Cold is not the whole story – what the health services need to know about housing

An AECB consultation response

This document was written in response to a NICE (National Institute for Health and Care Excellence) 2014 consultation on producing guidelines for health authorities on tackling excess winter deaths and illnesses. It was written (mainly) by me, on behalf of the AECB, teaming up with Severn Wye Energy Agency and the STBA (Sustainable Traditional Buildings Alliance) – who also contributed information.

While at the time of this consultation the deleterious impact of cold living conditions on health were well known – prompting the consultation – poor indoor air quality was less discussed.

Yet of course, air quality can be very poor in cold homes: people will block out any draughts they can – including the intended fresh air supply from a ventilation fan or vent – especially if they are in fuel poverty. This only increases the risk of condensation and mould – already high in a dwelling with cold, uninsulated surfaces. And more and more evidence is piling up of just how bad mould in particular is for people’s health and wellbeing.

We wanted to be sure NICE and the health care professions were aware of this, and also, we wanted them to be mindful of the importance not only of improving the energy efficiency of dwellings, but of doing it properly, so the interventions did not make matters worse – as, sadly, poorly executed schemes have done in the past.

We told NICE: “Although ‘cold homes’ is a handy shorthand for a cluster of related miserable and unhealthy circumstances, it would be a mistake to assume that excess winter deaths are all directly mediated by low temperatures.”

“All cold homes are unhealthy (pretty much), and many unhealthy homes will have cold as one of the contributing hazards, but focusing on temperature alone misses one of the main causes of housing-related ill-health, which is poor internal air quality (IAQ) and indoor toxins. Poor IAQ is much likelier in cold homes and generally gets worse in winter, so is clearly related, but the causes are a combination of temperature, water/damp penetration and badly-functioning ventilation.”

Gratifyingly, a specific mention of ventilation appeared in NICE guidance on preventing excess winter deaths.

From NICE 2016 guidance on preventing excess winter deaths

The response still seems germane at the time of posting in early 2018. It has also been pleasing to see that the most recent updates to the PAS 2030 requirements for installers of energy efficiency measures under the government’s ECO scheme, says a lot more about the need to check ventilation provision, than did earlier verisons. The Each Home Counts report from the Bonfield Review Team took these issues on board too. However, with retrofit activity at such a low ebb, it isn’t yet clear if practices on the ground have improved. This is something I’ll be keeping an eye on.

Download or view the response here, or view on the AECB website here