New Marmot Review: Thousands will die and millions of children will suffer from ‘humanitarian crisis’ of fuel poverty
Epidemic-levels of fuel poverty affecting half of UK households will cause a ‘significant humanitarian crisis with thousands of lives lost and millions of children’s development blighted’, warn leading health experts in the latest hard-hitting Marmot review led by the UCL Institute of Health Equity.
Published today, the new review, Fuel Poverty, Cold Homes and Health Inequalities, predicts significant health, social and education detriment for a new generation of children if, as forecast*, 55% of the UK’s households (around 15 million people), fall into fuel poverty by January 2023 without effective interventions.
A household is in fuel poverty if they are on a low income and face high costs of keeping adequately warm and other basic energy services. Fuel poverty is driven by three main factors: household income, the current cost of energy and the energy efficiency of a home.
Led by Professor Sir Michael Marmot, Director of UCL Institute of Health Equity, with
Professor Ian Sinha, Consultant respiratory Paediatrician at Alder Hey Children’s Hospital, Liverpool, the review links the ‘dangerous consequences’ of living in a cold home to a child’s health and future life expectancy.
In publishing the report, Sir Michael warns fuel poverty has a damaging and significant consequence for health, with thousands losing their lives unnecessarily and health inequalities widening, making the government’s attempt to ‘level up’ even harder to achieve:
“Warm homes, nutritious food and a stable job are vital building blocks for health. In addition to the effect of cold homes on mental and physical illness, living on a low income does much damage. If we are constantly worrying about making ends meet it puts a strain on our bodies, resulting in increased stress, with effects on the heart and blood vessels and a disordered immune system. This type of living environment will mean thousands of people will die earlier than they should, and, in addition to lung damage in children, the toxic stress can permanently affect their brain development.
“Over the last decade the UCL Institute of Health Equity has laid out clearly, in repeated reviews of health inequalities, what needs to be done to ensure everyone has the opportunity to live a long and healthy life, in dignity. In a rich country like the UK, the idea that more than half of households should face fuel poverty is a sad judgement of the management of our affairs. It is an absolute travesty that energy companies are raking in billions of pounds in profits and tax cuts are being suggested while half the population is facing shortened lives and severe hardship through no fault of their own.”
He added: “The government needs to act, and act right now. It’s clear we are facing a significant humanitarian crisis with thousands losing their lives and millions of children’s development blighted, leading to inequalities that will last a lifetime.”
Professor Ian Sinha, Consultant Respiratory Paediatrician at Alder Hey Children’s Hospital explains: “There is a window of opportunity in childhood for optimal respiratory maturation. This is impaired by problems associated with cold, substandard, or overcrowded housing such as viruses, dust,
mould, and pollution. When we add in factors such as cutting back on food to pay the gas bills, and the mental health and educational impact of cold houses, the picture is bleaker still.
“Without meaningful and swift action, therefore, my concern is that cold housing will have dangerous consequences for many children now, and through their life-course. Lifelong health inequalities, repeatedly and eloquently described by Sir Michael take root in childhood – there is no doubt that the standard of a child’s house is a key factor.”
Alongside health, the review also suggests fuel poverty will lead to substantial and long-lasting education inequalities.
Sir Michael added: “Children living in a cold house are less likely to be able to do their homework, leading to them falling behind at school. Long-term that is more likely to lead to low-income, unstable work and not being able to make ends meet. Educational achievement is a key predictor of long-term health and longevity, and health inequalities.”
Fuel poverty: the problem, some key facts and stats:
· Cold homes adversely affect child development, can cause and worsen respiratory conditions, cardiovascular diseases, poor mental health, dementia and hypothermia
· Illnesses linked to cold, damp and dangerous homes cost the NHS more than £2.5 billion a year
· An estimated 63,000 people died in England 2020-21 as a result of excess winter deaths (most caused by COVID-19**), to which cold homes and fuel poverty also contributed, with some 10% directly attributable to fuel poverty.
· England’s excess winter deaths index in 2002 to 2011 was higher than the average for Northern European countries, with this country ranking above the likes of Finland, which has much warmer homes.
· Households with children as well as those on low incomes, living with disabilities and Black and Minority Ethnic groups are more likely to be in fuel poverty.
· Local authorities in partnership with public health are well placed to address fuel poverty but national government must address the underlying causes of fuel poverty – national programmes had either stalled or received reduced funding prior to the pandemic.
The measurement of ‘fuel poverty’ differs across the home nations of the UK, which makes direct comparisons difficult. But the prediction of more than half of households being in fuel poverty by January 2023 in England will likely be even higher in Wales, Northern Ireland and significantly worse in Scotland, leading to even greater social, health and educational inequalities.
· Urgent setting up of a national fuel poverty strategy, with ring-fenced funding, to enable local government to plan and support local populations, proportionate to need, sustainably
· National policy interventions need to address the twin challenge of household incomes and energy need – solutions include introducing a social tariff (qualifying households offered a discounted rate on energy bills), lowering energy prices for everyone and recouping some of the cost through irises in income tax and ramping up windfall taxes on energy companies
· For the strategy to work long-term, the underlying root causes of fuel poverty must be addressed, including the vital building blocks for health such as warm homes, nutritious food, stable jobs and having enough money to lead a healthy life and education
· As Citizen’s Advice (CA) has shown, it is well placed to help households vulnerable to fuel poverty access all their entitled benefits (estimates suggest billions of pounds of benefits go unclaimed each year)
· At local level health providers should implement the NICE guidelines on health risks of cold homes e.g., healthcare workers working proactively to improve housing quality
· Local advice services must be tailored to personal needs, including home/face-to-face visits/translations to ensure digitally excluded households/those whose first language is not English are able access support
Case study examples of action to reduce fuel poverty
Northern Ireland: Neighbourhood Renewal A longitudinal study in Northern Ireland which focused on levels of fuel poverty in ‘neighbourhood renewal’ areas found that urban regeneration programmes reduced levels of fuel poverty, particularly in vulnerable groups including adults with low education, those receiving benefits and retired adults. Regeneration took place over a 7 to 10 year roll out, highlighting the need for long-term planning.
Scotland: East Ayrshire Joint Team Fuel Poverty Strategy Ringfenced funding from December 2006-March 2009 enabled East Ayrshire council to train team members to visit vulnerable people over the age of 60 in their homes to provide income maximisation advice and assist with application forms. In one year, the program helped make 673 successful claims, amounting to £1.358 million of extra income for pensioners
Wales: Child Poverty Income Maximisation Action Plan 2020-2021 The Welsh Government invested £800,000 in an advice service pilot project, training people who come into contact with vulnerable families in benefits awareness. The IMAP included projects which were specifically designed for families from Black and Minority Ethnic backgrounds, families with low income and families with children living with disabilities. The pilot reached 1440 households, and in total helped them claim over £2.468 million in additional benefits
England: Liverpool Bronchiolitis Parent Champions
From December 2020, Alder Hey Children’s Hospital employed 10 community bronchiolitis Parent Champions who worked in Children’s Centres within their own communities in Liverpool. All were mothers who had utilised Children’s Centres in Liverpool’s wards that have high levels of deprivation and paediatric respiratory illness. The mothers received training from paediatricians, Citizens Advice, Shelter and breastfeeding charities. As well as providing practical support and advice on bronchiolitis, the Parent Champions directly referred families to Citizens Advice social prescribing schemes and provided Healthy Start vouchers (to buy healthy food). In six months the Parent Champions reached approximately 2,000 families in deprived areas of Liverpool, with strong positive feedback from the community.
*Bradshaw J, Keung A (2022) Fuel Poverty: estimates for the UK. University of York. Available from: https://pure.york.ac.uk/portal/en/publications/fuel-poverty-estimates-for-the-uk(adc974d6-15cb-4e9a-9864-623f61aef48d).htm
** Excess winter deaths measures the increase in the winter period compared the summer https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/methodologies/excesswintermortalityinenglandandwalesqmi
All media enquiries: Felicity Porritt, UCL Institute of Health Equity
E: firstname.lastname@example.org T: 07739 419219
For more information join Fuel Poverty, Cold Homes and Health Inequalities webinar on Thursday 1st September, 2022, 13:00-14:00 BST – Link to register
The webinar will be a chance to discuss fuel poverty, its impact on worsening health inequalities, who is most affected by this and what policies could be introduced to reduce fuel poverty and its impacts.
Professor Sir Michael Marmot is Professor of Epidemiology at University College London, Director of the UCL Institute of Health Equity, and Past President of the World Medical Association. He is the author of The Health Gap: the challenge of an unequal world (Bloomsbury: 2015) and Status Syndrome: how your place on the social gradient directly affects your health (Bloomsbury: 2004). Professor Marmot holds the Harvard Lown Professorship for 2014-2017 and is the recipient of the Prince Mahidol Award for Public Health 2015. He has been awarded honorary doctorates from 18 universities. In 2021 Professor Marmot received BMJ's Outstanding Contribution to Health award. Professor Marmot has led research groups on health inequalities for over 40 years.
Professor Ian Sinha is consultant respiratory paediatrician at Alder Hey Children’s Hospital, with particular interests in asthma and neonatal lung disease. He is also Honorary Associate Clinical Professor in Child Health, University of Liverpool, NHS England NE Paediatric Asthma co-lead, clinical lead for National Asthma and COPD Audit Programme Children and Young Peoples Workstream, Co-Chief Investigator for the ASYMPTOMATIC Randomised Controlled Trial (NIHR) and Co-Director for the Lab to Life Child Health Applied Data Research Centre, Alder Hey Children’s Hospital Department of Innovation.
About the UCL Institute of Health Equity
The IHE is confident enough to conclude that we have the evidence on what needs to be done to advance health equity, as laid out in our 2010 Marmot Review. The UCL Institute of Health Equity works in local partnerships nationally and globally to influence the delivery of interventions to ensure they incorporate action on health, social and economic inequalities. Organisations with which the IHE works include business, city authorities, voluntary sector, local government and healthcare services.
In the UK the evidence on what needs to be done to advance health equity has been overlooked by central government. From 2010, the rate of increase in life expectancy slowed markedly; health inequalities increased, linked to deprivation and region; and life expectancy for the poorest people outside London declined.
This worsening health picture is related to policies of austerity and regressive cuts to spending during that period. The IHE produced Build Back Fairer: The COVID-19 Marmot Review in December 2020, which includes national for government, business, the health and care system, and the voluntary and community sector. Build Back Fairer in Greater Manchester published June 2021, builds on the 2020 review.
In April this year IHE published its first review for the role of business in reducing health inequalities: The Marmot Review for Industry. IHE continues to work closely with other cities and regions, including Coventry, for which a city evaluation was produced in 2020. We have begun programmes of work with Cheshire and Merseyside, Cumbria and Lancashire and other local authorities in England. In May 2021 IHE published a commentary report on UK ethnicity and mortality statistics in relation to the COVID-19 pandemic.
Internationally IHE has responded to COVID-19 with: · Build Back Fairer: Achieving Health Equity in the Eastern Mediterranean Region - The WHO EMRO Commission on the Social Determinants of Health, published on 31 March 2021
· Hong Kong, with the first report in a series from our collaboration with the Chinese University of Hong Kong's Institute of health Equity: Build Back Fairer: Reducing Socioeconomic Inequalities in Health in Hong Kong published 16 November 2021 · Evidence Brief: COVID-19, the social determinants of health and health equity, which discusses the disproportionate impacts that the COVID-19 pandemic is having on more disadvantaged population groups, with a focus on how it is widening health inequities.