Thursday 7 September 2023

Fuel Poverty and the Heat or Eat Diaries

Fuel poverty means being on a low income and at the same time facing high costs of keeping warm and ensuring basic energy services. It is driven by household income, the increasing cost of energy and the energy efficiency of a home. In 2020, one in five UK households with dependent children experienced fuel poverty. 

Households more likely to be affected by fuel poverty are, for instance, those that are home to people with disabilities or ethnic minority households.

Living with a disability increases the risk of experiencing fuel poverty. It leads to a reduced income: 27 per cent of households that include someone who is disabled are on a low income when measured before housing costs, compared with 15 per cent of households with no disability; and their cost of living is higher. Disabled people face higher energy bills due to having additional needs (such as medical equipment that requires a power source) and spending longer periods at home (41) (42) (2).

Minority ethnic households are more likely to be in fuel poverty than White households (Figure 8). This is partly explained by the income inequality experienced by Minority ethnic households. Official rates of fuel poverty show a decrease in the fuel poverty gap between White and non-White households since 2017, but fuel poverty rates are still higher for Minority ethnic households (43) (44).

Fuel poverty also means health inequality and has a negative impact on health. It can either cause or worsen poor mental health, dementia, respiratory and cardiovascular conditions, hypothermia, and problems with child development. According to estimations, the NHS spends a minimum of 2.5 billion pounds per year on treating illnesses that result from cold and damp homes.

Cold homes and fuel poverty contribute to the phenomenon of excess winter deaths. England saw an estimated 63,000 excess winter deaths in 2020–21. Estimates suggest that some 10 per cent of excess winter deaths are directly attributable to fuel poverty and 21.5 per cent are attributable to cold homes. (Lee et al., 2022)

Older adults, children and people with chronic illness or disabilities are more likely to experience the consequences in terms of health. Since body temperature lowers with old age, physiological thermoragulation becomes less effective. Cold temperature can cause rising blood pressure in older people and increase the risk of strokes. According to a study, the Fuel Poverty Index is a predictor for hospital admittance since there is a relationship between energy efficiency of the home and winter respiratory symptoms among older people.

Studies indicate that cold conditions can exacerbate existing medical conditions including diabetes, certain types of ulcers and musculoskeletal and rheumatological conditions (55). Decreasing body temperature is associated with a build-up of markers for dementia and Alzheimer’s in the brain. A study of over 3 million patients in the United States found fewer dementia-related hospital admissions when temperatures were warmer than average, and that variability in temperatures increased admissions (62). People living in fuel poverty with a diagnosis of dementia may be even more at risk from cold homes due to difficulties in communication and difficulties in being able to self-manage their indoor temperature (such as managing a heating system or being able to dress for the cold), and may become more confused (63). 

Excerpts from "Heat or Eat Diaries" of people living in the United Kingdom (The Guardian):

- 1  Marin, in her 60s

(...) I have battled a fair deal in my 60-something years, but these are some of the hardest times, demanding all of my fortitude. Because this isn’t living, it is enduring. I always got by, but now, due to low pay, soaring prices and my age, I teeter closer and closer to poverty. I worry about being able to keep earning enough to pay my bills. I worry how I’ll get through the next five years to state pension age. I worry, and then what? I worry. 

“Heat your room to 18C,” says the health advice. But what if you don’t have the money? There have been moments over the past few days when I have been so cold I can’t get warm, fingers fridge-chilly and stiff, body weary. I read about what the cold does to your body, increasing the risk of stroke and heart attack. The government knows this. Illness brought on from people being unable to keep themselves or their families warm is inhuman. Putin didn’t start austerity, the Tories did. (...)

I used to read my son Charlie and the Chocolate Factory, where his grandparents never got out of bed, and realise this is my life now. I am freelance, so I work from my bed – it’s a claustrophobic world. My woollen mattress topper, purchased in a charity shop for £10, helps keep me warm and is the best find ever. I try not to think about who probably died on it.

(...) My rented home is poorly insulated – I put the heating on for two hours last week to dry some washing and the temperature rose from 7C to 8.5C. (...)

- 2  Sophie, single mum to two autistic children

(...) Today I had cold rice pudding because I didn’t want to use the microwave. When I boil the kettle, I fill a flask up, so I can have another cup of tea later or some instant soup for lunch. The other day, I boiled some eggs in the same pan I was cooking pasta. Frozen veg seems to cook quicker and I do it all in one pan, and I’m certainly not cooking a roast dinner at the moment. It’s about scrimping and saving where I can to minimise that initial shock. (...)

- 3  Siobhan, in her 30s

(...) My dad is entitled to a rebate from his electricity provider – which got more and more urgent when temperatures dropped to -8C. He doesn’t have central heating, he’s 6ft 4in but only weighs about 8 stone. He needs the space heater on, but electricity has been costing him £15 a week. To claim the rebate on his behalf – which isn’t paid in cash, it just credits his account – I have to go to a post office with one of three forms of ID: either a passport, a driving licence or a utility bill. But my dad doesn’t have a passport or a driving licence. What’s the point when you’re too sick to travel or drive? He doesn’t have a utility bill as it’s all done online: who has a utility bill in 2023? 

For weeks, my life has been hanging on the phone to his electricity provider, who assure me every time that the post office will accept alternative ID, like letters from the DWP or the council or the NHS – and then queueing in every post office within walking distance, only to be turned away in front of a long line of neighbours because it’s not the ID specified by the provider. 

Yesterday, finally, my dad told me to give up as I probably looked too scruffy – and ask my landlord to have a go instead. My landlord went in – a middle-aged, middle class, white man – and the post office added the rebate to my dad’s account straight away. It may be just coincidence, but things like that make me so angry. I’m walking around in this total rage – and then a day later, I’m numb, then I’m so tired and exhausted to my bones, I feel like I’m going to cry. Then all that passes and I feel really accepting of all the stuff I can’t change – before something happens to trigger the anger again. I’m living on this constant emotional rollercoaster. 

Loads of my energy is spent keeping Dad warm. It’s hot-water bottles, blankets and I’ve now ordered him heated clothing – leggings and a vest that you can charge up with a USB, a bit like an electric blanket, but wearable. They were expensive – £30, so it was a big decision – but he’s so poorly that if he doesn’t stay warm, he’ll die. Like everything in the post, though, they still haven’t arrived. (...)

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- Alice Lee, Ian Sinha, Tammy Boyce, Jessica Allen, Peter Goldblatt (2022). Fuel poverty, cold homes and health inequalities. London: Institute of Health Equity.
- photographs by Saul Leiter via 

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