Housing retrofit is an essential public health intervention, writes Annika Hjelmskog from the University of Glasgow. We cannot meet our climate change targets without decarbonising our housing stock, and the CCC has repeatedly identified large gaps in existing policy efforts. This urgent priority creates an opportunity to reduce the health harms associated with fuel poverty and inefficient housing.

These health harms are not felt equally, however, and the impacts of spiralling energy costs will be felt disproportionately by both those who live in poorly-insulated housing, as well as those with low incomes. As we witness a perfect storm of injustice for poor households, these intersecting crises create an opportunity for policymakers to address health inequalities, energy poverty and climate breakdown through holistic retrofit action in the right places.

We have good evidence on what causes health inequalities. To reduce them, we need to focus on the unequal social conditions that drive unequal health outcomes, with an emphasis of support for people who are most disadvantaged. This ‘proportionate universalism’ means resourcing and delivering universal services at a scale and intensity proportionate to the degree of need.

Our existing efforts are falling short, and much retrofit assistance is only on offer to the owners of homes (owner-occupiers and landlords). Yet the largely unregulated private rented sector (particularly at the lower end) is home to the highest proportion of fuel poor households. Social landlords/registered providers have been able to apply for retrofit funding, but this has typically been on a competitive basis (such as the Sustainable Warmth competition, now closed).

Other attempts to boost or accelerate energy efficiency measures in homes have been either extremely short lived or scrapped before they could achieve their goals. Installation of insulation in lofts and cavity walls has plummeted since 2012, when grant support for households via the Green Deal was scrapped under Prime Minister David Cameron. Similarly, the Green Homes Grant scheme in England was only open 2020-2021 and was described as a “slam dunk fail”.

The short-term, reactive response to entrenched issues is the antithesis to a public health approach, which would argue that prevention is better than cure. As with recent ‘sticking plaster’ responses to the rising energy prices, offering one-off emergency vouchers or loans can deal with neither the root causes of the issue (neoliberal energy markets, poverty and inequality) nor the long-term problems that make these worse (historically poor housing quality, old housing stock).

Actions needed

For housing retrofit to take a health equity approach, it needs to be implemented with the following principles in mind:

• Proportionate universality: benefits of retrofit need to be available to everyone, but with targeted additional support to those who need it the most. Support should not be allocated competitively, which creates winners and losers
• Ease of access: a unified service/single point of contact is needed to reduce the fragmentation of services and the amount of effort and agency required. Our current system requires time, energy and different forms of capital, which disadvantages particular groups
• Empowerment: delivery is needed at all levels, and local authorities and community organisations are essential players in this, but they need national support to enable and equip (including with finance) them to fulfil their role
• Affordability: current measures don’t support households living in the private rented sector, even those on low incomes, whose landlords aren’t prepared to make a significant contribution to the costs of the improvements. Better use of means testing and progressive funding, combined with universal obligations for property owners to meet insulation standards could address some of this gap
• Holistic/joined-up thinking: this policy issue needs to be understood in terms of the wider system it sits within – it won’t be enough to simply retrofit the homes of those who can afford it, and we could lose the opportunity of creating co-benefits (such as the green, sustainable, good quality jobs needed for a Just Transition) that are also vital components for ‘levelling up’ health.

We need to insulate as many homes as possible, quickly – but huge escalations in fuel poor households (and more to come in October) makes it essential to target this activity at the households with the lowest incomes and least efficient homes first. Through housing retrofit we can improve the wellbeing of our population while stopping our depletion of nature’s resources, if we just take care to embed justice for both public and planetary health.