1. Introduction

The Scottish Fuel Poverty Advisory Panel committed to preparing the groundwork for a deep dive on the impact of fuel poverty on public health, as set out in their 2025-2026 workplan. This report forms part of the groundwork setting and is intended to inform the Panel’s understanding of the interactions between fuel poverty and public health policies.

A literature review was conducted to understand the impact of fuel poverty on health, focusing on key physical and mental health conditions. The review was narrative in nature, rather than systematic, as several scoping reviews on the topic already exist (e.g., Champagne et al., 2023), highlighting the well-established link between fuel poverty and health in the literature. Relevant academic and grey literature, published between 2015 and 2025, were sourced from Google Scholar and the Scottish Government’s KandE (knowledge and evidence) service. The time range ensured that potentially outdated studies would not be included. Additionally, the studies needed to focus on the UK. Where possible, data on Scotland was included; however, data from England was occasionally used to supplement the lack of Scottish data. This decision was made under the assumption that, while not representative of Scotland, the two countries have a similar climate and housing stock, making it likely for English data to be applicable to Scotland to some extent.

Next, fuel poverty, health, and housing policies were identified in line with the health conditions established during the literature review. The relevant policies were reviewed for overlaps, gaps, and areas of potential regarding health and fuel poverty.

The following publications were considered:

While it is recognised that there may be other policies (particularly poverty-focused policies) that have an indirect impact on fuel poverty and health, this report focuses solely on the link between fuel poverty and health. The policy selection intends to reflect this link.

The report starts out with contextual information on fuel poverty and health in Scotland, followed by a literature review outlining the key physical and mental health impacts of fuel poverty. Then, overlaps, gaps, and areas of potential are identified by mapping out each policy area, and policy implications are discussed.

1.1 Fuel Poverty and Health – Setting the Context

According to the 2023 Scottish House Condition Survey (SHCS), fuel poverty affects around 34% of all households in Scotland, with around 19.4% of all households experiencing extreme fuel poverty (Scottish Government, 2025c). Households in social housing are more likely to experience fuel poverty (61%, compared to 25% in the private sector) despite their homes generally having higher energy efficiency ratings, as they cannot afford energy (Donkin and Marmot, 2024; Scottish Government, 2025c). As such, fuel poverty is strongly associated with low incomes, although it is worth noting that 31% of all households in fuel poverty would not be considered income poor (Scottish Government, 2025c), highlighting that poor housing can also cause fuel poverty.

Fuel poverty is primarily discussed through a net zero or economic lens. The impacts of fuel poverty on health are often overlooked in that conversation, despite the well-established link. Cold homes increase the risk of contracting respiratory tract infections as well as the development and exacerbation of respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD). It is also known to cause cardiovascular conditions, such as heart attacks and strokes, and increase the likelihood of trips and falls in the house. Fuel poverty has significant impacts on mental health, causing social isolation, depression, and anxiety. As people in fuel poverty often have to choose between heating and eating, they are at greater risk of malnutrition.

Cold homes contribute to increased mortality rates during the winter season. Scotland reported 2,704 excess winter deaths in 2024/25; the leading causes of deaths were linked to respiratory and cardiovascular conditions (National Records of Scotland, 2026), which are caused and worsened by living in cold homes. Moreover, cold homes are linked to higher hospital admissions, increasing the strain on the NHS as well as health costs (Donkin and Marmot, 2024; Ruse, 2020). People in fuel poverty also miss more days at work/school due to illness; particularly children’s academic attainment and educational outcomes can be impacted negatively as it is more difficult to study in a cold, often overcrowded home (Donkin and Marmot, 2024; Ruse, 2020).

There are certain groups who will be more vulnerable to the cold. For example, people with pre-existing health conditions may see their condition worsen due to the cold exposure. Similarly, people who have a disability may have higher heating needs, especially if they are unable to move around to stay warm. Young children and their carers, which are often women, as well as older people are disproportionally affected by cold homes as they spend longer hours indoors. Finally, minority ethnic groups are more likely to live in damp housing and experience fuel poverty (Donkin and Marmot, 2024; Lee et al., 2022).

The impact of cold and mouldy housing conditions on health has recently received more attention within parliament and the media due to Awaab Ishak who died as a result of being exposed to mould in his home, leading to the introduction of Awaab’s Law (Scottish Government, 2025a). The case of Awaab Ishak demonstrates the importance of drawing the connection between fuel poverty, cold homes, and health to prevent further harm.