Cities, Climate and Inequalities – Energy poverty: An overlooked determinant of health and climate resilience in Canada

Mylène Riva, Associate Professor in the Department of Geography, McGill University

Introduction

Energy is essential for meeting our basic needs and is a prerequisite for good health (World Health Organization, 2018). In Canada, home heating during the winter months and home cooling during heat waves can be a matter of life and death. Excess mortality during heat waves is well documented in the Canadian context (BC Coroners Service, 2022; Lamothe et al., 2019; Lebel et al., 2019). Under likely-to-occur climate scenarios, this is projected to worsen in the coming decades due to a rise in summer temperatures and the number of heat waves. 

Canada is one of the largest energy producers in the world. Yet, not all Canadians can attain levels of domestic energy services required to meet their needs, maintain healthy indoor temperatures and live with dignity—a situation known as energy poverty (Bouzarovski & Petrova, 2015; Simcock & Mullen, 2016; Thomson et al., 2017a). Indeed, depending on the indicator employed, between 6% to 19% of Canadian households face energy poverty (Riva et al., 2021). The prevalence of energy poverty is socially and geographically patterned, with one-person and older households, households with lower socioeconomic status, renters and those living in dwellings requiring major repairs more at risk of energy poverty (Das et al., 2022; Riva et al., 2021). Many of these same groups are also most at risk of suffering from climate-related health impacts (Ebi et al., 2021; Kim et al., 2020; Orlando et al., 2021). 

Under a changing climate, energy poverty needs to become a priority issue. Extreme weather events such as storms, flooding and heat waves have the potential to compromise households’ access to and use of energy. Findings from our study published in the Canadian Journal of Public Health, which draws on data from a representative pan-Canadian population survey, show that energy poverty is significantly associated with poorer self-rated general and mental health (Riva et al., 2023). 

Literature review

Energy poverty is a complex, multi-dimensional phenomenon influenced by a range of factors including: household income and the practices and needs of household members; the type, conditions and energy efficiency of the dwelling; economic and political factors such as energy tariffs, available energy sources and governance; and climate-related hazards and events that can increase or compromise energy needs (Bouzarovski et al., 2021; Hernandez, 2016; Middlemiss, 2019). International studies show that exposure to energy poverty, particularly in the context of cold indoor temperature, can impact cardiovascular and respiratory systems, exacerbate some chronic diseases and compromise mental health and well-being (Ballesteros-Arjona et al., 2022; Liddell & Morris, 2010; Marmot Review Team, 2011; O’Sullivan, 2019; World Health Organization, 2018). 

A comparative study of 32 European countries revealed that, for most countries, adults in households unable to afford adequate heating reported poorer self-rated health, lesser emotional well-being and more depressive symptoms (Thomson et al., 2017b). Among the 20 countries where a statistically significant association was observed, the odds of poor health induced by energy poverty ranged from 1.63 to 2.80. In Australia, results from a panel study showed a strong negative association between energy poverty and self-rated health in the overall sample (Churchill & Smyth, 2021), with varying impacts across demographic groups. Other studies have reported inequalities in the health impacts of energy poverty across population groups (Bosch et al., 2019; Lacroix & Chaton, 2015; Mohan, 2022; Oliveras et al., 2020; Oliveras et al., 2021).

The implications of energy poverty during heat waves are increasingly acknowledged (Jesse et al. 2019; O’Sullivan & Chisholm, 2020; Sanchez-Guevara et al. 2019; Thomson et al., 2019). In the Australian panel study, findings indicated a more pronounced adverse effect of energy poverty on self-perceived general health during the summer months and in warmer states (Churchill & Smyth, 2021). Access to air conditioning is associated with reduced mortality and hospitalizations (Sera et al., 2020), yet is also socially patterned (Quick & Tjepkema, 2023). 

Robust data regarding energy poverty and its impacts on the health of Canadians are needed to inform ongoing health-related adaptation and mitigation efforts as well as emergency responses. As a first step in this direction, results from Riva et al.’s  study analyzed, for the first time in the Canadian context, the health risks associated with exposure to energy poverty in a representative sample of Canadian adults aged 18 years and older (Riva et al., 2023).

Methods

Access to microdata from the 2018 Canadian Housing Survey (CHS) and the corresponding Administrative Personal Income Masterfile (APIM) was obtained from Statistics Canada (Statistics Canada, 2018). The two datasets were linked together in order to obtain income information of the CHS respondents (with respondents’ consent). Analyses were conducted on a sample of more than 65,000 households residing in the ten provinces weighted to represent over 14 million Canadian households.

Participants self-reported their general and mental health. Those reporting their general or mental health as excellent, very good or good were contrasted to those reporting their health as fair or poor. In the CHS, participants reported annual payment for electricity as well as for oil, gas, coal, wood or other fuels. Energy poverty was measured using an indicator of “high share of energy expenditure in income,” based on which households are considered to face energy poverty if their share of energy spending relative to household income (after income taxes and housing costs such as rent or mortgage) is over twice the national median share (i.e., over ~6%; hereafter >2M). Participants also reported on their satisfaction with the energy efficiency of their dwelling and with their ability to maintain a comfortable temperature in the winter and the summer. Expenditure-based and self-reported measures were considered to capture the multi-faceted nature of energy poverty.

Logistic regressions modeled the association between energy poverty indicators and health outcomes (adjusting for potential confounding variables). Analyses were performed at the McGill-Concordia Research Data Centre (RDC), a secure physical environment available to accredited researchers to access anonymized microdata for research purposes.

Results

Due to the high share of energy expenditure in income (2M) threshold, 18% of respondents were in energy poverty (Fig. 1). Sixteen percent, 13% and 15% of respondents reported being dissatisfied with, respectively, the energy efficiency of their dwelling and their ability to maintain a comfortable temperature in winter and in summer. .

Associations between the different indicators of energy poverty and self-rated general and mental health are shown in Fig. 2. For conciseness, we only report on selected indicators of energy poverty: the high share of energy expenditure in income (2M) and the satisfaction with the ability to maintain a comfortable temperature in winter and summer. Results are presented using odds ratios and 95% confidence intervals (refer to the footnote of Fig. 2 for an explanation of their interpretation). 

Fully adjusted models demonstrated a significant association between all indicators of energy poverty and self-rated general and mental health. Those in energy poverty, as per the 2M, were almost 50% more likely to rate their general health as poor and 20% more likely to report poorer mental health. Dissatisfaction with thermal comfort significantly increased the likelihood of poor general and mental health, particularly during the summer months. Specifically, the likelihood of reporting poorer general and mental health is about 40% higher for those dissatisfied with their ability to maintain a comfortable temperature in the winter. The likelihood of rating one’s general and mental health as poor was, respectively, 44% and 60% higher among those dissatisfied with their ability to maintain a comfortable temperature in the summer.

^aSeparate logistic regression models for each measure of energy poverty and health outcome. Models are adjusted for age, gender, education, economic hardship, household composition, repairs needed, tenure, urban/rural location and province.

^bResults of logistic regression models are presented using odds ratios and their 95% confidence intervals. An odds ratio greater than 1 indicates that there is a higher likelihood of energy poverty being associated with the health outcome (adjusting for other variables). The statistical significance level is set at p<0.05. If the confidence interval does not cross the value of 1, the effect is considered statistically significant.

^cFigure adapted from Table 3 in Riva et al., 2023.

Findings show that energy poverty is a risk factor for the health of Canadians, independently of financial hardships and poor housing conditions, both of which are important social determinants of health that also affect a household’s vulnerability to experiencing energy poverty. These results support those of international studies demonstrating a negative association between energy poverty and self-rated general and mental health (Bosch et al., 2019; Lacroix & Chaton, 2015; Mohan, 2022; Oliveras et al., 2020; Oliveras et al., 2021; Kahouli, 2020; Thomson et al., 2017b). Results further reveal a stronger association between poorer health and dissatisfaction with the ability to maintain a comfortable temperature in the summer compared to the winter. This underscores the importance of considering the health implications of energy poverty with respect to cooling needs and is particularly relevant for Canada, where heat waves are expected to increase due to climate change (IPCC, 2021). 

Experiencing energy poverty is stressful. It creates worries about household finance, the ability to maintain or afford adequate temperature, the fear of incurring debt and the stigma of living in a cold home (Liddell & Guiney, 2015; Middlemiss & Gillard, 2015). International evidence indicates that people living in dwellings that are cold, damp and energy inefficient can feel ashamed to welcome guests, a factor that can lead to social exclusion and diminish well-being (Longhurst & Hargreaves, 2019; Middlemiss & Gillard, 2015). To cope with energy poverty, households sometimes curtail their energy consumption, exposing themselves to adverse thermal conditions (Chard & Walker, 2016; Longhurst & Hargreaves, 2019; O’Sullivan et al., 2017). In some cases, households may prioritize paying energy bills over other expenses such as food (Bhattacharya et al., 2003; Harrington et al., 2005). Qualitative research is needed for a more comprehensive understanding of the lived experience of energy poverty and the intricate impacts it exerts on daily life, health and well-being.

To prevent and reduce energy poverty and increase household-level energy security across the country, programs and policies should ensure that the price of energy remains affordable to households and accelerate energy retrofits in the residential sector. Given the close relationship between energy poverty and climate vulnerability, addressing energy poverty is a fundamental element of climate resilience. 

Interventions aimed at reducing energy poverty and bolstering energy security by improving the energy efficiency of residential buildings have demonstrated positive impacts on the health and well-being of diverse population groups (Ballesteros-Arjona et al., 2022; Thomson et al., 2013; Willand et al., 2020; Willand et al., 2015). For example, retrofitting residential buildings not only reduces greenhouse gas emissions but also generates social and economic benefits that can ameliorate health outcomes by mitigating energy poverty (Hoicka & Das, 2021; Pojar & Karásek, 2019; Sharpe et al., 2019). Programs and subsidies designed for housing retrofits and the construction of energy-efficient dwellings should be evaluated for their health and equity impacts, as they often primarily benefit those with the financial means to modify their residences.

Conclusion

Energy poverty is an overlooked factor influencing the health of Canadians. As the country transitions towards cleaner energy and a lower-carbon economy, it becomes imperative to ensure that energy remains affordable, particularly for those in vulnerable circumstances. There is a risk that policies designed to advance the energy transition, such as those targeting the housing sector, inadvertently exacerbate social and health disparities if the benefits are not distributed equitably in the population. Hence, it is crucial to establish programs that cater to population segments that would derive the most substantial advantages from them, including low-income individuals, older adults and renters.

Given the substantial number of Canadian households grappling with energy poverty and its demonstrated repercussions for public health, addressing this issue should be an integral part of discussions concerning an equitable energy transition and climate resilience. Moreover, with Canada set to confront more intense and prolonged extreme weather events such as heat waves, storms and floods (IPCC, 2021), public health authorities across the country should incorporate energy poverty in their climate change surveillance and monitoring programs. These extreme events have the potential to undermine households’ access to and utilization of energy resources. Hence, there is a pressing need for comprehensive data on energy poverty and its effects on population health to inform ongoing efforts related to health adaptation, mitigation and emergency responses.

 

Acknowledgments 

The information presented in this summary was adapted from the following article: “Energy poverty: an overlooked determinant of health and climate resilience in Canada,” Riva M, Kingunza Makasi S, O’Sullivan K, Das RR, Dufresne P, Kaiser D, Breau S (2023), Canadian Journal of Public Health 114: 422‒431. The analyses presented in the original paper (and reproduced in part in the current summary) were conducted at the McGill-Concordia Research Data Centre, a branch of the Quebec Interuniversity Centre for Social Statistics (QICSS), which is part of the Canadian Research Data Centre Network (CRDCN). The services and activities provided by the QICSS are made possible by the financial or in-kind support of the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Canada Foundation for Innovation, Statistics Canada, the Fonds de recherche du Québec – Société et culture, the Fonds de recherche du Québec – Santé and the Quebec universities. The views expressed in the original paper and in this summary are those of the authors and do not necessarily reflect those of the CRDCN or its partners.

To cite this article

Riva, M. (2024). Energy poverty: An overlooked determinant of health and climate resilience in Canada. In Cities, Climate and Inequalities Collection. VRM – Villes Régions Monde. https://www.vrm.ca/precarite-energetique-un-determinant-neglige-de-la-sante-et-de-la-resilience-climatique-au-canada-2

Reference text

Riva M, Kingunza Makasi S, O’Sullivan K, Das RR, Dufresne P, Kaiser D, Breau S (2023) Energy poverty: an overlooked determinant of health and climate resilience in Canada. Canadian Journal of Public Health 114: 422‒431

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