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Experimental treatment for chronic illness in winter: Paid-for heating bills


LONDON — Each winter, the symptoms of millions of people around the world living with chronic illnesses are exacerbated by falling temperatures, in some cases even killing them. Now, a small trial in Britain seeks to prevent some of those deaths with an alternative remedy: paying vulnerable people to heat their homes during winter.

The Warm Home Prescription, a collaboration by local government officials, the National Health Service and a nonprofit organization, will meet the domestic heating costs of more than 1,000 people living with cold-sensitive chronic conditions in low-income households across the country, in the hope that it will keep them healthier.

The trial is set to run from December to March and is based on the success of a smaller pilot program in Gloucestershire, in western England, this year. Organizers hope to reduce the overall risk of hospitalization for vulnerable people and will also test whether paying their heating bills lowers costs for health-care providers by preventing costly hospital stays.

Spiraling global energy costs and inflation in other areas have added to the financial pressures on households in Britain, Europe, the United States and beyond — raising concerns for many that they will not be able to properly heat their homes. The U.K. government placed a legal cap on household energy costs this year, but the wider economic outlook remains dire, with the Bank of England warning that the country is headed for its longest recession in modern history.

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More than half of all excess deaths recorded in Britain over a typical winter are caused by respiratory and circulatory diseases, which are known to worsen in colder temperatures, according to the government-run Office for National Statistics. The office’s latest figures estimate there were 28,300 excess deaths in the winter of 2019 to 2020.

“The aim is really to help them to stay well, because we know that if they’ve got a respiratory condition and they’re exposed to cold temperatures in the home, that they’re likely to get worse,” said Shantini Paranjothy, a doctor in Aberdeen, Scotland, who is involved in the trial. “We’re trying to keep them warm and safe at home and prevent them from needing any hospital admission.”

Those involved in the trial will have the average costs of heating their home met by the program or be sent electric heaters, as well as the funds to keep them switched on, Paranjothy said. Participants will be selected by local health authorities; the full list of this year’s participants has not been finalized.

Symptoms from illnesses like asthma and chronic obstructive pulmonary disease (COPD) frequently worsen over winter, when the likelihood of further respiratory problems and chest infections also increases, Paranjothy said.

“If you can’t heat your home and you have got problems with breathing,” she said, “it is going to make those things worse. That is what we know from the pathology of how these illnesses progress.”

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The World Health Organization, which advises people with chronic illnesses to take extra care to stay warm in the winter, says cold air can inflame the lungs, inhibit circulation and increase the risk of respiratory conditions. “Cold also induces vasoconstriction, which causes stress to the circulatory system that can lead to cardiovascular effects,” the guidance says.

Paranjothy advises patients with chronic conditions made worse in the cold to maintain the temperature of occupied rooms in their homes between about 64 and 70 degrees Fahrenheit (18 to 21 degrees Celsius) during the winter, but many Britons cannot afford to do that. Temperatures drop to an average low of just over 35 degrees Fahrenheit (2 degrees Celsius) in the winter, according to the U.K.’s Meteorological Office, with the country’s north experiencing much colder conditions.

Michelle Davis, 38, has multiple health conditions, including COPD, that are exacerbated in the winter when she cannot afford to heat her home adequately, qualifying her to take part in the program’s Gloucestershire trial last year. The “prescription” trial, which she hopes to join again, allowed her to heat her home comfortably, alleviated her cough and chest pain, and contributed to her overall physical and mental health last winter, she said.

“It meant that I didn’t end up in hospital,” she said, explaining how in 2020 — when she could not afford to keep the temperature of her home at a comfortable level — her chronic illnesses flared up, and she spent time in a hospital with pneumonia and flu.

“It’s agonizing when it gets cold,” she said. “When it’s cold and wet, my joints, they seize up. They become very painful. My bones just feel like they’re on fire.” In previous winters, she spent a lot of time in bed trying to stay warm, she explained, fearful of letting her two children play outdoors because she worried they would not be able to warm up afterward.

“I didn’t realize exactly how much a difference having the heating on for an extra hour or two would make,” she said. “It just made me able to be a mom for a bit.”

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As well as saving lives, Energy Systems Catapult — the nonprofit funding the program — hopes it could also reduce the wider financial cost placed on health services.

The NHS in England alone spends about $1.05 billion each year to care for patients who live in cold homes every winter, the group said in a statement, citing a 2021 study by the Building Research Establishment group. Long-standing pressures on Britain’s health system have been made worse by soaring inflation, which has squeezed the NHS’s public funding.

“If we buy the energy people need but can’t afford, they can keep warm at home and stay out of hospital. That would target support to where it’s needed, save money overall and take pressure off the health service,” Rose Chard, a program lead for Energy Systems Catapult said a statement.

Rising energy costs are set to make the Warm Home Prescription program more expensive to operate this winter, but Davis, who hopes to join the new program, says this is also what makes the “prescription” essential for helping keep her family warm and healthy. Without it, the energy bills for her two-bedroom duplex will exceed $300 a month, she said, an increase of $108 from last winter.

“In the long run, it’s going to cost a few hundred over a few months. But one night’s stay in hospital costs the government so much more,” she said.