A cold home is not just uncomfortable — it is a measurable driver of ill health, and one that falls unevenly across London. Fuel poverty sits alongside housing quality and employment as one of the wider determinants this review exists to track: the conditions outside a hospital or GP surgery that shape whether Londoners get sick in the first place. The 2014 “Better Health for London” report placed housing and the wider determinants of health squarely within its remit, and a decade on, fuel poverty remains one of the clearest examples of how an economic problem becomes a clinical one.
What Counts as Fuel Poverty in England
England measures fuel poverty using the Low Income Low Energy Efficiency (LILEE) indicator. A household is classed as fuel poor if it lives in a property with an energy efficiency rating of band D or below, and if, after paying what it would cost to heat that home adequately, its residual income falls below the official poverty line. “Adequate” heating is defined in line with World Health Organization guidance: 21°C in the main living room and 18°C in other occupied rooms during the day. Scotland, Wales and Northern Ireland use a different test, based on whether a household needs to spend more than 10% of its income on energy. Critics of the LILEE approach have pointed out that it is built around energy efficiency ratings rather than live energy prices, so a household squeezed by a sharp rise in bills may not register as fuel poor even while struggling to pay them. Whichever definition is used, the underlying question is the same: can this household afford to keep itself warm.
How a Cold Home Damages Physical Health
The clinical case against cold housing is well established. Cold temperatures cause blood vessels to constrict, raising blood pressure and increasing the risk of heart attack and stroke — a pattern reflected in the rise in cardiovascular deaths seen every winter, particularly among older residents and those with existing heart conditions. Cold and damp housing is also strongly associated with respiratory illness: asthma, bronchitis and chronic obstructive pulmonary disease are all aggravated by low indoor temperatures, and the mould that thrives in poorly heated, poorly ventilated homes adds allergic reactions, coughing and infection risk on top. Children are particularly exposed — cold homes have been linked to reduced lung function and slower cognitive development, and UK children miss more school days to illnesses associated with damp and mould than children in any other EU member state. Prolonged cold also worsens joint pain and arthritis, reduces manual dexterity, and increases the risk of falls among older residents. None of this is abstract: the NHS is estimated to spend around £1.4 billion a year treating illness directly linked to cold or damp housing, with the wider cost to society — lost productivity, social care, welfare support — put at roughly £15.4 billion.
The Mental Health Toll of Living Cold
The wider determinants framework this review uses treats mental and physical health as inseparable, and fuel poverty is a case in point. Living in a cold or damp home is associated with a significantly higher likelihood of depression and anxiety; some research suggests cold housing roughly doubles the risk of an adult developing a new mental health condition, and roughly triples the risk of an existing one getting worse. The strain of rationing heating, and the isolation of a home that is unpleasant to be in or invite people into, contribute to loneliness. Fuel poverty has also been identified as a recognised risk factor for suicide. Framed this way, an unheated flat is not simply an energy problem sitting next to a health problem — for many residents, it is the same problem.
A Health Gap Written Into London’s Boroughs
London’s overall fuel poverty rate rose from 9.3% to 9.6% in 2024, but that citywide figure obscures a sharp borough-level divide — the kind of variation that is the whole point of tracking wider determinants rather than city-wide averages. Outer east and northeast London consistently show the highest rates, while parts of central London show the lowest.
| Borough | Fuel poverty rate (LILEE, 2024) |
|---|---|
| Newham | 13.3% |
| Barking and Dagenham | 12.8% |
| Waltham Forest | 12.2% |
| Haringey | 11.4% |
| Enfield | 11.1% |
| City of London | 6.3% |
Earlier constituency-level analysis found an even starker split within individual boroughs: East Ham was estimated at close to 17% of households in fuel poverty, with Ilford South and Walthamstow also among the worst-affected areas in the capital, alongside Edmonton and Tottenham. A resident in one of these areas is considerably more likely to be living in a home that cannot be kept at a safe temperature than a resident a few miles away — and, by extension, more exposed to the cardiovascular, respiratory and mental health risks that follow from that.
Why This Belongs in a Health Review, Not Just an Energy Debate
Fuel poverty is usually discussed as an energy-bills story or a poverty story. Both are true, but neither captures what it does inside the body: raised blood pressure, aggravated lungs, worsened arthritis, higher risk of depression, and — for children in the coldest homes — measurable effects on development. That is precisely why housing sits inside this review’s wider determinants remit rather than being treated as someone else’s policy area. The borough-level gap in fuel poverty is not a side note to London’s health inequalities; in boroughs like Newham and Barking and Dagenham, it is one of the more direct, quantifiable mechanisms producing them. Understanding fuel poverty as a health issue, not only a household-finance one, is a necessary part of understanding why London’s health gap looks the way it does.