This paper examines the evidence relating to the impact of fuel poverty on health and health inequalities and sets out some areas for action. It is intended for the interests of directors of public health and public health teams within local authorities, health and wellbeing boards, and other local authority officers. The first part of this review provides an overview of fuel poverty, describing the evidence linking fuel poverty, cold homes and poor health outcomes. It examines the scale of the problem across England and trends over time. Evidence shows that living in cold homes is associated with poor health outcomes and an increased risk of morbidity and mortality for all age groups; furthermore, studies have shown that more than one in five (21.5%) excess winter deaths in England and Wales are attributable to cold housing.4 While fuel poverty will affect households’ ability to heat their home, it should be acknowledged that households can be cold without being in fuel poverty, if people do not heat their homes adequately whey they have the means to do so.

In addition to wide scale health damage, cold homes are also costly. While cost estimates vary widely, the charity Age UK estimates that the annual cost of cold temperatures to the NHS in England is £1.36bn, not including associated social care costs.5 Research on the cost of housingrelated ill health, where poor housing conditions are a main contributor, estimates that the annual cost to the NHS is £2.5bn. This includes costs accrued by primary care services, treatment costs, hospital stays and outpatient visits.6 The second part of this review provides a brief overview of national policy and sets out the role of local authorities and potential interventions at a local level. The government has introduced a range of national policies, such as the Green Deal and Energy Company Obligation (2013), which requires energy suppliers to provide measures which improve the ability of low income households to heat their homes, improving warmth. Other policies, including the warm home discount, winter fuel payments and cold weather payments, are designed to alleviate the situation of those on low incomes during cold weather. Public health in local areas also has an important role in prioritising, tackling, designing and commissioning interventions to reduce fuel poverty and thereby improve health and health inequalities locally. Efforts to reduce fuel poverty require cross-sector partnerships, involving public health, to address the issue. Tackling fuel poverty and cold home-related health problems 7 Fuel poverty is not just about poverty, but also about the quality of England’s housing stock and energy efficiency.

The review discusses some of the interventions that have been implemented at the local level to help people on low incomes during cold weather and to address cold homerelated health problems. Local authorities and local organisations have taken action to tackle these issues through the implementation of interventions to: • improve the energy efficiency of homes • improve access to support mechanisms to tackle fuel poverty, low household incomes and protect against cold weather • help residents reduce fuel bills • support residents who are vulnerable to cold weather The final section highlights gaps in the literature and recommends areas for further research. This paper is part of a collection of evidence reviews commissioned by Public Health England (PHE) and written by the UCL Institute of Health Equity.