Health effects of home energy efficiency interventions in England: a modelling study

Role of public health professionals in the climate and ecological crisis: a qualitative study

BACKGROUND

The climate and ecological emergency is the single biggest health threat facing humanity, yet it is not clear to what extent the public health workforce have been involved in work on this topic. This research aimed to establish what public health consultants working in local authorities in England perceive their role to be, whether the climate crisis is seen as a core component of public health and to identify barriers to action.

METHODS

Semi-structured interviews were undertaken with a purposive sample (n=11) of local authority public health consultants in England. Participants were recruited via public health organisations, social media or snowballing. Thematic content analysis was used to identify codes and themes.

RESULTS

Public health professionals have started work on climate change but reported being unclear about their role and feeling isolated working on this topic. Barriers to action included shortage of financial resources, communication tools and capacity, limited sharing of best practice, lack of local expertise and conflict between the need for action on climate change and other urgent issues.

CONCLUSION

We highlight the need to urgently address existing barriers to enable this important part of the public health workforce to play their role in tackling the climate and ecological crisis.

School building energy efficiency and NO2 related risk of childhood asthma in England and Wales: Modelling study

BACKGROUND

Climate change legislation will require dramatic increases in the energy efficiency of school buildings across the UK by 2050, which has the potential to affect air quality in schools. We assessed how different strategies for improving the energy efficiency of school buildings in England and Wales may affect asthma incidence and associated healthcare utilization costs in the future.

METHODS

Indoor concentrations of traffic-related NO2 were modelled inside school buildings representing 13 climate regions in England and Wales using a building physics school stock model. We used a health impact assessment model to quantify the resulting burden of childhood asthma incidence by combining regional health and population data with exposure-response functions from a recent high-quality systematic review/meta-analysis. We compared the effects of four energy efficiency interventions consisting of combinations of retrofit and operational strategies aiming to improve indoor air quality and thermal comfort on asthma incidence and associated hospitalization costs.

RESULTS

The highest childhood asthma incidence was found in the Thames Valley region (including London), in particular in older school buildings, while the lowest concentrations and health burdens were in the newest schools in Wales. Interventions consisting of only operational improvements or combinations of retrofit and operational strategies resulted in reductions in childhood asthma incidence (547 and 676 per annum regional average, respectively) and hospital utilization costs (£52,050 and £64,310 per annum regional average, respectively. Interventions that improved energy efficiency without operational measures resulted in higher childhood asthma incidence and hospital costs.

CONCLUSION

The effect of school energy efficiency retrofit on NO2 exposure and asthma incidence in schoolchildren depends critically on the use of appropriate building operation strategies. The findings from this study make several contributions to fill the knowledge gap about the impact of retrofitting schools on exposure to air pollutants and their effects on children's health.

A scoping review of the health co-benefits of climate mitigation strategies in South America

The accelerated production of greenhouse gases (GHG) due to human activity has led to unprecedented global warming, making climate mitigation strategies crucial for minimizing its impacts. South America, a region highly vulnerable to climate change, stands to benefit from implementing such strategies to reduce future risks and generate health co-benefits. This scoping review, aimed to assess the existing evidence on the health benefits of climate mitigation strategies in South American countries. PubMed, Web of Science, and LILACS databases were searched until June 15, 2023. Nine studies published between 2001 and 2021 were analyzed, focusing on Brazil, Chile, and Bolivia. All the studies identified in this review used scenario modeling. They evaluated various GHG emission mitigation strategies, including land management, reducing livestock production, biofuel production, increased active transportation, renewable energy, and waste reduction. Only one study looked at GHG capture and sequestration through afforestation. Given the limited information available, there is a pressing need for more research on the region's potential health, environmental, and economic co-benefits. This review serves as a starting point and suggests that climate mitigation can offer a range of positive co-benefits, such as improved air quality and increased resilience to climate impacts, thereby advancing public health initiatives.

Funding

MYG was supported by the Wellcome Trust (grant number 209734/Z/17/Z). The other authors did not receive financial support for their research or authorship. The publication of this article was financially supported by Universidad Peruana Cayetano Heredia.

["My life will be much better than before": a qualitative study on the relationship between renewal of public housing, quality of life, and health]

The objective was to understand the link between housing, health and quality of life in a context of social housing regeneration, through the experiences and perceptions of its inhabitants, exploring the mechanisms that sustain this link before regeneration, and those elements derived from housing regeneration that result in improvements in quality of life and potentially in health. Between 1980 and the 2000s, Chile faced a massive quantitative housing deficit through a policy that delivered more than 120,000 low-cost social housing apartments. Today, thousands present severe habitability problems, generating negative consequences for their inhabitants, their health and well-being. Seeking to solve the deterioration of housing and neighborhoods, the Chilean Ministry of Housing and Urbanism developed the Housing Complex Regeneration Program. The RUCAS project seeks to evaluate the effects of the program on health and to assess the impact of interventions such as these on vulnerable populations in Latin America. We present results of 8 interviews and 2 focus groups conducted in a social housing complex in process of intervention in Viña del Mar. Using discursive content analysis, results show that the poor material quality of housing is perceived as harmful to health. Regenerated housing, on the other hand, promotes the recovery and re-appropriation of spaces and their uses, sociability, new healthy practices, positive feelings and psychological well-being, bringing to the fore the psychosocial component of people's relationship with their house. It is concluded that housing regeneration has the potential to benefit physical and mental health through both direct mechanisms, derived from the renovated materiality, and indirect mechanisms related to the practices and experiences of the lived space.

Impact on mortality of pathways to net zero greenhouse gas emissions in England and Wales: a multisectoral modelling study

BACKGROUND

The UK is legally committed to reduce its greenhouse gas emissions to net zero by 2050. We aimed to understand the potential impact on population health of two pathways for achieving this target through the integrated effects of six actions in four sectors.

METHODS

In this multisectoral modelling study we assessed the impact on population health in England and Wales of six policy actions relating to electricity generation, transport, home energy, active travel, and diets relative to a baseline scenario in which climate actions, exposures, and behaviours were held constant at 2020 levels under two scenarios: the UK Climate Change Committee's Balanced Pathway of technological and behavioural measures; and its Widespread Engagement Pathway, which assumes more substantial changes to consumer behaviours. We quantified the impacts of each policy action on mortality using a life table comprising all exposures, behaviours, and health outcomes in a single model.

FINDINGS

Both scenarios are predicted to result in substantial reductions in mortality by 2050. The Widespread Engagement Pathway achieves a slightly greater reduction in outdoor fine particulate matter air pollution of 3·2 μg/m³ (33%) and, under assumptions of appropriate ventilation, a greater improvement in indoor air pollution (a decrease in indoor-generated fine particulate matter from 9·4 μg/m³ to 4·6 μg/m³) and winter temperatures (increasing from 17·8°C to 18·1°C), as well as appreciably greater changes in levels of active travel (27% increase in metabolic equivalent hours per week of walking and cycling) by 2050. Additionally, the greater reduction in red meat consumption (50% compared with 35% under the Balanced Pathway) by 2050 results in greater consumption of fruits (17-18 g/day), vegetables (22-23 g/day), and legumes (5-7 g/day). Combined actions under the Balanced Pathway result in more than 2 million cumulative life-years gained over 2021-50; the estimated gain under the Widespread Engagement Pathway is greater, corresponding to nearly 2·5 million life-years gained by 2050 and 13·7 million life-years gained by 2100.

INTERPRETATION

Reaching net zero greenhouse gas emissions is likely to lead to substantial benefits for public health in England and Wales, with the cumulative net benefits being correspondingly greater with a pathway that entails faster and more ambitious changes, especially in physical activity and diets.

FUNDING

National Institute for Health Research and the Wellcome Trust.

Heatwave Mortality in Summer 2020 in England: An Observational Study

High ambient temperatures pose a significant risk to health. This study investigates the heatwave mortality in the summer of 2020 during the SARS-CoV-2 coronavirus (COVID-19) pandemic and related countermeasures. The heatwaves in 2020 caused more deaths than have been reported since the Heatwave Plan for England was introduced in 2004. The total and cause-specific mortality in 2020 was compared to previous heatwave events in England. The findings will help inform summer preparedness and planning in future years as society learns to live with COVID-19. Heatwave excess mortality in 2020 was similar to deaths occurring at home, in hospitals, and in care homes in the 65+ years group, and was comparable to the increases in previous years (2016–2018). The third heatwave in 2020 caused significant mortality in the younger age group (0–64) which has not been observed in previous years. Significant excess mortality was observed for cardiovascular disease, respiratory disease, and Alzheimer’s and Dementia across all three heatwaves in persons aged 65+ years. There was no evidence that the heatwaves affected the proportional increase of people dying at home and not seeking heat-related health care. The most significant spike in daily mortality in August 2020 was associated with a period of high night-time temperatures. The results provide additional evidence that contextual factors are important for managing heatwave risks, particularly the importance of overheating in dwellings. The findings also suggest more action is also needed to address the vulnerability in the community and in health care settings during the acute response phase of a heatwave.

Evaluation of the Victorian Healthy Homes Program: protocol for a randomised controlled trial

INTRODUCTION

The evaluation of the Victorian Healthy Homes Program (VHHP) will generate evidence about the efficacy and cost-effectiveness of home upgrades to improve thermal comfort, reduce energy use and produce health and economic benefits to vulnerable households in Victoria, Australia.

METHODS AND ANALYSIS

The VHHP evaluation will use a staggered, parallel group clustered randomised controlled trial to test the home energy intervention in 1000 households. All households will receive the intervention either before (intervention group) or after (control group) winter (defined as 22 June to 21 September). The trial spans three winters with differing numbers of households in each cohort. The primary outcome is the mean difference in indoor average daily temperature between intervention and control households during the winter period. Secondary outcomes include household energy consumption and residential energy efficiency, self-reported respiratory symptoms, health-related quality of life, healthcare utilisation, absences from school/work and self-reported conditions within the home. Linear and logistic regression will be used to analyse the primary and secondary outcomes, controlling for clustering of households by area and the possible confounders of year and timing of intervention, to compare the treatment and control groups over the winter period. Economic evaluation will include a cost-effectiveness and cost-benefit analysis.

ETHICS AND DISSEMINATION

Ethical approval was received from Victorian Department of Human Services Human Research Ethics Committee (reference number: 04/17), University of Technology Sydney Human Research Ethics Committee (reference number: ETH18-2273) and Australian Government Department of Veterans Affairs. Study results will be disseminated in a final report and peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12618000160235.

Projecting the impacts of housing on temperature-related mortality in London during typical future years

Climate change means the UK will experience warmer winters and hotter summers in the future. Concurrent energy efficiency improvements to housing may modify indoor exposures to heat or cold, while population aging may increase susceptibility to temperature-related mortality. We estimate heat and cold mortality and energy consumption in London for typical (non-extreme) future climates, given projected changes in population and housing. Building physics models are used to simulate summertime and wintertime indoor temperatures and space heating energy consumption of London dwellings for 'baseline' (2005-2014) and future (2030s, 2050s) periods using data from the English Housing Survey, historical weather data, and projected future weather data with temperatures representative of 'typical' years. Linking to population projections, we calculate future heat and cold attributable mortality and energy consumption with demolition, construction, and alternative scenarios of energy efficiency retrofit. At current retrofit rates, around 168-174 annual cold-related deaths per million population would typically be avoided by the 2050s, or 261-269 deaths per million under ambitious retrofit rates. Annual heat deaths would typically increase by 1 per million per year under the current retrofit rate, and 12-13 per million under ambitious rates without population adaptation to heat. During typical future summers, an estimated 38-73% of heat-related deaths can be avoided using external shutters on windows, with their effectiveness lower during hotter weather. Despite warmer winters, ambitious retrofit rates are necessary to reduce typical annual energy consumption for heating below baseline levels, assuming no improvement in heating system efficiencies. Concerns over future overheating in energy efficient housing are valid but increases in heat attributable mortality during typical and hot (but not extreme) summers are more than offset by significant reductions in cold mortality and easily mitigated using passive measures. More ambitious retrofit rates are critical to reduce energy consumption and offer co-benefits for reducing cold-related mortality.

Home Energy Efficiency and Subjective Health in Greater London

The UK has introduced legislation that requires net-zero greenhouse gas emissions to be achieved by 2050. Improving the energy efficiency of homes is a key objective to help reach this target, and the UK government's Clean Growth Strategy aims to get many homes up to an Energy Performance Certificate (EPC) Band of C by 2035. The relationship between home energy-efficiency and occupant health and wellbeing remains an area of ongoing research. This paper explores the nexus between home energy efficiency, energy consumption and self-reported health-an indicator of the general health and wellbeing of the population. We focus on Greater London through secondary data analysis. Energy-efficiency ratings and air infiltration rates of dwellings, derived from EPCs, were aggregated and matched to local area self-reported health and energy consumption data obtained from the Greater London Authority's (GLA) Lower Layer Super Output Area (LSOA) Atlas database. Our regression model indicates that improving the energy efficiency (SAP) rating by 10 points for a typical home may reduce household gas consumption by around 7% (95% CIs: 2%, 14%). Beta regression finds a positive, but not statistically significant association between median SAP rating and the proportion of the population reporting 'good or very good' health when considering all Greater London LSOAs (z score = 0.60, p value = 0.55). A statistically significant positive association is observed however when repeating the analysis for the lowest income quartile LSOAs (z score = 2.03, p value = 0.04). This indicates that the least well-off may benefit most from home energy efficiency programs. A statistically significant positive association is also observed for the relationship between self-reported health and air infiltration rates (z score = 2.62, p value = 0.01). The findings support existing evidence for the predominantly naturally ventilated UK housing stock, suggesting that home energy efficiency measures provide a co-benefit for occupant health provided that adequate air exchange is maintained.

A tool for assessing the climate change mitigation and health impacts of environmental policies: the Cities Rapid Assessment Framework for Transformation (CRAFT)

Background: A growing number of cities, including Greater London, have set ambitious targets, including detailed policies and implementation plans, to reach global goals on sustainability, health, and climate change. Here we present a tool for a rapid assessment of the magnitude of impact of specific policy initiatives to reach these targets. The decision-support tool simultaneously quantifies the environmental and health impacts of specified selected policies. Methods: The 'Cities Rapid Assessment Framework for Transformation (CRAFT)' tool was applied to Greater London. CRAFT quantifies the effects of ten environmental policies on changes in (1) greenhouse gas (GHG) emissions, (2) exposures to environmental hazards, (3) travel-related physical activity, and (4) mortality (the number of attributable deaths avoided in one typical year). Publicly available data and epidemiological evidence were used to make rapid quantitative estimates of these effects based on proportional reductions in GHG emissions and environmental exposures from current baseline levels and to compute the mortality impacts. Results: The CRAFT tool estimates that, of roughly 50,000 annual deaths in Greater London, the modelled hazards (PM 2.5 (from indoor and outdoor sources), outdoor NO 2, indoor radon, cold, overheating) and low travel-related physical activity are responsible for approximately 10,000 premature environment-related deaths. Implementing the selected polices could reduce the annual mortality number by about 20% (~1,900 deaths) by 2050. The majority of these deaths (1,700) may be avoided through increased uptake in active travel. Thus, out of ten environmental policies, the 'active travel' policy provides the greatest health benefit. Also, implementing the ten policies results in a GHG reduction of around 90%. Conclusions: The CRAFT tool quantifies the effects of city policies on reducing GHG emissions, decreasing environmental health hazards, and improving public health. The tool has potential value for policy makers through providing quantitative estimates of health impacts to support and prioritise policy options.

The impact of energy retrofits on pediatric asthma exacerbation in a Boston multi-family housing complex: a systems science approach

BACKGROUND

Pediatric asthma is currently the most prevalent chronic disease in the United States, with children in lower income families disproportionately affected. This increased health burden is partly due to lower-quality and insufficient maintenance of affordable housing. A movement towards 'green' retrofits that improve energy efficiency and increase ventilation in existing affordable housing offers an opportunity to provide cost-effective interventions that can address these health disparities.

METHODS

We combine indoor air quality modeling with a previously developed discrete event model for pediatric asthma exacerbation to simulate the effects of different types of energy retrofits implemented at an affordable housing site in Boston, MA.

RESULTS

Simulation results show that retrofits lead to overall better health outcomes and healthcare cost savings if reduced air exchange due to energy-saving air tightening is compensated by mechanical ventilation. Especially when exposed to indoor tobacco smoke and intensive gas-stove cooking such retrofit would lead to an average annual cost saving of over USD 200, while without mechanical ventilation the same children would have experienced an increase of almost USD 200/year in health care utilization cost.

CONCLUSION

The combination of indoor air quality modeling and discrete event modeling applied in this paper can allow for the inclusion of health impacts in cost-benefit analyses of proposed affordable housing energy retrofits.

NICE public health guidance update

This article covers recent National Institute for Health and Care Excellence (NICE) guidance relevant to public health, with a focus on indoor air quality. It introduces the evidence behind this guideline, and the actions that need to be taken by a wide range of stakeholders to implement the guidance and help people to achieve good air quality in their homes. It also highlights the inequalities in exposure to poor quality indoor air and identifies groups that are more vulnerable to health impacts.

A tool for assessing the climate change mitigation and health impacts of environmental policies: the Cities Rapid Assessment Framework for Transformation (CRAFT)

Background: A growing number of cities, including Greater London, have set ambitious targets, including detailed policies and implementation plans, to reach global goals on sustainability, health, and climate change. Here we present a tool for a rapid assessment of the magnitude of impact of specific policy initiatives to reach these targets. The decision-support tool simultaneously quantifies the environmental and health impacts of specified selected policies. Methods: The 'Cities Rapid Assessment Framework for Transformation (CRAFT)' tool was applied to Greater London. CRAFT quantifies the effects of ten environmental policies on changes in (1) greenhouse gas (GHG) emissions, (2) exposures to environmental hazards, (3) travel-related physical activity, and (4) mortality (the number of attributable deaths avoided in one typical year). Publicly available data and epidemiological evidence were used to make rapid quantitative estimates of these effects based on proportional reductions in GHG emissions and environmental exposures from current baseline levels and to compute the mortality impacts. Results: The CRAFT tool estimates that, of roughly 50,000 annual deaths in Greater London, the modelled hazards (PM 2.5 (from indoor and outdoor sources), outdoor NO 2, indoor radon, cold, overheating) and low travel-related physical activity are responsible for approximately 10,000 premature environment-related deaths. Implementing the selected polices could reduce the annual mortality number by about 20% (~1,900 deaths) by 2050. The majority of these deaths (1,700) may be avoided through increased uptake in active travel. Thus, out of ten environmental policies, the 'active travel' policy provides the greatest health benefit. Also, implementing the ten policies results in a GHG reduction of around 90%. Conclusions: The CRAFT tool quantifies the effects of city policies on reducing GHG emissions, decreasing environmental health hazards, and improving public health. The tool has potential value for policy makers through providing quantitative estimates of health impacts to support and prioritise policy options.

Modelling climate change impacts on attributable-related deaths and demographic changes in the largest metropolitan area in Portugal: A time-series analysis

Previous studies have consistently analyzed the impact that extreme temperatures will have on human health. However, there are very few data on temperature-related mortality burden considering future demographic changes in a context of climate change in Portugal. This study aims to quantify the impact of climate change on heat-, cold-, and net change mortality burdens, taking into account the future demographic changes in Lisbon Metropolitan Area, Portugal. We applied a time-series generalized linear model with a quasi-Poisson model via a distributed lag nonlinear model to project temperature-related mortality burden for two climatological scenarios: a present (or reference, 1986-2005) scenario and a future scenario (2046-2065), in this case the Representative Concentration Pathway RCP8.5, which reflects the worst set of expectations (with the most onerous impacts). The results show that the total attributable fraction due to temperature, extreme and moderate cold, is statistically significant in the historical period and the future projected scenarios, while extreme and moderate heat were only significant in the projected future summer period. Net differences were attributed to moderate cold in the future winter months. Projections show a consistent and significant increase in future heat-related mortality burden. The attributable fraction due to heat in the future period, compared to the historical period, ranges from 0 to 1.5% for moderate heat and from 0 to 0.5% for extreme heat. Adaptation should be implemented at the local level, so as to prevent and diminish the effects on citizens and healthcare services, in a context of climate change.

Exposure to indoor air pollution across socio-economic groups in high-income countries: A scoping review of the literature and a modelling methodology

Disparities in outdoor air pollution exposure between individuals of differing socio-economic status is a growing area of research, widely explored in the environmental health literature. However, in developed countries, around 80% of time is spent indoors, meaning indoor air pollution may be a better proxy for personal exposure. Building characteristics - such as build quality, volume and ventilation - and occupant behaviour, mean indoor air pollution may also vary across socio-economic groups, leading to health inequalities. Much of the existing literature has focused on inequalities in exposure to outdoor air pollution, and there is thus a lack of an evidence base reviewing data for indoor environments. In this study, a scoping review of the literature on indoor air pollution exposures across different socio-economic groups is performed, examining evidence from both monitoring and modelling studies in the developed world. The literature was reviewed, identifying different indoor pollutants, definitions for socio-economic status and pre- and post- housing interventions. Based on the review, the study proposes a modelling methodology for evaluating the effects of environmental policies on different socio-economic populations. Using a sample size calculation, obstacles in obtaining sufficiently large samples of monitored data are demonstrated. A modelling framework for the rapid quantification of daily home exposure is then outlined as a proof of concept. While significant additional research is required to examine inequalities in indoor exposures, modelling approaches may provide opportunities to quantify exposure disparities due to housing and behaviours across populations of different socio-economic status.

Exposure to indoor air pollution across socio-economic groups in high-income countries: A scoping review of the literature and a modelling methodology

Disparities in outdoor air pollution exposure between individuals of differing socio-economic status is a growing area of research, widely explored in the environmental health literature. However, in developed countries, around 80% of time is spent indoors, meaning indoor air pollution may be a better proxy for personal exposure. Building characteristics - such as build quality, volume and ventilation - and occupant behaviour, mean indoor air pollution may also vary across socio-economic groups, leading to health inequalities. Much of the existing literature has focused on inequalities in exposure to outdoor air pollution, and there is thus a lack of an evidence base reviewing data for indoor environments. In this study, a scoping review of the literature on indoor air pollution exposures across different socio-economic groups is performed, examining evidence from both monitoring and modelling studies in the developed world. The literature was reviewed, identifying different indoor pollutants, definitions for socio-economic status and pre- and post- housing interventions. Based on the review, the study proposes a modelling methodology for evaluating the effects of environmental policies on different socio-economic populations. Using a sample size calculation, obstacles in obtaining sufficiently large samples of monitored data are demonstrated. A modelling framework for the rapid quantification of daily home exposure is then outlined as a proof of concept. While significant additional research is required to examine inequalities in indoor exposures, modelling approaches may provide opportunities to quantify exposure disparities due to housing and behaviours across populations of different socio-economic status.

Healthy buildings for a healthy city: Is the public health evidence base informing current building policies?

Research has demonstrated that housing quality is a key urban intervention in reducing health risks and improving climate resilience, addressing a key ambition of the United Nations Sustainable Development Goals. Yet housing quality remains a problem even in high income countries such as England. In particular, hazards such as excess cold, excess heat and lack of ventilation leading to damp and mould have been identified as a major issue in homes. Research shows that these hazards can lead to a range of health conditions, such as respiratory and cardiovascular disease, infections and mental health problems. This article explores the use of public health research and evidence in policy to regulate new buildings in England to deliver improved public health, climate resilience and a reduced carbon footprint, in particular exploring the policy drivers and awareness of the public health evidence. Findings show that public health evidence is hardly referenced in policy and that the focus on other evidence bases such as on climate mitigation in building regulations results in both positive and negative impacts on health. This reflects a lack of a systems approach around urban interventions leading to weaknesses in standards regulating the private development sector. In conclusion, this paper recommends: 1. the consideration of health impact in future building regulations; 2. the integration and coordination of key policies covering various scales and phases of the development processes and 3. the better education of residents to understand advances in new energy performance technologies.

Quantifying the impact of housing interventions on indoor air quality and energy consumption using coupled simulation models

While residential energy and ventilation standards aim to improve the energy performance and indoor air quality (IAQ) of homes, their combined impact across diverse residential activities and housing environments has not been well-established. This study demonstrates the insights that a recently-developed, freely-available coupled IAQ-energy modeling platform can provide regarding the energy and IAQ trade-offs of weatherization (i.e., sealing and insulation) and ventilation retrofits in multifamily housing across varied indoor occupant activity and mechanical ventilation scenarios in Boston, MA. Overall, it was found that combined weatherization and improved ventilation recommended by design standards could lead to both energy savings and IAQ-related benefits; however, ventilation standards may not be sufficient to protect against IAQ disbenefits for residents exposed to strong indoor sources (e.g., heavy cooking or smoking) and could lead to net increases in energy costs (e.g., due to the addition of continuous outdoor air ventilation). The modeling platform employed in this study is flexible and can be applied to a wide range of building typologies, retrofits, climates, and indoor occupant activities; therefore, it stands as a valuable tool for identifying cost-effective interventions that meet both energy efficiency and ventilation standards and improve IAQ across diverse housing populations.

Health benefits of policies to reduce carbon emissions

James Milner and colleagues argue that carefully considered policies to lower carbon emissions can also improve health, and we should use these benefits to push for strong climate action

MicroEnv: A microsimulation model for quantifying the impacts of environmental policies on population health and health inequalities

The Sustainable Development Goals (SDGs) recognise the critical need to improve population health and environmental sustainability. This paper describes the development of a microsimulation model, MicroEnv, aimed at quantifying the impact of environmental exposures on health as an aid to selecting policies likely to have greatest benefit. Its methods allow the integration of morbidity and mortality outcomes and the generation of results at high spatial resolution. We illustrate its application to the assessment of the impact of air pollution on health in London. Simulations are performed at Lower Layer Super Output Area (LSOA), the smallest geographic unit (population of around 1500 inhabitants) for which detailed socio-demographic data are routinely available in the UK. The health of each individual in these LSOAs is simulated year-by-year using a health-state-transition model, where transition probabilities from one state to another are based on published statistics modified by relative risks that reflect the effect of environmental exposures. This is done through linkage of the simulated population in each LSOA with 1 × 1 km annual average PM2.5 concentrations and area-based deprivation indices. Air pollution is a leading cause of mortality and morbidity globally, and improving air quality is critical to the SDGs for Health (Goal 3) and Cities (Goal 11). The evidence of MicroEnv is aimed at providing better understanding of the benefits for population health and health inequalities of policy actions that affect exposure such as air quality, and thus to help shape policy decisions. Future work will extend the model to integrate other environmental determinants of health.

Household energy efficiency and health: Area-level analysis of hospital admissions in England

INTRODUCTION

Fuel poverty affects up to 35% of European homes, which represents a significant burden on society and healthcare systems. Draught proofing homes to prevent heat loss, improved glazing, insulation and heating (energy efficiency measures) can make more homes more affordable to heat. This has prompted significant investment in energy efficiency upgrades for around 40% of UK households to reduce the impact of fuel poverty. Despite some inconsistent evidence, household energy efficiency interventions can improve cardiovascular and respiratory health outcomes. However, the health benefits of these interventions have not been fully explored; this is the focus of this study.

METHODS

In this cross sectional ecological study, we conducted two sets of analyses at different spatial resolution to explore population data on housing energy efficiency measures and hospital admissions at the area-level (counts grouped over a 3-year period). Housing data were obtained from three data sets covering housing across England (Household Energy Efficiency Database), Energy Performance Certificate (EPC) and, in the South West of England, the Devon Home Analytics Portal. These databases provided data aggregated to Lower Area Super Output Area and postcode level (Home Analytics Portal only). These datasets provided measures of both state (e.g. EPC ratings) and intervention (e.g. number of boiler replacements), aggregated spatially and temporally to enable cross-sectional analyses with health outcome data. Hospital admissions for adult (over 18 years) asthma, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) were obtained from the Hospital Episode Statistics database for the national (1st April 2011 to 31st March 2014) and Devon, South West of England (1st April 2014 to 31st March 2017) analyses. Descriptive statistics and regression models were used to describe the associations between small area household energy efficiency measures and hospital admissions. Three main analyses were undertaken to investigate the relationships between; 1) household energy efficiency improvements (i.e. improved glazing, insulation and boiler upgrades); 2) higher levels of energy efficiency ratings (measured by Energy Performance Certificate ratings); 3) energy efficiency improvements and ratings (i.e. physical improvements and rating assessed by the Standard Assessment Procedure) and hospital admissions.

RESULTS

In the national analyses, household energy performance certificate ratings ranged from 37 to 83 (mean 61.98; Standard Deviation 5.24). There were a total of 312,837 emergency admissions for asthma, 587,770 for COPD and 839,416 for CVD. While analyses for individual energy efficiency metrics (i.e. boiler upgrades, draught proofing, glazing, loft and wall insulation) were mixed; a unit increase in mean energy performance rating was associated with increases of around 0.5% in asthma and CVD admissions, and 1% higher COPD admission rates. Admission rates were also influenced by the type of dwelling, tenure status (e.g. home owner versus renting), living in a rural area, and minimum winter temperature.

DISCUSSION

Despite a range of limitations and some mixed and contrasting findings across the national and local analyses, there was some evidence that areas with more energy efficiency improvements resulted in higher admission rates for respiratory and cardiovascular diseases. This builds on existing evidence highlighting the complex relationships between health and housing. While energy efficiency measures can improve health outcomes (especially when targeting those with chronic respiratory illness), reduced household ventilation rates can impact indoor air quality for example and increase the risk of diseases such as asthma. Alternatively, these findings could be due to the ecological study design, reverse causality, or the non-detection of more vulnerable subpopulations, as well as the targeting of areas with poor housing stock, low income households, and the lack of "whole house approaches" when retrofitting the existing housing stock.

CONCLUSION

To be sustainable, household energy efficiency policies and resulting interventions must account for whole house approaches (i.e. consideration of the whole house and occupant lifestyles). These must consider more alternative 'greener' and more sustainable measures, which are capable of accounting for variable lifestyles, as well as the need for adequate heating and ventilation. Larger natural experiments and more complex modelling are needed to further investigate the impact of ongoing dramatic changes in the housing stock and health.

STUDY IMPLICATIONS

This study supports the need for more holistic approaches to delivering healthier indoor environments, which must consider a dynamic and complex system with multiple interactions between a range of interrelated factors. These need to consider the drivers and pressures (e.g. quality of the built environment and resident behaviours) resulting in environmental exposures and adverse health outcomes.

Burden of typical diseases attributed to the sources of PM2.5-bound toxic metals in Beijing: An integrated approach to source apportionment and QALYs

PM_2.5-bound toxic metals (TMs) are derived from various sources, and they can cause many adverse health effects on the human body. To effectively reduce the disease burden of TMs by controlling the relative sources, an integrated approach of quality-adjusted life years (QALYs) and source-apportionment (positive matrix factorization, PMF) was proposed and applied to some typical diseases induced by TMs in 2017 in Beijing. The estimation included two parts; first, the number of potentially affected people was calculated based on the source mass contribution from PMF and the inhalation unit risk of TMs; second, the QALYs lost per affected person was calculated based on the disease duration, expected years of life lost (EYLL) and quality of life (QoL) for both affected people and the general population. The results showed that QALYs lost per person for renal cancer (17.3 QALYs), pneumonia (14.4 QALYs), lung cancer (14.2 QALYs), skin cancer (12.7 QALYs) and diabetes mellitus (12.6 QALYs) were higher than those for other diseases. Combined with PMF, the source contributions to the overall burden of typical diseases from the TMs followed the order of coal combustion (50.2%) > vehicle emissions (24.4%) > fuel oil combustion (11.4%) > Cr-related industry (10.9%) > resuspended dust (3.0%). The rank was further compared with that assessed for noncancer and cancer risks, and we verified the reasonability of the QALYs method. For seasonal contributions to coal combustion, winter and spring had the highest contributions, which coincided with the fact that coal was the main fuel for heating in Beijing. The QALYs lost attributed to TMs for coal combustion decreased by 49.1% from 2016 to 2017, which may indicate an effective policy associated with coal control. Overall, the integrated approach was successfully employed for estimating the disease burden induced by TMs from each source and was an effective solution to identify the control rank of sources for TM reduction.

Home energy efficiency and radon: An observational study

Exposure to radon gas is the second leading cause of lung cancer worldwide behind smoking. Changing the energy characteristics of a dwelling can influence both its thermal and ventilative properties, which can affect indoor air quality. This study uses radon measurements made in 470 689 UK homes between 1980 and 2015, linked to dwelling information contained within the Home Energy Efficiency Database (HEED). The linked dataset, the largest of its kind, was used to analyze the association of housing and energy performance characteristics with indoor radon concentrations in the UK. The findings show that energy efficiency measures that increase the airtightness of properties are observed to have an adverse association with indoor radon levels. Homes with double glazing installed had radon measurements with a significantly higher geometric mean, 67% (95% CI: 44, 89) greater than those without a recorded fabric retrofit. Those with loft insulation (47%, 95% CI: 26, 69) and wall insulation (32%, 95% CI: 11, 53) were also found to have higher radon readings. Improving the energy performance of the UK's housing stock is vital in meeting carbon emission reduction targets. However, compromising indoor air quality must be avoided through careful assessment and implementation practices.

In Situ Measurements of Energy Consumption and Indoor Environmental Quality of a Pre-Retrofitted Student Dormitory in Athens

In the following years all European Union member states should bring into force national laws on the energy performance of buildings. Moreover, university campus dormitories are buildings of great importance, due to their architectural characteristics and their social impact. In this study, the energy performance along with the indoor environmental conditions of a dormitory of a university has been analysed. The in situ measurements included temperature, relative humidity, concentrations of carbon dioxide, total volatile organic compounds, and electrical consumption; lastly, the energy signature of the whole building was investigated. The study focused on the summer months, during which significantly increased thermal needs of the building were identified. The ground floor was found to be the floor with the highest percentage of thermal conditions within the comfort range, and the third floor the lowest. Lastly, a significant correlation between electrical consumption and the outdoor temperature was presented, highlighting the lack of thermal insulation. Overall, it was clear that a redesign of the cooling and heating system, the installation of a ventilation system, and thermal insulation are essential for improving the energy efficiency of this building.

Application of an indoor air pollution metamodel to a spatially-distributed housing stock

Estimates of population air pollution exposure typically rely on the outdoor component only, and rarely account for populations spending the majority of their time indoors. Housing is an important modifier of air pollution exposure due to outdoor pollution infiltrating indoors, and the removal of indoor-sourced pollution through active or passive ventilation. Here, we describe the application of an indoor air pollution modelling tool to a spatially distributed housing stock model for England and Wales, developed from Energy Performance Certificate (EPC) data and containing information for approximately 11.5 million dwellings. First, we estimate indoor/outdoor (I/O) ratios and total indoor concentrations of outdoor air pollution for PM_2.5 and NO₂ for all EPC dwellings in London. The potential to estimate concentration from both indoor and outdoor sources is then demonstrated by modelling indoor background CO levels for England and Wales pre- and post-energy efficient adaptation, including heating, cooking, and smoking as internal sources. In London, we predict a median I/O ratio of 0.60 (99% CIs; 0.53-0.73) for outdoor PM_2.5 and 0.41 (99%CIs; 0.34-0.59) for outdoor NO₂; Pearson correlation analysis indicates a greater spatial modification of PM_2.5 exposure by housing (ρ = 0.81) than NO₂ (ρ = 0.88). For the demonstrative CO model, concentrations ranged from 0.4-9.9 ppm (99%CIs)(median = 3.0 ppm) in kitchens and 0.3-25.6 ppm (median = 6.4 ppm) in living rooms. Clusters of elevated indoor concentration are found in urban areas due to higher outdoor concentrations and smaller dwellings with reduced ventilation potential, with an estimated 17.6% increase in the number of living rooms and 63% increase in the number of kitchens exceeding recommended exposure levels following retrofit without additional ventilation. The model has the potential to rapidly calculate indoor pollution exposure across large housing stocks and estimate changes to exposure under different pollution or housing policy scenarios.

Application of an indoor air pollution metamodel to a spatially-distributed housing stock

Estimates of population air pollution exposure typically rely on the outdoor component only, and rarely account for populations spending the majority of their time indoors. Housing is an important modifier of air pollution exposure due to outdoor pollution infiltrating indoors, and the removal of indoor-sourced pollution through active or passive ventilation. Here, we describe the application of an indoor air pollution modelling tool to a spatially distributed housing stock model for England and Wales, developed from Energy Performance Certificate (EPC) data and containing information for approximately 11.5 million dwellings. First, we estimate indoor/outdoor (I/O) ratios and total indoor concentrations of outdoor air pollution for PM_2.5 and NO₂ for all EPC dwellings in London. The potential to estimate concentration from both indoor and outdoor sources is then demonstrated by modelling indoor background CO levels for England and Wales pre- and post-energy efficient adaptation, including heating, cooking, and smoking as internal sources. In London, we predict a median I/O ratio of 0.60 (99% CIs; 0.53-0.73) for outdoor PM_2.5 and 0.41 (99%CIs; 0.34-0.59) for outdoor NO₂; Pearson correlation analysis indicates a greater spatial modification of PM_2.5 exposure by housing (ρ = 0.81) than NO₂ (ρ = 0.88). For the demonstrative CO model, concentrations ranged from 0.4-9.9 ppm (99%CIs)(median = 3.0 ppm) in kitchens and 0.3-25.6 ppm (median = 6.4 ppm) in living rooms. Clusters of elevated indoor concentration are found in urban areas due to higher outdoor concentrations and smaller dwellings with reduced ventilation potential, with an estimated 17.6% increase in the number of living rooms and 63% increase in the number of kitchens exceeding recommended exposure levels following retrofit without additional ventilation. The model has the potential to rapidly calculate indoor pollution exposure across large housing stocks and estimate changes to exposure under different pollution or housing policy scenarios.

Making the Case for "Whole System" Approaches: Integrating Public Health and Housing

Housing conditions have been an enduring focus for public health activity throughout the modern public health era. However, the nature of the housing and health challenge has changed in response to an evolution in the understanding of the diverse factors influencing public health. Today, the traditional public health emphasis on the type and quality of housing merges with other wider determinants of health. These include the neighbourhood, community, and "place" where a house is located, but also the policies which make access to a healthy house possible and affordable for everyone. Encouragingly, these approaches to policy and action on housing have the potential to contribute to the "triple win" of health and well-being, equity, and environmental sustainability. However, more effective housing policies (and in public health in general) that adopt more systemic approaches to addressing the complex interactions between health, housing, and wider environment are needed. This paper illustrates some of the key components of the housing and health challenge in developed countries, and presents a conceptual model to co-ordinate activities that can deliver the "triple win." This is achieved by offering a perspective on how to navigate more effectively, inclusively and across sectors when identifying sustainable housing interventions.

The impact of home energy efficiency interventions and winter fuel payments on winter- and cold-related mortality and morbidity in England: a natural equipment mixed-methods study

Background

England, and the UK more generally, has a large burden of winter- and cold-related mortality/morbidity in comparison with nearby countries in continental Europe. Improving the energy efficiency of the housing stock may help to reduce this, as well as being important for climate change and energy security objectives.

Objectives

To evaluate the impact of home energy efficiency (HEE) interventions on winter- and cold-related mortality/morbidity, including assessing the impact of winter fuel payments (WFPs) and fuel costs.

Design

A mixed-methods study – an epidemiological time-series analysis, an analysis of data on HEE interventions, the development and application of modelling methods including a multicriteria decision analysis and an in-depth interview study of householders.

Setting

England, UK.

Participants

The population of England. In-depth interviews were conducted with 12 households (2–4 participants each) and 41 individuals in three geographical regions.

Interventions

HEE interventions.

Main outcome measures

Mortality, morbidity and intervention-related changes to the home indoor environment.

Data sources

The Homes Energy Efficiency Database, mortality and hospital admissions data and weather (temperature) data.

Results

There has been a progressive decline in cold-related deaths since the mid-1970s. Since the introduction of WFPs, the gradient of association between winter cold and mortality [2.00%, 95% confidence interval (CI) 1.74% to 2.28%] per degree Celsius fall in temperature is somewhat weaker (i.e. that the population is less vulnerable to cold) than in earlier years (2.37%, 95% CI 0.22% to 2.53%). There is also evidence that years with above-average fuel costs were associated with higher vulnerability to outdoor cold. HEE measures installed in England in 2002–10 have had a relatively modest impact in improving the indoor environment. The gains in winter temperatures (around +0.09 °C on a day with maximum outdoor temperature of 5 °C) are associated with an estimated annual reduction of ≈280 cold-related deaths in England (an eventual maximum annual impact of 4000 life-years gained), but these impacts may be appreciably smaller than those of changes in indoor air quality. Modelling studies indicate the potential importance of the medium- and longer-term impacts that HEE measures have on health, which are not observable in short-term studies. They also suggest that HEE improvements of similar annualised cost to current WFPs would achieve greater improvements in health while reducing (rather than increasing) carbon dioxide emissions. In-depth interviews suggest four distinct householder framings of HEE measures (as home improvement, home maintenance, subsidised public goods and contributions to sustainability), which do not dovetail with current ‘consumerist’ national policy and may have implications for the uptake of HEE measures.

Limitations

The quantification of intervention impacts in this national study is reliant on various indirect/model-based assessments.

Conclusions

Larger-scale changes are required to the housing stock in England if the full potential benefits for improving health and for reaching increasingly important climate change mitigation targets are to be realised.

Future work

Studies based on data linkage at individual dwelling level to examine health impacts. There is a need for empirical assessment of HEE interventions on indoor air quality.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 11. See the NIHR Journals Library website for further project information.

Comparison of indoor temperatures of homes with recommended temperatures and effects of disability and age: an observational, cross-sectional study

OBJECTIVES

We examine if temperatures in winter in English homes meet the recommendation of being at least 18°C at all times. We analyse how many days meet this criterion and calculate the hours per day and night being at/above 18°C. These metrics are compared between households with occupants aged above 64 years or having a long-term disability (LTD) and those younger and without disability.

DESIGN

Cross-sectional, observational.

SETTING

England.

PARTICIPANTS

635 households.

OUTCOMES MEASURES

(1) Mean temperatures, (2) proportion of days of the measurement period meeting the criterion, (3) average hours at/above 18°C, (4) average hours at night at/above 18°C.

RESULTS

Mean winter temperatures in the bedroom were M_BR=18.15°C (SD=2.51), the living room M_LR=18.90°C (SD=2.46) and the hallway M_Hall=18.25°C (SD=2.57).The median number of days meeting the criterion was 19-31%. For the living room, more days meet the criterion in the group with a LTD (M_disability=342 vs M_{no_disability}=301, 95% CI 8 to 74), and with someone over 64 years present (M_above64=341, M_below65=301 95%, CI 8 to 74).The median number of hours/day meeting the criterion was 13-17. In the living room, households with a disability had more hours at 18°C (M_disability=364, M_{no_disability}=297, 95% CI 17 to 83) as did the older age group (M_above64=347, M_below65=296, 95% CI 18 to 84). In the hallway, more hours met the criterion in households with a disability (M_disability=338, M_{no_disability}=302, 95% CI 3 to 70).247 homes had at least nine hours of at least 18°C at night; no effect of age or disability.

CONCLUSIONS

Many households are at risk of negative health outcomes because of temperatures below recommendations.

Modeling the resiliency of energy-efficient retrofits in low-income multifamily housing

Residential energy efficiency and ventilation retrofits (eg, building weatherization, local exhaust ventilation, HVAC filtration) can influence indoor air quality (IAQ) and occupant health, but these measures' impact varies by occupant activity. In this study, we used the multizone airflow and IAQ analysis program CONTAM to simulate the impacts of energy retrofits on indoor concentrations of PM_2.5 and NO₂ in a low-income multifamily housing complex in Boston, Massachusetts (USA). We evaluated the differential impact of residential activities, such as low- and high-emission cooking, cigarette smoking, and window opening, on IAQ across two seasons. We found that a comprehensive package of energy and ventilation retrofits was resilient to a range of occupant activities, while less holistic approaches without ventilation improvements led to increases in indoor PM_2.5 or NO₂ for some populations. In general, homes with simulated concentration increases included those with heavy cooking and no local exhaust ventilation, and smoking homes without HVAC filtration. Our analytical framework can be used to identify energy-efficient home interventions with indoor retrofit resiliency (ie, those that provide IAQ benefits regardless of occupant activity), as well as less resilient retrofits that can be coupled with behavioral interventions (eg, smoking cessation) to provide cost-effective, widespread benefits.

Health effects of milder winters: a review of evidence from the United Kingdom

Cold-related mortality and morbidity remains an important public health problem in the UK and elsewhere. Health burdens have often reported to be higher in the UK compared to other countries with colder climates, however such assessments are usually based on comparison of excess winter mortality indices, which are subject to biases. Daily time-series regression or case-crossover studies provide the best evidence of the acute effects of cold exposure. Such studies report a 6% increase in all-cause deaths in England & Wales for every 1 °C fall in daily mean temperature within the top 5% of the coldest days. In major Scottish cities, a 1 °C reduction in mean temperature below 11 °C was associated with an increase in mortality of 2.9%, 3.4%, 4.8% and 1.7% from all-causes, cardiovascular, respiratory, and non-cardio-respiratory causes respectively. In Northern Ireland, a 1 °C fall during winter months led to increases of 4.5%, 3.9% and 11.2% for all-cause, cardiovascular and respiratory deaths respectively among adults. Raised risks are also observed with morbidity outcomes. Hip fractures among the elderly are only weakly associated with snow and ice conditions in the UK, with the majority of cases occurring indoors. A person's susceptibility to cold weather is affected by both individual- and contextual-level risk factors. Variations in the distributions of health, demographic, socio-economic and built-environment characteristics are likely to explain most differences in cold risk observed between UK regions. Although cold-related health impacts reduced throughout much of the previous century in UK populations, there is little evidence on the contribution that milder winters due to climate change may have made to reductions in more recent decades. Intervention measures designed to minimise cold exposure and reduce fuel poverty will likely play a key role in determining current and future health burdens associated with cold weather.

Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey

BACKGROUND

While existing research indicates that housing improvements are associated with health improvements, less is known about the wider social and health benefits of meeting national housing standards, as well as those of their specific constituent measures. This study evaluates the impacts of a managed housing upgrade programme through a repeated cross-sectional survey design.

METHODS

A five-wave repeated cross-sectional survey was conducted over a seven-year period from 2009 to 2016 (n = 2075; n = 2219; n = 2015; n = 1991; and n = 1709, respectively). The study followed a managed upgrade programme designed to meet a national social housing standard over an extended period. The data were analysed from a multilevel perspective to take account of the time-dependent nature of the observations and differences in socio-demographic composition.

RESULTS

The installation of the majority of individual housing measures (new windows and doors; boilers; kitchens; bathrooms; electrics; loft insulation; and cavity/external wall insulation) were associated with improvements in several social (housing suitability, satisfaction, and quality; thermal comfort and household finances) and health (mental, respiratory and general health) outcomes; and analyses showed relationships between the number of measures installed and the total amount invested on the one hand and the social and health outcomes on the other. There were however a few exceptions. Most notably, the installation of cavity wall insulation was associated with poorer health outcomes, and did not lead to better social outcomes. Also, no association was found between the number of measures installed and respiratory health.

CONCLUSIONS

The study suggests that substantial housing investments through a managed upgrade programme may result in better social and health outcomes, and that the size of the improvements are proportionate to the number of measures installed and amount invested. However, there may be risks associated with specific measures; and more attention is needed for mechanical ventilation when upgrading energy efficiency of houses through fabric work. In addition to providing new evidence regarding the wider social and health outcomes, the study provides an analytical approach to evaluate upgrade programmes that are delivered over multiple years.

Costs and outcomes of improving population health through better social housing: a cohort study and economic analysis

Objectives

We sought to determine the impact of warmth-related housing improvements on the health, well-being, and quality of life of families living in social housing.

Methods

An historical cohort study design was used. Households were recruited by Gentoo, a social housing contractor in North East England. Recruited households were asked to complete a quality of life, well-being, and health service use questionnaire before receiving housing improvements (new energy-efficient boiler and double-glazing) and again 12 months afterwards.

Results

Data were collected from 228 households. The average intervention cost was £3725. At 12-month post-intervention, a 16% reduction (−£94.79) in household 6-month health service use was found. Statistically significant positive improvements were observed in main tenant and household health status (p < 0.001; p = 0.009, respectively), main tenant satisfaction with financial situation (p = 0.020), number of rooms left unheated per household (p < 0.001), frequency of household outpatient appointments (p = 0.001), and accident/emergency department attendance (p < 0.012).

Conclusions

Warmth-related housing improvements may be a cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.

Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 European Countries

Despite growing pan-European interest in and awareness of the wide-ranging health and well-being impacts of energy poverty-which is characterised by an inability to secure adequate levels of energy services in the home-the knowledge base is largely British-centric and dominated by single-country studies. In response, this paper investigates the relationship between energy poverty, health and well-being across 32 European countries, using 2012 data from the European Quality of Life Survey. We find an uneven concentration of energy poverty, poor health, and poor well-being across Europe, with Eastern and Central Europe worst affected. At the intersection of energy poverty and health, there is a higher incidence of poor health (both physical and mental) amongst the energy poor populations of most countries, compared to non-energy poor households. Interestingly, we find the largest disparities in health and well-being levels between energy poor and non-energy poor households occur within relatively equal societies, such as Sweden and Slovenia. As well as the unique challenges brought about by rapidly changing energy landscapes in these countries, we also suggest the relative deprivation theory and processes of social comparison hold some value in explaining these findings.

Public health impacts of city policies to reduce climate change: findings from the URGENCHE EU-China project

BACKGROUND

Climate change is a global threat to health and wellbeing. Here we provide findings of an international research project investigating the health and wellbeing impacts of policies to reduce greenhouse gas emissions in urban environments.

METHODS

Five European and two Chinese city authorities and partner academic organisations formed the project consortium. The methodology involved modelling the impact of adopted urban climate-change mitigation transport, buildings and energy policy scenarios, usually for the year 2020 and comparing them with business as usual (BAU) scenarios (where policies had not been adopted). Carbon dioxide emissions, health impacting exposures (air pollution, noise and physical activity), health (cardiovascular, respiratory, cancer and leukaemia) and wellbeing (including noise related wellbeing, overall wellbeing, economic wellbeing and inequalities) were modelled. The scenarios were developed from corresponding known levels in 2010 and pre-existing exposure response functions. Additionally there were literature reviews, three longitudinal observational studies and two cross sectional surveys.

RESULTS

There are four key findings. Firstly introduction of electric cars may confer some small health benefits but it would be unwise for a city to invest in electric vehicles unless their power generation fuel mix generates fewer emissions than petrol and diesel. Second, adopting policies to reduce private car use may have benefits for carbon dioxide reduction and positive health impacts through reduced noise and increased physical activity. Third, the benefits of carbon dioxide reduction from increasing housing efficiency are likely to be minor and co-benefits for health and wellbeing are dependent on good air exchange. Fourthly, although heating dwellings by in-home biomass burning may reduce carbon dioxide emissions, consequences for health and wellbeing were negative with the technology in use in the cities studied.

CONCLUSIONS

The climate-change reduction policies reduced CO2 emissions (the most common greenhouse gas) from cities but impact on global emissions of CO2 would be more limited due to some displacement of emissions. The health and wellbeing impacts varied and were often limited reflecting existing relatively high quality of life and environmental standards in most of the participating cities; the greatest potential for future health benefit occurs in less developed or developing countries.

Identifying risk factors for exposure to culturable allergenic moulds in energy efficient homes by using highly specific monoclonal antibodies

The aim of this study was to determine the accuracy of monoclonal antibodies (mAbs) in identifying culturable allergenic fungi present in visible mould growth in energy efficient homes, and to identify risk factors for exposure to these known allergenic fungi. Swabs were taken from fungal contaminated surfaces and culturable yeasts and moulds isolated by using mycological culture. Soluble antigens from cultures were tested by ELISA using mAbs specific to the culturable allergenic fungi Aspergillus and Penicillium spp., Ulocladium, Alternaria, and Epicoccum spp., Cladosporium spp., Fusarium spp., and Trichoderma spp. Diagnostic accuracies of the ELISA tests were determined by sequencing of the internally transcribed spacer 1 (ITS1)-5.8S-ITS2-encoding regions of recovered fungi following ELISA. There was 100% concordance between the two methods, with ELISAs providing genus-level identity and ITS sequencing providing species-level identities (210 out of 210 tested). Species of Aspergillus/Penicillium, Cladosporium, Ulocladium/Alternaria/Epicoccum, Fusarium and Trichoderma were detected in 82% of the samples. The presence of condensation was associated with an increased risk of surfaces being contaminated by Aspergillus/Penicillium spp. and Cladosporium spp., whereas moisture within the building fabric (water ingress/rising damp) was only associated with increased risk of Aspergillus/Penicillium spp. Property type and energy efficiency levels were found to moderate the risk of indoor surfaces becoming contaminated with Aspergillus/Penicillium and Cladosporium which in turn was modified by the presence of condensation, water ingress and rising damp, consistent with previous literature.