The impact of household energy efficiency measures on health: A meta-analysis

It is widely accepted that interventions designed to promote household energy efficiency, like insulation, central heating and double glazing, can help to reduce cold-related illnesses and associated stress by making it easier for residents to keep their homes warm. However, these interventions may also have a detrimental effect on health. For example, the materials used or lower ventilation rates could result in poorer indoor air quality. The present research sought to systematically quantify the impact of household energy efficiency measures on health and wellbeing. Thirty-six studies, involving more than 33,000 participants were meta-analysed. Effect sizes (d) ranged from −0.43 (a negative impact on health) to 1.41 (a substantial positive impact on health), with an overall sample-weighted average effect size (d+) of 0.08. On average, therefore, household energy efficiency interventions led to a small but significant improvement in the health of residents. The findings are discussed in the context of the health improvements experienced by different groups of participants and the study design factors that influence health outcomes. The need for future studies to investigate the long term health benefits of interventions designed to promote household energy efficiency is identified.

[1]  Philippa Howden-Chapman,et al.  Evaluating energy, health and carbon co-benefits from improved domestic space heating: A randomised community trial , 2010 .

[2]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration , 2009, Annals of Internal Medicine [serial online].

[3]  W. Jędrychowski,et al.  Predisposition to acute respiratory infections among overweight preadolescent children: an epidemiologic study in Poland. , 1998, Public health.

[4]  T. Allan,et al.  Keeping Warm and Staying Well. Does Home Energy Efficiency Mediate the Relationship between Socio-economic Status and the Risk of Poorer Health? , 2005 .

[5]  Y. Ohya,et al.  Home environment and suspected atopic eczema in Japanese infants: The Osaka Maternal and Child Health Study , 2007, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[6]  Unfccc Kyoto Protocol to the United Nations Framework Convention on Climate Change , 1997 .

[7]  V. Murray,et al.  Will drivers for home energy efficiency harm occupant health? , 2010, Perspectives in public health.

[8]  A. S. St Leger,et al.  Housing conditions, respiratory illness, and lung function in children in South Wales. , 1977, British journal of preventive & social medicine.

[9]  C. Pickering,et al.  IPEADAM study: indoor endotoxin exposure, family status, and some housing characteristics in English children. , 2006, The Journal of allergy and clinical immunology.

[10]  M Weishoff-Houben,et al.  Indoor environment and respiratory symptoms in children living in the Dutch-German borderland. , 2005, International journal of hygiene and environmental health.

[11]  H. Thomson,et al.  Health Impact Assessment of Housing Improvements: a guide , 2013 .

[12]  M. Wjst,et al.  Indoor risk factors for atopic eczema in school children from East Germany. , 1999, Environmental research.

[13]  S. Lewis,et al.  Effects of volatile organic compounds, damp, and other environmental exposures in the home on wheezing illness in children , 2003, Thorax.

[14]  A. Emond,et al.  The effects of housing on the health of preterm infants. , 1997, Paediatric and perinatal epidemiology.

[15]  M. Somerville,et al.  Housing and health: does installing heating in their homes improve the health of children with asthma? , 2000, Public health.

[16]  P. Homøe,et al.  Acute otitis media and sociomedical risk factors among unselected children in Greenland. , 1999, International journal of pediatric otorhinolaryngology.

[17]  C. Liddell,et al.  Fuel Poverty and Human Health : A Review of Recent Evidence , 2010 .

[18]  W. Fisk,et al.  Meta-analyses of the associations of respiratory health effects with dampness and mold in homes. , 2007, Indoor air.

[19]  Geoff Green,et al.  Psychosocial routes from housing investment to health: Evidence from England's home energy efficiency scheme , 2012 .

[20]  D. Jarvis,et al.  Environmental and occupational disorders Housing characteristics, reported mold exposure, and asthma in the European Community Respiratory Health Survey , 2002 .

[21]  D. Jarvis,et al.  Association of respiratory symptoms and lung function in young adults with use of domestic gas appliances , 1996, The Lancet.

[22]  T. Waldhör,et al.  Symptoms suggestive of atopic rhinitis in children aged 6–9 years and the indoor environment , 2000, Allergy.

[23]  M. Curtis Localism and local government finance , 2011 .

[24]  P. Corey,et al.  Formaldehyde exposure and health status in households. , 1991, Environmental health perspectives.

[25]  Jan Gilbertson,et al.  Home is where the hearth is: grant recipients' views of England's home energy efficiency scheme (Warm Front). , 2006, Social science & medicine.

[26]  Rosalind J Wright,et al.  When home is where the stress is: expanding the dimensions of housing that influence asthma morbidity , 2006, Archives of Disease in Childhood.

[27]  E. de Oliveira Fernandes,et al.  Perceived health and comfort in relation to energy use and building characteristics , 2006 .

[28]  P. Ernst,et al.  The role of domestic factors and day-care attendance on lung function of primary school children. , 1998, Respiratory medicine.

[29]  J. Hills,et al.  Getting the measure of fuel poverty: final report of the Fuel Poverty Review , 2012 .

[30]  M. Petticrew,et al.  The health impacts of housing improvement: a systematic review of intervention studies from 1887 to 2007. , 2009, American journal of public health.

[31]  G. Richardson,et al.  The paradox of an energy-efficient home: is it good or bad for health? , 2006, Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association.

[32]  D. Strachan,et al.  The home environment and asthma symptoms in childhood: two population based case-control studies 13 years apart. , 1997, Thorax.

[33]  M. Schenker,et al.  Health effects of residence in homes with urea formaldehyde foam insulation: a pilot study , 1982 .

[34]  S. Hunt,et al.  The health effects of improvements to housing: A longitudinal study , 1996 .

[35]  A. Zeghnoun,et al.  August 2003 heat wave in France: risk factors for death of elderly people living at home. , 2006, European journal of public health.

[36]  Chris Cunningham,et al.  Effects of improved home heating on asthma in community dwelling children: randomised controlled trial , 2008, BMJ : British Medical Journal.

[37]  P. Corey,et al.  The effect of domestic factors on respiratory symptoms and FEV1. , 1989, International journal of epidemiology.

[38]  P. G. Rousseau,et al.  Energy efficiency of ultra-low-cost housing , 1995 .

[39]  Jacob Cohen,et al.  A power primer. , 1992, Psychological bulletin.

[40]  S. Chinn A simple method for converting an odds ratio to effect size for use in meta-analysis. , 2000, Statistics in medicine.

[41]  C. Kelleher,et al.  Home environment and childhood asthma. , 1994, Irish medical journal.

[42]  D Norbäck,et al.  Ocular, nasal, dermal and respiratory symptoms in relation to heating, ventilation, energy conservation, and reconstruction of older multi-family houses. , 2003, Indoor air.

[43]  T. Blakely,et al.  Effect of insulating existing houses on health inequality: cluster randomised study in the community , 2007, BMJ : British Medical Journal.

[44]  J. Peat,et al.  Effects of damp and mould in the home on respiratory health: a review of the literature , 1998, Allergy.

[45]  C. Infante-Rivard,et al.  Childhood asthma and indoor environmental risk factors. , 1993, American journal of epidemiology.

[46]  Jorun Rugkåsa,et al.  "The walls were so damp and cold" fuel poverty and ill health in Northern Ireland: results from a housing intervention. , 2007, Health & place.

[47]  R. Górny,et al.  Environmental risk factors for respiratory symptoms and childhood asthma. , 2010, Annals of agricultural and environmental medicine : AAEM.

[48]  Thien,et al.  Residential characteristics influence Der p 1 levels in homes in Melbourne, Australia , 1999, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[49]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[50]  C. Weschler Chemistry in indoor environments: 20 years of research. , 2011, Indoor air.

[51]  H Thomson,et al.  Health effects of housing improvement: systematic review of intervention studies , 2001, BMJ : British Medical Journal.

[52]  J. Douglas,et al.  A randomised trial of home energy efficiency improvement in the homes of elderly COPD patients , 2009, European Respiratory Journal.

[53]  R. Edwards,et al.  Housing related difficulties, housing tenure and variations in health status: evidence from older people in Wales. , 2006, Health & place.

[54]  Harris Cooper,et al.  Integrating Research: A Guide for Literature Reviews , 1989 .

[55]  Inga J. Smith,et al.  The efficacy of an energy efficient upgrade program in New Zealand , 2008 .

[56]  J. Baumer,et al.  Early house moves, indoor air, heating methods and asthma. , 1999, Respiratory medicine.

[57]  Martin Iversen,et al.  Health and comfort changes among tenants after retrofitting of their housing , 1986 .

[58]  M. Petticrew,et al.  Housing and health , 2007, British medical journal.

[59]  J. Kai,et al.  Effect of social factors on winter hospital admission for respiratory disease: a case-control study of older people in the UK. , 2008, The British journal of general practice : the journal of the Royal College of General Practitioners.

[60]  R. Edwards,et al.  Enhancing ventilation in homes of children with asthma: pragmatic randomised controlled trial. , 2011, The British journal of general practice : the journal of the Royal College of General Practitioners.

[61]  Irva Hertz-Picciotto,et al.  Coal Home Heating and Environmental Tobacco Smoke in Relation to Lower Respiratory Illness in Czech Children, from Birth to 3 Years of Age , 2006, Environmental health perspectives.

[62]  M. Petticrew,et al.  Housing improvements for health and associated socio-economic outcomes. , 2013, The Cochrane database of systematic reviews.

[63]  G. Russell,et al.  Wheeze, cough, atopy, and indoor environment in the Scottish Highlands , 1997, Archives of disease in childhood.

[64]  L. Hedges,et al.  Statistical Methods for Meta-Analysis , 1987 .

[65]  P. Chi,et al.  Energy efficiency and radon risks in residential housing , 1990 .

[66]  K. Dear,et al.  The health impacts of cold homes and fuel poverty , 2011, BMJ : British Medical Journal.

[67]  C. Foy,et al.  The Watcombe Housing Study: the short term effect of improving housing conditions on the health of residents , 2007, Journal of Epidemiology and Community Health.

[68]  J. Cochran,et al.  Energy Efficiency Policy in the United States: Overview of Trends at Different Levels of Government , 2009 .

[69]  P. Hunter,et al.  The prevalence of self-reported symptoms of respiratory disease and community belief about the severity of pollution from various sources , 2003, International journal of environmental health research.

[70]  E. Sammaljärvi Impact of certain indoor parameters on children: A questionnaire study , 1991 .

[71]  G. Viegi,et al.  Effects of home environment on respiratory symptoms and lung function in a general population sample in north Italy. , 1991, The European respiratory journal.

[72]  M. Petticrew,et al.  The effects on health of a publicly funded domestic heating programme: a prospective controlled study , 2008, Journal of Epidemiology & Community Health.