Homes are rather hazardous places, where all kinds of accidents can happen. Falls, fires and burns, or exposure to hazardous substances often require medical treatment, creating costs for the national health budget.

In 2013 in the United Kingdom, the National Health Service (NHS) linked ₤ 1.4 billion of its treatment expenses, including physician visits and hospitalisation, to household hazards. Extreme cold is one of the hazards connected to health costs. 

Health hazards of 'poor housing'

Ultimately, the healthcare costs associated with household hazards reflect two things: 1) the seriousness of the health problem; and 2) the likelihood of it occurring. An underlying risk factor is that as the quality of a house goes down, the chance of a high-cost risk occurring rises substantially. To better understand the risks and costs of cold homes, the BRE (Buildings Research Establishment) has drawn together data and information from multiple sources.

The BRE drew its first 'piece of the puzzle' from the English Housing Survey (EHS), an initiative carried out annually to get an overview of the condition and safety of the housing stock. When conducting the survey, home inspectors use the Housing Health and Safety Rating System (HHSRS) to classify specific defects and assess their potential effects on the health and safety of occupants and visitors.

The rating system defines 29 hazards and accounts for the seriousness of each, differentiating between minor hazards and those that represent an immediate threat of major harm. Anything that scores 1 000 (or more) on the HHSRS is deemed to be a Category 1 hazard.  

Rickety stairs or a slippery bathroom floor, primary factors in falls on stairs or on the level, represent immediate Category 1 hazards. But the bottom line is this: exposure to cold over a long period of time is considered equally high risk. So an inefficient furnace, leaky windows and doors, and poor ventilation are – in the eyes of the UK government –just as dangerous.

In 2011, 3.4 million homes – a full 15% of the English stock of 22 million homes – were found to have at least one Category 1 risk, with 'falls on stairs' and 'cold homes' being almost tied for occurring most frequently. Each accounted for about 40% of the Category 1 risks recorded. Moreover, both occurred more than twice as often as the third-highest risk (falls on the level), and more than 10 times more often than the 10th-ranked risk (getting trapped or having some kind of 'collision' in a home).   

A fundamental difference is this: cold homes, as the second-highest risk never send people to hospital or the doctor's office 'by chance'. They are not 'accidents waiting to happen', but rather are known to cause a steady decline in the health of occupants. Arguably then, taking steps to avoid this risk should be a high priority. 

Any dwelling with even one Category 1 hazard is considered to be below the minimum acceptable standard for housing and thus classified as “poor housing”. Yet clearly, a large number of people continue to live in such homes: 15% of 65 million equals some 9.7 million. 

How is cold hazardous? 

The HHSRS describes a 'healthy indoor temperature' as being around 21°C. But one of the risk factors is people's perception: most of people won't 'feel' cold until the temperature drops below 18°C. This is already 1°C below the level at which a person's immune system becomes comprised, creating a risk of that she or he will more easily catch a cold, flu or virus circulating in the community.

Below 16°C, the risk for respiratory and cardiovascular conditions increases substantially. This is because, just like molasses, when blood get cold it gets 'thicker' and flows more slowly. For each 1°C decrease in body temperature, blood becomes about 2% thicker and delivery of oxygen throughout the body is reduced. At 10°C or lower, even for two hours, the risk of hypothermia becomes quite high, especially for the elderly. 

Using NHS data, the BRE study overlaid the various household hazards with the 'first-year' cost of treating the associated health outcomes. Pneumonia, minor respiratory conditions and mild asthma have relatively low costs, on par with minor burns. The allergies and severe asthma associated with dampness and mould in a home start to get more costly, ranging from ₤242 to over ₤2 000. Burns and heart attacks are 7 to 10 times more costly still. But check back to the graph above showing the likelihood of each risk occurring: the actual risk ofcold homes causing heart attacks is 10 times that of fires causing severe burns.  

But check back to the graph above showing the likelihood of each risk occurring: the actual risk of cold homes causing heart attacks is 10 times that of fires causing severe burns. 

The latest estimates for the total healthcare cost of poor housing is £1.4billion annually, with over £800 million being attributable to cold homes. COLD@HOME examines the health risks of cold homes in more detail in other posts under What are the impacts? 

Impacts to communities and society

More recently, the BRE has carried out additional research to chart not only the healthcare costs of poor homes, but also their impacts on communities and society in general. When families reduce their living space to the rooms they can afford to heat, overcrowding can lead to psychological impacts that may eventually result in costs to the healthcare system or to social agencies and other civil society organisations. In some instances, negative health outcomes are shown to contribute to disruptive or destructive behaviour. It is much more difficult to attach a 'cost' to these impacts, but they should not be overlooked. 

Studies like these are vitally important to efforts to reduce fuel poverty: being able to 'count the costs' of poor homes can help build the case for investing in interventions. Installing a better ventilation system may be about on par with the recurring costs of treating severe asthma. But in fact, the ventilation system delivers much better value: a child not suffering from asthma is likely to do better at school, be less socially isolated and perhaps avoid the risk of falling into anti-social behaviour.  

EnAct is grateful to Ian Watson and Jack Hulme of BRE for their collaboration on this Feature.