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

Abstract

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.

Effects of indoor and outdoor temperatures on blood pressure and central hemodynamics in a wintertime longitudinal study of Chinese adults

“…Our results are most similar to two recent studies of adults in the UK (systolic: À0.3 to À0.5 mmHg; diastolic: À0.2 to À0.5 mmHg per 1 8C) that, like our study, also controlled for sociodemographic confounders (e.g. education, wealth, marital status) [13,34]. Controlling for these factors may be especially influential in settings like ours where socioeconomic constraints can influence home heating practices and S6, http://links.lww.com/HJH/B976.…”

Effectiveness of financial support interventions to reduce adverse health outcomes among households in fuel poverty in the United Kingdom

“…Among the two [ 44 , 45 ] studies that looked at the relationship between WFP and fibrinogen levels one study [ 44 ] has shown a significant reduction in serum fibrinogen as a health benefit associated with WFP. They further report that raising the eligible age for WFP with changing state pension age has adversely affected the health of those who lost the benefit [ 44 ].…”

Associations between indoor temperature, self-rated health and socioeconomic position in a cross-sectional study of adults in England

“…A recent study in England found no impact of Winter Fuel Payment eligibility on indoor temperature, 58 but no study has examined at individual level the impacts of energy efficiency retrofits on indoor temperature, residents’ heating-related behaviours, or health. When linked data are available, we intend to examine the associations of indoor temperature with subsequent hospital admissions and mortality.…”