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Els efectes sobre la salut de la pobresa energètica

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 of 35
Lluís Camprubí, Andrés Peralta
Barcelona, 27 abril 2015
Els efectes sobre la salut
de la pobresa energètica
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
Index
*Els determinants de la salut
Font: Modificat de Dalghren i Whitehead, 1991.
Els determinants de la salutEls determinants de la salut
Font: Comisió per reduïr les desigualtats en salut a Espanya, adaptat CDSS OMS
Els determinants de les desigualtats en salut
Font:Ana Novoa et al. (Gaceta Sanitaria 2014)
Marc conceptual habitatge i salut

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Els efectes sobre la salut de la pobresa energètica

  • 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
  • 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.
  • 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.
  • 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
  • 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