Last summer, a severe heat wave killed 28 people in the city of Montréal. Six months later, an Arctic polar vortex sent a brutal cold wave across the midwestern United States that killed 21 people. Both of these events made widespread news, with media outlets closely covering the weather and the deaths that followed. When no such extreme weather events are occurring, however, the news seldom mentions the many households that lack adequate heating and cooling year-round. Homes that are chronically chilly in the winter or overly warm in the summer can be physically uncomfortable. But does this have a detrimental effect on inhabitants’ health?
While we all know it’s important to heat and cool one’s home for comfort, the inability to do so, also known as “energy insecurity,” has rarely been looked at in terms of its potential contribution to poor health. My colleagues and I have been working to further understand how energy insecurity might harm the well-being of individuals through physical, economic, and behavioral pathways. In an underheated apartment, an example of a physical pathway would be shoddy insulation, and an economic pathway would be the financial burden of high heat bills. A behavioral pathway would be the adoption of strategies to counteract the impacts of economic and physical energy insecurity, such as the use of a space heater.
To look at the impact of energy insecurity on health in a community-based sample, we used data from a study of 2,494 households in Washington Heights, a neighborhood in northern Manhattan. Washington Heights is in the process of gentrification; older residents and Dominican families who have been in the neighborhood for generations live alongside younger professionals in old, multi-unit apartment buildings. When surveyed, some residents reported insufficient heating and taking extreme measures to combat their discomfort, such as using the kitchen stove to warm their apartments. We found that 27% of households in our sample were energy insecure. Because of this, we wondered: how might energy insecurity be affecting the health of Washington Heights residents?
While temperature-related deaths may make the news, we should not allow them to divert our attention away from these temperature-related ailments that are far more common and that may disproportionately affect the most vulnerable within our communities.
We looked at energy insecurity and its effect on a variety of common health outcomes like asthma, depression, and hypertension. We found that energy insecurity was associated with poor respiratory and mental health outcomes including recent pneumonia, self-reported anxiety/depression, and poor-quality sleep. Severely energy-insecure households had twice the odds of having lifetime asthma and more than four times the odds of having had a recent bout of pneumonia. This makes sense given that dampness, mold, and cold temperatures can aggravate respiratory ailments, as well as cause discomfort during the day and difficulty sleeping at night.
For comparison, we did not find energy insecurity to be associated with other health outcomes like overall self-reported health, diabetes, hypertension, or recent accidental fall. Given that there is no specific connection between cold temperatures and these conditions, we were not surprised to find that they had no relationship in our sample.
These associations held even after adjusting for income and race. However, energy-insecure households were significantly more likely than those that were energy-secure to be lower income, less educated, have children, and be Hispanic/Latino or Black. Residents who recently moved to the area were more likely to be energy-secure compared with long-term, “pre-gentrification” households. We found this particularly interesting given that, for most residents, heat is included in their rent, indicating that energy insecurity in this community is often not operating solely through economic pathways.
Future research can help us further illuminate the connection between energy insecurity and health so that we may prioritize it in the public health agenda. While temperature-related deaths may make the news, we should not allow them to divert our attention away from these temperature-related ailments that are far more common and that may disproportionately affect the most vulnerable within our communities.