Have winter fuel payments reduced excess winter mortality in England and Wales?

Iparraguirre, José Luis

doi:10.1093/pubmed/fdu063

Cited by 23 publications

(16 citation statements)

References 31 publications

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“…Nonetheless, many of the common causes of death in older people in England are associated with risk factors such as cold and impaired nutrition, with another form of income supplementation in older people, winter fuel payments, linked to about half of the decline in excess winter mortality observed in England during the 1990s. 19 Thus, the findings are biologically plausible.…”

Section: Discussionmentioning

confidence: 70%

Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007–2013

et al. 2016

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ObjectiveThere has been significant concern that austerity measures have negatively impacted health in the UK. We examined whether budgetary reductions in Pension Credit and social care have been associated with recent rises in mortality rates among pensioners aged 85 years and over.DesignCross-local authority longitudinal study.SettingThree hundred and twenty-four lower tier local authorities in England.Main outcome measureAnnual percentage changes in mortality rates among pensioners aged 85 years or over.ResultsBetween 2007 and 2013, each 1% decline in Pension Credit spending (support for low income pensioners) per beneficiary was associated with an increase in 0.68% in old-age mortality (95% CI: 0.41 to 0.95). Each reduction in the number of beneficiaries per 1000 pensioners was associated with an increase in 0.20% (95% CI: 0.15 to 0.24). Each 1% decline in social care spending was associated with a significant rise in old-age mortality (0.08%, 95% CI: 0.0006–0.12) but not after adjusting for Pension Credit spending. Similar patterns were seen in both men and women. Weaker associations observed for those aged 75 to 84 years, and none among those 65 to 74 years. Categories of service expenditure not expected to affect old-age mortality, such as transportation, showed no association.ConclusionsRising mortality rates among pensioners aged 85 years and over were linked to reductions in spending on income support for poor pensioners and social care. Findings suggest austerity measures in England have affected vulnerable old-age adults.

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Section: Discussionmentioning

confidence: 70%

Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007–2013

et al. 2016

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“…These appear to indicate a slight weakening of the relationship between low outdoor temperature and mortality since the introduction of the WFPs in 1997, a result that is compatible with an econometric analysis by Iparraguirre. 21 However, the period since 1997 has also been accompanied by changes in many other factors that may have reduced the risk of cold-related death. These include the efficiency of the thermal insulation of houses, improved heating systems (which are more likely to account for the temporal increase in indoor temperatures shown in Figure 4) and the reduced incidence/fatality of important 'temperature-sensitive' diseases, such as ischaemic heart disease, whose rates have declined rapidly in recent years.…”

Section: Discussionmentioning

confidence: 99%

The impact of home energy efficiency interventions and winter fuel payments on winter- and cold-related mortality and morbidity in England: a natural equipment mixed-methods study

et al. 2018

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Background England, and the UK more generally, has a large burden of winter- and cold-related mortality/morbidity in comparison with nearby countries in continental Europe. Improving the energy efficiency of the housing stock may help to reduce this, as well as being important for climate change and energy security objectives. Objectives To evaluate the impact of home energy efficiency (HEE) interventions on winter- and cold-related mortality/morbidity, including assessing the impact of winter fuel payments (WFPs) and fuel costs. Design A mixed-methods study – an epidemiological time-series analysis, an analysis of data on HEE interventions, the development and application of modelling methods including a multicriteria decision analysis and an in-depth interview study of householders. Setting England, UK. Participants The population of England. In-depth interviews were conducted with 12 households (2–4 participants each) and 41 individuals in three geographical regions. Interventions HEE interventions. Main outcome measures Mortality, morbidity and intervention-related changes to the home indoor environment. Data sources The Homes Energy Efficiency Database, mortality and hospital admissions data and weather (temperature) data. Results There has been a progressive decline in cold-related deaths since the mid-1970s. Since the introduction of WFPs, the gradient of association between winter cold and mortality [2.00%, 95% confidence interval (CI) 1.74% to 2.28%] per degree Celsius fall in temperature is somewhat weaker (i.e. that the population is less vulnerable to cold) than in earlier years (2.37%, 95% CI 0.22% to 2.53%). There is also evidence that years with above-average fuel costs were associated with higher vulnerability to outdoor cold. HEE measures installed in England in 2002–10 have had a relatively modest impact in improving the indoor environment. The gains in winter temperatures (around +0.09 °C on a day with maximum outdoor temperature of 5 °C) are associated with an estimated annual reduction of ≈280 cold-related deaths in England (an eventual maximum annual impact of 4000 life-years gained), but these impacts may be appreciably smaller than those of changes in indoor air quality. Modelling studies indicate the potential importance of the medium- and longer-term impacts that HEE measures have on health, which are not observable in short-term studies. They also suggest that HEE improvements of similar annualised cost to current WFPs would achieve greater improvements in health while reducing (rather than increasing) carbon dioxide emissions. In-depth interviews suggest four distinct householder framings of HEE measures (as home improvement, home maintenance, subsidised public goods and contributions to sustainability), which do not dovetail with current ‘consumerist’ national policy and may have implications for the uptake of HEE measures. Limitations The quantification of intervention impacts in this national study is reliant on various indirect/model-based assessments. Conclusions Larger-scale changes are required to the housing stock in England if the full potential benefits for improving health and for reaching increasingly important climate change mitigation targets are to be realised. Future work Studies based on data linkage at individual dwelling level to examine health impacts. There is a need for empirical assessment of HEE interventions on indoor air quality. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 11. See the NIHR Journals Library website for further project information.

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“…Although there is evidence to suggest that the WFP alters energy expenditure, it remains unknown whether or not this leads to warmer homes or to improved health. Iparraguirre 31 found a positive correlation between the introduction of the WFP in England and Wales and the recent reduction in EWDs in the UK. However, the study is based on aggregate time-series data (as opposed to individual-based data) without comparison regions, limiting the extent to which changes in mortality can be attributed to the WFP.…”

Section: The Winter Fuel Paymentmentioning

confidence: 99%

The effect of the Winter Fuel Payment on household temperature and health: a regression discontinuity design study

et al. 2019

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BackgroundThe Winter Fuel Payment (WFP) is a non-NHS population-level policy intervention that aims to reduce cold exposure and enhance the health and well-being of older adults. Labelling this cash transfer as ‘winter fuel’ has been shown to lead to increased household energy expenditure, but it is not known if this expenditure produces warmer homes or health benefits.ObjectivesFirst, the association between indoor temperature and health was established to identify the outcome measures most likely to be affected by the WFP. Then, whether or not receiving the WFP is associated with raised household temperature levels and/or improved health was assessed.DesignRandom and fixed effects regression models were used to estimate the link between ambient indoor temperature and health. A regression discontinuity (RD) design analysis exploiting the sharp eligibility criteria for the WFP was employed to estimate the potential impact of the payment.SettingThe sample was drawn from the English Longitudinal Study of Ageing (ELSA), an observational study of community-dwelling individuals aged ≥ 50 years in England.ParticipantsAnalyses examining the association between household temperature and health had a maximum sample of 12,210 adults aged 50–90 years. The RD analyses drew on a maximum of 5902 observations.InterventionThe WFP provides households with a member who is aged > 60 years (up to 2010, from which point the minimum age increased) in the qualifying week with a lump sum annual payment, typically in November or December.Main outcome measuresDifferences in indoor temperature were examined, and, following an extensive literature review of relevant participant-reported health indicators and objectively recorded biomarkers likely to be affected by indoor temperature, a series of key measures were selected: blood pressure, inflammation, lung function, the presence of chest infections, subjective health and depressive symptom ratings.Data sourcesThe first six waves of the ELSA were drawn from, accessible through the UK Data Service (SN:5050 English Longitudinal Study of Ageing: Waves 0–7, 1998–2015).ResultsResults from both random and fixed-effects multilevel regression models showed that low levels of indoor temperature were associated with raised systolic and diastolic blood pressure levels and raised fibrinogen levels. However, across the RD models, no evidence was found that the WFP was consistently associated with differences in either household temperature or the health of qualifying (vs. non-qualifying) households.LimitationsThe presence of small effects cannot be ruled out, not detectable because of the sample size in the current study.ConclusionsThis study capitalised on the sharp assignment rules regarding WFP eligibility to estimate the potential effect of the WFP on household temperature and health in a national sample of English adults. The RD design employed did not identify evidence linking the WFP to warmer homes or potential health and well-being effects.Future workFurther research should utilise larger samples of participants close to the WFP eligibility cut-off point examined during particularly cold weather in order to identify whether or not the WFP is linked to health benefits not detected in the current study, which may have implications for population health and the evaluation of the effectiveness of the WFP.FundingThe National Institute for Health Research Public Health Research programme.

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Have winter fuel payments reduced excess winter mortality in England and Wales?

Abstract: Almost half of the reduction in EWM since 1999/2000 is attributable to WFPs.

Cited by 23 publications

References 31 publications

Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007–2013

Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007–2013

The impact of home energy efficiency interventions and winter fuel payments on winter- and cold-related mortality and morbidity in England: a natural equipment mixed-methods study

The effect of the Winter Fuel Payment on household temperature and health: a regression discontinuity design study

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