The Government is committed to eliminating fuel poverty within the next decade. But can widespread energy improvements be made in time to meet this target? Drawing on the English House Condition Survey (Energy Report) 1996, published in December 2000, Roger Critchley investigates

According to the Government: "The issue of fuel poverty and cold represents the primary health risk in homes". The recent UK fuel poverty strategy commits the Government and devolved administrations to eradicating fuel poverty for vulnerable households by 2010, but is there any evidence to show that housing is being improved fast enough to tackle massive mortality and morbidity?1

LINKS BETWEEN COLD HOMES AND HEALTH
There are around 40,000 excess winter deaths a year in the UK and the search to pinpoint and quantify the causes continues. Cold homes have been found to cause strokes, heart attacks, bronchitis, pneumonia and other respiratory diseases,2 and can also lead to increased risk of home accidents, worsening of arthritis symptoms and impaired dexterity and co-ordination. Further health threats come from mould and house dust mites (eg asthma, eczema and allergic rhinitis). Figure 1 illustrates the range of temperatures associated with ill health.

The English House Condition Survey (EHCS) 1996, did not have health and energy as a primary objective. In consequence, the health questions were limited, but provide some interesting results. The survey included 30 self-assessment questions about the health of each household member. While no causal relationship can be established from this survey, a relationship is apparent between health problems and the standard assessment rating (SAP) and between health problems and means of heating.

The report also looked at SAP ratings in relation to specific problems.3 Although, generally, problems of arthritis, rheumatism and wheezing tended to decline as the SAP rating rose, there is an interesting pattern for asthma. The report notes a decline in asthma in the first three SAP groups, followed by a rise in the most energy efficient group.

Also, mould generally declines as SAP increases, but in the highest quintile of SAPs there is a noticeable increase in mould for both small and large households. These two results are strongly suggestive that relative humidity and ventilation play a key role and that far more attention should be paid to ventilation provision.

MOULD AND HEALTH
The EHCS showed that the incidence of rising damp is restricted to 2 per cent of the housing stock and penetrating damp to 5 per cent, yet 15 per cent of all households suffer from mould growth on walls, ceilings, floors, carpets or furniture. Approximately two thirds of mould cases are classified as slight, the remainder being moderate or severe. However, mould growth is likely to be underestimated, since it can grow behind furniture, beneath carpets and in other areas well hidden from surveyors and occupants.

The highest incidence of mould growth is in the rented sector. Problems are particularly associated with older flats and terraced houses, larger households and homes that lack a central heating system. The EHCS omits to record the ventilation provision in housing and relate that to mould growth.

Forthcoming research for the DETR aims to show just how adequately, or inadequately, ventilated some of the housing stock actually is. The new health questions in this EHCS survey reveal a strong association between mould and a range of health problems, both in households with smokers and those without.

Overall, the incidence of mould growth of any severity is reported to have fallen from 17.1 per cent to 14.6 per cent between 1991 and 1996. This is good news, but even if this rate is maintained it will be 30 years before the health risk of mould growth is eradicated.

TEMPERATURES AND THERMAL COMFORT
Satisfactory home temperatures are at the heart of providing a healthy home. Five key temperatures are generally used to judge conditions; the two "comfort" temperatures usually being defined as 21oC in the living room and 18oC in other rooms. Such temperatures fit in with the World Health Organisation's definition of health as "a state of complete, physical mental and social well-being and not merely an absence of disease".

Temperatures that can lead to illness or disease, or exacerbate other medical conditions, are generally held to be temperatures below 16oC, 12oC and 9oC (see figure 1). This is subjective, for instance sedentary people may need higher temperatures to feel comfortable, however these benchmark air temperatures are indispensable in judging the comparative warmth of the housing stock.

In 1996, the average living room temperature was 19.5oC, an increase of 1.5oC over 1986 when the external temperature was almost identical. In the hall (used as a proxy for the remainder of the home) the average temperature was 17.9oC, compared with 16.3oC in 1986. The rate of increase is even higher than anticipated from research in 1980, that found in the previous 30 years temperatures had been rising at around 1oC a decade.4

Considerable variations are noted within the stock. For instance, private tenants have both the coldest living rooms and bedrooms. Pre-1919 houses are on average 1oC colder than the mean. Yet the EHCS averages hide many of the coldest homes. Table 1 illustrates both the changes in a 10-year period and the range of temperatures.

A third of all households still have living room temperatures below 18oC, while a quarter of all households have hall temperatures below 16oC. Only 21 per cent of all households actually meet the comfort standards of 21 to 18oC. While 41 per cent only met a minimum temperature regime of 18 to 16oC The remaining 38 per cent of all households fail to meet either of these standard temperatures. Consequently, millions of households live in low temperatures which can impair health.

RATE OF IMPROVEMENT
In 1991, the average SAP of the English housing stock was 41.5, while in 1996, the average was 43.8. This is a relatively miserly increase of 2.3 on the 100 point scale. There was little difference in the average for owner occupiers, local authority and registered social landlord (RSL) tenants, but private tenants had an average SAP of 36. RSLs had the highest percentage of SAPs of 60 or above, with 21 per cent of their stock in this group. Sixteen per cent of local authority stock also fell in this group ahead of both owner occupiers and private tenants. These figures largely reflect the dwelling type and age within each tenure. As the report says: "For all tenures the dwelling age and the built form are the overwhelming factors that determine the heat loss through the fabric."

There is still huge potential for energy improvements. Surprisingly, 14 per cent of households with solid walls had some insulation or dry lining, while only 22 per cent of households with cavity walls had them insulated. In the 1919 to 1945 stock with cavity walls, levels of insulation had increased from 12 per cent in 1991 to 15 per cent in 1996, and the report dryly comments "there is clearly some way to go".

Yet, double glazing increases apace, with 60 per cent of households having some double glazing in 1996, compared with 52 per cent in 1991. Double glazing is thus increasing at almost three times the rate of cavity wall insulation. However, in a typical inter-war semi with good central heating, cavity wall insulation might increase the SAP rating four times more than double glazing would, and for a fraction of the price.

Turning to the least energy efficiency properties, there are 1.6m dwellings with a SAP of 20 or below; 21 per cent of private rented households fall into this group compared with 7 to 9 per cent of all households in the other three tenures. In this low SAP category, almost a third of households rely on fixed electric heating (non-storage), a further 5 per cent rely on storage heating and a further 17 per cent on electric central heating or programmable heaters. There are 2.5m households with no central heating.Dwellings in rural locations have the lowest average SAP with those in village centres having the second lowest SAP. Large differences can be found even within the same tenures in the urban/rural divide.

FUEL POVERTY
It is reasonable to expect fuel poor households to have colder homes. However, temperature monitoring indicates that it is unwise to assume that all low SAP homes of apparent similar design have similar low temperatures. Nor is it safe to assume that high SAP homes always lead to high temperatures.5 However, overall, fuel poverty and low temperatures can be expected to go hand in hand.

The concept of fuel poverty is widely accepted but the definition is subject to debate and the EHCS report uses two:

• a household's fuel expenditure exceeds 10 per cent of annual income; and
• the percentage by which the actual fuel spending falls below the required fuel cost.

The report defines annual income as basic net household income excluding housing benefit and income support for mortgage interest. The fuel poor are those who have to spend more than 10 per cent of their income to meet a particular heating regime. The cost of lights, cooking and appliances is also included. The report argues that the second definition most closely correlates with cold homes and the risks to health.

The most difficult assumption is what heating regime to choose as reasonable. The 1996 EHCS report extends its range of heating regimes to four different standards. Just under 20 per cent of all households would fail to meet the minimum regime even spending 10 per cent of their income, and nearly 30 per cent of all households would fail to reach the full regime at this spending level.

Different households have different needs so the report uses a further category of "satisfactory heating". This is where those likely to be in all day have full heating, those under-occupying their home have partial heating and people at work or in education have nine hours heating a day. Using the basic net income definition, 27 per cent of all households (5.3m) are fuel poor and 5 per cent are in severe fuel poverty, ie needing to spend over 20 per cent of their income to achieve satisfactory heating. Over half of council tenants are fuel poor and severe fuel poverty hits private tenants hardest, with one in six affected. Around one sixth of those spending 10 per cent or less of their income are not spending enough to achieve even the minimum heating regime. The reports suggest that for such low income households, 10 per cent may be unrealistic target.

The report pinpoints three key determinants of fuel poverty - low household income, poor energy efficiency and large dwelling size. The division of the fuel poor into six income bands reveals that the top band of fuel rich have less than 5 per cent of their households in fuel poverty. Their average income is £25,800, they spend 3 per cent of their income on fuel and have an average SAP rating of 49. The lowest fuel poverty band, where over 30 per cent of households are fuel poor, have an average income of £3,290, spend 15.9 per cent of their income on fuel and have an average SAP rating of 14.

Ironically, those in marginal or moderate fuel poverty have a home averaging just over 75m2 in size, while those in extreme poverty average 95m2. The report concludes that higher incomes and improved energy efficiency make the biggest in-roads on fuel poverty.

WHERE NOW?
The latest figures on UK energy improvements show an annual increase of 0.6 SAP points between 1996 and 1999.6 While a slight increase on the 1991 to 1996 figures, it is painstakingly slow progress. The Government's fuel poverty strategy, released in February 2001, summarises the range of initiatives and organisations that can positively affect energy efficiency. These include HECA, market transformation programme, Energy Efficient Commitment, Energy Savings Trust, HEES, Private Sector Renewal Grants, HIP, Home Improvement Agencies, revised fitness standard, Neighbourhood Renewal Fund, New Deal for Communities and the Single Regeneration Budget. Some of these are set to play a bigger part than others and the combined effect will undoubtedly speed up progress, but by how much and with what effect on the colder homes?

Brenda Boardman of the Environment Change Institute, University of Oxford, estimates that the cost of improving the worst properties up to a minimum of 50 SAP points would be £20.2bn. She recognises that this would cover all income groups but it would tackle fuel poverty in just 85 per cent of cases. No mention is made in the draft strategy of the level of potential funds.

Environmental health officers and housing officers can contribute in many ways, the strength of which is likely to be in four areas. First, in recognising the health risk of cold homes and helping to eradicate some of the complacent attitudes that still exist.

Second, by being aware of all possible sources of help and levering in funds to local areas. Third, by using existing and future statutory provisions to improve individual homes in relation to cold, mould and mites. Finally, officers can use local knowledge to pinpoint those homes with the coldest temperatures and lowest SAPs for the most urgent action.

1 DETR (2001) The UK Draft Poverty Strategy. Consultation draft.
2 A fuller description and discussion of the health effects of cold is available in Henwood M (1997) Fuel Poverty, energy efficiency and Health. EAGA Charitable Trust and Critchley R J (1997) Cold Homes and Health. EAGA Charitable Trust
3 The main measure of energy efficiency in homes is the Standard Assessment Procedure (SAP). The scale ranges from 0 (very poor) to 100 (excellent).
4 Hunt D R G, Steele M R (1980) "Domestic temperature trends", The Heating and Ventilation Engineer, April 1980
5 As yet unpublished research by Sheffield Hallam University Centre for Regional Economic and Social Research.
6 DTI (2000) UK Energy Sector Indicators 2000

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