This blog is written by members of staff at the UCL Institute of Health Equity. To find out more about us, visit our website.

Monday, 19 January 2015

Dr Angela Donkin Responds to Alarming New Data from Joseph Rowntree Foundation


Today JRF published alarming data that illustrate again an increase in the numbers of households not able to afford an acceptable standard of living. Of all the households studied, there has been an increase in those unable to afford an acceptable standard of living, from 21% in 2008/9, to 24.8 % in 20011/12, and now to 27.3% for this year.

For families with children it is more worrying.  In 2008/9 30.6% were unable to afford a minimum standard of living, now the figure is at 39%.

In the Marmot Review we made it very clear that having a sufficient income to lead a healthy life was a key social determinant of health. Therefore increasing numbers living below acceptable standards will be bad for health outcomes, and inequalities in health.

Not having enough money makes it difficult to afford a healthy diet, decent housing, fuel for heating and cooking, appropriate clothing, and to pay for any exercise that carries a cost.  Items such as travel and birthday cards that are important for social integration, are often out of reach. Alongside the associated health impacts of inadequate nutrition, and cold and damp housing, not having enough money, and particularly being in debt, is associated with increased stress and depression.  Increased stress and depression have been linked to a range of negative health outcomes, and can have a negative impact on children’s development.

It is deeply embarrassing to live in a country where nearly 4 out of 10 households with children cannot afford a decent standard of living.  We support JRF’s call for improvements in income and efforts to moderate the costs of essential goods.   

Wednesday, 16 November 2011

Dying of Cold

This blog is written by Jessica Allen, Deputy Director of the Institute of Health Equity, and is based on an article published by Public Health Today in September 2011.


Every year we have a public health emergency in England – it's called winter.  In 2008/9 there were 35,000 excess winter deaths associated with the cold.  Every year, the increase in deaths during winter months is measured, assessed, published and analysed, and every year the figures are shocking – and this winter they are likely to be even worse.  Just imagine the huge national outcry, level of resources and political attention if flu or BSE or other public health threats killed and harmed as many people.

In London, an average of 3,710 Londoners die every year as a result of living in a cold home, and there are over 23,000 additional emergency hospital admissions and almost 93,000 additional outpatient attendances. An awful lot of avoidable suffering and expense.

Many of these deaths and illnesses are preventable. The effects of cold homes are not confined to excess mortality, as our report 'Health Impacts of Cold Homes and Fuel Poverty' shows. They include reduced weight gain in infants, asthma in young children, impeded ability to learn in older children, various and often multiple mental health problems in adolescents, increased incidence of colds and flu, exacerbation of rheumatism and arthritis, depression and dementia, and chronic lung diseases, heart attacks and strokes in older people.

The numbers of people in fuel poverty, and suffering the health and financial impacts, will rise this winter as fuel prices increase.  More people will die and be made ill and suffer mental health problems.  There are many good local interventions to reduce the impacts, but they are of insufficient scale and often lack resources – many are being cut altogether.

Recent changes in policy may worsen the impact of cold weather.  We need urgent, national action in 3 areas:

  1.   Fuel prices: Fuel prices continue to rise and without tighter controls and demands on fuel companies to keep prices affordable it will be very difficult to stop increasing fuel poverty. It is not right that publicly funded payment schemes to householders act as subsidies to fuel companies, and increase greenhouse gas emissions.
  2.  Household income: In times of increased unemployment and cuts to welfare spending it is very important that household incomes are sufficient to enable householders to keep their homes warm. 
  3. Domestic energy efficiency: To address both fuel poverty and climate change it is necessary that the energy efficiency of homes is dramatically improved, an activity that is difficult but not impossible. The more insulated homes there are, the lower the winter mortality from cardiovascular disease – the UK, Ireland and Portugal all have warmer winters than other countries  in Europe, such as Finland and Sweden, which have much lower death rates and ill health from the cold.  That is because their homes are insulated.
We know the scale of our annual public health emergency, and we know what to do to prevent it. 

Jessica Allen