This week we publish our Cold Weather Plan for 2014, part of the national effort to reduce an estimated 25,000+ excess winter deaths in England each year, many of which are entirely preventable.
It may not be a surprise to hear that older people or those with long term conditions can be the hardest hit during the winter and so whilst much of the plan is aimed at health and social care services and staff who support vulnerable people, we also aim to raise awareness amongst the public of how they can help their family, friends and neighbours stay safe.
Our core messages are generally unchanged every year; urging the most vulnerable to stay warm by dressing in multiple thin layers, having regular hot meals and drinks and making sure their property is well insulated. And for those that aren’t vulnerable we ask them to look out for others as the temperature drops.
One significant change to this year’s plan is a revision to our recommendation on winter minimum home indoor temperatures.
So, what is the change and why have we made it? Previously we had recommended a minimum temperature of 21°C for living rooms and 18°C for bedrooms but we now advise that people heat their homes to at least 18°C (65F), with some additional nuancing of that advice for vulnerable groups and healthy people.
We’ve made the change for a number of reasons:
1. The evidence
The previous recommendation was based on a number of policy documents, which were derived from a WHO consensus document - now some 30 years old. Although we were well aware of the methodological challenges in establishing such temperature thresholds, we felt it was time to review the scientific literature systematically to see if there was any new information available.
The review showed that, whilst there is reasonably robust evidence to indicate that cold homes increase the risk of death and illness in winter, there is, as we expected, limited evidence to indicate a definitive indoor temperature threshold at which these effects start to occur.
The evidence that’s available points to 18°C being the most appropriate threshold, with little to support the 21°C recommendation, particularly for the fit and healthy. What it also made clear was that the ageing process makes our bodies less able to regulate our temperature, and less able to detect the cold, so a recommendation that just relied on people adjusting the temperature to one that is ‘comfortable’ might put older people in danger.
2. The bigger picture
We have to mindful that, if taken up by households, our indoor room temperature recommendations will likely have an impact on fuel use, and thus carbon emissions and the money in people’s pockets. This could have the unintended consequence of harming people’s health and wellbeing, as we know both climate change and financial difficulties are bad for people’s health too. We therefore need to consider the balance between the desire to protect health of the vulnerable from cold, whilst avoiding unnecessary fuel use and the unintended consequences.
We know that people have strong feelings about their homes and don’t want to be told what to do in them. But we also have a duty to protect health, particularly of those most vulnerable in our society. And as regards vulnerability to cold, this is not just a handful of people living on the margins, but large numbers of older, frail or chronically unwell people.
After careful discussion with a number of partners and people working directly with those living in cold homes, we have settled on a broad recommendation of at least 18°C for everyone, but with scope for flexibility to individual circumstances.
We aren’t saying homes must be heated to this point and no higher – neither are we saying that this temperature will suit everyone. Indeed, people who feel the cold, people who are less active due to mobility problems or are particularly vulnerable because of illness may wish to heat their homes to temperatures higher than this.
Younger people who are healthy, active, and able to ‘layer up’ may find a lower temperature more comfortable.
So what else can be done to reduce the numbers of deaths and illnesses during cold weather? Long-term solutions aimed at increasing the energy efficiency of the UK’s housing stock are likely to have the biggest impact. As well as improved health this will likely have additional advantages such as reducing carbon emissions and developing the ‘green economy’.
But there are simple things we can do each winter to reduce the burden, largely around supporting vulnerable people to keep warm, get a flu jab and access advice on financial and other assistance available.
Much of this advice is sometimes labelled “common sense” but we have to do everything we can to make sure these messages get through. The sad reality is that we can show - quite clearly - that when the weather gets just a bit colder, people die and become unwell and are admitted to hospital.
Cover page image: UK snow by David Merrigan, Licensed under Creative Commons