Managing heath in a cold home – the case of childhood asthma Dr. Anna Cronin de Chavez Sheffield Hallam University

‘Secondary hypothermia' ‘sub-clinical hypothermia’ 'urban hypothermia‘ Where hypothermia can occur because of an underlying condition that prevents production and/or conservation of enough body heat. Urban hypothermia

Age related impaired thermoregulation – the very young and very old Immature thermoregulation Thinner skin High body surface area: volume Lack of subcutaneous fat Inability to shiver Lower metabolic rate Malnutrition

Infections Alcoholic intoxication Thyroid conditions Diabetes Stroke Dementia Malnutrition Immobility Open wounds Drugs affecting thermoregulation (e.g. tranquilizers, sedatives, antidepressants) Neurological impairments Conditions that predispose people to hypothermia

The problem of measuring hypothermia Fever focus Ideas of resilience to cold Cost Availability Manufacturing standards

Cold stress and health 22,000+ excess winter deaths per year Cold stress = Decreased immunity, increased blood viscosity, stress on heart Cold stress affects health of people with heart conditions, reduced immunity, at risk of stroke, sickle cell disease, asthma

Impaired thermoregulation Are not always able to detect they are experiencing thermal stress Cannot independently provide thermal care for themselves Difficulty communicating their thermal need to others Live in a household at risk to fuel poverty Multiple risk factors

WHO recommend 20˚C for room temperature Room temperature at birth recommended by WHO to be 32˚C if wet and unclothed, 25-28˚C if dry and clothed How cold is too cold?

Professor Angela Tod To explore influences on older people regarding keeping warm at home Method – qualitative, 50 older people, 25 health and social care staff, focus groups and consultation Pen portraits Warm Homes, Healthy People Funding Winter Warmth England website Input into Cold Weather Plan for England KWILLT junior Segmentation Group Pen Portrait Name Description Isolated and not wanting to cause a bother Pat Low income household and fuel poor, over 55, socially isolated and frightened, lacks information and understanding about keeping warm, private rented housing, long term mental health problems (depressions/anxiety) Getting by cautiously Ben and Joan Low income household and fuel poor, over 65, some social connections but not well informed about keeping warm, privately owned house, one partner has chronic health problems Dependent and poorly informed Meena Low income household and fuel poor, over 55, limited social connections, poorly informed about keeping warm, privately owned housing, poor health and mobility and very dependent on close family. Just about managing Enid Can pay for home heating but values thrift, over 70, some social connections but is private and trusts few people so is poorly informed about keeping warm, social housing, physical health problems and sensory impairment Lonely and out of touch Pearle Financially secure but lives in a cold home, over 70, widowed, and socially isolated, poorly informed about keeping warm, privately owned house, physically well but bereaved Proud and wants to be self sufficient Fred Low income but not fuel poor, over 70, regular but superficial social connections, poorly informed but values stoicism and hardiness and thinks he doesn’t need any help, social housing, good health, minor ailments.

Six-year-old Joe lives in one of the poorest areas of Wales. His dad, Paul, works as a part-time shop manager and his mum, Vanessa, is unemployed but desperate to find work. Black spores and damp in their council home aggravate Joe’s asthma. (Save the Children - Child Poverty in 2012 – It shouldn’t happen here) Childhood asthma and cold homes Asthma globally Asthma nationally Asthma locally Costs

Not just the mould.. Mould and cold Broncospasm Respiratory infections School attainment

Understanding childhood asthma in the home Several interventions showing reduction in asthma with warmer, better ventilated houses KWILLT Junior = Warm and Well Families The study will be an in-depth, qualitative exploration of factors influencing the decisions and behaviour of vulnerable households with children regarding keeping warm and well at home.

Study details Study location Study criteria Recruitment Advisory groups Study design Analysis Timescale 1. Values and beliefs regarding heating and health in general 2. Beliefs around heating and asthma 3. About their home heating system and patterns 4. About their house condition and energy efficiency 5. Paying for fuel 6. Social networks and support

Outputs and dissemination Final report Social marketing segmentation model similar to the KWILLT pen portraits Collaboration with charities working with charities interested in alleviating fuel poverty and improving child health Peer review academic publications Film Recommendations for interventions, training, referral processes, policy Film and other social marketing materials Winter Warmth England website expansion