to vulnerable households. Surveys were undertaken of dwellings and households participating in the scheme in five urban areas. Half-hourly living room and main bedroom temperatures and RH measurements were recorded for two to four weeks in a subset of dwellings (no.=1604) over the winters of 2001–02 and 2002-03. For each dwelling, regression of indoor vapour pressure excess on outdoor temperature was used to obtain estimates of daily living room and bedroom indoor vapour pressure under standardised conditions (outdoor temperature of 5°C and 80% RH), from which standardised values of indoor relative humidity were derived. We present evidence on the relationship between mould severity and standardised relative humidity, and between both these parameters and household and dwelling characteristics, including Warm Frontimprovements.

Determinants of winter indoor temperatures in low income households in England

The objective of this study is to quantify the extent to which variation in heating season indoor temperatures is explained by dwelling and household characteristics and increased by energy efficiency improvements in low income households. A survey of dwellings in the Warm Front home energy efficiency scheme was carried out in five urban areas of England. Half-hourly living room and main bedroom temperatures were recorded for 2–4 weeks over two winters. For each dwelling, regression of indoor on outdoor temperature was used to obtain estimates of daytime living room and night time bedroom temperatures under standardized conditions (outdoor temperature of 5 °C). The results indicate that the median standardized daytime living room temperature was 19.1 °C and the median standardized night time bedroom temperature 17.1 °C. Temperatures were influenced by property characteristics, including its age, construction and thermal efficiency and also by the household number of people and the age of the head of household. Dwellings that received both heating and insulation measures through the Warm Front scheme had daytime living room temperatures 1.6 °C higher than pre-intervention dwellings, night time bedroom temperatures were 2.8 °C higher. Warm Front energy efficiency improvements lead to substantial improvements of both living room and bedroom temperatures which are likely to have benefits in terms of thermal comfort and well-being.

Targeting fuel poverty in England: is the government getting warm?

AbstractThis paper examines the cost‐effectiveness of the new Home Energy Efficiency Scheme (HEES), a key component of the UK government's Fuel Poverty Strategy. The impact on the fuel poverty gap is simulated using data on a large‐scale and representative sample of households in England. The scope for improving the scheme's targeting is considered by examining the optimal allocation of grants between households. The extent to which these potential gains might be achieved in practice using pragmatic criteria for distributing grants, and the implications of taking into account the dynamics of fuel poverty and the self‐selection of grant applicants, are also explored. The current scheme is unlikely to have a very significant impact on fuel poverty, and considerable gains could be achieved by redesigning HEES, although the paper also highlights the difficulties involved in efficient targeting, including some additional complications not encountered in the analysis of more traditional anti‐poverty measures.