Intended for healthcare professionals

Editor's Choice US editor's choice

Is a warm house a medical intervention?

BMJ 2007; 334 doi: (Published 01 March 2007) Cite this as: BMJ 2007;334:0-a
  1. Douglas Kamerow (dkamerow{at}

    You don't have to work very long taking care of poor people before you realize that the contents of our medical bag of tricks are often insufficient to improve their health status. One key contributor to ill health is the environment around the patient—do people smoke? Can the family afford healthy food? Is the home safe and warm?

    The last of these is explored this week in a ground-breaking randomized controlled trial from New Zealand (doi: 10.1136/bmj.39070.573032.80). Philippa Howden-Chapman and colleagues randomized 1350 single family homes in low income communities to receive new insulation or not and measured changes in environmental and health outcomes over one year. As one might expect, they found significant increases in winter indoor temperature and decreased dampness (humidity) in the insulated homes, despite decreased energy consumption. But they also found that residents of the insulated homes reported significantly improved quality of life, decreased wheezing, and fewer GP visits and sick days from school and work.

    In a related editorial (doi: 10.1136/bmj.39133.558380.BE), Hilary Thomson and Mark Petticrew comment on how unusual this trial is. Most previous studies have been smaller and uncontrolled. They recommend that this study inform housing policies and serve as a model for how to link housing investments to impacts on health.

    It may be that the real intervention here was to increase disposable income by reducing fuel costs, but as the study's authors point out, “it is easier to upgrade low income housing than to redistribute income.” More acceptable to politicians as well, I would think, at least in the US.

    But is it the job of a general medical journal to publish housing insulation studies? Are we promoting a new field called “evidence-based housing”? It is admittedly a bit far from our usual fare, but the links to health are clear. Not exactly “helping doctors make better decisions,” as the logo says at the top of your screen? Maybe not, unless we include in those decisions whom we should vote for and what our elected officials should do with our tax dollars to improve health.