Having stated in another blog that many people in fuel poverty can't afford to even visit a doctor, it's legitimate to ask how experts know so much about the health impacts of cold homes.
Officials rely on evidence they can measure – which they refer to as 'indicators' – and make connections across different types of evidence to identify situations where a 'cause and effect' relationship is highly likely.
To measure the health impacts of cold homes, officials typically use two types of indicators. One set focuses what risks a person in a cold home is exposed to. The second focuses on health-related activities or symptoms the occupants of a cold home display.
Indoor exposure indicators refer to characteristics in the house that could affect health, and usually include the following (some organisations will add others):
average temperature in main room and sleeping rooms
humidity levels
other contamination levels
number of rooms heated
type of heating system used
percentage of monthly budget spent on energy, and
subjective comfort assessment by occupants.
Measuring these elements makes it possible to assess the overall level of risk a particular home represents. Importantly, this assessment can trigger a risk alert even before any health problems start to occur and identify the need for energy efficiency or other support measures to avoid illness.
Health indicators shift the focus to actions that suggest something in a person's environment (in this case the cold home) are causing health problems. They typically include things like the:
number of times a person visits the family doctor or is admitted to the hospital
amount of time spent in the hospital
number of days off sick from work or school
number of accidents or injuries, and
cost of medicines and treatment.
Using these indicators, experts can make a fairly accurate estimate about how a particular house of poor quality is affecting health of its occupants, and identify and prioritise measures that should be taken to reduce the most serious and costly risks.
To a degree, health and indoor exposure indicators work in opposite directions, yet they are highly complementary and can be used by different groups engaged in addressing fuel poverty. A home renovation expert, for example, may initially assess the quality of the home and make residents aware of the exposure risks and potential impacts on health. Conversely, a family doctor may notice trends in the types of illnesses that keep a family coming back again and again, and make the connection to a poor quality home being the underlying cause. Ideally, both experts will be well-informed of government programs or social agencies and able to point the family towards help, prompting the first step towards measure that can put an end to the health problems.
When health indicators suggest a patient is living in a cold home, health professionals typically dig deeper, using a range of medical tests and subjective questions to more thoroughly assess the individual’s health status and quality of life. In turn, the data physicians collect (while protecting the privacy of their patients) helps governments better understand how poor housing affects public health.
Governments, in turn, often use three measures when studying the health impacts of cold homes and designing policies to reduce such impacts: quality of life, quality-adjusted life years (QALYs) and life years.
Quality of life is relatively straightforward if a little subjective in some areas: it assesses the degree to which living in a cold home reduces overall health and well-being. Constantly having colds or minor allergies may have minor impacts, whereas if mould causes severe asthma, the inhabitant suffers considerably more. Quality of life can also include whether a person is socially isolated or feels anxious or depressed because of economic hardship.
Theexample of severe asthma is relevant to quality-adjusted life years in that a child's ability to fully participate in school activities may be reduced. If the child does not master basic skills needed later in life, the cold home may reduce overall quality of life long after the asthma attacks occur.
The last measure, life years, examines whether an effect is so severe it actually shortens the expected life-span of a person, which can be the case if adults or elderly people have respiratory or cardiac problems from chronic cold that become fatal.
Policy makers are particularly interested in tracking how exposure and health indicators change over time. This allows them to compare what happens if nothing is done to address the situation against the outcomes associated with diverse interventions.
Governments in the United Kingdom and Ireland are taking innovative steps to engage front-line health professionals in the fight against fuel poverty, and in collecting more data and information that will help shape future policy to address fuel poverty.
COLD@HOME will return to the topic of cold homes and health regularly over the coming weeks.