The Tip of the Iceberg

In 1841, Registrar General William Farr, a distinguished mathematician and physician who famously said to Florence Nightingale, ‘Statistics should be as dry as dust’ produced the first report which identified a seasonal excess of deaths in the British winter.  Some 170 years later, we are still recording a yearly excess of between 20 and 40,000 winter deaths.  And by far the greatest numbers of those dying in the winter are those over 65, for many of whom both physiology and social conditions create a special vulnerability.

It has taken generations of scientists to unravel the causes of winter mortality.  The evidence is now clear on cause – it is the cold that is the killer.  All other factors, except in conditions of epidemic influenza, pale into insignificance.  So precise is this relationship that it has been calculated at 8,027 extra deaths for every 1°C the winter is colder than the average.  Paradoxically, this algorhythm applies only to the United Kingdom.  The irony is that the colder countries of the world – such as the Nordic lands, Russia, Canada and so on – have much lower winter mortality than the ‘warm’ UK.  It is an amazing truth that Yakutsk, the coldest city on earth with average winter temperatures of – 30°C, has virtually no seasonal fluctuation in mortality.  How can this be?

The answers are peculiarly British. Our heritage of an old and poorly insulated housing stock has meant that for years many have been consigned to winters spent in indoor cold, unable to afford their heating bills.  Add to that the exceptionally cold winters of recent years, rising energy prices and declining winter fuel benefits, we have a lethal cocktail of risk.  Fuel poverty is a real and vital issue for increasing numbers of older people.

But the evidence shows that indoor cold is only half of the story.  Deaths in the winter are largely due to respiratory illness and disease caused by blood clotting, the so-called ‘thrombotic illnesses’ of heart attack and stroke. Over the last few decades we have seen a reduction in deaths from respiratory illness in the winter, brought about it is thought by improving indoor warmth.  What has not declined is the mortality through heart attack and stroke.  These conditions are more dependent on going out into the cold, insufficiently protected by our winter clothes.  If you doubt this, look at the typical British wardrobe: how many of us have a separate winter edition? And how many of us frequently take trips outside without hat, scarf, gloves and coat? And so we are ambushed by winter cold.

Even a conservative estimate shows that the British winter, since Farr’s first report, will have been responsible for over 3 million deaths, deaths which we now know are entirely avoidable.  No wonder research tells us that older people in Britain fear the winter more than any of their European neighbours.  The question is, then, how may these deaths be avoided? Physiologists will tell you that ‘man is a tropical animal’: we must stay warm in order to stay well.  That is why Age UK, working with the Met Office, has taken the best scientific advice to launch its campaign ‘Spread the Warmth’. On the basis of new and compelling evidence, we are advising older people of the risks of both indoor and outdoor cold in an effort to stem the ‘British disease’.   And with DH, we are joining the Met Office as it seeks to alert the public of impending severe cold.  

Some estimates have said that 2,700 people every winter die because of fuel poverty. This is only the tip of a huge iceberg of winter deaths brought about by cold.  By translating the best research evidence into practice and by working with others, we are attempting win the war against the British winter.

Find out more about the Spread the Warmth campaign

Read Met Office guest blog


Hills Fuel Poverty Review

Professor John Hills is possibly the leading contemporary academic expert on poverty and inequality in Britain today.   He follows in the distinguished footsteps of Tawney, Titmus and Peter Thompson.   He accepted the challenge to lead the independent review into fuel poverty because, as he modestly says,

Julio Martinez

he was intrigued by the subject and wanted to understand it better.

The first part of his brief was “to consider fuel poverty from first principles:  to determine the nature of the issues at its core, including the extent to which fuel poverty is distinct from poverty, and the detriment it causes”.   Long term fuel poverty campaigners were fearful that by making this the question, Government ministers wanted to find an excuse to airbrush fuel poverty off the agenda and get off the hook of confronting the rapidly escalating numbers of households dropping into fuel poverty over the last five or six years.   Their fears are confounded in Hills’ Foreword to his report:  “That fuel poverty remains a serious problem is clear from the evidence we review”, he states.  

His report goes on to observe that households in or on the margins of poverty face costs stacking up an aggregate to £1.1bn more than typical households to keep warm, that those on low incomes cannot afford the investment to make their houses energy efficient – which is a key issue in the climate change and carbon reduction agenda, and crucially that living in cold homes has a series of effects on illness and mental health.   That last is the lead item on his chapter on the Impacts of Fuel Poverty.

For the rest of this typically thorough and comprehensive review (over 150 pages), the Hills team have looked at different ways of defining fuel poverty.   The current definition, which John Hills accepts, is based on the 2000 Warm Homes and Energy Conservation Act, which states that “a person is to be regarded as living in fuel poverty if he is a member of a household living on a lower income in a home which cannot be kept warm at a reasonable cost”.   But if the devil is in the detail, this leads to further issues about defining low income, adequate warmth, and reasonable cost, and most of this Interim Report is probing around this area.  

 Hills props up several different methodologies to measure fuel poverty, all of which come up with big numbers, and some are higher and some lower than the current statistical measurements indicate.

 Hills will produce his final report in January, when he will put some recommendations forward, as well as analysing the impact of various policy prescriptions for the growing number of households in fuel poverty.  

 Read the full report

 Find out about our Spread the Warmth campaign

Reading too much into the label?

The Institute for Fiscal Studies (IFS) recently published a paper claiming that ‘households receiving the winter fuel payment are almost 14 times as likely to spend the money on fuel than would have been the case had their incomes been increased in other ways’. They said this would come as a result of how the benefit is labelled: it’s because it’s called ‘winter fuel’ that people spend it disproportionately more on heating their homes in winter –an example of the fashionable ‘nudge’ theory (i.e. behavioural economics) in practice. For once, the IFS may be wrong.

The IFS economists are very competent, and this paper has been covered in the national media, so the possibility that they may have got it wrong took me by surprise.

Statistical regression analysis investigates whether one variable depends on a number of factors. Needless to say, there are always more potential factors influencing the variable under study than the number any researcher can get hold of. Provided none of the aspects excluded from the analysis are highly relevant, the results would be valid nonetheless. Instead, if some crucial factors were left out, then you cannot say anything about what’s being looked into –preferably, you would not even start crunching the numbers.

The IFS investigated the change in expenditure on fuel as a proportion of total household budget following the receipt of the winter fuel payment benefit. Through various statistical techniques they came to the conclusion above. But –and this is the killer ‘but’- the winter fuel allowance is automatically paid… at the onset of winter.  Would people spend the extra £200-£300 in heating their homes if the allowance were paid in, say, June? Hardly so, even if it were re-labelled ‘the extremely polar conditions mother of all winters payment’. The IFS did not take into account one decisive factor: the time of year the payment is given. True, no-one can disentangle the likely influence of labelling and timing on how the winter fuel allowance is spent –but the consequence of this impossibility is that the existence of a labelling effect is far from established.

We, at Age UK, welcome the fact that recipients of the winter fuel payment spend more on fuel, of course, but this is beside the point: this extra spending may not come as a consequence of the word ‘fuel’ but of the allowance being paid when people need to heat their houses most –it’d be more the ‘winter’ side of things than the ‘fuel’. Hence, it’d be very premature to draw the conclusion that benefit recipients could be nudged towards consuming this or that by merely labelling and re-labelling allowances. It might work, it might not. The IFS paper didn’t prove it.

In some countries in Latin America, the annual salaries are divided into 13 payments –not because there are thirteen months, just in case you wonder. The 13th instalment –known as ‘aguinaldo’ in Spanish- corresponds to a payment given a couple of weeks before Christmas. What do people do with their ‘aguinaldo’? They spend it disproportionately on Christmas gifts, dos and dinners, and the vacations they tend to take shortly after. I remember one year in Argentina the government decided to postpone the payment of the ‘aguinaldo’ until the beginning of January. That year, Christmas dinners lacked some of the usual trimmings and retailers saw their seasonal sales plummet, but the following month there was more pocket money to spend by the seaside than usual. Continue reading “Reading too much into the label?”

Tackling fuel poverty and excess winter deaths

It may seem like an odd time to be thinking about the winter and the severe weather we have experienced over the last couple of years, but this month saw the publication of an important report by Prof Sir Michael Marmot and his report team for Friends of the Earth, looking at the health impacts of cold homes and fuel poverty. The report concludes that excess winter deaths (above what would normally be expected) are almost three times higher in the coldest quarter of housing than in the warmest quarter. As a result, thousands of deaths could be prevented each year if British homes were made more energy efficient.

In considering the impact on older people in particular, the report concluded that “the effects of cold housing were evident in terms of higher mortality risk, physical health and mental health.” It goes on to say that improving the energy efficiency of the existing stock is a long-term, sustainable way of ensuring multiple gains, including environmental, health and social gains. Around 5,500 more deaths occur in the coldest quarter of houses every year than would happen if those houses were warm. In 2009-10, there were an estimated 25,400 excess winter deaths, of which 21.5% can be attributed to the coldest quarter of housing.

Perhaps most tellingly, Prof Marmot argues that Government policies, actions and financial support for interventions aimed at reducing fuel poverty and improving the energy efficiency of existing stock need to match its stated commitment to both the public health and climate change agendas. The Government’s current support and financial commitment to addressing the problem of poor thermal efficiency of housing remains inadequate, given the potential it has to improve the health and wellbeing of the population and help mitigate climate change.

If, as the report concludes, a renewed effort is needed to support programmes and policies which have shown to be successful in increasing energy efficiency of homes and improving the health of their residents, then much of this effort will have to come through the ‘Warm Front’ scheme. This supplied grants to help pay for heating and insulation improvements, but the programme was not well targeted and it effectively ran out of money, leading to its suspension in December 2010. It was reopened in April 2011, but is now targeted at a smaller range of households on certain income-related benefits and living in properties that are poorly insulated or have a broken heating system.

The government is meanwhile conducting an independent review into the definition of fuel poverty, which while it might help us identify those most in need, will do little to address the underlying problem of cold homes and how to treat them.

Here at Age UK, we aim to tackle the problem on a number of levels, not least by offering practical advice and support services to help older people live safer, healthier and more fulfilling lives. Find out more at Spread the Warmth.

Making the Energy Bill work for the fuel-poor

Energy is top of the news bulletins at the moment with cold weather leading to supply difficulties for people who don’t have access to mains gas and electricity supplies. The Government’s immediate response has been heavily scrutinised but their longer-term strategy for energy use should perhaps receive more attention than it has. The Energy Bill, published in the House of Lords in mid-December, lays out the Government’s approach for the future.

The Energy Bill, which will give effect to the Green Deal, signals a welcome step change in the government’s approach to improvement of housing stock, much of which is characterised by inadequate insulation and inefficient heating systems. A concerted programme of home improvement work is essential if we are to improve energy efficiency in homes and reduce our use of fuel. The Green Deal will include a financial plan that lets householders pay for energy saving measures in instalments through their energy bills. Continue reading “Making the Energy Bill work for the fuel-poor”

Big chill continues

Photo: Andy Wilkes via Flickr
Photo: Andy Wilkes via Flickr

Why does snow always seems to catch us by surprise? Once the joy of a pretty snow-filled landscape has passed the realities of getting out and about and keeping warm set in – and it’s hard work. This year, as we enter the third week of severe cold weather, it’s clear that the UK just isn’t built for this.

Over the past few years snow problems seem to point to one thing, councils having enough grit. But even if enough had been supplied, with this much snow and ice it will mostly be used on main roads rather than our residential roads. That doesn’t help if you just want to get to the corner shop for a few essentials while you wait for the thaw. It’s even worse if you’re venturing out on foot. The government’s latest response is to get the public to clear the roadsContinue reading “Big chill continues”

Winter fuel payments – a necessity for millions

Winter radiator - Photo: HarlanH via Flickr
Photo: HarlanH via Flickr

With the recent Comprehensive Spending Review protecting universal benefits for older people for example the Winter Fuel Payment, there has been lots of debate about whether better-off older people really need these payments. Opinion is divided on the issue – including among older people.  Peter Preston in the Guardian argued that those older people who could afford it should donate their Winter Fuel Payments to charities – one such scheme has now opened in SomersetContinue reading “Winter fuel payments – a necessity for millions”