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Living without energy

When energy is not affordable: health and wellbeing impacts of energy poverty

living without energy: table 1Table 1: Inability to afford to keep a home adequately warm in 2012:
% of population in each Member State.
EU (2012) Living Conditions in Europe.

One of the most useful Europe-wide measures of whether energy needs are affordable for households is the EU’s Standards of Income and Living Conditions Survey. In one of the questions, respondents are asked whether they can afford to keep their home adequately warm. The most recent results (2012) can be seen on Table 1.

The extent of domestic energy inequality in Europe is amply illustrated by this table, with about one-third of households unable to heat their homes adequately in Bulgaria, Lithuania and Cyprus, falling to 1% in Sweden and Luxembourg. Europe-wide, more than one in 10 households find their heating needs exceed what they can afford.

Living without energy: patterns of energy consumption in lower income households

living without energy: figure 1Figure 1: Electricity consumption in Northern Ireland:
average-income (blue), high-income (red) and low-income (green) households compared.
Liddell (2013)

Lower income households are often thought able to save money through being advised on how to become more energy efficient in their daily routines. In many cases, this is a misleading assumption, since many poorer families will have already cut their energy use to a bare minimum. In this context, smart meters, which have been installed in most homes across part of Europe like Spain, Italy, and the UK, allow us a unique opportunity to examine precisely what households use on an hour by hour basis.

Figure 1 compares electricity use for households in Northern Ireland, illustrating the average consumption in the region, as well as consumption for high-income and low-income families. From this, it is clear that low income households:

  • Consume significantly less electricity throughout the year than other households
  • Show very little evidence of a seasonal change in the amount of electricity they consume; despite darker and much longer nights in winter, they do not show the same December-March peak that better off households do.

With patterns of consumption already so constrained, it is difficult to justify the expectation that the poorest families should be expected to use less energy. The all-important investment in making the homes of the poorest people energy efficient has a much more important role: in protecting human health by allowing people to live in decent homes.

Why investment in energy efficiency matters: health and wellbeing effects of living without enough energy

living without energy: figure 2Figure 2: Excess winter mortaility in Europe 1980-2013:
percentage increase in deaths during winter months when compared with warmer months.
Liddell et al., (2015) Journal of Public Health (in press)

Research evidence on the impacts of being unable to afford energy has been growing year on year.

Excess winter deaths: At the most extreme, more people in Europe die in the winter months of each year than die in the warmer months, and this is the case throughout the region, as can be seen on Figure 2.

Excess winter deaths are most prominent in Member States with milder winters, for example Malta (29%), Portugal (28%), and Spain (21%).  This has long been known as the excess winter mortality paradoxin which people are more likely to die during cold spells if they live in areas where summers are very hot and winters only cool, than if they live in areas where summers are temperate but winters are severe. 

Many factors appear to contribute to this paradox. Spending proportionally more of income on heating costs is an obvious protective factor, which in the coldest winter regions is virtually non-negotiable for survival; in Denmark for example, the lowest income quartile spends 8% of their income on energy, compared with 4% in Spain and the UK[1] Other protective factors include housing quality (especially insulation and energy efficiency of building fabric), lifestyle adjustments to cold such as wearing adequate protective clothing, and altering activity patterns when temperatures are low[2].

For many years, people at higher risk of dying in winter were thought to be mostly people living with respiratory or cardiovascular ailments, and this remains the case now. However, a new risk group is emerging in Europe, namely people living with Alzheimer’s Disease and related dementia’s. New UK research[3] based on mortality data between 1991 and 2013 indicates the following statistics:

  • among people who die of respiratory causes, there is a 55% greater likelihood of dying in winter than in the warmer months of the year
  • among people who die of cardiovascular causes, there is an 18% greater likelihood of dying in winter
  • among people who die as a result of circumstances arising from their dementia, there is a 27% greater likelihood of dying in winter.

In other words, dementia is emerging as a primary risk factor for excess winter deaths, even more of a risk factor than cardiovascular illness.

A number of explanations can be found for this, including the treatment regimes for dementia, which reduce people’s sensitivity to heat and cold; deterioration in central nervous system functionality which seems to be focused in part on people’s ability to perceive cold; forgetting how heating controls work, worrying obsessively about the cost of heat and light, eating poorly and losing weight, and dressing inappropriately for cold temperatures.

Impacts of living without enough energy: effects on wellbeing

More recently, studies have begun to document impacts on mental health, most notably borderline depression and general anxiety. Here, the consensus of findings is even more convincing than it is for effects of physical health. Living in cold and damp housing contributes to a variety of different mental health stressors[4]. These include:

  • chronic thermal discomfort, where people report feeling cold and shivery  all day and often through the night
  • worry about energy bills and what these will be, particularly when bills are only issued quarterly
  • concern about falling into debt
  • enduring the discomfort of cutting back on food and other items in order to save for energy bills
  • concern that cold is damaging people’s physical health, especially where households have children
  • "spatial shrink” and the stress which results from living in only one or two rooms that can be affordably heated
  • stigma within one’s community
  • damage to possessions that are affected by damp and mould, such as clothes, curtains, and furniture
  • the absence of any solution or sense of control over the problem.

Improving the energy efficiency of people’s homes: impacts on health and wellbeing

Not surprisingly, when homes of people in poverty are insulated and heated more efficiently, they report a wide range of improvements to their health, such as:

  • having more energy
  • being able to move about more easily
  • going to the doctor less often
  • sleeping better
  • feeling less anxious
  • being more interested in getting out and about.[5] 

Many also report that they are spending just as much on energy bills as before, but that they now feel this is worth it, since much less is wasted when homes are insulated. In a large-scale English study, approximately three-quarters of recipients of energy efficiency improvements  increased their indoor temperatures to levels approximating World Health Organisation standards for health and safety[6]. People’s money after improvements pays for comfort and a home which can be enjoyed.

Evidence suggests that children in homes which receive winter fuel payments consume more calories than other infants[7]. This corroborates an American study in which low-income households showed  a 10% reduction in food intake during cold weather, this reduction being found in adults and children alike. By contrast, higher-income households maintained the same level of food intake year-round[8]. 

Also from North America, research has shown that infants from low-income families who received a winter fuel subsidy gained weight more normally than those from similar homes without a fuel subsidy. They also had lower odds for needing hospital treatment[9].

In a suite of studies from New Zealand caregivers whose homes had been insulated reported that children had 15% fewer days off school than did wait-listed control children[10]. These findings were corroborated by an English study, which found that – when many other contributory factors had been accounted for – espiratory problems were more than twice as prevalent in children that lived for 3 years or longer in homes that lacked affordable warmth (15%), compared with children who had never lived in homes that were hard to heat during the previous 5 years (7%)[11].


Energy affordability in European Member States varies very widely, with 99% of households in Sweden and Luxembourg finding energy costs affordable, compared with on 53% and 66% in Bulgaria and Lithuania respectively. When energy cannot be paid for, households experience a wide variety of consequences, ranging from worrying about (or being in) debt, suffering the discomfort of cold over long periods of the winter, experiencing impacts on their physical health, as well as experiencing a wide variety of mental health impacts commonly associated with long periods of worry and stress. 

This text was published in German in neue caritas 2/2016

[1] Nierop, S. Energy Poverty in Denmark 2014.

[2] Wilkinson et al. Lancet

[3] Liddell et al. (2015). Energy Research and Social Science (in press).

[4]Liddell & Guiney (2015)

[5] Liddell & Guiney (2015)

[6] Critchley et al., 2007

[7] Cook & Frank, 2008 Annals of the New York Academy of Sciences

[8] Bhattacharya, et al., 2003American Journal of Public Health

[9] Frank et al., 2006 Pediatrics

[10] Howden-Chapman et al., 2007British Medical Journal

[11] Barnes, et al., 2008 National Centre for Social Research, London

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