Household Energy Insecurity and COVID-19 Have Independent and Synergistic Health Effects on Vulnerable Populations

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.

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.

Barriers to COVID-19 Health Products in Low-and Middle-Income Countries During the COVID-19 Pandemic: A Rapid Systematic Review and Evidence Synthesis

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has intensified the urgency in addressing pressing global health access challenges and has also laid bare the pervasive structural and systemic inequities that make certain segments of society more vulnerable to the tragic consequences of the disease. This rapid systematic review analyses the barriers to COVID-19 health products in low-and middle-income countries (LMICs). It does so from the canon of global health equity and access to medicines by proposing an access to health products in low-and middle-income countries framework and typology adapted to underscore the complex interactive and multiplicative nature and effects of barriers to health products and their root cause as they coexist across different levels of society in LMICs.

Methods

Modified versions of the Joanna Briggs Institute (JBI) reviewers' manual for evidence synthesis of systematic reviews and the PRISMA-ScR framework were used to guide the search strategy, identification, and screening of biomedical, social science, and gray literature published in English between 1 January 2020 and 30 April 2021.

Results

The initial search resulted in 5,956 articles, with 72 articles included in this review after screening protocol and inclusion criteria were applied. Thirty one percent of the articles focused on Africa. The review revealed that barriers to COVID-19 health products were commonly caused by market forces (64%), the unavailability (53%), inaccessibility (42%), and unaffordability (35%), of the products, incongruent donors' agenda and funding (33%) and unreliable health and supply systems (28%). They commonly existed at the international and regional (79%), health sectoral (46%), and national cross-sectoral [public policy] (19%) levels. The historical heritage of colonialism in LMICs was a commonly attributed root cause of the barriers to COVID-19 health products in developing countries.

Conclusion

This review has outlined and elaborated on the various barriers to health products that must be comprehensively addressed to mount a successful global, regional, national and subnational response to present and future epidemics and pandemics in LMICs.

Nexus Between Economic Efficiency, Healthcare, and Environmental Expenditures: A Perspective of BRI Countries

Public health and the environment are the most essential pillars, and play a vital role in the economy. In order to better public health, the economic and environmental atmosphere must be stable and clean, respectively. Thus, this paper emphasizes on nexus between economic, public health, and the environment. Therefore, the objective of this paper is whether healthcare and environmental expenditures affect economic efficiency and vice versa. So, this study evaluates the performance of the country's economic efficiency and investigates the effect of healthcare and environmental expenditures for 62 Belt and Road Initiative countries for the period from 1996 to 2020. Suitable input-output variables are employed under the framework of DEA-window and Malmquist Index Productivity, and Stochastic Frontier Analysis (SFA). In addition, this study estimates the relationship between economic efficiency, healthcare, and environmental expenditures by fixed and random effects models. Therefore, the analytical outcomes reveal that countries are economically efficient. On the contrary, SFA estimation concludes that countries are found to be inefficient, because higher variation is exists in efficiency change compared to technological efficiency change and total factor productivity change on average. In addition, it is worth notable that healthcare and environmental expenditures improve the country's economic efficiency. Furthermore, public health is also influenced by economic efficiency. Thus, this study suggests that countries should better utilize given resources and invest a specific portion of national income in order to improve economic efficiency.

Analyzing changes to U.S. municipal heat response plans during the COVID-19 pandemic

Extreme heat events are the deadliest weather-related event in the United States. Cities throughout the United States have worked to develop heat adaptation strategies to limit the impact of extreme heat on vulnerable populations. However, the COVID-19 pandemic presented unprecedented challenges to local governments. This paper provides a preliminary review of strategies and interventions used to manage compound COVID-19-extreme heat events in the 25 most populous cities of the United States. Heat adaptation strategies employed prior to the COVID-19 pandemic were not adequate to meet during the co-occurring compound hazard of COVID-19-EHE. Long-term climate-adaptation strategies will require leveraging physical, financial, and community resources across multiple city departments to meet the needs of compound hazards, such as COVID-19 and extreme heat.

Energy poverty in the COVID-19 era: Mapping global responses in light of momentum for the right to energy

This article presents the results of the COVID Energy Map, a novel, global mapping exercise tracking emergency responses undertaken by governments, regulators, utilities and companies in the Global North and South to mitigate energy poverty by keeping energy affordable and available. The map constitutes a comprehensive open access evidence-based database, so far collating 380+ emergency measures, in 120+ countries. This paper particularly shows and discusses how the response has been developing until early 2021, highlighting various emerging longer-term concerns and strategies across Global North and South. The global COVID-19 response merits close attention in our view, as it reveals both the universal importance of household energy services access and important underlying existing narratives and policy-making questions about securing energy services access as a vital basic need, and even a 'basic right'. In fact, the paper additionally evaluates whether and how COVID-19 responses seem to fall in step with a nascent global trend of (legal) recognition of 'rights to energy' in international, regional and national policy, including for example in the EU, India, Philippines, and Colombia. We conclude that while the COVID-19 response clearly reflects broad recognition of the vital importance of affordable, continuous energy services access for basic human well-being and capabilities during the pandemic, a right to energy perspective could additionally lay bare or give shape to important concerns about some households' too minimal (insufficient) forms of modern energy access, questions of equity, and the role of the state and other actors. In terms of equity the article particularly raises issues with the manner in which support was made available only to some consumers (e.g. on-grid, off-grid, regulated, or non-regulated, post-paid or pre-paid), or only for specific fuels, and not others. In addition, the lack of attention to clean (renewable) (off-grid) energy services in COVID-19 responses is striking, and worrying, both in terms of immediate response, and green recovery from COVID-19. We argue that a right to (clean) energy perspective would help to reflect on, and inform, both shorter-term and longer-term responses to energy poverty and COVID-19, and should aid the realization of sufficiently equitable, robust, modern energy systems in line with universal UN Global Sustainable Development Goal 7. Specifically, it should also help to fulfil SDG7.1.'s promise of 'leaving no one behind'.

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

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

COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs

This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.

COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs

This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.

Pay-as-you-go liquefied petroleum gas supports sustainable clean cooking in Kenyan informal urban settlement during COVID-19 lockdown

Approximately 2.8 billion people rely on polluting fuels (e.g. wood, kerosene) for cooking. With affordability being a key access barrier to clean cooking fuels, such as liquefied petroleum gas (LPG), pay-as-you-go (PAYG) LPG smart meter technology may help resource-poor households adopt LPG by allowing incremental fuel payments. To understand the potential for PAYG LPG to facilitate clean cooking, objective evaluations of customers' cooking and spending patterns are needed. This study uses novel smart meter data collected between January 2018-June 2020, spanning COVID-19 lockdown, from 426 PAYG LPG customers living in an informal settlement in Nairobi, Kenya to evaluate stove usage (e.g. cooking events/day, cooking event length). Seven semi-structured interviews were conducted in August 2020 to provide context for potential changes in cooking behaviours during lockdown. Using stove monitoring data, objective comparisons of cooking patterns are made with households using purchased 6 kg cylinder LPG in peri-urban Eldoret, Kenya. In Nairobi, 95% of study households continued using PAYG LPG during COVID-19 lockdown, with consumption increasing from 0.97 to 1.22 kg/capita/month. Daily cooking event frequency also increased by 60% (1.07 to 1.72 events/day). In contrast, average days/month using LPG declined by 75% during lockdown (17 to four days) among seven households purchasing 6 kg cylinder LPG in Eldoret. Interviewed customers reported benefits of PAYG LPG beyond fuel affordability, including safety, time savings and cylinder delivery. In the first study assessing PAYG LPG cooking patterns, LPG use was sustained despite a COVID-19 lockdown, illustrating how PAYG smart meter technology may help foster clean cooking access.

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

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