Earth Notes: 10:10 Heat and Health Conference (2019)

Updated 2024-04-19.
Read brief live notes from the workshop. Yes, heating does impact health!

Waterloo Action Centre, mezzanine room, 14 Baylis Road, London SE1 7AA Tuesday 30th April 2019 10:00 to 16:00 BST.

I am here today having seen a tweet by @alicebell. Fixing fuel poverty is something that Radbot can help with.

This event was described by Alice as part of a suite of meetings to get interesting people to talk to one another.


Q&A Session One

Short presentations and questions.

Brenda Boardman, Oxford University

Dr Brenda Boardman Emeritus Research Fellow, Oxford Environments Change Institute

Assume that (UK) people need heating.

Worse performing buildings increase stress, eg mental health issues.

50k excess winter deaths in 2017--2018: unusually high.

Does a cold home cause cold-related illness? NICE suggests 30% of it. Dr Boardman thinks that that's a gross underestimate. No firm data, and applies to all age groups, bar young men who have excess summer deaths (eg on motorbikes).

Suggested 1 : 15 : 17 (deaths : hospital admissions : GP visits)

No reliable costs, cannot quantify benefits.

Medics don't know home conditions of those they treat, sending people back to cold homes.

Move someone out of fuel poverty by putting them in EPC band B or A home.

There are UK government fuel-poverty targets of lifting people from bottom bands. By 2030 have no one in EPC band D or below (legally binding), but not enough is actually being done.

In Q&A suggested mean temperature should be at or above 18°C over 24h period. Maybe 15°C at night, 21°C during day?

Eleanor Benton and Laura Lane, LSE

LSE Housing and Communities

Retrofit to the Rescue: Environmental upgrading of multi-storey estates.

Eleanor will talk about EnerPHit. Upgrades of three tower blocks in Portsmouth.

11 storeys of 3-bedroom maisonettes, residents in situ throughout. Expected life (at least) 40 years.

Far cheaper to refurb then demolish and rebuild.

LSE interviewed a sample of residents before, during and after. Questions included health.

Clear majority of residents described flats as too cold, eg not using the living room during winter.

Significant reductions in bills and increase in comfort. Draft, condensation and mould problems gone.

Builders interactions with tenants initially not adequate, but improved markedly through the process. (Eg builders actually turning up for appointments with tenants.)

Tenants have to adjust to new issues, eg overheating, and windows that opened on to a balcony now open into enclosed balcony.

£117k per flat. Heat demand after works 25kWh/m^2/y. Went from EPC band E or D to ~B (EnerPHit).

Were also able to add new dwellings in previously unused space.

Kate de Selincourt, freelance consultant

Kate de Selincourt: Environment, energy, sustainable building

Cold homes and Ill-health

Some cold-home-caused illness include asthma and dementia, as well as heart disease, circulatory disease and stroke, and mental health.

Hard to invite friends round, get space for children to do homework, etc.

Underheated bedrooms (down to 10°C) can suffer condensation and then mould. This causes illness.

Cold and damp go together.

People turn off extractor fans that they can hear, thinking them expensive to run.

Does heating/fabric efficiency improvement make people better? Lots of anecdotal evidence, but fewer hard numbers. Health numbers (including costs) are elusive.

Carmarthen study: 20,000 homes (30,000 residents) upgraded over 10 years. (Sarah Rogers, now at Liverpool.)

University of Swansea (or Wales?) looked at medical records (hospital stays) vs building interventions.

Looked at emergency hospital admissions for lungs, heart, falls. Focus on over 60s.

39% fewer admissions.

Biggest fall was where ventilation was upgraded with other electrical work. 57% fewer admissions in the over 60s.

Welsh study - ARBED

Energy retrofit helps with damp, especially with improved ventilation.

Bad retrofits driven by simplistic cheap metrics make things worse, eg cavity wall insulation in rain-lashed walls lets water soak through.

Ofgem knows fraction of failures of measures (eg 8% of solid wall).

New standards coming in for government-mandated retrofit, and include ventilation.

What about carbon? What about gas?

With EnerPHit or Passivhaus, direct electricity heating bills can be very low, eg below gas standing charge for social tenants.

Tenants worry about revenge evictions if they complain about being cold, or rents going up which is then totally non-discretionary expenditure.

Open Space Discussion

11:30 Open space discussion. Topics to be decided by participants.

A couple of discussion topics that I was involved in:


Heating the person, eg by putting more clothes on, is a message that people need reminding of. Annie of Speakup Self-Advocacy says that peer support and reminders are very powerful with the people she works with, eg learning disabilities, autism, enduring mental health problems,

Q&A Session Two

Q&A session two. Short presentations and questions.

Graeme Sherriff, University of Salford

Dr Graeme Sherriff, Sustainable Housing & Urban Studies Unit, University of Salford.

Heat and health...

Talked to people about their experiences of health and heating rather than calling it fuel poverty.

With mental health issues, the additional stress of big utility bills does not help.

Conversely, helping people (eg) get on the right tariff, and understand how to use their heating system, can be reassuring.

Using the heating correctly often meant using a some more, so not saving carbon.

Sometimes though people can be guided to benefits that they did not know about to deal with the extra cost.

After retrofit, people could use more of their home, eg not having to put heating on in the living room hours in advance.

Interesting case: dealing with unplanned ventilation persuaded one household to stop smoking, saving them money on top of the energy savings!

In EnergPHit retrofit, people liked only having to use the heating a few days a year, but did not like being unable to have a letterbox for example.

Some things that effected quality of life but were not part of the plan, were such as not being able to allow people to fit own satellite dish to match their cultural background (not making penetrations in the building fabric).

Elsewhere in the world (even in the UK), eg in Australia, overheating is a danger in any residential building.

Ruth London and John Charnock, Fuel Poverty Action

Fuel Poverty Action, @fuelpovaction

Going ~8 years, one main worker!

Rules are not being enforced, such as minimum energy standards for rental.

Residents do need to be listened to when they speak up, and would be more engaged if they got results when they did so.

District heating is not well regulated and illustrates that people that will have to pay to cut carbon have to be involved.

Unexpected/unwanted side-effects of insulation: damp, flammability, toxicity of insulants (and even combustion products).

Results in people rejecting insulation, for example.

In other cases attempts by residents (Pembroke Park) to get grossly defective (loft) insulation fixed have been fruitless for 10 years or so.

District heating can be very good. But can be very bad eg because of poor billing and poor regulation and inability to switch suppliers. Unaccountability has a mental health impact.

Some of the bad cases have helped influence standards, eg from CIBSE and BEIS.

John described 90h of outages over ~19 times per year. An old rickety 60s/70s system where the whole system has to be shut down to fix any one part. (Compensation for the 90h outage is £15.)

Also the heating system is off from May to September, regardless of weather. Also tenants don't understand why they are paying a fixed amount each month, even when the heating is not running.

Also a lot of "computer says no" and similar council bureaucracy makes the experience worse.

(District heat does not have a full equivalent of the priority service register of other utilities.)

All sorts of safety issues eg with carrying how water around from the kettle when the central system goes off.

Heating is a huge and dominating issue for all tenant discussions.

Summary: "low carbon heating can't just be left to the experts, essential though the experts are."

Annie Ferguson, Speakup

Speakup, and presentation on Being Warm Being Happy.

Works with people with learning disabilities, also persistent mental health issues for example, in south Yorkshire.

Project: "Being Warm, Being Happy".

Phase 2: insight into 10 households' experience of fuel poverty, eg emotions and values, knowledge and experience. (2 homes were very cold.)

Phase 3: people confused about smart meters, people with prepayment meters felt in control (direct debit not right for them), people with sight and mobility problems said that prepayment meters were hard to use.

People thought about how to make things better, eg developing training about energy and fuel poverty that adults with learning disabilities can understand, and making bills easy to understand for the same group.

Summary: improve energy comms, tell adults with learning disabilities about the priority services register and about different energy companies (and switching), and making tech easier to use.

(DHD note: the energy market, like mobile phones, is partly a confusopoly, so difficult for anyone to understand, partly by design.)

Web sites are an extra hurdle for those with learning difficulties. And telephone customer service also need more training to help this group.

Maybe have tech that literally talks to the users with messages like "your house is far too warm, please turn down the heat." (Or far too cold, etc.)

Households were turning the heating off if the implicit budget ran out. (Improved heating controls would probably not save carbon, since the same full implicit budget would probably be used anyway, but might avoid some or all of the self-denial of heating when still needed.)

Open Space Discussion

From the floor... care homes: tend to be overheated because architects/owners frightened of killing occupants with cold but not thinking about the reverse.

Are adaptation for warming climate such as shading being brought in in the UK? Excess heat deaths not expected to exceed excess winter deaths for decades.

Open space discussion. Topics to be decided by participants.

Q: what level of insulation is needed to ensure no heating is needed at all?

A: with new-build well-insulated Passivhaus or retrofit EnerPHit maybe a few days a heat of electric fan heating should be enough. Airtightness is also vital.

Q: should there be some Total Cost of Ownership (TCO) for normal people to work out where to spend money on insulation and/or different heating systems from district heat to heat-pumps (or health costs of not spending that money)?