Intended for healthcare professionals


Millions of children face a “humanitarian crisis” of fuel poverty

BMJ 2022; 378 doi: (Published 01 September 2022) Cite this as: BMJ 2022;378:o2129

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Doctors warn of “significant humanitarian crisis” as half of UK households face fuel poverty

  1. Michael Marmot, director1,
  2. Ian Sinha, consultant respiratory paediatrician and co-director of the Lab-to-Life Child Health Applied Data Group2,
  3. Alice Lee, North West paediatric registrar and clinical innovation and research fellow2
  1. 1UCL Institute of Health Equity, London
  2. 2Alder Hey Children’s Hospital, Liverpool

By January 2023 more than half of UK households,1 including millions of children, will be in fuel poverty unless effective interventions are established. Our concern is with the health effects of this crisis, in particular its effects on certain groups at risk: black and ethnic minority groups, households with children, people on low incomes, and people with disabilities.2 Fuel poverty is driven by the energy efficiency of a home, household income, and the cost of fuel. Substandard housing and insufficient income are deep rooted problems in the UK, and more than a third of children live in poverty. Energy prices are soaring. This winter, fuel poverty and cold homes will present a public health and humanitarian crisis.

Cold homes affect health throughout the life course. Excess winter deaths have long been a problem, with the relative excess in the UK greater than in other, colder European countries.3 Cold homes cause and exacerbate respiratory and cardiovascular diseases, mental illness, and dementia. Financial insecurity can cause significant stress for households, with consequent effects on mental and physical health.4 Hypothermia and cold, damp, and dangerous housing cost the NHS more than £2.5bn a year.5

There is also a direct threat to children, in whom lifelong health inequalities take root. A person’s respiratory system, which develops in utero and in early childhood, is a key determinant of their health and longevity. Without doubt, substandard or overcrowded living circumstances are key risk factors for impaired lung development as, in addition to cold, these are associated with viruses, dust, mould, and pollution.6 The picture for children is bleaker still when we add the impact of living in cold accommodation on the quality of their sleep, development, and mental health. As families make financial sacrifices to stay warm, fundamental aspects of a happy, healthy, and productive childhood—good nutrition, educational essentials, toys, birthday parties, and Christmas presents—will give way.

The crisis of fuel poverty this winter is the result of a short term problem of fuel prices coming on top of long term problems of housing quality, inadequate investment in sustainable energy and energy independence, and families having insufficient money to lead a healthy life. The solutions, too, must address these long term problems. But a priority this winter must be a national strategy to manage fuel poverty, with ring fenced funding to enable local authorities to plan and sustainably support their populations proportionate to need. Many national programmes that either stalled or received reduced funding prior to the pandemic (including the Energy Savings Trust, Energy Company Obligation, and the government’s pledge to offer smart meters) should be reinvigorated, and efforts to improve building insulation should be prioritised.7

Urgent financial approaches are required. Vulnerable households should be protected from the catastrophic threat of having their gas and electricity supplies cut off this winter. A lower energy price cap, which kept thousands of households out of fuel poverty, should be reinstated and fixed. If the supply costs of gas and oil are increasing, these should instead be absorbed by companies who profit from these essential commodities. Government can provide the funds to support the price cap, paid for out of a windfall tax on energy production companies, and should reject the idea of tax cuts, which will favour the rich. If more than 50% of households will be affected, support to those on benefits will be insufficient. Our concept of proportionate universalism implies support across the social gradient with effort proportionate to need.

Local level health providers should implement guidelines from the National Institute for Health and Care Excellence8 on health risks of cold homes with immediate effect. Services such as Citizen’s Advice Bureau will be invaluable in supporting households to access their entitled benefits—currently, billions of pounds are estimated to go unclaimed each year, reflecting a system that is difficult to navigate.

The prospect of more than half of households facing fuel poverty is a sad state of affairs in a rich country. To avoid a humanitarian crisis this winter, efforts to help households stay warm must be immediate, meaningful, and have sufficient reach and accessibility.


  • Competing interests: IS is clinical lead for the Children and Young People’s Workstream of the National Asthma and COPD Audit Programme, Royal College of Physicians, as well as honorary associate professor in child health at University of Liverpool and NHS England North West clinical co-lead for children and young people’s asthma. None further declared. MM and AL none declared.

  • Provenance and peer review: commissioned, not peer reviewed.