Energy poverty, its intensity and health in vulnerable populations in a Southern European city

Heating or eating? The framing of food and fuel poverty in UK news media

Amidst the cost-of-living crisis the UK news has been increasingly reporting of individuals "choosing between heating and eating," suggesting overlapping food and fuel poverty (FFP). The media plays a powerful role in establishing narratives, shaping political debates, and even influencing what societies regard as an "issue" or a "public health issue." Relying on framing theory, this media analysis seeks to better understand how FFP have been constructed relationally in the UK news and how surrounding public health messaging has been employed. Using the NexisLexis database, we searched for UK news articles about intersecting FFP published between January 2010 and April 2022. After double screening, relevant data were extracted from 185 articles and data fragments were coded and analysed. FFP-focused news largely gained momentum in late 2021 into 2022. Two frame categories - descriptive and prescriptive - of FFP were identified. Descriptive frames explained the experience of FFP as a: trade-off between goods (71% of articles), mutual cutback of goods (28%), or just poverty (income/monetary poverty) (1%). Prescriptive frames assigned blame or responsibility to: government (59% of articles), food/fuel industry (13%), community or charity organisations (12%), or individuals (3%). Relatively few (29%) articles linked FFP with health consequences, and none framed it as a health issue. The prominence of the trade-off frame in the UK news suggests that FFP is a crucial topic for the UK public that requires joint attention. Despite the prominence of the government responsibility framing, the frame lacks accompanying prescriptions of consistent, specific, targeted solutions. A public health frame in the UK news may address this gap by outlining potential evidence-based solutions and increasing capacity by appointing responsible actors to help prevent and address this issue.

Household energy poverty and trajectories of emotional and behavioural difficulties in children and adolescents: findings from two prospective cohort studies

PURPOSE

The aim of this study is to examine the association between household energy poverty (EP) and trajectories of emotional and behavioural difficulties during childhood.

METHODS

The Growing up in Ireland study is two nationally representative prospective cohorts of children. The Infant Cohort (n = 11,134) were recruited at age 9 months (9 m) and followed up at 3, 5, 7 and 9 years (y). The Child Cohort (n = 8,538) were recruited at age 9 y and followed up at 13 y and 17/18 y. EP was a composite of two relative measures of EP. Emotional and behavioural difficulties were repeatedly measured using the strengths and difficulties questionnaire (SDQ). Linear spline multilevel models were used, adjusted for confounders to examine the association between (1) EP (9 m or 3 y) and trajectories of emotional and behavioural difficulties from 3 to 9 y in the Infant Cohort and (2) EP at 9 y and the same trajectories from 9 to 18 y in the Child Cohort.

RESULTS

In adjusted analyses, EP at 9 m or 3 y of age was associated with higher total difficulties score at 3 y (0.66, 95% CI 0.41, 0.91) and 5 y (0.77, 95% CI 0.48, 1.05) but not at 7 y or 9 y. EP at 9 y was associated with higher total difficulties score at 9 y (1.73, 95% CI 1.28, 2.18), with this difference reducing over time leading to 0.68 (95% CI 0.19, 1.17) at 17/18 y.

CONCLUSIONS

Our study demonstrates a potential association between early life EP and emotional and behavioural difficulties that may be transient and attenuate over time during childhood. Further studies are required to replicate these findings and to better understand if these associations are causal.

[Energy poverty and self-rated health among Roma population and general population in Spain]

OBJECTIVE

To quantify energy poverty in Roma population and in general population in Spain, in 2016, as well as to observe the association of this phenomenon with self-rated health, adjusted according to the main socio-economic determinants.

METHOD

Energy poverty has been defined as the financial inability to keep a home warm, the presence of dampness in the dwelling and falling into arrears in utility bills, using data from two European surveys from Spain in 2016: the Survey on Income and Living Conditions (EU-SILC) and the Second Survey on Minorities and Discrimination (EU-MIDIS II). Hierarchical logistic regression models were estimated with self-rated health as the outcome variable, progressively adjusted according to demographic (gender and age), environmental (household temperature, humidity and arrears in utility bills) and socio-economic (level of education, marital status and employment status) variables.

RESULTS

Our results show that 45% of the Roma population had moderate or high levels of energy poverty. The odds ratio (OR) of poor self-rated health was higher in the Roma population (OR: 3.11; 95% confidence interval [95% CI]: 2.59-3.74). The inability to maintain an adequate indoor temperature significantly increased the risk of poor health (OR: 2.10; 95% CI: 1.90-2.32). After adjusting according to demographic, environmental and socio-economic variables, no association was observed between the population of ascription and self-rated health.

CONCLUSIONS

Taking into account the main social determinants, including energy poverty indicators, being Roma is not associated with reporting poor health. This result points to the importance of tackling socio-economic factors, including energy poverty, to reduce health inequalities.

Assessing the impact of energy and fuel poverty on health: a European scoping review

BACKGROUND

The burden of energy and fuel poverty (EFP) in Europe is increasing in the face of the cost-of-living crisis, the Russian invasion of Ukraine, the coronavirus disease 2019 (COVID-19) pandemic and the climate emergency. While the health impacts of EFP are often the driving reason for addressing it, EFP's association with health is poorly delineated. This review aims to scope the evidence of EFP's association with health in Europe.

METHODS

A scoping review based on Arksey and O'Malley's framework was conducted using search terms relevant to EFP, health and Europe. Five databases were searched, in addition to hand searching. Review selection was performed by two independent reviewers, and articles were thematically analyzed.

RESULTS

Thirty-five articles published between January 2000 and March 2022 were included. The literature varied in definitions and measurements of EFP and in the health indicators examined. The review revealed a negative association between EFP and health, specifically, general unspecified poor health (9 articles), excess winter mortality (3 articles), communicable diseases (3 articles), non-communicable diseases (11 articles), mental health (15 articles) and well-being (12 articles). While women were reported to be at a higher risk of EFP than men, children and older adults were identified as particularly vulnerable to EFP's adverse health repercussions.

CONCLUSIONS

This scoping review illustrates a significant and complex association between EFP and various domains of health. Though heterogeneity across research makes it difficult to compare findings, our review supports the use of health as a justification to address EFP and urges public health to be more involved in EFP mitigation.

Cold housing environments: defining the problem for an appropriate policy response

Researchers across disciplines are increasing attention to cold housing environments. Public health, environmental and social sciences, architecture, and engineering each define and measure cold housing environments differently. Lack of standardisation hinders our ability to combine evidence, determine prevalence, understand who is most at risk--and to formulate policy responses. We conducted a systematic, cross-disciplinary review of literature to document the measures used. We examined benefits and limitations of each approach and propose a conceptualisation of cold housing: where temperature is too low to support optimal health and wellbeing of inhabitants, measured using one or a combination of economic, 'objective', or subjective approaches. More accurate data on home temperatures for all population groups, combined with an understanding of factors leading to cold homes, will enable appropriate policy response to reduce adverse health effects and costs. Policies targeting better building standards and energy subsidies both improve temperature conditions in housing environments.

Energy poverty and its impacts on health and education: a systematic review

Purpose

People with energy poverty are denied the modern energy services such as cooking, lighting, heating, cooling and communication. These needs are all crucial to maintaining an acceptable level of living standards. This paper aims to examine the effects of energy poverty on health and education.

Design/methodology/approach

This systematic review was conducted using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The ScienceDirect, Scopus and Google Scholar databases were used to search the studies conducted between 2012 and 2022. Studies included in this review were searched with some combinations of keywords and saved in Mendeley Desktop for review and referencing. Of 1,745 articles retrieved after removing the duplicates from the databases, 22 met the inclusion criteria.

Findings

Out of the total 22 studies reviewed, six were conducted in Asia, six in Europe, four in Africa, three in developing countries and one each in North America, Australia and at global level. Results indicated that impacts of energy poverty on health and education were negative. Efforts should be made to improve the economic conditions of the population in order to allow them access to energy services to achieve higher levels of living.

Practical implications

As this systematic review excludes non-peer-reviewed literature, case studies, reports and theses, and only includes studies published between 2012 and 2022 in English language only, consequently, it may not provide an exhaustive overview of the literature on topic.

Originality/value

To the best of the authors’ knowledge, this is the first systematic review to investigate the relationship between energy poverty, health and education conducted here. The search methodologies involve systematic searches of databases and other manual searches. Considering the wide inclusion criteria, this review is useful as a general overview of the issues and identifies particular gaps in the existing evidence.

Energy Poverty and Personal Health in the EU

The aim of this paper is to assess the impact of energy poverty on health in the EU-27 countries for the period from 2003-2020 using Panel Autoregressive Distributed Lag models and generalized ridge regressions. Arrears on utility bills exerts positive long-run effects on capacity to keep the home adequately warm, current health expenditures, and self-perceived health as bad or very bad, but a negative long-run influence on energy import dependency. In the long-term, the population being unable to keep their home adequately warm positively affects self-perceived health as bad and very bad and negatively influences number of cooling days. Current health expenditure has a long-run influence on self-perceived health as bad and very bad and the number of heating days. Positive short-run impacts were observed for energy import dependency, arrears on utility bills, and number of heating days on current health expenditure and the population unable to keep their home adequately warm. People at risk of poverty or social exclusion in different zones had a significant impact on energy poverty indicators. A separate analysis is made for those EU states with the highest energy import dependency and the implications of the results are discussed.

Self-Assessment of Health Professionals' Cultural Competence: Knowledge, Skills, and Mental Health Concepts for Optimal Health Care

Current research often refers to cultural competence to improve health care delivery. In addition, it focuses on the cultural uniqueness of each health service user for optimal personalized care. This study aimed to collect self-assessment data from health professionals regarding their cultural competence and to identify their development needs. A mixed methods design was adopted using the Cultural Competence Self-assessment Checklist of the Central Vancouver Island Multicultural Society. This was translated into Greek, validated, and then shared with health professionals in Cyprus. Subsequently, a semi-structured interview guide was designed and utilized. This was structured in exactly the same question categories as the questionnaire. Data collection took place between October 2021 and May 2022, and convenience sampling was used to recruit 499 health scientists in Cyprus. The sample comprised doctors, nurses, psychologists, midwives, social workers, and physiotherapists. Subsequently, 62 interviews were conducted with participants from the same specialties. The results showed that (compared to other health professionals) nurses and psychologists are more sensitive to issues of cultural competence. It would appear that the more socially oriented sciences had better-prepared healthcare staff to manage diversity in context. However, there is a gap between knowledge and skills when comparing doctors to nurses; they seem to be more skilled and willing to intervene actively in cases of racist behavior or problem-solving. In conclusion, participants identified the importance of their cultural competence; they also realized the importance of optimal planning of personalized health care. There is a significant need for continuous and specialized cultural competence training for all health professions.

Effectiveness of an Energy-Counseling Intervention in Reducing Energy Poverty: Evidence from a Quasi-Experimental Study in a Southern European City

Energy poverty is a serious social problem with well-known adverse health consequences. This problem has been addressed mainly through improvements in the energy efficiency of housing. Still, little is known about the effects of information-based measures on energy poverty and their impacts on health. A quasi-experimental study was implemented to assess the effectiveness of an energy-counseling home visit intervention targeting the vulnerable population in a southern European city, Barcelona, in alleviating energy poverty and improving health. The intervention had beneficial impacts on keeping homes at an adequate indoor temperature and reducing primary care visits. No effects were found on self-perceived health or self-reported anxiety and depression. After the intervention, participants reported a decrease in arrears on utility bills, but less pronounced than in the comparison group. In conclusion, the study showed that information-based measures lead to psychosocial gains and reduced healthcare use. Nevertheless, the impact of these measures could be enhanced by combining them with policies and programmes that address the structural determinants of energy poverty.

Energy Poverty and Depression in Rural China: Evidence from the Quantile Regression Approach

Despite the growing awareness and interest in the impact of energy poverty on depression, studies in developing economies are relative limited, and there is a gap of knowledge of such impact among rural individuals in China. In this study, we investigate the impact of energy poverty on depression among rural Chinese individuals aged 16 and above, and our sample includes 13,784 individuals from 6103 households. With data from the 2018 China Family Panel Studies, we apply the instrumental variable (IV) quantile regression approach to address the potential endogeneity of energy poverty and allow for heterogeneous effects of energy poverty on depression across individuals with different levels of depression. Our estimates from the IV quantile regression suggest a strong positive impact of energy poverty on depression at the upper quantile of depression scores, but no impact at the middle and lower quantiles. The primary results are robust and consistent with alternative energy poverty measures, and we find that energy poverty does not affect depression of low-risk individuals (with low depression scores), but it does affect that of high-risk individuals. We also find individual socio-demographic factors of age, gender, household size, religious belief, education, marriage and employment status play roles in affecting depression. The findings of this study generate policy implications for energy poverty alleviation and mental health promotion.

Indoor Environmental Quality and Consumption Patterns before and during the COVID-19 Lockdown in Twelve Social Dwellings in Madrid, Spain

This article analyses the situation that prevailed in 12 dwellings located on the outskirts of Madrid during Spain’s state of emergency. How did 24/7 occupation affect the quality of indoor air and power consumption patterns? The mixed method used (surveys and instrumental monitoring) pragmatically detected the variation in consumption, comfort and indoor air quality patterns before and during the COVID-19 pandemic. The characteristics initially in place and household predisposition had a conclusive effect on such variations. The starting conditions, including household composition, habits and the way daily activities were performed, differed widely, logically affecting power consumption: 8/12 case studies increase occupancy density by more than 25 percent; 11/12 improve thermal comfort; 10/12 improve air quality but not necessarily translate in a sufficient ventilation practices; air quality was lower in the bedrooms on the whole; only 4/12 case studies use the potential of passive measures; only one household adopted energy savings strategies; 10/12 case studies increase electric power consumption but none of the dwellings was fitted with a renewable power generation system. The conclusion drawn is that, despite starting conditions differing widely, household composition, habits (including performance of daily activities performance) and power consumption also played an active role in the end result. This approach allowed to integrate qualitative and quantitative findings on indoor environmental quality (IEQ), energy use and households’ behavior. The objective data on the energy situation of the case studies not only is useful for the study, but also for potential enrollment in energy rehabilitation programs, such as the European Regional Development Fund (ERDF).

Behavior Patterns, Energy Consumption and Comfort during COVID-19 Lockdown Related to Home Features, Socioeconomic Factors and Energy Poverty in Madrid

During spring 2020, the world was shocked at the imminent global spread of SARS-CoV-2, resorting to measures such as domestic confinement. This meant the reconfiguration of life in an unusual space; the home. However, not all households experienced it in the same way; many of them were vulnerable. A general increase in energy consumption and discomfort in many cases, led these families to suffer the ravages of confinement. This study analyzes the energy and comfort situation for the Madrid (Spain) population, according to the configuration of the homes, the characteristics of the dwellings, the vulnerability index by district, and energy poverty (measured with the 10% threshold of energy expenditure of home incomes). The results show a greater exposure, in confinement, of vulnerable and energy-poor households to scenarios of discomfort in the home, to which they could not respond, while energy consumption inevitably increased. Driven by need, energy-poor homes applied certain saving strategies, mainly resorting to thermal adaptation with clothing. This study shows the risk these households experienced in the face of an extreme situation, and invites reflection on preventive and containment measures that aim to avoid harming the disadvantaged in the future; harm that would also entail serious consequences on the health of their cohabitants.