Fuel Poverty: The Risk to Population Health
09 November 2023
For countless people living in fuel poverty, the colder winter months mean making the harsh choice between heating their homes and having enough food on the table.
Fuel poverty isn’t just a financial issue – it can be a severe threat to population health. A significant portion of the UK is at risk of serious direct and long-term health issues from living in cold and damp homes.
Here, we look at the full impact of fuel poverty on patient health and how population health management tools can help healthcare teams identify and support those most at risk.
What is fuel poverty?
Fuel poverty refers to households that cannot afford to adequately heat their home. This is a pressing issue, as living with cold indoor temperatures can have significant health consequences for people of all ages.
There is no international standard for calculating rates of fuel poverty. Even in the UK, there are discrepancies in calculations between different countries due to their individual strategies and policies – which makes it impossible to directly compare fuel poverty rates across nations.
In England, the Government uses a metric called Low Income Low Energy Efficiency (LILEE) to determine whether a household is fuel poor. Households are considered to be in fuel poverty if they meet the following criteria:
- The home has an energy efficiency of band D or below
- Their combined housing and energy costs put the household’s residual income below the official poverty line.
An estimated 13.4% of households (3.26 million) were living in fuel poverty in England in 2022. , according to the Government’s annual fuel poverty statistics (last released in February 2023).
This number is predicted to rise to 14.4% in 2023. 
Fuel poverty and health inequality
Low income is a key factor in determining fuel poverty, which contributes to already-existing health inequalities.
Certain demographics are more likely to experience fuel poverty . These include:
- Households with children – especially single parent households
- Younger households, where the eldest member is aged 16-24
- Elderly people without children
- People living with disabilities
- Ethnic minority households
Many of these groups – including children, young people and people with pre-existing conditions or disabilities – are also at a higher risk of developing health problems linked to living in cold or damp housing conditions.
Health risks of living in a cold house
The health consequences of living in a cold home are serious. In 2019, the UK Government estimated that the NHS spends at least £1.4 billion a year on treating illnesses that are directly linked to cold homes.
Among other pressing issues, low temperatures increase the risk of:
- Strokes or heart attacks, due to raised blood pressure
- Respiratory infections such as pneumonia, bronchitis, bronchiolitis and COPD
- Falls or other injuries, due to people's reduced strength and dexterity
- Poor mental health, including depression, anxiety and stress
Alongside the direct effects, other environmental factors of cold indoor temperatures, such as damp and mould, can also cause and aggravate longer-term conditions, such as:
- Chronic pain
Patients with long-term conditions, particularly those with respiratory or cardiovascular disease, are much more likely to experience exacerbations in their condition.
In some instances, fuel poverty health problems can become deadly. The leading causes of excess winter deaths in England are respiratory diseases, circulatory and cardiovascular diseases, and dementia  – all of which are made worse by living in a cold house.
How population health management tools can help
Population health management tools give Integrated Care Systems (ICS) access to the data they need to pinpoint the people most at risk of fuel poverty and cold-related health conditions. This can help them to target resources where they are most needed.
Graphnet’s Shared Care Records collate information from a range of sources, including GPs, hospitals, social care, community services and more. The population health management software displays this data in a configurable analytics dashboard, which can be used to identify relevant at-risk cohorts ahead of winter.
Healthcare teams can then proactively contact patients to offer targeted support, provide medical optimisation, and signpost available social care resources, such as fuel vouchers. This results in:
- Improved patient health outcomes
- Reduced pressure on the NHS
- Strengthened community relationships
Case Study: Cheshire and Merseyside ICB
Cheshire and Merseyside ICB created a fuel poverty dashboard in their Graphnet-hosted population health analytics platform.
The dashboard analyses a range of data points to identify patients with chronic respiratory disease and asthma who may deteriorate because of fuel poverty. These authorised data sets include:
- GP data
- Deprivation scores
- Johns Hopkins risk-of-admission prediction scores
- Fuel poverty data profiles
Household energy certificates were linked to each patient, along with an estimation of their household size,to highlight people living on their own with poorer energy ratings.
Risk stratification algorithms provided a score for each person’s risk of emergency admission, morbidity profile and complexity.
By linking the national fuel poverty data set to the individual patient records within Graphnet, the team were able to create a profile of citizens likely to live in a cold home.
Direct care professionals in Knowsley and St Helens then used the dashboard to drill down to patient level and contact patients who would benefit from medical optimisation.
- 100% (85) referrals to the Wellbeing Team
- 100% (85) referrals to the Affordable Warmth Team
- 16% (14) referrals to the Pulmonary Rehabilitation Team
- 21% (18) patients onboarded to the COPD Telehealth Service
- 76% (65) patients received £500 payments from household support funds. Further payments are due in October 2023.