Eligibility criteria for the UK Winter Fuel Payment: are we targeting the right people?
Publisher DOI
PubMed ID
41448940
Abstract
Background
Cold weather remains a serious health threat in the UK and elsewhere, particularly for older adults. The Winter Fuel Payment has been a key government strategy to mitigate health risks linked to cold homes in the UK, but recent policy shifts have raised questions about whether income-based eligibility criteria effectively identify those most at risk.Methods
We analysed cold-related mortality in adults aged ≥75 across 324 local authority districts in England (2007-2019) using distributed lag non-linear models in a spatial Bayesian framework. Multivariate meta-regression was used to evaluate modification of cold effects by deprivation, income-based pension credit uptake, home energy efficiency and fuel poverty.Results
Areas in the highest quartile of fuel poverty had significantly greater cold-related mortality risk than those in the lowest quartile, with a 15.3% versus 13.1% increase in mortality risk at the first compared with the 50th percentile of wintertime temperature, ie, an absolute difference of 2.2% (p<0.001). This effect was stronger than the corresponding differences for energy efficiency (1.7%, p=0.04), income as indicated by pension credit uptake (0.6%, p=0.39) and deprivation-based measures, for which differences were minimal. Overall, an estimated 17% of cold-related deaths among people aged ≥75 were attributable to fuel poverty.Conclusion
Fuel poverty, an indicator designed to capture both low-income and housing energy efficiency, is a stronger predictor of cold-related mortality than income (as indicated by pension credit update) or deprivation-based indicators alone. Winter energy support schemes should consider fuel poverty metrics in their targeting to more effectively reduce health risks associated with cold homes and improve equity.
Cold weather remains a serious health threat in the UK and elsewhere, particularly for older adults. The Winter Fuel Payment has been a key government strategy to mitigate health risks linked to cold homes in the UK, but recent policy shifts have raised questions about whether income-based eligibility criteria effectively identify those most at risk.Methods
We analysed cold-related mortality in adults aged ≥75 across 324 local authority districts in England (2007-2019) using distributed lag non-linear models in a spatial Bayesian framework. Multivariate meta-regression was used to evaluate modification of cold effects by deprivation, income-based pension credit uptake, home energy efficiency and fuel poverty.Results
Areas in the highest quartile of fuel poverty had significantly greater cold-related mortality risk than those in the lowest quartile, with a 15.3% versus 13.1% increase in mortality risk at the first compared with the 50th percentile of wintertime temperature, ie, an absolute difference of 2.2% (p<0.001). This effect was stronger than the corresponding differences for energy efficiency (1.7%, p=0.04), income as indicated by pension credit uptake (0.6%, p=0.39) and deprivation-based measures, for which differences were minimal. Overall, an estimated 17% of cold-related deaths among people aged ≥75 were attributable to fuel poverty.Conclusion
Fuel poverty, an indicator designed to capture both low-income and housing energy efficiency, is a stronger predictor of cold-related mortality than income (as indicated by pension credit update) or deprivation-based indicators alone. Winter energy support schemes should consider fuel poverty metrics in their targeting to more effectively reduce health risks associated with cold homes and improve equity.
Date Issued
2026-05-08
Publication Type
Article
Subject(s)
Subjects
ENVIRONMENTAL HEALTH
•
HOUSING
•
Health inequalities
•
POVERTY
•
PUBLIC HEALTH
Language(s)
en
Author(s)
Wan, Kai | |
Taylor, Jonathon | |
Ballester, Joan | |
Hajat, Shakoor |
Journal
Journal of Epidemiology and Community Health
Publisher
BMJ Publishing Group
ISSN
1470-2738
0143-005X
Access(Rights)
open.access