The total health gains and cost savings of eradicating cold housing in Australia

Shiva Raj Mishra; Tim Wilson; Hassan Andrabi; Driss Ait Ouakrim; Ang Li; Edifofon Akpan; Rebecca Bentley; Tony Blakely

doi:10.1016/j.socscimed.2023.115954

The total health gains and cost savings of eradicating cold housing in Australia

Soc Sci Med. 2023 Oct:334:115954. doi: 10.1016/j.socscimed.2023.115954. Epub 2023 May 5.

Authors

Shiva Raj Mishra¹, Tim Wilson², Hassan Andrabi³, Driss Ait Ouakrim², Ang Li⁴, Edifofon Akpan⁵, Rebecca Bentley⁴, Tony Blakely²

Affiliations

¹ Scalable Health Intervention Evaluation (SHINE), Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. Electronic address: shivarajmishra@gmail.com.
² Scalable Health Intervention Evaluation (SHINE), Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
³ Scalable Health Intervention Evaluation (SHINE), Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Centre for Brain, Mind, and Markets, Department of Finance, University of Melbourne, Melbourne, Australia.
⁴ Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
⁵ Centre for Health Economics and Development, Abuja, Nigeria.

PMID: 37672848
DOI: 10.1016/j.socscimed.2023.115954

Abstract

Background: Cold indoor temperature (<18 °C) is associated with hypertension-related and respiratory disease, depression, and anxiety. We estimate total health, health expenditure and income impacts of permanently lifting the temperature in living areas of the home to 18 °C in cold homes in South-eastern Australia (N = 17 million).

Methods: A proportional multistate lifetable model was used to estimate health adjusted life years (HALYs), health expenditure and income earnings, over the remainder of the lifespan of the population alive in 2021 (3% discount rate). Multiple data were integrated including the prevalence of cold housing (5.87%; mean temperature 15 °C), the effect of temperature to hypertension-related, respiratory disease, depression and anxiety.

Findings: Eradicating cold housing was predicted to lead to 89,600 (95% UI 47,700 to 177,000) lifetime HALYs gained over the population's remaining lifespan, nearly half of which occurred from 2021 to 2040. Respiratory disease (32.4%) and mental illness (60.6%) made large contributions to HALYs gained, but also had large uncertainty (95% UI 30.0%-42.9% and 45.1%-64.6%, respectively) due to uncertain estimates of their magnitude of causal association with cold housing. Health gains per capita were 6.1 times greater (95% UI 4.7 to 8.1) among the most compared to least deprived quintile. From 2021 to 2040, health expenditure decreased by AUD$0.87 billion (0.35-1.98) and income earnings increased by AUD$4.35 billion (1.89-9.81).

Interpretation: Eliminating cold housing would lead to substantial health gains, reductions in health inequalities, savings in health expenditure, and productivity gains. Next steps require research to reduce uncertainty about the magnitude of causal associations of cold with mental and respiratory health.

Keywords: Australia; Health equity; Health gains; Housing; Indoor temperature.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Cold Temperature
Cost Savings
Housing*
Humans
Hypertension*