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Health effects of home energy efficiency interventions in England: a modelling study
  1. Ian Hamilton1,
  2. James Milner2,
  3. Zaid Chalabi2,
  4. Payel Das3,
  5. Benjamin Jones4,
  6. Clive Shrubsole3,
  7. Mike Davies3,
  8. Paul Wilkinson2
  1. 1UCL Energy Institute, University College London, London, UK
  2. 2Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
  3. 3UCL Institute for Environmental Design and Engineering, University College London, London, UK
  4. 4Department of Architecture and Built Environment, University of Nottingham, Nottingham, UK
  1. Correspondence to Ian Hamilton; i.hamilton{at}


Objective To assess potential public health impacts of changes to indoor air quality and temperature due to energy efficiency retrofits in English dwellings to meet 2030 carbon reduction targets.

Design Health impact modelling study.

Setting England.

Participants English household population.

Intervention Three retrofit scenarios were modelled: (1) fabric and ventilation retrofits installed assuming building regulations are met; (2) as with scenario (1) but with additional ventilation for homes at risk of poor ventilation; (3) as with scenario (1) but with no additional ventilation to illustrate the potential risk of weak regulations and non-compliance.

Main outcome Primary outcomes were changes in quality adjusted life years (QALYs) over 50 years from cardiorespiratory diseases, lung cancer, asthma and common mental disorders due to changes in indoor air pollutants, including secondhand tobacco smoke, PM2.5 from indoor and outdoor sources, radon, mould, and indoor winter temperatures.

Results The modelling study estimates showed that scenario (1) resulted in positive effects on net mortality and morbidity of 2241 (95% credible intervals (CI) 2085 to 2397) QALYs per 10 000 persons over 50 years follow-up due to improved temperatures and reduced exposure to indoor pollutants, despite an increase in exposure to outdoor-generated particulate matter with a diameter of 2.5 μm or less (PM2.5). Scenario (2) resulted in a negative impact of −728 (95% CI −864 to −592) QALYs per 10 000 persons over 50 years due to an overall increase in indoor pollutant exposures. Scenario (3) resulted in −539 (95% CI −678 to -399) QALYs per 10 000 persons over 50 years follow-up due to an increase in indoor exposures despite the targeting of pollutants.

Conclusions If properly implemented alongside ventilation, energy efficiency retrofits in housing can improve health by reducing exposure to cold and air pollutants. Maximising the health benefits requires careful understanding of the balance of changes in pollutant exposures, highlighting the importance of ventilation to mitigate the risk of poor indoor air quality.


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