Exploring the links between energy efficiency improvements ...Exploring the links between energy efficiency improvements and health and wellbeing Elaine Caldow, Public Health Practitioner,

Exploring the links between energy

efficiency improvements and health and

wellbeing

Elaine Caldow, Public Health Practitioner,

NHS Ayrshire and Arran

and

Cassandra Dove, Researcher Officer,

Energy Agency

Reducing CO2 and greenhouse gas

emissions in

ScotlandReducing CO2 and

greenhouse gas

emissions in

Scotland

Building Foundations for Health

and HousingExploring the links between energy

efficiency improvements and health and

wellbeing

Oct 2018


emissions in

Scotland

Background

Local Housing Strategy

Sustainable Housing

Local Context

Fuel Poverty

Climate Change

Contribution of Housing Stock to Climate Change

Extent, location and nature of fuel poverty

Maximising the uptake of energy-efficiency programmes

HEEPS:ABS targets & outcomes

Housing Contribution Statement

Health & Social Care


emissions in

Scotland

Background

Fuel Poverty:

Respiratory

conditions

Cardiovascular

conditions

Mental health

Excess winter

deaths

Poor health:

Housing

energy-

efficiency

Cold homes:65% of

households in

the west of

Scotland are

classed as

‘cold homes’

(EPC rating of

between D

and G)

Households spending more than

10% of their income on fuel

(2014-2016):

31% Scotland

38% East Ayrshire

28% South Ayrshire

Average Energy-

efficiency Rating:

63 Scotland

64 East Ayrshire

63 South Ayrshire

Target:

69+

Band C

Local context


emissions in

Scotland

Energy Agency:

Charity providing free, impartial and expert advice to households, businesses and communities, covering energy efficiency, renewable energy and sustainable transport.

Managing agent for the HEEPS:ABS programme*

• South Ayrshire

• East Ayrshire

• Dumfries & Galloway

• *Home Energy Efficiency Programme Scotland: Area Based Schemes

Background

Initial Discussions

Feasibility Study (2015)

Full-scale Evaluation (ongoing)

NHS Ayrshire & Arran (Public Health)

Energy Agency


Literature Review

Pilot Study

Steering Group Advisors

Energy Agency

Recruitment of Participants


South Ayrshire & East Council - Steering Group Advisors

Scottish Government - Steering Group Advisor


Research Support


Dissemination

Energy Agency

Employment of full-time Research Officer

Project management and administration

Equipment & other resources


South Ayrshire & East Council - Steering Group Advisors

Scottish Government - Steering Group Advisor

University of Strathclyde/GlasgowFindings


emissions in

Scotland

Background

Feasibility Study (2015)

Literature review

Fuel poverty, cold homes and health

Housing energy efficiency

improvements and health (logic

model)

Methodological considerations

Theory of change

Study Design

Timescales

Confounding factors

Research tools

Semi structured qualitative interviews

Testing and prioritising outcomes

Methodological considerations

Confounding factors

Feasibility Study

(led by Public Health)


emissions in

Scotland

Background

Quantitative

Data

Qualitative

Data

Warmth &

Energy-

efficiency

Improvements

Use house for

hospitality

Housing

conditions

improved

Fuel use/costs

reduced

Reduced fuel bills

Increased indoor

warmth and

comfort

Increased control

over house

temperature and

hot water

Increased pride in

house

Improved ease of

heating house

Affected relationship

with housing provider

varied by status of

tenant

Increased disposable

income for food

Increased use of

kitchen

Increased use of

indoor space

Increased motivation

to tidy & clean house

Improved diet

Increased privacy

Improved

relationships &

social interaction

within the household

& family functioning

Increased

opportunities for

leisure & study in

house

Increased emotional

security & feeling of

being at ease in

home

Improved physical

and mental health

Improved/no change for

“other symptoms”

General health

improved

Respiratory health

improved/little change

Mental health

improved/deteriorated

Reduced

time off

school/work

Links supported

by data

Links implied by

data

(Thomson et al., 2013)

Logic Model


emissions in

Scotland

HEEPS:ABS

Eligibility:

• Funding allocation for

each local authority in

Scotland

• Open to all tenures

•Targeted at fuel poor

areas

• Primarily external

wall insulation

Home Energy Efficiency Programmes for Scotland:

Area Based Schemes


emissions in

Scotland

Evaluation

Energy Efficiency

Temperature change within

the home

Thermal comfort experienced in

the home

Changes in home temperature management

Changes in actual fuel

consumption

Changes in actual expenditure on

fuel

Health & Well-being

Impact on general health

Impact on respiratory and

circulatory diseases

Impact on mental

wellbeing

Change in SAP

Ratings

Change in Modelled Fuel

Costs

Customer Satisfaction

Annual/Lifetime CO2 savings

Annual/Lifetime cost savings

Fuel Poverty Status

Previous Evaluation


emissions in

Scotland

Evaluation

Energy Efficiency

Temperature change within

the home

Thermal comfort experienced in

the home

Changes in home temperature management

Changes in actual fuel

consumption

Changes in actual expenditure on

fuel

Health & Well-being

Impact on general health

Impact on respiratory and

circulatory diseases

Impact on mental

wellbeing

Change in SAP

Ratings

Change in Modelled Fuel

Costs

Customer Satisfaction

Annual/Lifetime CO2 savings

Annual/Lifetime cost savings

Fuel Poverty Status

Proposed Evaluation


emissions in

Scotland

Proposed EvaluationStudy design

2015 2016 2017 2018

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Apr-

Jun

Prospective: Baseline

Retrospective Study

Prospective: Follow-up

Prospective: Pre-Assessment

Prospective : Post-Assessment

Install period

Control Intervention Control Intervention


emissions in

Scotland

Proposed EvaluationStudy Design

2015 2016 2017 2018 2019

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Prospective:

Baseline

Retrospective Study

Prospective:

Follow-up

Completed

projects in

South and

East Ayrshire


emissions in

Scotland


2015 2016 2017 2018 2019

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Prospective:

Baseline

Retrospective Study

Prospective:

Follow-up

Prospective:

Baseline

Retrospective Study

Prospective:

Follow-up

Prospective:

Baseline

Prospective:

Follow-up in 2019

Part 2

Completed

projects in

Dumfries &

Galloway

Part 3

Completed

projects in

South and

East Ayrshire


emissions in

Scotland


2015 2016 2017 2018 2019

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Apr-

Jun

Jul-

Sep

Oct-

Dec

Jan-

Mar

Prospective:

Baseline

Retrospective Study

Prospective:

Follow-up

Prospective:

Baseline

Retrospective Study

Prospective:

Follow-up

Prospective:

Baseline

Prospective:

Follow-up in 2019

Prospective:

Baseline

Prospective:

Follow-up in 2020

Part 2

Part 1

Part 3

Prospective 1 = 95 households

Prospective 2 = 94 households

Prospective 3 = 113 households (including North Ayrshire &

South Lanarkshire)

Prospective 4 = Ongoing

Retrospective I = 78 households

Retrospective II = 42 households

Part 4


emissions in

Scotland

Control Group

Baseline Assessment (Winter prior to the insulation upgrades):

No Intervention

Intervention Group

Intervention

Follow-up Assessment (Winter following the insulation upgrades)

Prospective StudyAssessment tools

• Household Questionnaires: Property conditions, occupancy patterns,

heating system and expenditure on fuel

• Health Questionnaires: SF-36 scores, GP & Hospital visits, long term

health problems, colds & flus

• Environmental Monitoring: Record of room temp/RH, thermal comfort

diary, meter readings

Detailed temp/RH monitoring on

selected properties

• EPCs: Modelled energy consumption, modelled fuel

costs, modelled CO2 emissions

°C

??


emissions in

Scotland

Findings to dateAggregate results

Property conditions

94% of respondents agreed that the

appearance of their home had been

improved by the insulation

79% also felt that the street or

neighbourhood had improved a lot

55% of participants who reported

having a problem with condensation or

dampness said that this appears to have

been improved

There was a reduction in the number of

intervention households reporting issues

with cold spots and draughts in the

property.

23% had noticed a reduction in the

level of noise

Average EER increase

of 8 points

Before

Properties with below average

energy-efficiency

After

Properties with below average

energy-efficiency49% 21%


emissions in

Scotland


Property conditions

“In the winter the upstairs is used, whereas

the last couple of winters it hasn’t been…We

were all sleeping in here [living room] but

last winter we were in our own rooms”

“I always liked it to be nice but now I take

more pride in it. I even got my hedge cut

shorter so everybody could see my house. I

think it’s lovely”

“You used to get up in the

morning and the window would

just be running with

condensation and now it’s not“

“We noticed the difference straight

away...it was quite obvious that it

was a lot warmer”


emissions in

Scotland


Neighbourhood

“More folk talk because they’re

talking about the houses. Folk

speak to you that’s never spoke

to you before”

“You it makes the street look great.

Everybody’s happy and it makes you want

to do stuff to the building to keep it nice”

“I think it’s improved the street,

definitely...Not even just the

street, the whole village”

“It’s made a nice change to the

village itself. Nearly all of the

homes got done….so you feel

pride in that”


emissions in

Scotland Fuel Costs

Fuels bills were reduced by

23% on average (2 - 39%)

This equated to average annual

fuel saving of approximately:

£250

£Modelled changes in fuel expenditure (EPC)

Fuel Poverty (estimated)

Before

After

45%

27%


57%34%

9%

Fuel Bills

Decrease

About thesame

Increase

Reported changes in fuel expenditure

“My gas and electricity has

gone from £140 to £79”

“They’re gonna actually repay me

now...£496 you know, it’s very nice

thank you very much”


emissions in

Scotland Occupant Behaviour

Over 46% of households

reported that they did not monitor

their energy use at all

11% reported becoming more

energy conscious since receiving

the insulation

°C

43% have decreased the number of heating

hours required per day

20% have decreased the temperature of

their main thermostat

15% have turned down at least 1 radiator

The need for additional room heaters, hot

water bottles, electric blankets and extra

clothing and has been reduced

78% felt that the

overall temperature of

their home had increased

79% found that

their home now

heated up more

quickly88% agreed that their

home was able to retain

the heat more effectively

34% had been prompted to

make other improvements to

their property (e.g. gardens,

internal décor)



emissions in

Scotland

Prospective Study Monitoring example

Living room:

increase from 19°C

to 21°C

Kitchen:

increase from 18°C

to 20°C

Bedroom:

No change (not

typically heated)

Gas consumption

decreased by 43%

(Close predicted

benchmark of 35%)

Estimated annual

saving: £220

Example property (end-terrace occupied by 2 pensioners):

Environmental Monitoring


emissions in

Scotland

Prospective Study Monitoring example

Environmental Monitoring

Relative Humidity Monitoring:

Part 2 Findings

The majority of properties

exhibited mean relative

humidity values which were

within the

recommended range of 40 to

60%RH.

There were however 15

households where there

was evidence of high relative

humidity during the baseline

assessment.

Following the

insulation upgrades, only 1

household exhibited average

relative humidity values which

were above 65%RH.


emissions in

Scotland

“I believe I feel better and

more comfortable about the

house, I really am….With the

dampness…it helps my

breathing a lot and I sleep

better”

“I think with the house being

warmer its helped my

arthritis a lot cause I’m not as

sore now…It doesn't take me 3

hours in the morning now to

get moving”

“I don’t know if it’s just

a general thing but I’ve

not had as many colds”

“My kids and my husband used to get

tonsillitis all the time…we genuinely

believed that those [condensation &

damp problems] were factors in how

unwell we were in the house and I

think it has improved”

Health results (self-reported)

16 cases of improved respiratory health in

adults (e.g. asthma, COPD and seasonal

illnesses)

7 similar cases for children

5 cases of pain reduction (e.g. arthritis)

Health FindingsAggregate results


emissions in

Scotland

“you are a bit more content

that you know you’re coming

into a warm house…it’s quite

nice to come in and shut the

door and be quite cosy”

Health results (self-reported)

16 cases of improved respiratory health in

adults (e.g. asthma, COPD and seasonal

illnesses)

7 similar cases for children

5 cases of pain reduction (e.g. arthritis)

39 cases of improved mood/mental well-

being – linked to increased comfort and

satisfaction with the home

“It just looks better. If somethings

nice you try to keep it tidier. That’s

just general human nature isn’t it?”

Health FindingsAggregate results

“Well it’s more comfortable

and a pleasant environment…

Psychologically, since you’ve

had the insulation you feel the

house is gotta be warmer”

“It’s like the outside of a

book, you know, it’s nice

when you open up the pages

and go in feeling different”


emissions in

Scotland

SF-36 Scoring System

0

20

40

60

80

100

PhysicalFunctioning

Rolelimitations(physical)

Rolelimitations(emotional)

Energy &fatigue

Emotionalwell-being

Socialfunctioning

Pain

General health

Physical

Health

Mental

Health

5861

6763

0

20

40

60

80

100

Warmth Improvements No Warmth Improvements

Avera

ge S

core

(0

-100) Baseline

Follow-up

General Health Domain

Prospective Study (Part 1)Health Results


emissions in

Scotland

Prospective Study (Part 2)Health Results


0

20

40

60

80

100

PhysicalFunctioning



Energy &fatigue

Emotionalwell-being

Socialfunctioning

Pain

General health

Physical

Health

Mental

Health

78 84Overall Scores:


emissions in

Scotland

Prospective Study (Part 2)Results


0

20

40

60

80

100

PhysicalFunctioning



Energy &fatigue

Emotionalwell-being

Socialfunctioning

Pain

General health

Individual categories:

(participants who described their home ‘much warmer’)


emissions in

Scotland

Data Linkage (Postcode level data)Preliminary Results

Standardized

Hospital

Admissions for

Respiratory

Conditions

All Ayrshire

Control

Intervention

Standardized

Hospital

Admissions for

Cardiovascular

Conditions

All Ayrshire

Control

Intervention


emissions in

Scotland

Theory of changeEvidence to date


emissions in

Scotland What we have achieved:

• Development of a practical evaluation procedure for ABS

• Ongoing partnership with NHS (Ayrshire & Arran)

• Recruitment of households – 300+ visits conducted to date

Difficulties Encountered:

•Sample sizes & diversity

•Project timescales & follow-up period

•Recruiting control groups

•Obtaining accurate energy consumption data


emissions in

Scotland Outputs:

• Prospective Study Wave I (Complete – Aug 2017)

• Prospective Study Wave II (Complete - June 2018)

• Prospective Study Wave III (Expected June 2019)

• Retrospective Study Wave I (Complete – Mar 2017)

• Retrospective Study Wave II (Complete – Mar 2018)

Next Steps:

• Wave III Data collection

• Further NHS collaboration – health data linkage

• PhD project in collaboration with Glasgow University


emissions in

Scotland

Thank you

www.energyagency.org.uk

Home Energy Scotland:

0808 808 2282

http://www.energyagency.org.uk/

Documents

Exploring the links between energy efficiency improvements ...Exploring the links between energy efficiency improvements and health and wellbeing Elaine Caldow, Public Health Practitioner,