Cold House Epidemiology & Psychology

Back in May, a group called the Marmot Review Team, in conjunction with Friends of the Earth, published a paper titled The Health Impacts of Cold Homes and Fuel Poverty.  An associated editorial was also published in the British Medical Journal.

The bottom-line conclusions of the Marmot paper, which focused primarily on Britain, are that living in cold housing is harmful, that the harm falls disproportionately on the economically disadvantaged, and that fairness demands that society provide more warmth to those in “fuel poverty”.

As you might expect, my feelings about this report are mixed.  On the positive side, I strongly support the authors’ sense of social justice, and of course agree that living in cold housing is potentially hazardous for elderly, disabled, or otherwise physically compromised people.

I have skepticism, however, about many of the inferences drawn in the paper, which are based primarily on epidemiologic correlations, rather than proven cause-and-effect.  For example, the paper notes that there is an increase in deaths over the winter months, and goes on to state: “Cold weather, and in particular cold homes, is believed to be a main factor in causing the winter increase of respiratory and circulatory diseases”.  The one citation for this statement leads to another policy paper by the same group, which, by my reading, actually provides no data whatsoever to support the assertion that cold weather (rather than, say, the increased indoor contact, lower exposer to fresh air,  and lower indoor humidities common in winter) cause these diseases– let alone any evidence for the “belief” that cold homes are to blame.

Indeed, I cannot picture any way that scientific conclusions on this topic could be drawn from epidemiology alone.  Why?  Because in the real world there is a nearly 100% correlation between living in an “underheated” house and living in general poverty, with the myriad other social and physical risks that come with it.  Just for the most obvious example, people in poverty smoke more: a report from the CDC yesterday shows that in the U.S. people living in poverty have a 43% higher likelihood of smoking than the national average, and a Gallup poll from 2008 purports that the poorest Americans smoke at rates 2-3 times that of the wealthiest.  Since smoking is one of the greatest known risks for cardiovascular and respiratory diseases, it seems obvious that there could be a connection.  It would be theoretically possible do a study of cold-housing morbidity risk controlling for smoking, but even if done, that would just be the tip of the iceberg in terms of the health risks of poverty.

A part of the Marmot paper which I found particularly difficult to swallow was the assertion that living in a cold house is likely to cause mental health problems.  For example, citing another paper, the authors assert that “Residents with bedroom temperatures at 21º C [70º F] are 50% less likely to suffer depression and anxiety than those with temperatures of 15º C [59ºF]”.  They also state that “A significant proportion of children living in cold homes felt unhappy in their family – 10% as opposed to 2% of the group living in warm homes”, without really considering whether it is the cold per se causing the “unhappiness”, or some other factor causing both the unhappiness and the cold house (many possibilities come to mind.)

In general, there is considerable confusion in this paper between the concept of cold housing, inefficient-to-heat housing, and unaffordable-to-heat housing.  The first is simply a measure of temperature, the second is determined by the physical house, and the last is related to the first two but also dependent on the inhabitant’s financial situation.  The authors conflate these ideas when they make statements such as, “Social isolation among older people is exacerbated by living in a cold home…. costly fuel bills prevent them from going out.”  It is not, obviously, the house being cold that causes the costly fuel bills– indeed, any given house, kept colder, will have lower fuel bills than the same house kept warmer.  Saying that poorly-insulated housing leads to less money for going out may well be true.  But to say that a cold house causes people to stay home and isolate is… uh… wouldn’t they be more likely to hang out in a warm pub, then?

The cited paper describing the bizarre depressogenic bedroom-temperature situation also made some much wiser points.  For example, the authors state that, beyond the idea of cold literally causing depression, “Fuel poverty was even more significant.  Compared with householders who paid fuel bills easily, those with great difficulty paying were over four times more likely to suffer anxiety or depression”.  This idea is much easier to accept than the concept of low temperatures inducing depression.  They even have this nice chart, which I hope they don’t object to my reprinting:Indeed, if you combine the “cold bedroom” effect and the “stressful bills” effect, you could come to this conclusion:  If, by lowering his house temperature from 71F to 59F, a person also succeeds in reducing his fuel-bill from “very difficult” to “very easy”, he will increase his risk for depression by 2-fold in one way, but reduce it by 4-fold in another way.  Thus, overall, he will reduce his risk of depression by 50%.”  This is great news!

Ultimately, for the connection between happiness and heat, I’ll reiterate what I’ve hypothesized before: it’s not about how warm your house is, it’s about how much control you have over how warm your house it.  I’m happy living at the temperatures I do partly because I know it’s a choice, not something I have to do out of poverty.  It’s the difference between rowing to exhaustion in a college regatta and rowing to exhaustion as a galley slave.  Same physical experience, different mental experience.  But this is not to say that cold living, when done voluntarily, is merely recreational: the dollars saved are real, and, more importantly, the resources conserved and carbon emissions prevented are also real.

With regard to the question of physical illness, I don’t think the data is there.  It can’t be studied epidemiologically, because almost everyone who can afford a lot of heat, uses a lot of heat.  (I’m a notable exception– and my N of 1 says, the cold did not make me sick– but you’d need hundreds or thousands of me to make a viable study.)  Lacking good data, I think it is going far out on a limb to say that keeping houses chillier is a health danger to otherwise-healthy people.  In fact, I think it’s environmentally criminal to suggest to people that they have to burn more oil to protect their health.

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6 Responses to “Cold House Epidemiology & Psychology”

  1. tAlissa Says:

    I have conflicting points of view. I think that ‘consenting adults’ are future thinking poineers in living in a colder house, the reason that I subscribe to your log is that the idea fascinates me to the point of trying to do so (except for a spouse that claims frostbite at < 75 degrees).
    I did grow up in a cold house. It eventually killed my father, and could have been prevented. More on that later.
    As a kid, I never knew our house was cold (approx 60F daily in winter, 50-55F night) until I was old enough to visit friends, whose houses were the accepted 75F plus, warm and inviting. Upon returning home to our cold house, I soon realized that yes, I was freezing, and I HATED IT!! Cold hand and feet, shivering no matter how much clothing I wore- and what kids wants to walk around with 2 sweaters! frosty beds that took an hour to warm, dressing in stiff frigid clothes on dreaded school mornings, and most importantly, never-ever bringing friends home for embarrasment! If only my el-cheapo Dad would turn the heat up!! He Could Afford to! I left home at 17, for several reasons, one being that I hated my cold dark VERY DEPRESSING house.
    In 2003 my father died from a condition called myxedema coma. It is a combination of 3 factors-
    1. Untreated hypothyroidism Dad was to miserly to pay the five dollar co-pay for Synthroid. which would have treated the condition. We did not know about this until agfter he died.
    2.Pneumonia . A month before he became gravely ill, he told me that he felt he had pneumonia, as he was chronically exhausted.
    3. Cold temperatures
    These three factors combines likely will lead to Myxedema Coma,and in may Dads case, it killed him
    (Don't tell me that my sis and I should have 'done something'
    We tried, even filing to become his guardian (failed).
    I know I sound crum-mugeoney, but these are my experiences with cold living. Great if you choose, horrible for those who are forced, parents please consider your kids before turning the heat down, or off. That is all!

    • Cold House Journal Says:

      Alissa, I’m so very sorry to read this about your dad– it is a sad story. Serious, untreated hypothyroidism is obviously high on the list of medical problems that would NOT be safe to combine with being cold.

      I appreciate the rest of your comment as well, though. There is an aspect of “cold living” that is or isn’t comfortable as a pure experience– but then there is an aspect that depends heavily on social norms. I grew up in a house where the downstairs was probably just a bit on the cool side of “normal”, but the upstairs (bedrooms, particularly) were pretty frigid in winter (not to mention hot, in summer). I don’t recall any heat-related issues with bringing friends over, but I certainly remember shivering under heaps of comforters until the bed warmed up. It helped in this regard to have some comparison that was even chillier, namely, my mom’s parents’ 19th century farmhouse, where the bedrooms were truly frigid (and, so I heard, even more so in her own youth.)

      But I do recall a sense of social embarrassment about our house in other (in retrospect ridiculous) ways. I went to school with a lot of kids whose families were extremely “well-to-do”. Some of my friends lived in houses that were two, three, or four times the size of ours, where there were housekeepers, where there were color TV’s with remote controls and the latest video games, not to mention cable TV… all of these things seemed important at the time, but looking back, of course, silly (and I realize I less tangible benefits some of these other kids didn’t– more than half of them, for example had divorced parents– though even that, at the time, was almost cool– because you seemed to get more Christmas presents, and your parents left you alone more, and you got to have TWO bedrooms, and…) Anyway, I can’t legitimately dispense any wisdom about child-rearing, but it does seem there often is this challenge to find a balance between instilling values of independence vs. assisting in achieving social acceptance. And it doesn’t end in childhood of course…

  2. Jane Says:

    Couldn’t possibly agree with you more on this, point by point. In fact, it’s long since been amply proven that the reason colds and flu are more common in winter is just as you surmise, that people confined indoors with each other spread these things more readily. There is absolutely zero evidence that cold per se “causes” any disease or increases susceptibility to disease.

    I think you’re entirely right in speculating that cold homes are simply an indicator of life conditions that increase susceptibility to depression and ill health. It has been amply demonstrated that stress and anxiety are major factors for that, and financial insecurity is a huge and deadly source of stress and anxiety, particularly among the elderly poor who have no hope of improving their lives ever.

    I too applaud the study’s authors for their goals, but this kind of report only tends to discredit those who are working to improve the living conditions of the poor because of just the things you point out. And the pity of it is that they could easily have fixed it without blunting their point at all by underlining instead of avoiding the fact that it’s the stress and anxiety of financial insecurity that is the heart of the problem.

    Well said, and I wish you’d send this excellent write-up to the medical journal that published the report.

    • Cold House Journal Says:

      “I wish you’d send this excellent write-up to the medical journal that published the report.”

      Considering that. The BMJ isn’t just some random obscure medical journal– it’s at the top of the world’s most-read and most-respected medical journals. I do wish I’d noticed these publications a little sooner, so I could’ve had a more timely response. Not sure why they decided to write about cold housing in May, rather than save it for publishing in winter!

  3. Lesley Brown Says:

    How refreshing to read your blog, which I came across while browsing comments on the Marmot report. I’m English, 66, living on a state pension only, in council [subsidised] housing, and rather tired of our media images which depict people in my situation as sitting huddled friendless in front of a one-bar electric fire eating cat food out of a tin!
    I think you’ve done an excellent job of showing that while there may be an association between cold housing and poor health, it’s not necessarily direct cause and effect, there are likely to be be other factors as you have suggested Currently it’s 6C – about 43F- outside with frost forecast. Well, I’m wearing just a T-shirt and jumper, haven’t got any heating on [apart from the warm glow of my laptop!] and feel perfectly comfortable. I’m normally cheerful, so, not depressed, and a normal weight, so, not obese either. I enjoyed your observation about the appeal of a cosy pub, how true! I hear that some of my contemporaries are also using their free bus passes to get out and about and travel the country on warm buses. No need at all to be isolated [even if you are disabled, as many buses are wheelchair accessible].
    My mother once told me proudly, ‘I used to put you outside in your pram in the snow’. That would include the winter of 1946-47, the coldest British winter on record – thanks Mum! [They believed in
    ‘fresh air’ in those days.] Having survived this Spartan upbringing, I grew up fit and hardy like most of my generation. Currently I am a keen community gardener and nature conservation volunteer, and regularly practise Chi Kung. In these activities I sometimes encounter much younger friends who seem to suffer more frequent colds or conditions like ME and have little cold tolerance.
    So in conclusion my experience entirely bears out your hypothesis and I wish you continued luck with your experiment. I’m grateful for the contribution of the state winter fuel allowance to my limited budget, but I’m confident it will last me the whole year.

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