Editing IPCC:AR6/WGIII/Chapter-9 (section)

==== 9.8.2.2 Energy/fuel Poverty, Indoor Environmental Quality and Health ====

<div id="h3-25-siblings" class="h3-siblings"></div>

Living in fuel poverty, and particularly in cold and damp housing is related to excess winter mortality and increased morbidity rates due to respiratory and cardiovascular diseases, arthritic and rheumatic illnesses, asthma, and so on ( [[#Lacroix--2015|Lacroix and Chaton 2015]] ; [[#Payne--2015|Payne et al. 2015]] ; [[#Camprubí--2016|Camprubí et al. 2016]] ; [[#Wilson--2016|Wilson et al. 2016]] ; [[#Ormandy--2016|Ormandy and Ezratty 2016]] ; [[#Thema--2017|Thema et al. 2017]] ). In addition, lack of affordable warmth can generate stress related to chronic discomfort and high bills, fear of falling into debt, and a sense of lacking control, which are potential drivers of further negative mental health outcomes, such as depression ( [[#Howden-Chapman--2012|Howden-Chapman et al. 2012]] ; [[#Liddell--2015|Liddell and Guiney 2015]] ; [[#Payne--2015|Payne et al. 2015]] ; [[#Wilson--2016|Wilson et al. 2016]] ). Health risks from exposure to cold and inadequate indoor environmental quality may be higher for low-income, energy-poor households, and in particular for those with elderly relatives, young children, and members with existing respiratory illness ( [[#Payne--2015|Payne et al. 2015]] ; [[#Thomson--2017b|Thomson et al. 2017b]] ; Nunes 2019). High temperatures during summer can also be dangerous for people living in buildings with inadequate thermal insulation and inappropriate ventilation ( [[#Ormandy--2016|Ormandy and Ezratty 2016]] ; [[#Sanchez-Guevara--2019|Sanchez-Guevara et al. 2019]] ; [[#Thomson--2019|Thomson et al. 2019]] ). Summer fuel poverty (or summer overheating risk) may increase significantly in the coming decades under a warming climate ( [[#9.7|Section 9.7]] ), with the poorest, who cannot afford to install air conditioning, and the elderly ( [[#Nunes--2020|Nunes 2020]] ) being the most vulnerable.

Improved energy efficiency in buildings contributes in fuel poverty alleviation and brings health gains through improved indoor temperatures and comfort as well as reduced fuel consumption and associated financial stress ( [[#Curl--2015|Curl et al. 2015]] ; [[#Lacroix--2015|Lacroix and Chaton 2015]] ; [[#Liddell--2015|Liddell and Guiney 2015]] ; [[#Thomson--2015|Thomson and Thomas 2015]] ; [[#Willand--2015|Willand et al. 2015]] ; [[#Poortinga--2018|Poortinga et al. 2018]] ). On the other hand, households suffering most from fuel poverty experience more barriers for undertaking building retrofits ( [[#Braubach--2013|Braubach and Ferrand 2013]] ; [[#Camprubí--2016|Camprubí et al. 2016]] ; [[#Charlier--2018|Charlier et al. 2018]] ), moderating the potential health gains associated with implemented energy efficiency programs. This can be avoided if implemented policies to tackle fuel poverty target the most socially vulnerable households ( [[#Lacroix--2015|Lacroix and Chaton 2015]] ; [[#Camprubí--2016|Camprubí et al. 2016]] ). [[#Mzavanadze--2018a|Mzavanadze (2018a)]] estimated that in EU-28 accelerated energy efficiency policies, reducing the energy demand in residential sector by 333 TWh in 2030 compared to a reference scenario, coupled with strong social policies targeting the most vulnerable households, could deliver additional co-benefits in the year of 2030 of around 24,500 avoided premature deaths due to indoor cold and around 22,300 disability adjusted life years (DALYs) of avoided asthma due to indoor dampness. The health benefits of these policies amount to EUR4.8 billion in 2030. The impacts on inhabitants in developing countries would be much greater than those in EU-28 owing to the much higher prevalence of impoverished household.

Apart from thermal comfort, the internal environment of buildings impacts public health through a variety of pathways including inadequate ventilation, poor indoor air quality, chemical contaminants from indoor or outdoor sources, outdoor noise, or poor lighting. The implementation of interventions aiming to improve thermal insulation of buildings combined with inadequate ventilation may increase the risk of mould and moisture problems due to reduced air flow rates, leading to indoor environments that are unhealthy, with the occupants suffering from the sick building syndrome symptoms ( [[#Willand--2015|Willand et al. 2015]] ; [[#Cedeño-Laurent--2018|Cedeño-Laurent et al. 2018]] ; [[#Wierzbicka--2018|Wierzbicka et al. 2018]] ). On the other hand, if the implementation of energy efficiency interventions or the construction of green buildings is accompanied by adequate ventilation, the indoor environmental conditions are improved through less moisture, mould, pollutant concentrations, and allergens, which result in fewer asthma symptoms, respiratory risks, chronic obstructive pulmonary diseases, heart disease risks, headaches, cancer risks, and so on ( [[#Allen--2015|Allen et al. 2015]] ; [[#Hamilton--2015|Hamilton et al. 2015]] ; [[#Thomson--2015|Thomson and Thomas 2015]] ; [[#Cowell--2016|Cowell 2016]] ; [[#Doll--2016|Doll et al. 2016]] ; [[#Wilson--2016|Wilson et al. 2016]] ; [[#Militello-Hourigan--2018|Militello-Hourigan and Miller 2018]] ; [[#Underhill--2018|Underhill et al. 2018]] ; [[#Cedeño-Laurent--2018|Cedeño-Laurent et al. 2018]] ). [[#Fisk--2018|Fisk (2018)]] showed that increased ventilation rates in residential buildings results in health benefits ranging from 20% to several-fold improvements; however, these benefits do not occur consistently, and ventilation should be combined with other exposure control measures. As adequate ventilation imposes additional costs, the sick building syndrome symptoms are more likely to be seen in low income households ( [[#Shrubsole--2016|Shrubsole et al. 2016]] ).

The health benefits of residents due to mitigation actions in buildings are significant (for a review see [[#Maidment--2014|Maidment et al. 2014]] ; [[#Thomson--2015|Thomson and Thomas 2015]] ; [[#Fisk--2020|Fisk et al. 2020]] ), and are higher among low income households and/or vulnerable groups, including children, the elderly and those with pre-existing illnesses ( [[#Maidment--2014|Maidment et al. 2014]] ; [[#IEA--2014|IEA 2014]] ; [[#Ortiz--2019|Ortiz et al. 2019]] ). [[#Tonn--2018|Tonn et al. (2018)]] estimated that the health-related benefits attributed to the two weatherisation programs implemented in the US in 2008 and 2010 exceeds by a factor of 3 the corresponding energy cost savings yield. [[#IEA--2014|IEA (2014)]] also found that the health benefits attributed to energy efficiency retrofit programs may outweigh their costs by up to a factor of 3. [[#Ortiz--2019|Ortiz et al. (2019)]] estimated that the energy retrofit of vulnerable households in Spain requires an investment of around EUR10.9–12.3 thousands per dwelling and would generate an average saving to the healthcare system of EUR372 per year and dwelling (due to better thermal comfort conditions in winter).

<div id="9.8.2.3" class="h3-container"></div>

<span id="outdoor-air-pollution"></span>