4. Policy Implications
The findings highlighted various overlaps, gaps, and areas of improvement. The current fuel poverty policies primarily focus on retrofitting houses in order to alleviate fuel poverty and reach net zero targets. These interventions can also have a positive effect on health, arguably addressing ill health caused by fuel poverty most effectively. While they should remain a priority, it is vital to acknowledge that implementing these interventions is costly and will take time. As a result, the following policy implications focus more on mitigating health impacts in the meantime.
4.1 Broader Integration of Health and Fuel Poverty Policy
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.
Energy efficiency measures are vital for promoting good health and reducing the impacts of fuel poverty on health. Hence, health policy needs to recognise fuel poverty as a driving factor of ill health and consider fuel poverty policy in their approaches going forward. Similarly, fuel poverty policy needs to consider health in their planned actions. While energy efficiency measures may be the most effective way to combat fuel poverty-related ill health, they can have unintended negative health impacts that can be damaging to a person’s health. Additionally, energy efficiency measures are costly and take long to implement; as people are waiting on these measures, it is vital to mitigate any health impacts caused by fuel poverty. Going forward, these policy areas should work on a joint strategy.
To facilitate collaboration between these areas, there could be a single point of contact referral service combining housing and health. This service could involve local housing and health providers, advice services, and community organisations which could work together to provide solutions to people in fuel poverty. Anyone should be able to refer themselves to this service; however, it will be important for health and social care staff, heating and energy efficiency installers, as well as anyone else who may encounter individuals in fuel poverty to be able to refer them to this service. Additionally, the referral service should provide tailored support as individuals will have varying needs depending on their situation and background.
While intersectionality must be embedded across all areas in any approach taken, it is especially vital to ensure its implementation in this referral service and the tailored support it offers. Staff need to take into account that certain groups are disproportionately affected both by negative health outcomes and fuel poverty (along with other types of poverty) and work together to ensure that everyone receives the support they need, so their situation can be improved. Advice will primarily focus on energy efficiency measures programmes and grants, effectively managing energy within the home to prevent fuel poverty-related ill health, information on the health impacts of fuel poverty, claiming entitled benefits, and arranging repairs, e.g., the removal of mould. Where individuals rent their homes, they could also receive legal advice on ensuring that their landlords adhere to their responsibilities regarding the home’s minimum housing standard.
An example of such a collaboration between health and fuel poverty can be observed in the Warm Home Prescription® 2022-2026 trial. Healthcare staff and local energy advisors work together to deliver practical help to patients in fuel poverty who have health conditions that are worsened by the cold, enabling them to keep their homes warm.
4.2 Effective Use of Data
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.
Linking fuel poverty with health will help us understand the extent of the problem on a national level but also ensure that treatment remains effective. If the connection is not made and people return to cold homes, the treatment will become ineffective. Symptoms may worsen, resulting in increased hospitalisations and further strain on the NHS (Donkin and Marmot, 2024; Ruse, 2020). However, when cases are attributable to fuel poverty, the underlying causes can be addressed, improving health outcomes. Additionally, this data could help us understand the impact of fuel poverty-related ill health on the NHS as well as the potential savings and benefits of energy efficiency measures for the NHS. Hence, it is vital to connect health and fuel poverty data.
Furthermore, data sharing between public services should be enabled. For example, when a person receives fuel poverty support, this data should be made available to their primary care physician who can then arrange appointments for health check-ups for fuel poverty-related health conditions. Similarly, when a person is diagnosed with a fuel poverty-related health condition, enquiries about their housing condition, energy usage behaviour and heating needs should take place. House visits could be arranged to assess the situation further. Where appropriate, this information should be shared with the relevant welfare services so people can receive fuel poverty support and claim benefits they may be entitled to. Generally, it could become good practice to enquire about heating needs during yearly health check-ups, offering opportunities to identify individuals who may be struggling to warm their home and sharing this data with the appropriate services.
4.3 Staff Training
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.
Health and social care staff need to be trained on how to identify and help people in fuel poverty. When people go to their primary care team with fuel poverty-related health symptoms, the team needs to consider fuel poverty as an underlying cause and effectively rule it out. Where people are experiencing ill health due to fuel poverty, the team can play a vital role in ensuring people get the help they need. Accordingly, staff need to be trained on the local systems and services available. Finally, this training should be included in medical education to ensure that healthcare professionals learn about this intersection as early as possible.
Similarly, heating and energy efficiency installers need to receive training on fuel poverty and its impact on health. When entering someone’s home to conduct work, they need to be aware of how cold indoor temperatures can negatively impact a person’s health and should be able to assess whether an individual may struggle with warming their home adequately, adjusting their behaviour and how they approach the situation accordingly. Additionally, they should be able to explain the work they are conducting in an easily understandable manner, highlighting the resulting benefits to the residents’ health. A quick assessment could be made about the additional work that could be done to improve the home’s energy efficiency, and information about it should be provided to the resident.
This training could form part of wider health and safety training as even short exposures to cold indoor temperatures can already pose a health risk to heating and energy efficiency installers (Ruse, 2020). For the sake of their own health, they need to be aware of the cold’s potential impact and be able to minimise any risks while conducting their work. Especially as the cold can affect dexterity and strength (Ruse, 2020), it is vital to ensure that installers have protections in place to prevent work accidents or poor installations that could potentially further damage the residents’ health.
All staff should be trained in line with the Time, Space and Compassion (TSC) framework. When they are suspecting an individual of residing in a cold home, they need to be able to raise the issue sensitively, especially as people may want to hide the fact that they are struggling. Care needs to be taken not to further stigmatise individuals experiencing fuel poverty. Advice should be given in a non-judgemental manner, and individuals should be offered to be referred to the appropriate services.
4.4 Awareness Campaigns
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.
Campaigns could include information on how the cold can affect a person’s health and specify how symptoms may present, focusing on respiratory, cardiovascular and mental health conditions. While these are most commonly impacted, it is also vital to focus on lesser-known associations, e.g., higher prevalence of trips and falls among older adults. Additionally, information could be provided about what is considered a safe indoor temperature and how to keep the home warm to prevent ill health. Given that many people do not open their windows during winter to avoid heat escaping, unintentionally promoting poor indoor air quality, guidance on efficient window-opening could be given. Similarly, it will be essential to debunk common misconceptions people may have about cold temperatures, e.g., drinking alcohol can help keep you warm (Drinkaware, 2024) or closing vents prevents heat loss (Shokar, 2025). These misconceptions can result in negative health outcomes, highlighting the need for public awareness campaigns to combat misinformation.
Moreover, campaigns could focus on the support and advice services available. Experiencing fuel poverty can be overwhelming and it may not be immediately obvious where support is available but also what kind of support they can receive. Pointing people to the appropriate services where they can get help and advice could significantly reduce stress and overwhelm. The campaign could also highlight peer support groups to try and tackle the stigma associated with fuel poverty. These support groups could be further involved in promoting the available support and advice services.
Furthermore, information about the different types of energy efficiency measures should be made available in an easily digestible format. Research has shown that people do not always know which options are available and what the best investment would be (Van Rooyen and Sharpe, 2024). Similarly, funding options, particularly governmental financial support, loans, and grants, should be laid out clearly. Additionally, when explaining the different options, people need to be made aware of the ventilation systems required as well as their maintenance and operation to mitigate any unintended negative health impacts of energy efficiency measures. Homeowners should receive advice on how they can find out the energy rating of their home. People living in rented homes should be encouraged to approach their landlord and ask for details about the energy rating of their homes, any energy efficiency measures already implemented, and the current state of their ventilation systems. Additionally, research shows that some landlords attempt to evict tenants when reporting repairs, resulting in tenants not reporting repairs due to fear of eviction (Citizens Advice Scotland, 2025). As a result, people live in cold, mouldy houses due to disrepair, negatively impacting their health. Hence, tenants should be informed about their rights regarding repairs and maintaining a minimum housing standard, and be pointed to legal advice services.
Finally, the benefits of energy efficiency measures could be reframed through a public health lens to encourage uptake. The current approach primarily focuses on net zero and climate change. While many likely understand the need to implement these measures to combat climate change, climate change is often considered an abstract concept that will not impact people until far in the future (Duan et al., 2019). Research further suggests that chronic health conditions are seen as a bigger threat to health than climate change, although it is worth noting that Scottish people are concerned about climate change’s impact on health (The Health Foundation, 2021). Thus, reframing the benefits related to health might create an immediate urgency that is more concrete and easier for people to relate to, increasing uptake of energy efficiency measures.
Research on current knowledge of health impacts and energy usage behaviour within the home, specifically focusing on the Scottish context, may provide further avenues for awareness campaigns. Importantly, this additional information will allow the campaigns to be more targeted at the Scottish public, ultimately making them more effective.