A report by the Institute of Health Equity (IHE), Fuel Poverty, Cold Homes and Health Inequalities, paints a devastating picture of living conditions for millions of UK families and their children.

The study was co-led by Professor Ian Sinha, Consultant Respiratory Paediatrician at Alder Hey Children’s Hospital, Liverpool, and Sir Michael Marmot, the director of the UCL Institute of Health Equity. Currently Professor of Epidemiology and Public Health at University College London, Marmot is highly respected for his work leading research groups on health inequalities for over three decades.

The IHE began looking at the health impacts of fuel poverty and cold homes in 2014. Over the last eight years, the data has charted an alarming deterioration. In their foreword the authors write, “If fuel poverty and cold homes were a concern in 2014, now, with the rapidly increasing price of energy, they are likely to become a significant humanitarian crisis.”

The report explains, “Fuel poverty means cold homes, but it means so much more,” including “food banks, desperate attempts to stay warm, inability to meet children’s needs, insufficient resources to pay the rent” and other stresses that “damage the health of adults and blight children’s development.”

It continues, “A child’s lungs play a crucial role in determining his or her health and life expectancy.” Their development is “impaired by problems associated with cold”. Adding factors such as “cutting back on food to pay the gas bills, and the mental health and educational impact of cold houses, the picture is bleaker still. Without meaningful and swift action cold housing will have dangerous consequences for many children now, and through their life-course.”

Local Government Association estimates for 2019 reveal that the National Health Service (NHS) has to spend around £2.5 billion per year treating illnesses directly linked to cold, damp and unsafe homes which are particularly dangerous for babies, children, older people and those with pre-existing health conditions—especially respiratory and cardiovascular.

Babies and children in early years living in cold homes are especially at risk as these conditions impact on the “development of their organs and body systems and social, emotional and cognitive function.” Cold, damp, and mouldy conditions also leave them with reduced resistance to upper and lower respiratory tract infections including bronchiolitis, and increased risk of asthma and acute asthmatic attacks. This is worsened by house dust mites which proliferate as windows are closed due to cold.

At the launch of the Fuel Poverty report, Professor Sinha said he had “no doubt” that children would die this winter as a result. The Financial Times noted Sinha’s comment that at his own Alder Hey Children’s Hospital in Liverpool, staff were treating babies for respiratory illnesses at a cost of £3,000 per child “and yet we are going to send them home to the very circumstances which are going to make them ill in the first place.”

Among adults and older people, resistance to respiratory infections is directly related to cold temperatures. Studies have shown that visits to doctors for respiratory illnesses increase by up to 19 percent for every one degree below the mean temperature. Circulatory problems and long-term conditions such as diabetes, musculoskeletal and dementia are also more prevalent among those living in cold conditions.

COVID-19, a disease with potentially serious respiratory symptoms and the leading cause of excess winter mortality in 2020/21, is expected to surge again this winter.

The report notes, based on figures from the Office of National Statistics (ONS), that “Cold homes and fuel poverty contribute to the phenomenon of excess winter deaths. England saw an estimated 63,000 excess winter deaths in 2020–21. Estimates suggest that some 10 per cent of excess winter deaths are directly attributable to fuel poverty and 21.5 per cent are attributable to cold homes.

“England’s excess winter deaths index is higher than the Northern European average.”

With the numbers of people falling into fuel poverty rising, the government has sought to change how it is measured to conceal the truth.

Fuel Poverty explains, “The most recent UK government estimates suggest a 13.2 percent rate of fuel poverty for English households (2020), a 14 percent rate for Welsh households (2021), an 18 percent rate for Northern Irish households (2018) and a 24.6 percent rate for Scottish households (2019). However different fuel poverty definitions and measurements across the UK’s nations make direct comparisons “difficult.”

In the most diplomatic language, the report’s authors point to attempts to falsify the data, writing that it is “unclear what prompted the change in the measurements of fuel poverty in England in 2021.” The result is that households are “not deemed fuel-poor if they live in a property with an energy efficiency rating in band C or above, regardless of whether or not they can afford adequate heating,” leading to significant underestimates.

But redefinitions cannot hide the horrendous social conditions being inflicted on millions.

“In the spring of 2022,” the report writes, “National Energy Action, a national fuel poverty charity,estimated 6.5 million households across the UK (23.4 percent of all households) were in fuel poverty—an increase from their estimate of 4 million in October 2021.” The figure will be even higher this winter.

Marmot’s report does not pull its punches on how these terrible social conditions arose. Identifying as factors the “post-pandemic rise in demand, war in Ukraine, and oil and gas companies “obscene profits,” it concludes,“But the underlying issues are the quality of housing, poverty, and the price of fuel. In a rich country, the idea that more than half of households should face fuel poverty is a sad judgement of the management of our affairs.”

Fuel Poverty highlights the impact of wage stagnation and austerity since the 2008 financial crash. It notes the “steady decline in real wages in recent years” and that “By June 2022, inflation hit a 40-year high.” The biggest cost increases have been in basic goods like transport, housing and household services, and food, “driving the so-called ‘heat or eat’ dilemma.”

Marmot’s report was released just as the Resolution Foundation think-tank forecast that 3 million people across the UK would be pushed into absolute poverty (below 60 percent of the median income after housing costs) due to a projected 10 percent drop in income over the next two years, the most severe assault on living standards in over a century.

This would mean 14 million people in the UK living in absolute poverty by 2023-24. Child poverty was forecast to reach 33 percent in 2026-27.

Both reports recommended the introduction of a “social tariff” for energy bills targeted at those on low incomes, with Marmot’s concluding that “efforts aimed at the poorest will not be enough. We need policies that will reduce fuel poverty across the social gradient, with effort proportionate to need—greatest for those most at risk. We call this proportionate universalism.”

But Prime Minister Liz Truss’s hard-right Thatcherite government has declared itself against any redistribution, except from the poor to the rich. If those in power have been willing to sacrifice over 200,000 people to a preventable virus, they will think nothing of the deaths and ill-health caused by freezing homes.