Energy, Poverty, and Health in Climate Change: A Comprehensive Review of an Emerging Literature

Energy burden and mental health: A national study in the United States

The prevalence of mental health issues in the US has significantly risen over the past decade, and it is presumably linked to an energy burden issue that has recently gained attention as a critical social determinant of mental health. Utilizing extensive nationwide datasets at the census tract, we found that the census tract level energy burden is positively associated with two key mental health indicators even after accounting for living, housing, and sociodemographic characteristics: the prevalence of frequent mental distress and physician-diagnosed depression, across all US urban areas. We also observe that these associations are consistent across various climate regions. The findings highlight that energy burden has a detrimental impact on mental health, and that it should be e considered a significant social determinant of health in future studies. Lastly, our study advocates for national policies to achieve energy justice and address disparities in mental health.

Mapping Spatiotemporal Disparities in Residential Electricity Inequality Using Machine Learning

The move toward electrification is critical for decarbonizing the energy sector but may exacerbate energy unaffordability without proper safeguards. Addressing this challenge requires capturing neighborhood-scale dynamics to uncover the blind spots in residential electricity inequality. Based on publicly available, multisourced remote sensing and census data, we develop a high-resolution, spatiotemporally explicit machine learning (ML) framework to predict tract-level monthly electricity consumption across the conterminous U.S. from 2013-2020. We then construct the electricity affordability gap (EAG) metric, defined as the gap between electricity bills and 3% of household income, to better identify energy-vulnerable communities over space and time. The results show that our framework largely improves the resolution of electricity consumption data while achieving an R2 of 0.82 compared to the Low-Income Energy Affordability Data (LEAD). We estimate an annual $16.18 billion economic burden on the ability to afford electricity bills, exceeding current federal appropriations in alleviating energy difficulties. We also observe pronounced seasonal and urban-rural disparities, with monthly EAG in summer and winter being 2-3 times greater than other seasons and rural residents facing burdens up to 1.7 times higher than their urban counterparts. These insights inform equitable electrification by addressing spatiotemporal mismatches and multiple jurisdictional challenges in energy justice efforts.

Investigating the role of community organizations in communicating extreme weather events in New York City: A content analysis

The communication of extreme weather forecasts (e.g., heatwaves and extreme precipitation) is a challenge for weather forecasters and emergency managers who are tasked with keeping residents safe during often unprecedented situations. Weather models have inherent uncertainty, and the ability for potentially life-saving information to get to the people who need it most (e.g., those who need to evacuate) remains a challenge despite the proliferation of digital access to information and social media sites like Twitter. It is also unclear the role that community-based organizations and super-local governmental entities play or may play during weather events in transmitting weather information and providing assistance. In New York City, there remains robust inequality, with communities that are historically disadvantaged often suffering the highest number of deaths and level of destruction following weather events. Results from interviewing 26 New York City community leaders suggest that local organizations often act as intermediaries, passing on official weather information to members of their audience, regardless of the mission statement of their organization. Common challenges for communities in responding to extreme weather include lack of access to information, language barriers, and insufficient resources. Considerations for future weather communication strategies are discussed.

Readiness for a clean energy future: Prevalence, perceptions, and barriers to adoption of electric stoves and solar panels in New York City

Adoption of electric stoves and rooftop solar can reduce fossil-fuel reliance and improve health by decreasing indoor air pollution and alleviating energy insecurity. This study assessed prevalence and perceptions of these clean-energy technologies to increase adoption in New York City (NYC). A representative survey of 1,950 NYC adults was conducted from February 28 to April 1, 2022. Fourteen percent of people had an electric stove; 86% had gas stoves. Black, Latino/a, and lower-income residents were more likely to have electric stoves than White and higher-income residents. Only 14% of residents were interested in switching from gas to electric stoves. Of the 71% with gas stoves uninterested in switching, nearly half (45%) preferred gas cooking, particularly among White and higher-income residents, indicating a large opportunity to shift preferences. About 5% used solar for their home or building; another 77% were interested in solar. Of the 18% uninterested in solar, reasons included lack of agency, confusion about operation, and costs. Education about health and cost benefits, induction technology, how to transition, available subsidies, and other efforts to reduce adoption barriers can support clean technology uptake. Residential clean energy metrics should be tracked regularly to ensure that technology adoption proceeds equitably.

Household fuel use and the regression from prehypertension to normotension among Chinese middle-aged and older adults: a cohort study

To examine the association of household fuel use with prehypertension regression among middle-aged and older people based on the China Health and Retirement Longitudinal Study (CHARLS), we included a total of 3501 participants with prehypertension at baseline, and they were followed up from 2011-2012 to 2015-2016 with information on blood pressure and household solid fuel use (heating and cooking fuels). Cox proportional hazards regression models were used to explore the hazard ratio (HR) and 95% confidence interval (CI) between fuel use and prehypertension regression. Additionally, we investigated the impact of switching fuels (2011-2013) on the regression to normotension during the 4-year follow-up. Linear regression was used to examine the effect of household fuel use on changes in blood pressure. Compared to solid fuel users, those who used clean fuel for heating at baseline had a positive effect on the regression of prehypertension (HR: 1.28, 95% CI: 1.08-1.53). Participants who used clean fuels for both heating and cooking had increased odds for the regression of prehypertension (HR: 1.32, 95% CI: 1.09-1.60). Compared to consistent solid fuel users, those who consistently used clean fuel for heating had a higher likelihood of transitioning from prehypertension to normotension (HR: 1.36, 95% CI: 1.06-1.73) and exhibited 2.45 mmHg lower systolic blood pressure. In conclusion, household clean fuel use for heating was positively associated with the regression of prehypertension to normotension. Furthermore, switching from solid fuel to clean fuel for heating could reduce the risk of prehypertension in Chinese middle-aged and older adults.

Inequalities in global residential cooling energy use to 2050

Intersecting socio-demographic transformations and warming climates portend increasing worldwide heat exposures and health sequelae. Cooling adaptation via air conditioning (AC) is effective, but energy-intensive and constrained by household-level differences in income and adaptive capacity. Using statistical models trained on a large multi-country household survey dataset (n = 673,215), we project AC adoption and energy use to mid-century at fine spatial resolution worldwide. Globally, the share of households with residential AC could grow from 27% to 41% (range of scenarios assessed: 33-48%), implying up to a doubling of residential cooling electricity consumption, from 1220 to 1940 (scenarios range: 1590-2377) terawatt-hours yr.-1, emitting between 590 and 1,365 million tons of carbon dioxide equivalent (MtCO2e). AC access and utilization will remain highly unequal within and across countries and income groups, with significant regressive impacts. Up to 4 billion people may lack air-conditioning in 2050. Our global gridded projections facilitate incorporation of AC's vulnerability, health, and decarbonization effects into integrated assessments of climate change.

Identifying groups at-risk to extreme heat: Intersections of age, race/ethnicity, and socioeconomic status

Anthropogenic climate change has resulted in a significant rise in extreme heat events, exerting considerable but unequal impacts on morbidity and mortality. Numerous studies have identified inequities in heat exposure across different groups, but social identities have often been viewed in isolation from each other. Children (5 and under) and older adults (65 and older) also face elevated risks of heat-related health impacts. We employ an intersectional cross-classificatory approach to analyze the distribution of heat exposure between sociodemographic categories split into age groups in the contiguous US. We utilize high-resolution daily air temperature data to establish three census tract-level heat metrics (i.e., average summer temperature, heat waves, and heat island days). We pair those metrics with American Community Survey estimates on racial/ethnic, socioeconomic, and disability status by age to calculate population weighted mean exposures and absolute disparity metrics. Our findings indicate few substantive differences between age groups overall, but more substantial differences between sociodemographic categories within age groups, with children and older adults from socially marginalized backgrounds facing greater exposure than adults from similar backgrounds. When looking at sociodemographic differences by age, people of color of any age and older adults without health insurance emerge as the most exposed groups. This study identifies groups who are most exposed to extreme heat. Policy and program interventions aimed at reducing the impacts of heat should take these disparities in exposure into account to achieve health equity objectives.

NPCC4: Climate change, energy, and energy insecurity in New York City

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report provides an overview of energy trends in New York City and the State of New York, as well as accompanying challenges and barriers to the energy transition-with implications for human health and wellbeing. The link between energy trends and their impact on health and wellbeing is brought to the fore by the concept of "energy insecurity," an important addition to the NPCC4 assessment.

The impact of energy poverty on the health and welfare of the middle-aged and older adults

Drawing upon data from the 2018 CHARLS, this paper utilizes MEPI and a 10% threshold indicator to, respectively, assess the energy poverty (EP) status among middle-aged and older adults in China, focusing on the unavailability and unaffordability of energy services. Additionally, an econometric model is constructed to investigate the effects of EP on the health and welfare of middle-aged and older adults. Regression results indicate that EP exerts a significant negative impact on the health and welfare of middle-aged and older adults. This conclusion remains robust after conducting endogeneity and robustness tests, demonstrating its validity. Finally, based on the calculation results, we propose relevant policy recommendations including enhancing energy services for older adults in rural areas, integrating household energy alternatives with targeted poverty alleviation, enhancing monitoring mechanisms, and conducting energy education activities to alleviate EP and improve the quality of life of middle-aged and older adults.

Heatwaves and Hardship: Shortcomings and Solutions for Enhancing the Low Income Home Energy Assistance Program to Mitigate Extreme Heat and Energy Insecurity

The Low Income Home Energy Assistance Program (LIHEAP) must adapt and evolve to keep pace with the challenges posed by climate change and increased economic strain. Urgent action is needed to improve LIHEAP to effectively address extreme heat and energy insecurity faced by low-income households and protect the health and well-being of disadvantaged groups spurred by climate change. In evaluating LIHEAP's shortcomings, we demonstrate that there is a substantial gap between program eligibility and enrollment, such that many households are not receiving this vital benefit or do so mainly when facing a crisis. We also show that LIHEAP funds overwhelmingly support cold-weather states even as record-breaking heat is a critical stressor. The spatial mismatch we unveil shows that southern states receive less LIHEAP funds despite higher cooling degree days and higher rates of energy insecurity. The importance of swift action based on sound data and up-to-date research can enhance the efficacy of LIHEAP, expand its reach, and ultimately improve the living conditions of millions of energy insecure households. We offer several recommendations to improve LIHEAP to ensure that this critical lifeline program remains an effective tool to mitigate energy insecurity and safeguard livelihoods in the face of extreme heat.

Persons Experiencing Homelessness during Extreme Temperatures: Lessons for Promoting Socially Inclusive Adaptive Capacity

Climate change and increasing extreme temperatures present unique challenges to persons experiencing homelessness (PEH), including heightened physical and psychological harm. While green and urban infrastructure has emerged as one possible mitigation strategy, homeless populations are rarely included in municipal disaster planning or infrastructure research. This study used in-depth interviews with PEH (N = 42) during the summers of 2022 and 2023. Questions were designed around phenomenological methods to explore the individuals' firsthand descriptions of the lived experience of coping during extreme temperatures within a mid-size city in the Southeastern United States. Our findings highlight how social exclusion within the built environment reduces PEH's adaptive capacity and increases the physical and psychological risks of extreme temperatures, namely through limiting and policing scarce resources and restricting the mobility of PEH. In contrast, public transit provided relief from extreme temperatures. Implications from our findings include the need for attention on inclusive green urban infrastructure, including increased placement and access to shade, public water, mixed-use daytime sheltering models, and the installation of lockers to increase capacity to maintain supplies and gear necessary for enduring extreme temperatures. Findings also highlight the challenges of designing inclusive green infrastructure and the importance of de-stigmatizing homelessness and building more housing and income support to increase adaptive capacity for an entire community in the context of a rapidly warming climate.

When concentrated disadvantage happens: Exploring the nexus of energy and internet insecurities among vulnerable households

Digital divide and energy insecurity are pervasive issues among underserved communities, issues that become prounoued during the COVID-19 lockdowns. These disparities underscore the critical need to address them promptly to narrow socio-economic gaps. Our study, based on an online survey of 2,588 respondents in the United Kingdom, explores how concentrated socio-economic disadvantage exacerbates insecurities relating to energy and internet access. Our findings reveal that marginalized groups including low-income households, women, renters, ethnic minorities, and individuals with lower educational attainment are disproportionately affected. Our research extends beyond financial implications to explore the broader social and psychological effects such as trust in utility and internet providers. The study also demonstrates how heightened burdens from energy and internet costs adversely affect the quality of indoor environments, underscoring the interconnected nature of these challenges. Based on these insights, we advocate for policy interventions that adopt comprehensive social justice frameworks to tackle these intersecting inequalities effectively.

Knowledge, behaviours, practices, and expectations regarding climate change and environmental sustainability among health workers in France: a multicentre, cross-sectional study

BACKGROUND

Faced with climate change, hospitals are confronted with a dual challenge. On one hand, they need to embark on a far-reaching ecological transformation to reduce their contribution to greenhouse gas emissions and other environmental impacts; on the other hand, they need to limit the effects of climate change on their activities. We aimed to evaluate the knowledge, behaviours, practices, and expectations of health workers in French hospitals regarding climate change and environmental sustainability.

METHODS

This multicentre, cross-sectional study was carried out in six French hospitals from June 1, 2021 to Dec 31, 2022. All health workers at the hospitals were eligible to participate and were recruited through internal publicity. We designed a structured questionnaire consisting of five parts: participant characteristics, knowledge and perceptions of climate change, pro-environmental behaviours, practices concerning environmental sustainability actions, and expectations. A multilevel logistic regression model was used to evaluate associations between the knowledge, behaviours, and practices of health workers and the characteristics of the health workers and hospitals.

FINDINGS

Of 57 034 health workers across the six hospitals, 4552 (8·0%) participated in the study. Of those for whom gender data were available, 3518 (78·2%) participants were women and 979 (21·8%) were men. Participants considered energy consumption (71·0%) and waste and discharges related to medical activities (55·6%) and non-medical activities (50·2%) to be the three activities with the greatest environmental impact. On a scale of 1 (not a priority) to 10 (high priority), the median rating attributed by the participants to the commitment of their hospitals to ecological transformation was 5·0 (IQR 3·0-6·0). 1079 (23·7%) of 4552 participants had already initiated at least one environmental sustainability action in their hospital. Barriers reported by participants to the implementation of environmental sustainability-related projects were the lack of dedicated time (40·4%), hierarchical support (32·5%), methodological support (28·9%), and access to training (23·7%). The presence of a sustainable development steering committee, especially one with more than 5 years of activity, was positively associated with health workers feeling better informed about the ecological transformation of their hospital (adjusted odds ratio 1·78 [95% CI 1·29-2·45]), having better knowledge of the environmental impacts of their hospital (1·83 [1·32-2·53]), and initiating a larger number of environmental sustainability actions (1·74 [1·33-2·29]).

INTERPRETATION

We showed that health workers in French hospitals seem to be committed to the ecological transformation of their workplaces, and identified some drivers and barriers to further support these essential transformations. There is an urgent need to bolster training for all health workers, enhance structural frameworks within hospitals, and encourage future interdisciplinary research on the vulnerability of health-care facilities to climate change.

FUNDING

The University Hospital of Poitiers.

The effects of extreme heat on human health in tropical Africa

This review examines high-quality research evidence that synthesises the effects of extreme heat on human health in tropical Africa. Web of Science (WoS) was used to identify research articles on the effects extreme heat, humidity, Wet-bulb Globe Temperature (WBGT), apparent temperature, wind, Heat Index, Humidex, Universal Thermal Climate Index (UTCI), heatwave, high temperature and hot climate on human health, human comfort, heat stress, heat rashes, and heat-related morbidity and mortality. A total of 5, 735 articles were initially identified, which were reduced to 100 based on a set of inclusion and exclusion criteria. The review discovered that temperatures up to 60°C have been recorded in the region and that extreme heat has many adverse effects on human health, such as worsening mental health in low-income adults, increasing the likelihood of miscarriage, and adverse effects on well-being and safety, psychological behaviour, efficiency, and social comfort of outdoor workers who spend long hours performing manual labour. Extreme heat raises the risk of death from heat-related disease, necessitating preventative measures such as adaptation methods to mitigate the adverse effects on vulnerable populations during hot weather. This study highlights the social inequalities in heat exposure and adverse health outcomes.

Climate change and healthy ageing: An assessment of the impact of climate hazards on older people

Background

Climate change not only directly impacts older people's longevity but also healthy ageing, which is the process of maintaining physical and mental capacities while optimising functional abilities. The urgency to address both population ageing and climate change necessitates a rethink and assessment of the impact of climate change on older people. This includes identifying what can be done to anticipate, mitigate and adapt to climate change and engage older persons.

Methods

A review of climate change and healthy ageing forms the basis of evidence in this report. We developed a comprehensive search to assess current literature, combining terms related to ageing and climate change across four major data sets and assessing articles published up to the end of 2021.

Results

We summarised the current and future impact of climate change on older people and developed a framework identifying climate change impacts on older persons, recognising social and environmental determinants of healthy ageing. Major hazards and some key exposure pathways include extreme temperatures, wildfire, drought, flooding, storm and sea level rise, air quality, climate-sensitive infectious diseases, food and water insecurities, health and social care system displacement, migration, and relocation. Strategies to address climate change require interventions to improve systems and infrastructure to reduce vulnerability and increase resilience. As a heterogeneous group, older people's perceptions of climate change should be integrated into climate activism. Increasing climate change literacy among older people and enabling them to promote intergenerational dialogue will drive the development and implementation of equitable solutions. Pathways may operate via direct or indirect exposures, requiring longitudinal studies that enable assessment of exposures and outcomes at multiple time points, and analyses of cumulative impacts of hazards across the life course.

Conclusions

The lack of systematic reviews and primary research on the impact of most climate hazards, except for heat, on older people is apparent. Future research should include outcomes beyond mortality and morbidity and assess how older people interact with their environment by focusing on their capacities and optimising abilities for being and doing what they value.

Manufactured housing communities and climate change: Understanding key vulnerabilities and recommendations for emergency managers

Manufactured housing communities (MHCs), commonly referred to as mobile home parks, provide an estimated 2.7 million American households with largely unsubsidized, affordable housing. Climate change threatens those who call these communities home by exacerbating known structural and social vulnerabilities associated with this housing type-including but not limited to increased risks to flooding, extreme temperatures, high winds, and wildfires. Climate change requires emergency managers to understand the diverse, integrated, and complex vulnerabilities of MHCs that affect their exposure to climate change risk. This article presents findings from an integrative literature review focused on the climate-related vulnerabilities of these communities described at three levels of scale: household, housing structure, and park community. It then draws on 15 years of engagement and action research with MHC residents and stakeholders in Vermont, including several federally declared flooding disasters, to distill key recommendations for emergency managers for assisting MHCs to prepare for and respond to emergencies. As climate change accelerates, emergency managers can increase efficacy by learning about the MHCs in their jurisdictions by leveraging the best available data to characterize risks, integrating MHCs into planning and mitigation activities, and engaging in conversations with stakeholders, including MHC residents and their trusted partners.

"They Did Not Know What They Were Doing": Climate Change and Intergenerational Compassion

BACKGROUND AND OBJECTIVES

Compassion is described as an affective experience arising from witnessing the undeserved suffering of another that propels one to provide protection and cooperation. Climate change is often associated with "underserved suffering," especially of younger and future generations. Consequently, contemporary climate discourse has expressed hostility toward older generations for inflicting such suffering. Studies on intergenerational relations within the context of climate change agree that intergenerational solidarity, rather than conflict, is necessary for effective climate action. Because compassion is instrumental to solidarity, in this study, we explore intergenerational climate-related expressions of compassion leading to intergenerational solidarity.

RESEARCH DESIGN AND METHODS

We interviewed 16 climate activists from 8 countries (aged 16-76 years) to understand how they view climate responsibility. Thematic analysis was undertaken to create and explore themes related to intergenerational compassion and solidarity.

RESULTS

Compassion flowed in both directions: from younger to older generations in the form of forgiveness, empathy, and understanding, and from older to younger generations through advocacy, lifestyle changes, and transmission of knowledge and skills. All participants emphasized solutions over accusations. Areas of focus varied between industrialized and developing countries. Cultural factors played an essential role in intergenerational perceptions.

DISCUSSION AND IMPLICATIONS

Climate change can be a polarizing issue with older adults fielding accusations and younger people facing criticism for demanding climate action. Examples of intergenerational compassion can counter ageism, reshape climate narratives, encourage intergenerational cooperation, harness the skills of different generations, and create a sustainable world for all ages.

Energy Insecurity Indicators Associated With Increased Odds Of Respiratory, Mental Health, And Cardiovascular Conditions

Energy insecurity, defined as the inability to meet household energy needs, has multiple economic, physical, and coping dimensions that affect health. We conducted the first citywide representative survey of energy insecurity and health in a sample of 1,950 New York City residents in 2022. We compiled ten indicators that characterize energy insecurity as experienced in New York City housing settings and then examined associations between number and types of indicators and health conditions. Nearly 30 percent of residents experienced three or more indicators, with significantly higher levels among Black non-Latino/a and Latino/a residents compared with White non-Latino/a residents, renters compared with owners, recent immigrants compared with those living in the United States for longer, and those in households with children compared with those with no children. Residents with three or more indicators of energy insecurity had higher odds of respiratory, mental health, and cardiovascular conditions and electric medical device dependence than residents with no indicators. Our study demonstrates that broadening the understanding of energy insecurity with context-specific metrics can help guide interventions and policies that address disparities relevant to health and energy equity.

Coping during socio-political uncertainty

Introduction

Well-being of young adults is known to be compromised in times of significant changes, such as economic and political turmoil. This study focuses on university students in Lebanon during one of the most prominent social unrests of its modern history to determine potential understudied protective factors that would predict the youth capacity to strive.

Methods

A sample of 489 university students were asked to fill an online survey including standardized questionnaires of wellbeing (WEMWBS), depression (PHQ-9), anxiety (HAM-A), intolerance of uncertainty (IUS-12), coping (Brief COPE) in addition to demographics and questions about their attitudes and future perspectives.

Results

We found increased rates of mental distress, predominantly in women, with around 80% of the sample being highly intolerant to the uncertainty climate. Results unsurprisingly show that well-being negatively correlated with anxiety, depression and intolerance of uncertainty. Overall, mental distress was found to mediate the relation between uncertainty and wellbeing, and the relation between maladaptive coping and wellbeing. Students who were intolerant of uncertainty and who used maladaptive coping strategies were more likely develop anxiety and depression and subsequently report poorer wellbeing. Conversely, having adaptive strategies was directly linked to higher well-being.

Discussion

In spite of increased distress, some university students managed to preserve their well-being within a climate of severe socio-political uprise. These findings suggest that modifying subjective experience of events and using soft skillset could alleviate young adults' emotional distress in unstable societies.

[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.

Cold, dark and malnourished: a cross-sectional analysis of the relationship between energy poverty and household burden of malnutrition in sub-Saharan Africa

OBJECTIVE

Energy poverty contributes to the general well-being of households; however, there is representational paucity on its role in household nutrition across sub-Saharan Africa (SSA). This study examined the influence of different domains of energy poverty and a Multidimensional Energy Poverty Index (MEPI) on household burden of malnutrition in SSA.

SETTING

Secondary data from the most recent Demographic and Health Survey conducted in 18 SSA countries were analysed.

DESIGN

A cross-sectional design was used to examine the relationship between household energy poverty and household burden of malnutrition.

METHODS

Different dimensions of household energy poverty and an MEPI were computed from the sources of energy used for cooking, lighting, entertainment and accessing information by households. Household burden of malnutrition was coded as a binary categorical dependent variable using indicators of undernutrition, overnutrition and anaemia among women of reproductive age (15-49 years) and children under five years in the household.

RESULTS

More than nine in ten households were energy poor in terms of cooking fuel and about three in four were energy poor in terms of lighting. Considering the various domains of energy poverty, lack of electricity for lighting, using biofuels, not owning a refrigerator/freezer, not owning a television/radio and not owning a mobile phone were associated with increased odds of a household experiencing undernutrition. Similarly, deprivation in these domains was associated with a lower likelihood of households experiencing overnutrition, the only exception being using biofuels. Overall, households that were most energy poor on the MEPI were more likely to be undernourished and double and triple burden malnutrition households but less likely to suffer from overnutrition.

CONCLUSION

These results highlight the complex and multifaceted nature of the relationship between energy poverty and household burden of malnutrition and provides guidance for appropriate interventions to address energy poverty and malnutrition in SSA.

The impact of access to electricity on mental health in conflict-affected territories: An exploratory study in Gaza

BACKGROUND

Access to affordable and clean energy is an essential component of the Sustainable Development Goals and a determinant of physical and mental health. However, the occupied Palestinian territory, the Gaza Strip, has experienced prolonged issues with electricity, water and gas supplies. This has significantly impacted on daily life and the area is on the verge of disaster. This research focused on the mental health effects of the lack of electricity in Gaza which have not been previously documented.

METHODS

A cross-sectional analytic approach was adopted. A survey was administrated face-to-face with respondents from 350 participating households. Inferential statistical analysis was used to examine the relationship between the domains of anxiety, depression, wellbeing and electricity supply factors. A multiple linear regression model was also utilised.

RESULTS

There is a highly statistically significant link between continuity of electricity and level of anxiety (p < .001). The same effect was reported in the level of depression, and a higher level was observed among residents with an intermittent or disrupted electricity supply, with a statistically significant link between the level of depression and continuity of electricity.

CONCLUSION

Electricity issues, especially when combined with other stressors associated with living in Gaza, lead to serious mental health concerns. Urgent attention must be given to developing sustainable, reliable and affordable energy supplies for short- and long-term health and community development.

Simulating Energy Use, Indoor Temperatures, and Utility Cost Impacts Amidst a Warming Climate in a Multi-family Housing Model

Rising ambient temperatures due to climate change will impact both indoor temperatures and heating and cooling utility costs. In traditionally colder climates, there are potential tradeoffs in how to meet the reduced heating and increased cooling demands, and issues related to lack of air conditioning (AC) access in older homes and among lower-income populations to prevent extreme heat exposure. We modeled a typical multi-family home in Boston (MA) in the building simulation program EnergyPlus to assess indoor temperature and energy consumption in current (2020) and projected future (2050) weather conditions. Selected households were those without AC (no AC), those who ran AC sometimes (some AC), and those with sufficient resources to run AC always (full AC). We considered stylized cooling subsidy policies that allowed households to move between groups, both independently and in conjunction with energy efficiency retrofits. Results showed that future weather conditions without policy changes yielded an increase in indoor summer temperatures of 2.1 °C (no AC), increased cooling demand (range: 34-50%), but led to a decrease in net yearly total utility costs per apartment (range: - $21 to - $38). Policies that allowed households to move to greater AC utilization yielded average indoor summer temperature decreases (- 3.5 °C to - 6.2 °C) and net yearly total utility increases (range: + $2 to + $94) per apartment unit, with greater savings for retrofitted homes primarily due to large decreases in heating use. Our model results reinforce the importance of coordinated public policies addressing climate change that have an equity lens for both health and climate goals.

[Vulnerability and social determinants in diabetes]

Social determinants of health significantly influence the development and progression of chronic diseases such as type2 diabetes (T2DM). This article examines key social determinants including education, economic stability, neighborhood, and factors such as ethnicity, race, or religion that impact individuals with T2DM. The role of gender as a social determinant is also explored, emphasizing the need for gender-specific considerations in T2DM management and research. Additionally, the impact of poverty on health outcomes is analyzed, highlighting the bidirectional relationship between poverty and disease. Comprehensive measures addressing these determinants are crucial to improving the health and well-being of individuals with T2DM. Addressing social inequalities through targeted interventions can contribute to better treatment outcomes and equitable healthcare.

Exploring medical students' perceptions and understanding of the health impacts of climate change: a qualitative content analysis

BACKGROUND

Climate change has been identified as the greatest threat to global health in the twenty-first century, with its unfavorable health consequences being among its impacts on humans. Exploring the perspectives and understanding of healthcare professionals and service providers concerning climate change becomes imperative. The aim of this study is to investigate the perceptions and understanding of final-year medical students regarding the health impacts of climate change on individuals and the healthcare system using a qualitative content analysis.

METHODS

This study employed a qualitative content analysis approach. Face-to-face interviews were conducted with the aid of an interview guide to explore the students' awareness, understanding, and attitudes towards the impacts of climate change on public health and the healthcare system. The collected interview data were subsequently organized into codes, categories, and subcategories based on the students' perspectives and attitudes towards climate change.

RESULTS

Fifteen medical intern students were interviewed for this study, and the qualitative findings were categorized into 3 categories, 23 subcategories, and 229 codes. The study's findings revealed various health impacts of climate change, which were classified into three main categories, including environmental effects with 8 subcategories, socio-economic effects with 8 subcategories, and health effects with 7 subcategories. The study's findings revealed medical students' perceptions of various health impacts of climate change and These findings suggest that medical student understand that climate change has significant impacts on individuals' health and society, mainly through environmental degradation, increased risks, and climate-related disasters, which ultimately lead to adverse health outcomes.

CONCLUSIONS

The perspectives of medical students in this study indicate that climate change may not have a direct and immediate impact on the health of individuals and communities. However, it can significantly influence their health and socio-economic well-being by exacerbating or causing environmental problems, increasing the risk of weather-related events and natural disasters, ultimately leading to adverse health outcomes. While the medical students' perspectives on the health impacts of climate change are indeed broad, incorporating scientific knowledge about this topic into the medical curriculum and educating students on how to deal with patients affected by these consequences can have a significant impact on health management. This proactive approach, despite the students' already comprehensive understanding, can enhance their preparedness to address the health effects of climate change and contribute to strengthening the healthcare system's resilience in the face of climate-related challenges.

Exploring the Spatial Patterning of Sociodemographic Disparities in Extreme Heat Exposure at Multiple Scales Across the Conterminous United States

Climate change has led to an increase in heat-related morbidity and mortality. The impact of heat on health is unequally distributed amongst different socioeconomic and demographic groups. We use high-resolution daily air temperature-based heat wave intensity (HWI) and neighborhood-scale sociodemographic information from the conterminous United States to evaluate the spatial patterning of extreme heat exposure disparities. Assuming differences in spatial patterns at national, regional, and local scales; we assess disparities in heat exposure across race, housing characteristics, and poverty level. Our findings indicate small differences in HWI based on these factors at the national level, with the magnitude and direction of the differences varying by region. The starkest differences are present over the Northeast and Midwest, where primarily Black neighborhoods are exposed to higher HWI than predominantly White areas. At the local level, we find the largest difference by socioeconomic status. We also find that residents of nontraditional housing are more vulnerable to heat exposure. Previous studies have either evaluated such disparities for specific cities and/or used a satellite-based land surface temperature, which, although correlated with air temperature, does not provide the true measure of heat exposure. This study is the first of its kind to incorporate high-resolution gridded air temperature-based heat exposure in the evaluation of sociodemographic disparities at a national scale. The analysis suggests the unequal distribution of heat wave intensities across communities-with higher heat exposures characterizing areas with high proportions of minorities, low socioeconomic status, and homes in need of retrofitting to combat climate change.

Impact of Global Climate Change on Pulmonary Health: Susceptible and Vulnerable Populations

As fossil fuel combustion continues to power the global economy, the rate of climate change is accelerating, causing severe respiratory health impacts and large disparities in the degree of human suffering. Hotter and drier climates lead to longer and more severe wildland fire seasons, impairing air quality around the globe. Hotter temperatures lead to higher amounts of ozone and particles, causing the exacerbation of chronic respiratory diseases and premature mortality. Longer pollen seasons and higher pollen concentrations provoke allergic airway diseases. In arid regions, accelerated land degradation and desertification are promoting dust pollution and impairing food production and nutritional content that are essential to respiratory health. Extreme weather events and flooding impede healthcare delivery and can lead to poor indoor air quality due to mold overgrowth. Climate and human activities that harm the environment and ecosystem may also affect the emergence and spread of viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and associated morbidity and mortality exacerbated by air pollution. Children and elderly individuals are more susceptible to the adverse health effects of climate change. Geographical and socioeconomic circumstances, together with a decreased capacity to adapt, collectively increase vulnerability to the adverse effects of climate change. Successful mitigation of anthropogenic climate change is dependent on the commitment of energy-intensive nations to manage greenhouse gas emissions, as well as societal support and response to aggravating factors. In this review, we focus on the respiratory health impacts of global climate change, with an emphasis on susceptible and vulnerable populations and low- and middle-income countries.

Energy poverty: an overlooked determinant of health and climate resilience in Canada

OBJECTIVE

Despite Canada being an important energy producer, not all Canadians can access or afford adequate levels of energy services at home to meet their needs, maintain healthy indoor temperatures, and live a decent life-a situation known as energy poverty. Depending on the measure, 6-19% of Canadian households face energy poverty. Health risks associated with energy poverty are documented in countries with milder climates. This study explores, for the first time in the Canadian context, the association between energy poverty and health.

METHODS

Cross-sectional data are from the 2018 Canadian Housing Survey. Analyses are conducted on a sample weighted to represent 14 million Canadian households. The associations between expenditure-based and self-reported measures of energy poverty and self-rated general and mental health were assessed using logistic regression models, adjusted for potential confounding variables.

RESULTS

The odds of rating one's general (OR: 1.48; 95%CI: 1.29, 1.70) and mental (OR: 1.21; 1.04, 1.41) health as poor are significantly higher for Canadian adults in households with a high share of energy expenditure to income. The likelihood of poor general and mental health was significantly higher for those dissatisfied with the energy efficiency of their dwelling, and with their ability to maintain a comfortable temperature both in the winter and in the summer.

CONCLUSION

Exposure to energy poverty is associated with significantly increased likelihood of poor general and mental health. Given the high proportion of Canadian households facing energy poverty, with demonstrated implications for population health, tackling energy poverty is essential for an equitable energy transition and for climate resilience.

Fleeting energy protections: State and utility level policy responses to energy poverty in the United States during COVID-19

Millions of American households suffer from energy poverty, threatening their continued access to electricity. The COVID-19 pandemic of 2020 has unveiled the entrenched environmental and energy injustices that threaten public health at the household level and has inspired energy protection responses to address pandemic-caused economic hardship. While policies supporting energy protections have been in place for years, they vary spatially. Moreover, the scholarly research that explores energy protection responses during the pandemic is limited. This paper explores energy protection responses to the pandemic implemented in 25 major metropolitan areas in the United States. We employ a content analysis of policy language to examine the response time, authorization level, and type of energy protections deployed during the initial months of the pandemic. We demarcate authorization level as either mandatory or voluntary measures and characterize 'energy resiliency responses' as a suite of residential energy protections required to reduce vulnerability to energy poverty and build resilience during the pandemic. We examine the total number and type of responses relative to household energy burden. We find differences in residential consumer energy protections among low-income and highly energy burdened households and conclude that protections are unevenly deployed across the country. Our findings motivate contemporary national, state, and local energy poverty recognition and responses that center personal and economic wellbeing during and after crises.

Assessing the role of sustainable strategies in alleviating energy poverty: an environmental sustainability paradigm

The rapid urbanization and industrialization of India have caused a demand-supply gap in the electrical sector, leading to higher electric bills. Lower-income households face the worst energy poverty in the country. Sustainable strategies like corporate social responsibility are the most effective way to combat the energy crisis. This study aims to assess the contribution of corporate social responsibility (CSR) to energy poverty alleviation (EPA) by developing the role of mediating variables such as assessment of renewable energy resource (RER), feasibility of sustainable energy supply (SES), and sustainable energy development (SED). We used hybrid research methodology such as partial least squares structural equation modeling (PLS-SEM) to analyze the collected data from professionals, economic experts, and directors in the country in 2022. The study proved that CSR directly affects energy poverty alleviation. Besides, the findings suggest RER, SES, and SED significantly lead the energy poverty alleviation. The findings of this study will divert the attention of policymakers, stakeholders, and economists toward the corporate social responsibility to mitigate the energy crisis in Indian context. A mediating role of a renewable energy resource (RER) as a value-added contribution to this study can be strengthened more in future research. Based on the results, the study illustrates that CSR acts as a catalyst to alleviate energy poverty.

Synthesizing the links between secure housing tenure and health for more equitable cities

Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.

Integrating Health into Local Plans: A Comparative Review of Health Requirements for Urban Development in Seven Local Planning Authorities in England

A local plan is a statutory policy document that supports urban development decisions across a local government area in England. Local plans are reported to need more specific requirements for development proposals regarding wider health determinants to address potential health outcomes and health inequalities. This study reviews the integration of Health in Local Plans of seven local planning authorities through documentary analysis methods. A review framework was formulated based on health and planning literature regarding local plans, health policy and determinants of health and dialogue with a local government partner. The findings identify opportunities to strengthen the consideration of Health in Local Plans, including ensuring that policies are informed by local health priorities and signpost national guidance, strengthening health-related requirements for developers (e.g., indoor air quality, fuel poverty and security of tenure) and improving implementation of requirements for developers (e.g., through adoption of health management plans and community ownership). The study identifies further research needs regarding how policies are interpreted by developers in practice, and on national guidance for Health Impact Assessment. It highlights the benefit of undertaking a comparative review, contrasting local plan policy language and identifying opportunities to share, adapt and strengthen planning requirements regarding health outcomes.

[Developing tools to study the health impact of urban transformations in high vulnerability contexts: the RUCAS study]

This article describes the design and characteristics of a questionnaire and an intradomiciliary observation tool developed to assess the housing-neighborhood-health relationship both cross-sectionally and longitudinally in the context of urban transformations carried out in populations of high socio-territorial vulnerability. The instruments were developed for the multi-method longitudinal study RUCAS (Urban Regeneration, Quality of Life and Health), a natural experiment aiming to assess the quality of life and health impact of a comprehensive Urban Regeneration Program in two social housing complexes in Chile. The design of the instruments followed four main stages: (1) narrative review of the literature to define the dimensions of the study, and of existing measurement instruments to identify appropriate items for measuring them; (2) content validation with experts; (3) pre-test; and (4) pilot study. The resulting questionnaire, composed of 262 items, considers the different stages of the life course and gender issues. The intradomiciliary observation tool (77 items) is applied by the interviewer. The instruments assess (i) characteristics of the current residential situation that are known to affect health and will be intervened by the program; (ii) dimensions of health potentially affected by the residential situation and/or by the intervention within the time frame of the study (4 years); (iii) other health and health-related conditions that are relevant, even if changes will not be modified within the time frame of the study; and (iv) relevant socioeconomic, occupational and demographic dimensions. The instruments have shown to be capable of addressing the multidimensionality of urban transformation processes in contexts of urban poverty in formal housing.

The 2021 Texas Power Crisis: distribution, duration, and disparities

BACKGROUND

Precipitated by an unusual winter storm, the 2021 Texas Power Crisis lasted February 10 to 27 leaving millions of customers without power. Such large-scale outages can have severe health consequences, especially among vulnerable subpopulations such as those reliant on electricity to power medical equipment, but limited studies have evaluated sociodemographic disparities associated with outages.

OBJECTIVE

To characterize the 2021 Texas Power Crisis in relation to distribution, duration, preparedness, and issues of environmental justice.

METHODS

We used hourly Texas-wide county-level power outage data to estimate geographic clustering and association between outage exposure (distribution and duration) and six measures of racial, social, political, and/or medical vulnerability: Black and Hispanic populations, the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), Medicare electricity-dependent durable medical equipment (DME) usage, nursing homes, and hospitals. To examine individual-level experience and preparedness, we used a preexisting and non-representative internet survey.

RESULTS

At the peak of the Texas Power Crisis, nearly 1/3 of customers statewide (N = 4,011,776 households/businesses) lost power. We identified multiple counties that faced a dual burden of racial/social/medical vulnerability and power outage exposure, after accounting for multiple comparisons. County-level spatial analyses indicated that counties where more Hispanic residents resided tended to endure more severe outages (OR = 1.16, 95% CI: 1.02, 1.40). We did not observe socioeconomic or medical disparities. With individual-level survey data among 1038 respondents, we found that Black respondents were more likely to report outages lasting 24+ hours and that younger individuals and those with lower educational attainment were less likely to be prepared for outages.

SIGNIFICANCE

Power outages can be deadly, and medically vulnerable, socioeconomically vulnerable, and marginalized groups may be disproportionately impacted or less prepared. Climate and energy policy must equitably address power outages, future grid improvements, and disaster preparedness and management.

Medical Certification for Utility Shut-Off Protection and Health-Related Social Needs

BACKGROUND AND OBJECTIVES

Children in families facing energy insecurity have greater odds of poor health and developmental problems. In this study of families who requested and received medical certification for utility shut-off protection and were contacted by our Medical Legal Partnership (MLP), we aimed to assess concurrent health-related social needs related to utilities, housing, finances, and nutrition.

METHODS

After medical certificates were completed at our academic pediatric center, our MLP office contacted families and assessed utility concerns as well as other health, social, and legal needs. In this observational study, we present descriptive analyses of patients who received certificates from September 2019 to May 2020 via data collected through the MLP survey during the coronavirus disease 2019 pandemic (June 2020-December 2021).

RESULTS

Of 167 families who received utility shut-off protection from September 2019 to May 2020, 84 (50.3%) parents and guardians were successfully contacted. Most (93%) found the medical certificate helpful. Additionally, 68% had applied for Energy Assistance, and 69% reported they were on utility company payment plans. Most (78%) owed arrearages, ranging from under $500 to over $20 000, for gas, electric, and/or water bills. Food, housing, and financial insecurity screening positivity rates were 65%, 85%, and 74%, respectively.

CONCLUSIONS

Patients who were contacted by an MLP after receiving medical certification for utility shutoff protection were found to have challenges paying for utilities and faced multiple food, housing, and financial stressors. Through consultation and completion of medical forms for utility shutoff protection, pediatricians and MLPs can provide resources and advocacy to support families' physical, emotional, and psychosocial needs.

Environmental justice and climate change policies

Climate change is an environmental justice issue because it is likely to cause disproportionate harm to low-income countries and low-income populations in higher-income countries. While climate change mitigation and adaptation policies may be able to minimize these harms, they could make them worse unless they are developed and implemented with an eye toward promoting justice and fairness. Those who view climate change as an environmental justice issue should be wary of endorsing policies that sound like they promote the cause of social and economic justice, but in fact do not. While climate change policies may help to mitigate the effects of climate change on poor people, there is no guarantee that they will be just at the local, national, or global level. Those who care about global climate justice must remain actively engaged in policy formation and implementation to ensure that justice does not get shortchanged in the response to global warming.

Inequality in the availability of residential air conditioning across 115 US metropolitan areas

Continued climate change is increasing the frequency, severity, and duration of populations' high temperature exposures. Indoor cooling is a key adaptation, especially in urban areas, where heat extremes are intensified-the urban heat island effect (UHI)-making residential air conditioning (AC) availability critical to protecting human health. In the United States, the differences in residential AC prevalence from one metropolitan area to another is well understood, but its intra-urban variation is poorly characterized, obscuring neighborhood-scale variability in populations' heat vulnerability and adaptive capacity. We address this gap by constructing empirically derived probabilities of residential AC for 45,995 census tracts across 115 metropolitan areas. Within cities, AC is unequally distributed, with census tracts in the urban "core" exhibiting systematically lower prevalence than their suburban counterparts. Moreover, this disparity correlates strongly with multiple indicators of social vulnerability and summer daytime surface UHI intensity, highlighting the challenges that vulnerable urban populations face in adapting to climate-change driven heat stress amplification.

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.

Climate Change Impact on Energy Poverty and Energy Efficiency in the Public Housing Building Stock of Bari, Italy

The public housing stock across the European Union is generally constituted of old buildings (built prior to 1980) with high energy demand and indoor thermal comfort issues, which could be exacerbated by climate change. The aim of this paper was to quantify the impact of climate change on the energy demand of the public housing building stock. A neighbourhood located in Bari (south Italy) is considered as representative of a common construction typology of late 1970s in Italy. Energy models were created and calibrated with real-time data collected from utilities’ bills. The results showed a medium to strong correlation between age and energy consumption (r = 0.358), but no evident correlation between the number of tenants and energy consumption, although a significantly low energy consumption was found in apartments occupied by more than five tenants. An energy penalty of about 7 kWh/m2 of heating energy consumption for every 10 years of increase in the average age of tenants was calculated. Moreover, the impact of future weather scenarios on energy consumptions was analysed and an average annual energy penalty of 0.3 kWh/m2 was found.

Change in the Affordability of Owner-Occupied Housing in the Context of Rising Energy Prices

Household energy constitutes an important share of affordable housing. Unaffordable housing and inadequate household energy represent a new dimension of poverty. Connections between energy, housing affordability and well-being are still under-researched. Building on housing affordability framework, this study explores the magnitude in changes in affordability of acquisition and use of an apartment between January 2018 and January 2022. Over the last four years, the real estate market in Europe has changed significantly. This paper deals with primary data for the Czech Republic, where acquisition prices of residential real estate increased depending on the region in the range of 50 to 120%. Since January 2022, there has been a sharp rise in energy prices and a tightening of conditions for the acquisition of mortgage loans. All these factors affect the standard of living in the Czech Republic. The article quantifies the magnitude of this change by calculating shares of total housing costs to total average net household income for the period January 2018 and January 2022. It is found that the affordability of owner-occupied housing in the Czech Republic has deteriorated and part of the middle class will be forced to move to the rental housing sector, multifamily housing and sharing. Finally, we argue that energy poverty needs to be considered in addressing the government housing policies. The aim of the article is to analyze the changes that have taken place in the real estate market over the last four years in relation to the growth of total housing costs and energy costs associated with housing.

Energy poverty in pandemic times: Fine-tuning emergency measures for better future responses to extreme events in Spain

Energy poverty has been exacerbated by the COVID-19 pandemic and the economic crisis it triggered. Spain, one of the first countries affected by the outbreak, introduced several measures to protect energy consumers during the initial lockdown and to provide them with economic relief (including a disconnection ban and the introduction of new categories of beneficiaries for its energy assistance programmes). This article presents a critical assessment of these interventions, based on the regulatory theory and a review of international experiences. It shows how emergency measures should rely on a robust but flexible targeting strategy and be supported by appropriate financing; it also sheds light on the importance of information campaigns that allow the aid to reach more households, improving the effectiveness of the intervention. The reflections and recommendations presented in this article may help improve the design of emergency measures during future health crises or extreme weather events.

Synthesizing the links between secure housing tenure and health for more equitable cities

Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.

Indoor apparent temperature, cognition, and daytime sleepiness among low-income adults in a temperate climate

The burden of temperature-associated mortality and hospital visits is significant, but temperature's effects on non-emergency health outcomes is less clear. This burden is potentially greater in low-income households unable to afford efficient heating and cooling. We examined short-term associations between indoor temperatures and cognitive function and daytime sleepiness in low-income residents of Detroit, Michigan. Apparent temperature (AT, based on temperature and humidity) was recorded hourly in 34 participant homes between July 2019-March 2020. Between July-October 2019, 18 participants were administered word list immediate (WLL) and delayed (WLD) recall tests (10-point scales) and the Epworth Sleepiness Scale (24-point scale) 2-4 times. We applied longitudinal models with nonlinear distributed lags of temperature up to 7 days prior to testing. Indoor temperatures ranged 8-34°C overall and 15-34°C on survey days. We observed a 0.4 (95% CI: 0.0, 0.7) point increase in WLL and 0.4 (95% CI: 0.0, 0.9) point increase in WLD scores per 2°C increase in AT. Results suggested decreasing sleepiness scores with decreasing nighttime AT below 22°C. Low-income Detroit residents experience uncomfortably high and low indoor temperatures. Indoor temperature may influence cognitive function and sleepiness, although we did not observe deleterious effects of higher temperatures.

Energy Poverty among Tertiary Students in Aotearoa New Zealand

Energy poverty in Aotearoa New Zealand is well-documented, and tertiary students have been identified as an at-risk group. However, there has been very little research on tertiary students’ experiences of energy poverty in New Zealand. This paper used a nationwide online survey to investigate the extent and impact of energy poverty among tertiary students. Furthermore, it aimed to identify disparities between different demographic groups, understand the effects of COVID-19 and evaluate the effectiveness of the support policies available to students. Responses from 522 students were analysed; 85% were under 30 years old, 72% were female, 14% identified as Māori, and 14% reported having long-term disabilities or health concerns. The findings of this study are concerning. Tertiary students in New Zealand are largely living in dwelling conditions that do not meet recommended health standards and exacerbate energy poverty. Energy poverty has adverse effects on their physical and mental health; however, available support is limited or inaccessible. Most significantly, the impact of energy poverty is disproportionally affecting students with long-term disabilities or health concerns as well as students identifying as Māori. Moreover, the impact of COVID-19 further strained students experiencing energy poverty and again, disproportionally affected more vulnerable students.

How limitations in energy access, poverty, and socioeconomic disparities compromise health interventions for outbreaks in urban settings

Low-income households (LIHs) have experienced increased poverty and inaccess to healthcare services during the COVID-19 pandemic, limiting their ability to adhere to health-protective behaviors. We use an epidemiological model to show how a households' inability to adopt social distancing, owing to constraints in utility and healthcare expenditure, can drastically impact the course of disease outbreaks in five urban U.S. counties. LIHs suffer greater burdens of disease and death than higher income households, while functioning as a consistent source of virus exposure for the entire community due to socioeconomic barriers to following public health guidelines. These impacts worsened when social distancing policy could not be imposed. Health interventions combining social distancing and LIH resource protection strategies (e.g., utility and healthcare access) were the most effective in limiting virus spread for all income levels. Policies need to address the multidimensionality of energy, housing, and healthcare access for future disaster management.

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Energy and socioeconomic constraints and public health interventions are discussed

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Utility and health costs constrain a county's ability to enact public health policies

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Securing household utilities is essential to low-income households' health and safety

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Affordable energy and healthcare for vulnerable communities are a critical policy issue

Energy poverty and its relationship with health: empirical evidence on the dynamics of energy poverty and poor health in Australia

Does poor health increase the likelihood of energy poverty or vice versa creating a vicious poverty trap? We use data from the Household, Income and Labour Dynamics of Australia (HILDA) survey from 2005–2018 to explore if these two processes are dynamically related across a number of subjective and objective measures of physical and mental health as well as subjective and objective measures of energy poverty. We employ univariate dynamic models, introduce controls for initial conditions, and explore inter-dependence between energy poverty and health using a dynamic bivariate probit model. Our results show that controlling for initial conditions impacts on the magnitude and significance of the lagged coefficients. We only find cross-dependency effects between energy poverty and health for subjective measures of energy poverty. This suggests that individuals’ feelings about being in energy poverty may impact on their health leading to poor health/energy poverty traps. Targeting individuals in financial stress/debt may be one way to reduce these poor health/energy poverty traps.

Inequitable and heterogeneous impacts on electricity consumption from COVID-19 mitigation measures

The COVID-19 pandemic has exacerbated energy insecurity and economic hardship among vulnerable populations. This paper provides robust empirical evidence of the degree to which COVID-19 mitigation measures, especially the mandates of school closure and limiting business operations, have impacted electricity consumption behavior in low-income and ethnic minority groups in the United States. We use a regression discontinuity design applied to individual-consumer-level high-frequency smart meter data in Arizona and Illinois to highlight the disparities in mitigation measure impacts. We find that the mandates of school closures and limiting business operations increase residential electricity consumption by 4-5%, but reduce commercial electricity consumption by 5-8%. Considerable heterogeneity is observed across income and race: low-income and ethnic-minority populations experience a larger electricity consumption increase, reflecting the disproportionate impact of COVID-19 on electricity insecurity in the residential sector. Policies that address energy insecurity, especially during the pandemic, become essentially important.

Bibliometric Literature Analysis of a Multi-Dimensional Sustainable Development Issue: Energy Poverty

Energy plays a critical role in building a sustainable future—economically, socially, and environmentally. Energy poverty holds a similarly prominent position and covers certain economic, social and environmental issues that are underlined by the United Nations’ Sustainable Development Goals. Due to its multidimensional role in plans for achieving sustainable development, there is a growing body of literature focusing on various aspects of energy poverty. This study conducts a bibliometric analysis of this literature by utilizing more extensive data from the Web of Science, covering all information on energy poverty studies. The analysis reveals how energy poverty has attracted attention over time, who the leading authors are, which studies constitute outstanding contributions to the literature, which different sides of the research topic stand out, and also highlights the potential research gaps. The results reveal all the network flows among researchers, publications, journals, keywords, organizations, co-cited publications, and bibliographic coupling for energy poverty studies. The findings confirm the increasing popularity of energy poverty as a topic and demonstrate the increasing awareness of the issue in academia over time.