This winter will present the unprecedented public health challenge of having to face the COVID-19 pandemic and the flu season at the same time. The colder months bring challenges for less affluent households to heat their homes adequately, thus increasing their exposure to health risks. On World Cities Day, 31 October, we take a moment to value our cities and communities, especially those most vulnerable in cold weather, and consider what can be done to reduce their risks.
In most countries in the WHO European Region, inequalities related to keeping a home warm in winter have increased in recent years, as have inequalities in the ability to afford heating costs. In almost all European countries, the poorest households are 4 to 5 times more exposed to cold homes than the most affluent ones, and in several countries more than 30% of low-income households are unable to keep their homes warm. The resulting fuel poverty is often associated with polluting and unsustainable fuel choices.
The use of polluting solid fuels for indoor heating and cooking is also unequally distributed and mostly seen in rural areas and low-income households. Solid fuel use may increase the risk of premature death due to long-term exposure to particulate matter from the burned material, and also due to acute poisoning caused by carbon monoxide exposure from poorly maintained heating devices and limited ventilation. The burden of disease due to indoor air pollution from household activities, such as heating or cooking, was estimated to be 55 000 premature deaths in the WHO European Region in 2016.
COVID-19 related restrictions particularly affect those already more vulnerable
The topic of affordable and clean indoor heating is particularly important this year due to the ongoing COVID-19 pandemic. Households need to anticipate possible restrictions on movement or lockdowns in addition to home schooling and home office work. This will increase the time spent in the home and further enhance the impact of low indoor temperatures as well as potential indoor air pollution, especially for low-income families.
Such increased exposure will especially affect population groups that are already more vulnerable, such as the elderly, children or persons with pre-existing medical conditions, if restricted to their home, and in households in which a family member is requested to go into home-based quarantine or isolation. The situation might be further exacerbated by the economic crisis that, in many countries, has resulted in job losses and furlough schemes, significantly increasing the number of people suffering from energy poverty and its consequences.
Finally, during the COVID-19 pandemic, extended presence in indoor, crowded and inadequately ventilated spaces may affect the risk of community transmission, as the virus spreads from an infected person’s mouth or nose in small liquid particles when they cough, sneeze, speak, sing or breathe heavily.
These transmission patterns further raise the importance of good indoor ventilation during the winter, despite a tendency to keep the house sealed to reduce energy consumption and keep it warm. This is most critical in large households with little floor space, as crowding and reduced possibility of maintaining physical distance increases transmission risk. Crowding is of concern predominantly for poor as well as single-parent households. For example, in some Eastern European countries, nearly 3 out of 4 single-parent households with a low income are affected by crowding.
What can be done?
At the individual level, we should continue washing our hands with soap, covering our cough, keeping safe distance from other people, and – where this is not possible – wearing a mask. We know that these measures are essential to breaking the chain of transmission, and – especially in winter – remain the most effective way to protect yourself and other household members. Good ventilation of indoor environments will also add to people’s protection, particularly at this time of the year.
Working with national governments, cities can play an important role in reducing these risks by supporting adequate and affordable energy supply for the coming winter and preparing support schemes for those who cannot afford heating. Preparing well in order to avoid local and national disruptions in supplying heating services and in infrastructure can further reduce risks and health effects related to heating shortages. Finally, local authorities can increase their awareness of the distribution of housing problems related to thermal comfort, energy use and crowding, all of which affect health and well-being for disadvantaged households and may contribute to increased transmission risk during lockdown periods.
By planning ahead, individuals and authorities can reduce the health burden on health care systems during the cold season, especially now when they are already severely stretched to treat COVID-19 patients.