Key Findings

This report explores the ways in which fuel poverty and public health policy interact within the context of the Scottish Government. Key findings are provided below.

Evidence From the Literature on the Link Between Health and Fuel Poverty

• Respiratory disease: Cold air and mould can irritate the airways and impair the immune system, making the body more susceptible to respiratory tract infections. It also increases the risk of developing or exacerbating symptoms of asthma and chronic obstructive pulmonary disease (COPD).
• Cardiovascular disease: Cold temperatures narrow blood vessels, raising blood pressure and strain on the cardiovascular system, which, in turn, increases the risks of stroke, heart attack, and hypertension.
• Mental Health: Depression and anxiety can be caused by residing in a cold home. It can also result in loneliness and isolation as people withdraw from their social lives.
• Other conditions: Cold homes increase the risks of falls and injuries as well as worsen arthritis and rheumatism. It can also disrupt the skin barrier, causing rashes, inflammation or allergic reactions on the skin.

Fuel Poverty

• Fuel poverty policy primarily focuses on net zero and economic factors. Only two out of 55 policy actions within the Fuel Poverty Strategy directly address health, focusing on general health rather than a specific condition. While other actions could have a possible indirect impact on health, this impact is currently not measurable.
• Energy efficiency measures, such as retrofitting, generally have a direct positive impact on health and are considered the most effective interventions in addressing fuel poverty-related ill health.
• Nevertheless, energy efficiency measures can have unintended negative health impacts that need to be taken into account.

Respiratory Conditions

• The Respiratory Care Action Plan references fuel poverty as a significant risk factor for the development and exacerbation of respiratory conditions. Subsequently, it emphasises the importance of collaboration between these policy areas to ensure optimal preventative care.
• Areas of potential include:
  • Using high quality data more effectively and identify whether new cases are linked to cold homes
  • Hospital to Home programme to consider social determinants of health
  • Tackling stigma through peer support

Cardiovascular Conditions

• The Heart Disease Action Plan and Stroke Improvement Plan do not mention fuel poverty (or poverty generally) as a risk factor for the development and exacerbation of cardiovascular conditions.
• Other factors, such as clean air and diet, are acknowledged, and their respective policies are complementary to these plans. Yet, a more explicit link is needed.
• Areas of potential include:
  • Community models of care including energy-focused third sector organisations to promote cardiovascular health
  • Use of telemonitoring to facilitate enquiries into underlying causes
  • Broader integration of multi-disciplinary approach

Mental Health

• Scotland’s Mental Health and Wellbeing Strategy does not mention fuel poverty explicitly but acknowledges housing and poverty as drivers of poor mental health.
• Areas of potential include:
  • Intersectionality
  • Time, Space, Compassion Model
  • Tackling stigma through peer support

Diet & Nutrition

• Scotland’s Diet & Healthy Weight Delivery Plan recognises poverty and deprivation as barriers to eating healthier.
• The Fuel Poverty Strategy primarily addresses diet through free school meals in primary school. Additionally, the Scottish Government’s Islands Cost Crisis Emergency Fund handed out food vouchers to households in fuel poverty.
• Areas of potential include:
  • Expansion of free school meals
  • Expansion of food vouchers
  • Meals on Wheels

General Health

• The Housing to 2040 Plan and Population Health Framework recognise that adequate, affordable housing and living spaces can improve health.
• There is emphasis on building new homes in areas that already have health services to make it easier to access these (20-minute neighbourhoods).
• New regulation for zero emissions heating and energy efficiency will consider people’s health and well-being.
• Greater involvement of the NHS in income maximisation (e.g., people who need income assistance can access support within the healthcare setting).

Policy Implications

• Even though the findings demonstrate the occasional overlap between health and fuel poverty policy, it is necessary to integrate these policy areas more closely with each other and foster collaboration.
• Health data needs to be used more effectively to improve care and treatment. For example, new cases of fuel poverty-related health conditions should be made attributable to fuel poverty, where possible.
• Staff might not necessarily be aware of the link between health and fuel poverty due to the current lack of integration between these areas. Thus, it is vital that staff working with those in or at risk of fuel poverty receive training on the interaction between health and fuel poverty.
• It should not be assumed that everyone will be aware of the health impacts of a cold home and the various ways in which symptoms can present. Awareness campaigns on these topics in accessible and inclusive formats will be necessary to educate the public and practitioners. These campaigns have the potential to be useful even for people who do not experience fuel poverty.