Els efectes sobre la salut de la pobresa energètica, by Lluís Camprubí, Andrés Peralta. Presented at the workshop on Energy Poverty "La pobresa energètica: anàlisi i respostes a una prioritat social". Barcelona, 27-28 abril, 2015.

1. Lluís Camprubí, Andrés Peralta
Barcelona, 27 abril 2015
Els efectes sobre la salut
de la pobresa energètica

2. Index
*Els determinants de la salut
*Impactes en la salut de la pobresa energètica i el fred
domèstic
*Impactes en la salut de les intervencions per a la millora de
l’eficiència energètica
*Conclusions

3. Index
*Els determinants de la salut

4. Font: Modificat de Dalghren i Whitehead, 1991.
Els determinants de la salutEls determinants de la salut

5. Font: Comisió per reduïr les desigualtats en salut a Espanya, adaptat CDSS OMS
Els determinants de les desigualtats en salut

6. Font:Ana Novoa et al. (Gaceta Sanitaria 2014)
Marc conceptual habitatge i salut

7. Index
*Impactes en la salut de la pobresa energètica i el fred
domèstic

8. *La pobresa energètica és la dificultat de mantenir la vivenda a una
temperatura comfortable i poder satisfer el seu consum energètic
domèstic necessari a un cost econòmic assumible.
*Consideracions prèvies:
Hills, J. Fuel poverty: the problem and its measurement. CASE report, 69. London: Department for Energy and Climate Change; 2011.
Marmot Review Team. The Health Impacts of Cold Homes and Fuel Poverty. Friends of the Earth & the Marmot Review Team; 2011. Disponible en:
http://www.instituteofhealthequity.org/projects/the-health-impacts-of-cold-homes-and-fuel-poverty/the-health-impacts-of-cold-homes-and-fuel-poverty-full-report.pdf
[Accessed: 27th November 2013].
Thomson H, Thomas S, Sellstrom E, Petticrew M. Housing improvements for health and associated socioeconomic outcomes. Cochrane Database Syst
Rev.2013;(2):CD008657.
Gibson M, Petticrew M, Bambra C, Sowden AJ, Wright KE, Whitehead M. Housing and health inequalities: a synthesis of systematic reviews of interventions aimed at
different pathways linking housing and health. Health Place. 2011;17(1):175-84.
World Health Organization (WHO). (2011) Environmental burden of disease associated with inadequate housing [Online]. Disponible en:
http://www.thehealthwell.info/node/87948 [Accessed: 27th November 2013].
Howden-Chapman P, Crane J, Chapman R, Fougere G. Improving health and energy efficiency through community-based housing interventions. Int J Public Health.
2011;56(6):583-8.
Healy, JD. Excess winter mortality in Europe: a cross country analysis identifying key risk factors. J Epidemiol Community Health. 2003;57:784-9.
Idees introductòries
*Objectiva
*Subjectiva
Medició
*Morbilitat
*Mortalitat (“EWD”, “Harvest”…)
Severitat
*via fred
*via trade-offs (“heat or eat”)
Mecanisme
*agut
*crònic (efecte acumulatiu)
*agravador
Impacte
*física (Circulatori,
respiratori,…)
*mental (ansietat, depressió)
Aspecte de la
salut

9. Impactes:Impactes:Impactes:Impactes:
*Infeccions tracte respiratori
*Cardiovascular: ACV i infarts (PArt)
*Problemes salut mental
Stress, ansietat, depressió, aïllament
*Exacerbació:
-Musculoesquelètiques
-Cardiovasculars
-Respiratòries(astma, EPOC,…)
*Retroalimenta determinants: laboral, educació)
The Marmot Review Team for Friends of the Earth. The Health Impacts of Cold Homes and Fuel Poverty. London: Marmot Review Team and Friends of the Earth, 2011.
Wilkinson P, Landon M, Armstrong B, et al. Cold Comfort: The Social and Environmental Determinants of Excess Winter Deaths in England, 1986-96. Bristol: The Policy
Press, 2001.
Rudge J, Gilchrist R. Excess winter morbidity among older people at risk of cold homes: a population-based study in a London borough. J Public Health 2005;27:353–8.
Donaldson GC, Keatinge JE. Early increases in ischaemic heart disease mortality dissociated from and later changes associated with respiratory mortality after cold
weather in south east England. J Epidemiol Commun Health 1997;51:643–8.
Idees introductòries
GrupsGrupsGrupsGrups vulnerables:vulnerables:vulnerables:vulnerables:
*Menors:
Menor guany de pes
Retard desenvolupament
Menor assoliment educatiu
Majors ingressos hospitals/CAPs (30% UK)
Major incidència i severitat brots asma i dobla
prob problemes respiratoris
*Gent gran: Empitjorament artritis i reumatismes
Aíllament
Caigudes
*Grups passen més estona a casa:
Aturats
Persones grans
Malalts
Infants

14. Liddell, C., & Guiney, C. (2015). Living in a cold and damp home: frameworks for understanding impacts on mental well-being. Public Health, 129(3), 191–199.
De la mala salut mental a la física
1.chronic thermal discomfort,
2. worry about energy bills,
3. the experience of falling
into debt
(or the fear of it),
4. concern that cold is
damaging physical health,
5 ‘spatial shrink’ from living in
only one or two rooms that
can be affordably heated,
6.stigma within one's
community,
7.damage to possessions
from damp and mould,
8. the absence of any
solution or sense of control
over the problem.

15. Salut auto-percebuda

16. 1.
Excés Mortalitat hivernal
Tirado Herrero., S., Jiménez Meneses, L., López Fernández, J.L., Martín García, J. 2014. Pobreza energética en España. Análisis de tendencias. Asociación de
Ciencias Ambientales, Madrid.

17. Excés Mortalitat hivernal
Tirado Herrero., S., Jiménez Meneses, L., López Fernández, J.L., Martín García, J. 2014. Pobreza energética en España. Análisis de tendencias. Asociación de
Ciencias Ambientales, Madrid.

18. Excés Mortalitat hivernal
Tirado Herrero., S., Jiménez Meneses, L., López Fernández, J.L., Martín García, J. 2014. Pobreza energética en España. Análisis de tendencias. Asociación de
Ciencias Ambientales, Madrid.

19. Excés Mortalitat hivernal-Europa
Atanasiu, B., Kontonasiou, E., & Mariottini, F. (2014). Alleviating fuel poverty in the EU: investing in home renovation, a sustainable and inclusive solution. Brussels,
Belgium.
Fowler, T., Southgate, R. J., Waite, T., Harrell, R., Kovats, S., Bone, A., … Murray, V. (2015). Excess Winter Deaths in Europe: a multi-country descriptive analysis.
European Journal of Public Health, 25(2), 339–45.

20. Excés Mortalitat hivernal-Europa
Fowler, T., Southgate, R. J., Waite, T., Harrell, R., Kovats, S., Bone, A., … Murray, V. (2015). Excess Winter Deaths in Europe: a multi-country descriptive analysis.
European Journal of Public Health, 25(2), 339–45.

21. Altres impactes

22. Index
*Impactes en la salut de les intervencions per a la millora de
l’eficiència energètica

23. Rutes: Intervenció -> Salut
Willand, N., Ridley, I., & Maller, C. (2015). Towards explaining the health impacts of residential energy efficiency interventions–A realist review. Part 1:
Pathways. Social Science & Medicine.

24. Thomson, H., Thomas, S., Sellstrom, E., & Petticrew, M. (2013). Housing improvements for health and associated socio-economic outcomes. Cochrane Database of Systematic Reviews (Online)

26. Efectes potencialment inesperats/negatius sobre la salut
de les intervencions
1) Willand, N., Ridley, I., & Maller, C. (2015). Towards explaining the health impacts of residential energy efficiency interventions–A realist review. Part 1:
Pathways. Social Science & Medicine.
2) Lichtenbelt, W. van M., Kingma, B., van der Lans, A., Schellen, L., 2014. Cold exposure – an pproach to increasing energy expenditure in humans. Trends in
Endocrinology & Metabolism. doi:10.1016/j.tem.2014.01.001
3) Norman,G.R.,Pengelly,L.D.,Kerigan,A.T.,Goldsmith,C.H.,1986.Respiratory- function of children in homes insulated with ureaformaldehyde foam insulation.
Can.Med.Assoc.J.134,1135–1138.
*Limitació de la ventilació (evidència no concloent i limitada) (1)
-Falta renovació aire
-Augment Humitat Relativa
-condensació, PMs, contaminants químics, fongs, alergens
*Interiors caldejats -> alentiment metabolisme -> obesitat. (2)
*Presència materials nocius en aïllament (Formaldehid) (3)

27. Impactes en salut mental
de les intervencions
Liddell, C., & Guiney, C. (2015). Living in a cold and damp home: frameworks for understanding impacts on mental well-being. Public Health, 129(3), 191–199. doi:10.1016/j.puhe.2014.11.007

29. Meta-anàlisis de Maidment:
*There was however no significant difference between the effect size for
vulnerable groups and that for the general population
*Greater effects of energy efficiency interventions on health were found
though in studies focusing on participants with low incomes
*Studies that employed medical tests tended to report larger effect sizes
*Studies that compared cases with controls found significantly larger effects
on health than purely cross sectional studies with no control group
*Studies published from 1998 onwards produced larger effects on health
than those published earlier
Maidment, C. D., Jones, C. R., Webb, T. L., Hathway, E. A., & Gilbertson, J. M. (2014).
The impact of household energy efficiency measures on health: A meta-analysis. Energy Policy, 65, 583–593. doi:10.1016/j.enpol.2013.10.054

31. Conclusions i recomanacions preliminars Revisió Realista Intervencions per
rehabilitació energètica edifics: el procés d’implementació
RELEVANCE: POLICY APPROACH – SPLIT INCENTIVES – TAKEBACK EFFECT
-Some contexts imply activation of different mechanisms (social housing)
-Main mechanisms vary significantly its effect depending on inequality position (take-back in
Socioeconomic).
-Inequality/vulnerability axes may have summative/multiplicative when concentrated in one
group.
-Recommendations on policy design:
CO2 / energy saving focus may increase inequality gap
Proportional universalism
Take into account different coping strategies
Enhance participation in definition of the intervention
-Need to tackle:
Coordination
Planning
Age
Health eligibility criteria

32. Index
*Conclusions

33. Conclusions i recomanacions
*Hi ha àmplia evidència de l’impacte negatiu sobre la salut de la pobresa energètica i el fred domèstic
*Hi ha àmplia evidència de l’impacte positiu sobre la salut de les intervencions per millorar l’eficiència
energètica i el comfort tèrmic
*Segueixen havent reptes per a la Recerca:
Impactes llarg plaç; interaccions vulnerabilitats; salut auto-percebuda; variabilitat contextual
*Importància de “efectes petits individuals” a escala poblacional
*Variabilitat d’EWD en països climes similars: marge per a l’acció de polítiques públiques i salut pública
*Al dissenyar intervencions cal tenir present complexitat, context i universalisme proporcional
*És important situar la salut (HIA) al centre de les estratègies d’eficiència energètica
*Cal abordar el fenomen des d’una perspectiva de treball intersectorial i amb la mirada “Salut en totes
les polítiques”

34. *Braubach, M.et al (2011). Environmental burden of disease associated with inadequate housing.
Methods for Quantifying Health Impacts of Selected Housing Risks in the WHO European
Region. Summary Report, WHO.
*Fowler, T. et al (2015). Excess Winter Deaths in Europe: a multi-country descriptive analysis.
European Journal of Public Health, 25(2), 339–45.
*Gibson, M. et al (2011). Housing and health inequalities: a synthesis of systematic reviews of
interventions aimed at different pathways linking housing and health. Health & Place, 17(1),
175–84.
*Howden-Chapman, P., et al (2007). Effect of insulating existing houses on health inequality: cluster
randomised study in the community. BMJ (Clinical Research Ed.), 334(7591), 460.
*Liddell, C., et al (2015). Living in a cold and damp home: frameworks for understanding impacts on
mental well-being. Public Health, 129(3), 191–199.
*Liddell, C., et al (2010). Fuel poverty and human health: A review of recent evidence. Energy
Policy, 38(6), 2987–2997.
*Marmot Review Team. (2011). The Health Impacts of Cold Homes and Fuel Poverty.
*Thomson, H., et al (2013). Housing improvements for health and associated socio-economic
outcomes. Cochrane Database of Systematic Reviews
*UCL Institute of Health Equity. (2014). Fuel Poverty and Cold Home-related Health Problems.
Bibliografia imprescindible salut i PE

35. sophie-project.eu
aspb.cat
@sophieproject
@salutpublicabcn
lcamprub@aspb.cat
aperalta@aspb.cat
Thank you!
Gràcies!