Energy Insecurity: A Framework for Understanding Energy,the Built Environment, and Health Among Vulnerable Populations in the Context of Climate Change

EDITORIAL Energy The recent occurrence of Hurricane Sandy and other cli- the built environments that im- mediately surround us.11 Prob- Often relegated to the least efficient housing units, low- Insecurity: A mate change---related calamities prompt us to consider the signifi- lematic housing deficiencies af- fected in this process, in turn, income householders experience the greatest energy burden be- Framework for cance of public health in the af- termath of disaster. However, the translate into severe health con- sequences that may create or cause of residence in older housing stocks, long-term disin- field of public health also has exacerbate risks of respiratory ill- vestments, and lack of mainte- Understanding a role to play in the awareness, preparedness, and deterrence of nesses such as asthma and aller- gies, nutritional deficiencies, loss nance by landlords as well as the landlord’s use of lower quality Energy, the Built environmental factors that affect vulnerable populations on a daily of productivity, and injury and mortality.12,13 Social and eco- materials and less efficient hous- ing structures and appliances.19 Environment, basis. The growing incidence of extreme weather events attribut- nomic factors restrict housing and neighborhood options and force As residential energy costs for heating, cooling, and other and Health able to climate change and the parallel surge in energy prices trade-offs in meeting basic needs such as food, housing, and health household needs steadily esca- late, the household expenditure Among trickle down to formidable health impacts that may prove especially care, resulting in housing insecu- rity and food insecurity.14 In ad- differentials between richer and poorer households are becoming Vulnerable detrimental to vulnerable popu- lations.1 In instances of extreme dition, many low-income house- holders in the United States more pronounced. For house- holds earning more than $50 cold, poor families often wear hats experience a phenomenon called 000, residential energy expendi- Populations in and gloves at home and use ex- pensive and hazardous electric “energy insecurity.”15 Those im- pacted by energy insecurity allo- tures represent a mere 3% of their average after-tax income the Context of heaters or cooking ovens to keep the cold at bay.2---4 During heat cate a disproportionate share of their income to utilities-related compared with 33% for low- income householders making Climate Change waves, the elderly and poor are more likely to “sweat it out” or expenses and encounter ineffi- ciencies in the home such as older less than $10 000.20 Evidence suggests that young children die because they cannot keep and less efficient appliances and in energy-insecure homes are their homes adequately cool.5,6 drafts that induce heat-loss. Con- more likely to contend with Furthermore, many low-income comitants of energy insecurity housing and food insecurity, ex- households face the “heat or eat” include extreme home tempera- perience fair or poor health, dilemma; they must decide be- tures, hazardous heating alterna- have been hospitalized at least tween paying for food or fuel.7,8 tives, and the constant threat of once since birth, and be at risk All the while, economically disad- utility shut-offs or mounting ar- for developmental delays.15 vantaged householders dispro- rearages in utility bills because Energy-insecure householders portionately occupy housing units of nonpayment. This problem is have been found to eat less as with poor air quality and harmful especially acute for low-income evidenced by a 10% reduction in temperature and humidity condi- residents such as single parents, caloric intake and weight loss tions, resulting in excess moisture, the elderly, the disabled, and during winter months.7,8 One dampness, and mold, conditions others with low or fixed in- strategy that has been proposed that can trigger respiratory ill- comes.16,17 Those facing energy to offset the shock of skyrocket- nesses such as asthma.9,10 insecurity may be homeowners ing heating bills is to increase unable to invest in efficiency up- enrollment in supplemental nu- HOUSING, FOOD, AND grades or may be renters living tritional assistance programs ENERGY: A TRIFECTA OF in housing units where landlords (formerly food stamps) among INSECURITY do not pay for the utilities and eligible families.21 While this consequently have very little in- strategy provides an additional The trickle-down effects of centive to create more energy- income source, it is not a long- climate change are experienced in efficient units.18 term solution. Such an approach e32 | Editorial American Journal of Public Health | April 2013, Vol 103, No. 4  EDITORIAL merely masks the problem, FUTURE DIRECTIONS IN health-related knowledge to elderly people in Britain: population based trades off one financial pres- ENERGY INSECURITY members of marginalized com- study. BMJ. 2004;329(7467):647. sure for another, and creates RESEARCH AND munities. Greater awareness of 5. Klinenberg E. HeatWave: A Social Autopsy of Disaster in Chicago. Chicago, further dependency among low- TRANSLATION energy-related linkages to health IL: University of Chicago Press; 2003. income householders. In the and the built environment are 6. Canouï-Poitrine F, Cadot E, Spira A, current economic climate, more As the impact of global climate necessary among those most af- Groupe Régional Canicule. Excess deaths sustainable approaches are change becomes more apparent, fected by energy insecurity and during the August 2003 heat wave in Paris, France. Rev Epidemiol Sante Publi- needed. its association with the built envi- can be acquired with the help of que. 2006;54(2):127---135. ronment and the health of vul- community health workers who 7. Bhattacharya J, DeLeire T, Haider, S, HOUSING INTERVENTIONS nerable groups warrants greater emphasize energy and environ- Currie J. Heat or eat? Cold weather shocks TO ADDRESS ENERGY attention and innovative ap- mental factors that impact health. and nutrition in poor American families. INSECURITY proaches toward awareness and Combined, these activities will National Bureau of Economic Research working paper 9004. Available at: amelioration. Indeed, the concept begin to provide the requisite http://www.nber.org/papers/w9004. Energy efficiency and weath- of energy insecurity, in particular, evidence to position energy in- Published June 2002. Accessed January erization are often cited as merits far more attention given security as a major public health 3, 2013. “low-hanging fruit” that might its widespread prevalence and its concern with potential to fuel 8. Frank DA, Roos N, Meyers A, et al. Seasonal variation in weight-for-age in simultaneously address high ties to housing instability, food scalable policy changes. j a pediatric emergency room. Public Health energy costs, energy indepen- insecurity, and health as well as a Rep. 1996;111(4):366---371. dence, and global climate growing interest in energy solu- Diana Hernández, PhD 9. Institute of Medicine. Damp Indoor change. While we know these tions within the policy realm. To Spaces and Health. Washington, DC: National Academies Press; 2004. http:// “fruit” produce clear-cut and date, this problem remains largely About the Author www.nap.edu/openbook.php?record_id= high-yielding benefits compared outside of the public’s conscious- 11011&page=R2. Accessed January 3, 2013. Diana Hernández is with the Department with other proposed or climate ness, ignored in the scientific lit- of Sociomedical Sciences, Mailman School 10. Evans J, Hyndman S, Stewart-Brown change strategies, the health erature, and overlooked in public of Public Health, Columbia University, New S, Smith D, Petersen S. An epidemiologi- policy. Furthermore, it has re- York, NY. cal study of the relative importance of gains linked to energy efficiency Correspondence should be sent to Diana damp housing in relation to adult health. remain largely unknown.22 De- ceived inadequate government Hernández, Department of Sociomedical J Epidemiol Community Health. 2000;54: spite the obvious and extensive support in the forms of sufficiently Sciences, Mailman School of Public Health, 677---686. financial, environmental, and funded fuel assistance or weath- Columbia University, 722 West 168th 11. Institute of Medicine. Climate Change, Street, Rm 934, New York, NY 10032 likely health benefits, low- erization and energy efficiency the Indoor Environment and Health. Wash- (e-mail: dh2494@columbia.edu). Reprints ington, DC: National Academies Press; income householders face key subsidies. Additional consider- can be ordered at http://www.ajph.org by 2011. Available at: http://www.nap.edu/ ations for revised regulations and clicking the “Reprints” link. barriers in adopting home en- catalog.php?record_id=13115. Accessed This editorial was accepted December 1, ergy efficiency and weatheriza- policy enforcement related to in- 2012. January 3, 2013. tion measures because of high spection procedures and energy doi:10.2105/AJPH.2012.301179 12. Heyman B, Harrington BE, Merleau- up-front costs and limited efficiency standards in subsidized Ponty N, Stockton H, Ritchie N, Allan TF. Keeping warm and staying well. Does decision-making authority as housing along with coordinated Acknowledgments home energy efficiency mediate the re- renters. Of particular concern in policy programs in housing, en- Special thanks to Lisa Metsch, PhD, and lationship between socio-economic status Karolynn Siegel, PhD, for reviewing ear- low-income housing is the oc- ergy, and health for the poor are and the risk of poorer health? Housing lier drafts of this article. Stud. 2005;20(4):649---664. currence of cumulative housing also warranted. Further evidence 13. Shay DK, Holman RC, Newman RD, problems that include not only is also needed to demonstrate the References Liu LL, Stout JW, Anderson LJ. Bron- energy inefficiencies, but also feasibility and impacts of energy- 1. Haines A. Sustainable policies to chiolitis-associated hospitalizations health and safety hazards within efficiency interventions on the improve health and prevent climate among US children, 1980-1996. JAMA. change. Soc Sci Med. 2012;74(5):680--- 1999;282(15):1440---1446. the home and in the neighborhood health and well-being of socio- 683. environments as well.23 Accord- economically disadvantaged 14. Children’s Health Watch. Healthy 2. Harrington BE, Heyman B, Merleau- Families in Hard Times: Solutions for ing to a recent report that for the households. In addition, new ap- Ponty N, Stockton H, Ritchie N, Heyman Multiple Family Hardships. Boston, MA: first time measured efficiency in proaches for translating the sci- A. Keeping warm and staying well: find- Children’s Health Watch; 2010. Avail- ings from the Qualitative Arm of the able at: http://www.childrenshealth private buildings in New York City, ence and research into practice are Warm Homes Project. Health Soc Care watch.org/upload/resource/multiplehard the least-efficient residential build- required so as to garner opportu- Community. 2005;13(3):259---267. ships_report_jun10.pdf. Published June ings were located in neighbor- nities to advance health and en- 3. Wilkinson P, Landon M, Armstrong 2010. Accessed January 3, 2013. hoods that also reported the high- ergy literacy. The community B, et al. Cold Comfort: The Social and 15. Cook JT, Frank DA, Casey PH, et al. Environmental Determinants of Excess est asthma rates.24 When pressed health worker model has been A brief indicator of household energy Winter Death in England, 1986---1996. security: associations with food security, to explain this association, the au- embraced within public health Bristol, UK: The Policy Press; 2001. child health, and child development in US thors of the report stated only that because it has demonstrated sig- 4. Wilkinson P, Pattenden S, Armstrong infants and toddlers. Pediatrics. 2008; it “deserves more analysis.”25 nificant results when translating B, et al. Vulnerability to winter mortality in 122(4):e867---e875. April 2013, Vol 103, No. 4 | American Journal of Public Health Editorial | e33  EDITORIAL 16. Nord M, Kantor LS. Seasonal varia- tion in food insecurity is associated with heating and cooling costs among low- income elderly Americans. J Nutr. 2006; 136(11):2939---2944. 17. Hernández D, Bird S. Energy burden and the need for integrated low-income housing and energy policy. Poverty Public Policy. 2010;2(4). 18. Bird S, Hernández D. Policy options for the split incentive: increasing energy efficiency for low-income renters. Energy Policy. 2012;48:506---514. 19. Evans GW. The environment of childhood poverty. Am Psychol. 2004;59 (2):77---92. 20. American Coalition for Clean Coal Electricity. Energy cost impacts on American families, 2001-2012. Available at: http://www.americaspower.org/sites/ default/files/Energy_Cost_Impacts_ 2012_FINAL.pdf. Published February 2012. Accessed January 3, 2013. 21. Food Research and Action Center. Heat and eat: using federal nutrition pro- grams to cushion the shock of skyrocket- ing heating bills. Available at: http:// www.frac.org/pdf/energy_paper05.pdf. Published November 2005. Accessed January 3, 2013. 22. Wilkinson P, Smith KR, Beevers S, Tonne C, Oreszczyn T. Energy, energy efficiency and the built environment. Lancet. 2007;370(9591):1175---1187. 23. Evans GW, Kim P. Childhood pov- erty and health cumulative risk exposure and stress dysregulation. Psychol Sci. 2007;18(11):953---957. 24. PlaNYC Green Buildings & Energy Efficiency. New York City’s first bench- marking scores for non-residential covered properties. Available at: http://www.nyc. gov/html/gbee/html/plan/ll84_scores. shtml. Accessed January 30, 2012. 25. Navarro M. Wide differences found in buildings’ power use. New York Times. August 2, 2012. Available at: http:// www.nytimes.com/2012/08/03/ nyregion/wide-differences-found-in- large-buildings-power-use.html?_r=1. Accessed January 3, 2013. e34 | Editorial American Journal of Public Health | April 2013, Vol 103, No. 4