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The Scottish Executive Central Heating Programme: Assessing Impacts on Health

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EXECUTIVE SUMMARY

This Report presents the findings from an evaluation of the health impacts of the Scottish Executive Central Heating Programme ( CHP). The evaluation was based on data collected between November 2002 and March 2006, and contrasted the experiences of a group of 1,281 households which received central heating under the CHP ('recipients') with those of a comparison group of 1,084 households not enrolled in the CHP.

The key message from the evaluation is that the CHP significantly reduced condensation, dampness and cold in recipients' homes, long-term exposure to which is associated with poor health.. However, there was little evidence of a clear and systematic direct impact of the Programme on health outcomes and use of health services. While receipt of heating under the programme was associated with a reduced probability of receiving a first diagnosis of heart disease and of high blood pressure, this finding must be treated with caution: it was based on self-reported data, rather than clinical records, and was not accompanied by any reduction in the use of medical services or medication which might be expected as a consequence.

The main findings of the evaluation are as set out below.

  • Two years after installation, the Programme had no clear impact on respondents' current health or their use of health services or medication.
  • The prevalence of poor environmental conditions - specifically, the presence of condensation, dampness and / or mould (long term exposure to which is associated with poor health) - in individual rooms within the home was significantly lower for those who received heating under the CHP than for the comparison group. Recipients were also less likely than comparison respondents to avoid the use of rooms due to difficulty in heating them, or to problems of damp or condensation.
  • Receipt of central heating under the CHP was associated with a reduced probability of receiving a first diagnosis of heart disease, or of high blood pressure, during the period examined by the evaluation. (However for reasons discussed below this finding must be treated with caution.)
  • The CHP did not show any significant relationship with respondents' usage of primary or secondary health services.
  • Heating recipients were more likely than the comparison group to report receiving a first diagnosis of a nasal allergy (such as hayfever) during the evaluation period.
  • A further fourteen outcome measures representing specific symptoms and health conditions exhibited no significant associations with the receipt of heating under the Programme.
  • Receipt of heating via the Programme was associated with better outcomes on two dimensions of the SF-36 Health Survey questionnaire 1: physical functioning ( i.e. fitness and mobility) and general health. However, the estimated size of the difference between recipients and non-recipients of heating was small in both cases.
  • The Programme was not associated with any significant effect on respondents' experience of long-standing illness or disability.
  • Heating recipients were found not to be significantly different from the comparison group in their use of medications, either prescribed or 'over the counter'.
  • No significant effect of the Programme was found on respondents' behaviour in respect of cigarette smoking or alcohol consumption.
  • Those acquiring heating via the Programme were less likely to report any degree of inability to manage financially.
  • Receipt of heating under the CHP was associated with apparently contradictory effects on respondents' overall satisfaction with their homes. Recipients were less likely to perceive home as a place 'to get away from' but were more likely to express a desire to move home if able to do so.
  • CHP recipients perceived their homes to be warmer in winter, indicated that their heating was less likely to be a serious problem and reported that they were more satisfied with their heating overall, relative to those who were not part of the CHP.
  • Those who received central heating under the CHP reported that in general a greater proportion of the home was heated, and for longer, than was the case for the comparison group. The only exception to this pattern was that recipients were found to heat the dwelling's main living room in cold weather for a shorter time than comparison households.
  • Those receiving heating under the Programme were less likely than the comparison group to dissuade friends or relatives from staying overnight, or from visiting, due to poor housing conditions such as dampness or cold.
  • There is no evidence to suggest that the CHP had different effects on specific subgroups, e.g. owner occupiers versus tenants or different age groups, among those who received heating.

Overall, the results indicate that receipt of heating under the Central Heating Programme had considerable impacts on the home environment, including on conditions such as cold, dampness and mould. However, there was no evidence of a clear and systematic direct effect on health. The findings indicating a reduced likelihood of diagnosis with high blood pressure or heart disease, while noteworthy, must be treated with caution. Although the recipient group were subsequently less likely to be diagnosed with heart disease and high blood pressure than the comparison group, this difference was not accompanied by a difference in the use of health services. This suggests that the apparent difference in incidence of diagnosis may not be reliable.