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Fuel poverty and excess winter deaths

This section contains infiormation on the following:

Fuel Poverty

Excess Winter Deaths



Fuel Poverty

Fuel poverty is defined as occurring when a household has required fuel costs that are above average, and after spending that amount, they are left with an income that is below the official poverty line.[1]  Whether a household is in fuel poverty is determined by the interplay of three key factors:

  1. the energy efficiency of the property
  2. the household income
  3. fuel/energy prices[2]

National analysis of fuel poverty data indicates that households in fuel poverty are more likely to occupy large, older houses, and be owner-occupiers and families.[3]  

Herefordshire, like other rural counties, has a considerable number of dwellings without access to the mains gas grid.  The Health Housing Survey (2011) identified that mains gas was available to only 69 per cent of properties in Herefordshire, compared to 87 per cent nationally.[4]  Being off the mains gas grid significantly increases the risk of a household being in fuel poverty, as the fuel options for off-grid homes are often more expensive and less energy efficient than gas.[5]  Furthermore, rural households are also more likely to be living in older and less thermally efficient dwellings, and to have a lower than average household income.[6]

Fuel poverty adversely impacts upon health and wellbeing through associated financial hardship as well as increased risk of conditions such as respiratory illness, high blood pressure, and hypothermia 

The physiological effects of exposure to cold room temperatures are well documented and cold homes are known to contribute to excess winter deaths.[7]  Older people, children and people with disabilities and long-term illnesses are particularly vulnerable to the adverse effects of fuel poverty.  In addition, cold can worsen arthritic pain and/or contributing to a general feeling of illness.[8] Fuel poverty can exacerbate involuntary social isolation, making those affected less able to afford to go out, or fearful of going out knowing they will come in, already feeling cold, to a cold home; or reluctant to invite friends into a cold house. 

In 2015, there were an estimated 79,800 households in Herefordshire, 16.6 per cent of which were in fuel poverty (13,300); a higher proportion than in the West Midlands region (13.5 per cent) and England (11 per cent). The majority of households affected by fuel poverty live in rural areas. 

Older people are more susceptible to ill health (including the risk of death in the winter) as a result of residing in cold homes.  An estimated 60 per cent of people aged 65 and over live in rural parts of Herefordshire, where access to mains gas may not be possible, and properties with poor thermal efficiency are more common, both of which increase the risk of fuel poverty.  The detrimental effects of fuel poverty pose a considerable threat to the health and wellbeing of older people living in Herefordshire.

Excess Winter Deaths

More people in the UK die in the winter period (December to March) than at any other time of year.  Deaths of people who would not otherwise have been expected to die during the winter are defined as ‘excess winter deaths’.  The majority occur among older people with serious underlying health conditions – for example cerebrovascular diseases, ischaemic heart disease and respiratory disease.  Physiological evidence indicates that colder home temperatures cause high blood pressure among older people, increasing the risk of a cardiovascular event.  Poor thermal efficiency is a particular issue among Herefordshire’s housing stock, and so is fuel poverty. 

Between 2001/02 and 2014/15, there were a total of 1,376 excess winter deaths in Herefordshire.  Almost two-thirds (63 per cent) were women, and more than half (53 per cent) were people aged 85+.  The number fluctuates each year, but the annual index is similar to that seen in England as a whole – including a spike in 2014/15.  An Office for National Statistics investigation concluded that the main reason the UK saw such high numbers of excess winter deaths that year was moderate ‘flu levels caused by the ‘flu vaccine only being 34 per cent effective, combined with the dominant ‘flu strain being one which is particularly virulent in older people.

Excess winter deaths index* for Herefordshire and England, 2001/02-2014/15

Excess winter deaths index (single year) for Herefordshire and England, 2001/02-2014/15

Source:  Public Health England

[1] Annual Fuel Poverty Statistics Report 2017, Department, for Business Energy and Industrial Strategy, 2017. Available at:  This definition is based on the Low Income, High Cost (LIHC) methodology which became the official fuel poverty indicator in 2013.

[2]Annual Fuel Poverty Statistics Report 2017, Department, for Business Energy and Industrial Strategy, 2017. Available at:

[3] Cutting the cost of keeping warm: A fuel poverty strategy for England, Department of Energy and Climate Change, 2015. Available at:

[4] Healthy Housing (Final Report), Michael Dyson Associates Ltd on behalf of Herefordshire Council, 2012. Available at: /media/12674/healthy_housing_final_report_3rd_oct_2012.pdf

[5] Energy Advice Pack for Homes Off-Mains Gas: Practical advice on saving energy and reducing fuel costs for homes off the mains gas grid, National Energy Action Cymru. 2017.  Available at:

[6] Energy Advice Pack for Homes Off-Mains Gas: Practical advice on saving energy and reducing fuel costs for homes off the mains gas grid, National Energy Action Cymru. 2017.  Available at:

[7] Cold comfort: The social and environmental determinants of excess winter deaths in England, 1986–1996, Wilkinson P, Landon M, Armstrong B, et al., Joseph Roundtree Foundation, 7 November 2001.  Available at: .

[8] The UK Fuel Poverty Strategy: The causes and effects of fuel poverty, Department of Trade and Industry, 1998. Available at:

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Last updated: Friday, July 20, 2018