2. Literature Review
Fuel poverty is associated with various negative health impacts. Most commonly, the respiratory system, the cardiovascular system, and mental health are affected by living in a cold and damp home (Champagne et al., 2023). Babies, children, older adults, and people with pre-existing health conditions are particularly at risk of developing health issues due to residing in a cold home and experiencing fuel poverty (Ruse, 2020). Thus, the following reviews the key physical and mental health impacts of fuel poverty. It is vital to note that there is a dynamic interplay between these health impacts and fuel poverty, with fuel poverty both causing and exacerbating health conditions (Budrìa et al., 2025).
2.1 Respiratory Disease
Respiratory diseases are conditions that affect the ability to breathe. Chronic obstructive pulmonary disease (COPD) and asthma are two common chronic respiratory diseases in children and adults (Scottish Government, 2025d). Both conditions make it hard to breathe due to inflammation and narrowing of the airways. While COPD is typically a result of long-term exposure to cigarette smoke, dust, and air pollution, with symptoms being persistent (Asthma + Lung UK, 2022), asthma can be triggered by various causes, e.g., exercise, smoking, cold air, infections or allergies, whereby symptoms may not always be present (Asthma + Lung UK, 2024). Additionally, poor nutrition, especially during early childhood, can increase the risk of developing COPD and asthma or exacerbating the conditions if already present (Collins et al., 2019). Notably, individuals living in (fuel) poverty are more likely to develop and die a preventable death from respiratory diseases (Asthma + Lung UK, 2023). Both diseases are incurable and thus life-long conditions. Even though some children can outgrow asthma by the time they are adults, this outcome is unlikely for children who live in (fuel) poverty (Holden et al., 2025).
It is well-established that humans become more susceptible to respiratory tract infections (RTI) during winter (Richards, 2024). Exposure to cold temperatures increases the production of stress hormones, which significantly impair the body’s immune system (Wu et al., 2022). As the body redirects its energy to focus on heat generation, the immune system is further weakened and, ultimately, becomes more susceptible to RTIs (Wu et al., 2022). Additionally, breathing in cold air over extended periods can irritate airways and increase the production of mucus, which in turn can further the risk of developing RTIs, especially in patients with asthma and COPD (Ruse, 2020). Households in fuel poverty can then spread RTIs more easily to other household members due to overcrowding (Holden et al., 2023). Research also suggests that early-life RTIs can substantially impact lung function and the development of asthma and COPD in later childhood (Bush, 2021; van Meel et al., 2018). Similarly, RTIs can worsen an existing condition (Asthma + Lung UK, 2023). Consequently, people living in fuel poverty are at an increased risk of developing RTIs, which in turn may cause or exacerbate symptoms of asthma and COPD, due to prolonged exposure to cold temperatures.
Furthermore, food gives our bodies the energy we need to maintain basic bodily functions. However, people in fuel poverty often have to forego meals and spend less on food to afford energy (Lee et al., 2022). Reduced food intake, especially of healthy foods and essential nutrients, as well as poor diets can lead to fatigue, lack of energy, and more importantly, higher susceptibility to RTIs and subsequent respiratory diseases (Berthon and Wood, 2015; Tharumakunarajah et al., 2024). Especially in early child development, poor nutrition can have detrimental effects on growth that will significantly impact a person throughout their lifetime (Alves and Alves, 2024; Hurley et al., 2016). For example, research suggests that children who do not receive sufficient essential nutrients growing up can experience stunted lung growth and development, impairing lung function and increasing the risks of asthma and COPD (Arigliani et al., 2018; Tharumakunarajah et al., 2024). Similarly, a lack of proper nutrition can exacerbate COPD-related symptoms as COPD patients have increased nutritional needs and compromised nutritional intake (Collins et al., 2019). If daily nutritional intake requirements are not met, patients lack energy to carry out daily activities, resulting in inactivity and reduced physical function. In turn, respiratory muscles get weaker, compromising respiratory function and ultimately worsening the condition (Collins et al., 2019). As a result, patients experience increased emergency hospitalisations, putting further strain on the healthcare system and leading to poorer survival rates for patients (Collins et al., 2019). Considering the overlap between fuel and food poverty, people experiencing fuel poverty are particularly at risk of poor nutrition and its negative impact on respiratory health (Champagne et al., 2024).
Finally, respiratory diseases are linked to air pollution, which people in (fuel) poverty are disproportionately exposed to (Asthma + Lung UK, 2018). First, outdoor air pollution is highest in Scotland’s deprived areas as well as rented accommodation within large, urban areas (Catalano and Congreve, 2025). As outdoor sources infiltrate the indoors, people experiencing (fuel) poverty deal with higher levels of indoor air pollution (Ferguson et al., 2021). Second, indoor sources, e.g., cooking, showering, and smoking, produce harmful indoor air pollution (Ferguson et al., 2021; Shrubsole et al., 2016), negatively impacting on respiratory health (Holden et al., 2023). Households in fuel poverty also spend more time indoors and are more likely to experience overcrowding due to high levels of occupant density and/or smaller floor areas, which has been linked to higher levels of indoor air pollution (Ferguson et al., 2021). The resulting poor air quality can cause RTIs and exacerbate symptoms of asthma and COPD (Asthma + Lung UK, 2023).
Good ventilation, facilitated through extractor fans and opening windows, can help with eliminating pollutants from indoor sources. However, research has shown that only 11% of homes across Great Britain have minimum ventilation provisions installed that meet the building standards requirements and know how to use them (Van Rooyen and Sharpe, 2024). Moreover, households in fuel poverty might be less likely to open their windows to keep heat in (Lee et al., 2022). As windows stay shut during winter, the lack of ventilation in a cold, damp home promotes mould growth and lets dust and other allergens (e.g., tobacco smoke) settle, which, when inhaled, can irritate airways or cause allergic reactions (Holden et al., 2025; Lee et al., 2022; Patella et al., 2015). Especially prolonged exposure to mould can have negative respiratory health effects, causing and worsening conditions such as asthma and COPD (Asthma + Lung UK, 2023; Moorcroft et al., 2025; Varga et al., 2024). Thus, indoor air pollution poses a significant health risk for people in fuel poverty, whereby a cold, damp home contributes to the development and exacerbation of respiratory diseases, with children in fuel poverty disproportionately affected.
2.2 Cardiovascular Disease
Cardiovascular diseases generally refer to conditions relating to the heart and blood vessels, e.g., coronary heart disease and strokes. The cardiovascular system is affected by cold temperatures, specifically where indoor temperatures go below 12°C (Lee et al., 2022), although the effect can already be noticeable below 18°C (Ruse, 2020). The cold narrows the blood vessels, increasing blood pressure and the blood’s viscosity, which ultimately results in an increased risk of stroke, heart attack, and hypertension (Lee et al., 2022). People who already are hypertensive have an even greater risk of stroke and heart attack when exposed to the cold (Li et al., 2022). Additionally, Ruse (2020) points out that inflammation from RTIs can increase the risk of blood clots forming in arteries. Considering that people in fuel poverty often underheat their homes, they are at higher risk of developing cardiovascular conditions.
When exposed to the cold, the body engages in heat generation to stay warm. While crucial for survival, this process puts increased strain on the cardiovascular system, which can be detrimental for people with pre-existing cardiovascular conditions (Ikäheimo, 2018). Older adults also have an impaired ability to maintain the body’s core temperature in cold environments; combined with the cardiovascular strain caused by heat generation, they are particularly susceptible to hypothermia and frostbite (Sun and Cheng, 2025). Hence, they need to keep their homes at a higher temperature, which increases their heating costs. Still, despite the need for higher temperatures, older adults are more likely to undertake self-rationing (Jenkins and Eatwell-Roberts, n.d.), increasing the risk of developing cardiovascular conditions.
Additionally, exercise and physical activity are recommended for general good health but can be a crucial part of the treatment plan for respiratory and cardiovascular conditions outlined above, such as asthma, COPD, and hypertension. However, research indicates that exercise in cold environments can add even more strain on the cardiovascular system, especially in people with pre-existing conditions and poor nutrition (Ikäheimo, 2018). As individuals in (fuel) poverty often cannot afford expensive gym memberships (Higgerson et al., 2018), they either have to risk exercising in a cold home or be physically inactive, both of which are detrimental to their cardiovascular health. Physical inactivity, obesity and resulting cardiovascular diseases are already an issue among lower socio-economic groups (Higgerson et al., 2018; Paudel et al., 2023), particularly children (Goisis et al., 2016), with fuel poverty potentially worsening it.
2.3 Mental Health
Apart from the physical health consequences, fuel poverty can also have detrimental effects on a person’s mental health (Champagne et al., 2023). Khavandi et al. (2024) identify four pathways that interact between fuel poverty and mental health; these are social, economic, environmental, and behavioural. Each will be explored in more detail in the following. It is vital to note that these factors do not exist in isolation but rather occur concurrently.
2.3.1 Social
Households experiencing fuel poverty will often resort to heating only one commonly shared room, e.g., living rooms, in the entire home to try and save on energy costs, which is also known as “spatial shrink” (Grey et al., 2017; Mohan, 2022). As a result, damp and mould is caused in the unheated rooms, which has negative health consequences. Additionally, household members will spend most of their time in the heated room, leading to overcrowding and reduced privacy (Mohan, 2022). A lack of privacy can be particularly detrimental for children and teenagers as the ability to retreat to their own (warm) private spaces is crucial for the maturation process, including establishing their identity and becoming independent (Mazzei, 2022; Reid, 2012). Thus, privacy plays a vital role in a household unit and a lack thereof, thus, can deteriorate home relationships.
Furthermore, people who experience fuel poverty may withdraw from social life as fuel poverty is highly stigmatised (Sawyer et al., 2022). This withdrawal can manifest itself in not inviting friends and family over due to the cold temperatures and state of the building (Grey et al., 2017; Sawyer et al., 2022). People may also withdraw from social activities due to not being able to afford the associated costs (Grey et al., 2017). As a result, they feel ashamed, isolated, and lonely. Particularly older people, who may also have a long-term health condition, disproportionately suffer from loneliness (Age UK, 2024), which could be exacerbated if they also experience fuel poverty.
2.3.2 Economic
The effects of poverty and economic hardship on mental health have been well documented. Similarly, they apply to people living in fuel poverty, too. For example, worries about debt, money, and energy bills can present significant stressors for individuals in fuel poverty (Liddell and Guiney, 2015). Specifically, they experience considerable stress and anxiety around receiving bills and the unknown costs these entail (Longhurst and Hargreaves, 2019). Additionally, individuals, particularly primary caregivers, often have to choose between a warm home or a meal; this problem is nowadays widely known as the “heat or eat” dilemma (Grey et al., 2017; Lee et al., 2022). Consequently, they often choose to forgo meals in favour of heating their homes, in turn leading to a poor diet. Facing these difficult decisions daily can worsen one’s mental health.
2.3.3 Environmental
The environmental component primarily refers to the living spaces people inhabit and the subsequent impacts on mental health. An environmental factor that people experiencing fuel poverty are often affected by is thermal discomfort. Thermal discomfort is a subjective and objective dissatisfaction with the ambient temperature (Ormandy and Ezratty, 2015). Research indicates that the physical discomfort of being cold can worsen one’s mental health and contribute to stress, anxiety, and depression (Champagne et al., 2023).
Finally, concerns about the building’s deterioration can negatively impact the inhabitants’ mental health. According to Liddell and Guiney (2015), these concerns present twofold: First, individuals are aware of the negative physical health impacts of a cold, damp, and mouldy home. Consequently, they are worried about the damage to their physical health, causing stress and anxiety. This effect is especially noticeable among disabled individuals and parents of children with long-term health conditions (Mohan, 2022). Second, potential and real damage to possessions as a result of dampness and mould can similarly cause anxiety and depression in individuals.
2.3.4 Behavioural
People living in fuel poverty often make significant changes to their behaviour to try and mitigate the impact of fuel poverty (Khavandi et al., 2024). For example, energy use for appliances, such as ovens, washing machines and heaters, is carefully planned and restricted as part of daily budgeting activities (Longhurst and Hargreaves, 2019; Middlemiss and Gillard, 2015). Even where washing machines are used, households still face the challenge of adequately drying clothes in a cold home, with the added moisture from the clothes further contributing to the dampness and mould production in the house (Whitehead et al., 2022). Additionally, showers are greatly reduced or completely foregone to save energy. As a result, people may appear unkempt, which carries further social stigma and ostracization from society; especially children are at risk of being bullied (Whitehead et al., 2022). Overall, these behavioural changes can take a significant toll on people and worsen their mental health.
2.4 Other Conditions
Cold temperatures can negatively impact other parts of the body, too. For example, exposure to the cold can worsen arthritis and rheumatism (Ruse, 2020). Similarly, it can impact strength and dexterity, leading to increased risks of falls and injuries in older people (Ruse, 2020). Engebretsen et al. (2016) further posit that cold temperatures can disrupt the skin barrier, causing the skin to react more intensely towards irritants and allergens. Combined with the poor air quality, people in fuel poverty are arguably more likely to experience rashes, inflammation or allergic reactions on their skin.