Prevalence, health effects, and coping

Households with high energy bills relative to their income may experience energy insecurity. Various factors contribute to high energy costs, including energy-inefficient homes, climate change, and external factors such as oil shortages.

Energy insecurity can negatively affect health in several ways, including worsening mental health, sleep quality, respiratory health, pediatric health, and thermal stress.

Energy insecurity is the inability to meet basic household energy requirements, such as:

• heating or cooling the home
• maintaining adequate lighting
• cooking
• using basic household appliances

If a person has high energy costs relative to their income, they may find it difficult to meet these requirements. Energy insecurity may be physical or economic.

Physical energy insecurity may occur as part of a cycle of poverty and housing deficiency.

Lower income individuals often live in energy-inefficient homes. Factors in homes that may contribute to energy inefficiency include:

• insufficient insulation
• leaky roofs
• unmaintained cooling and heating systems
• homes in climates that require extensive heating or cooling

Energy inefficiency can increase energy expenses and lead to a loss of energy access, as people may have to defer costly maintenance of malfunctioning or aging equipment.

On average, households in the United States allocate 3.1% of their earnings toward energy expenses. However, low income households typically need to allocate 8.1% or more. The severe discrepancy between income and energy cost is called the energy burden.

Energy costs that exceed 6% of a household income count as a “high burden,” and those that exceed 10% are a “severe burden.”

Energy expenses require a larger proportion of income, so lower income households may have fewer financial resources for other necessities, such as food, medical care, and housing.

A lack of access to affordable or reliable energy can affect mental and physical health. Energy insecurity can also affect children’s development, health, well-being, and behavior.

The methods that people use to manage energy insecurity can also have negative health consequences.

A 2020 study suggests that energy insecurity may contribute to depression in the following ways:

• worries about energy bills
• conflict with family members
• chronic thermal discomfort, as people may be unable to find relief from extreme temperatures
• stigma within the community
• feeling hopelessness and a loss of control over the situation
• worries about the health consequences of energy poverty
• the experience and fear of financial debt

Older and energy-inefficient households may contribute to the following physical issues:

• Respiratory problems: Energy insecurity may lead to indoor pollution, mold, and extreme temperatures, which can contribute to respiratory illnesses such as asthma and chronic obstructive pulmonary disease (COPD).
• Thermal discomfort: The inability to control a home’s temperature can lead to thermal discomfort, which can disturb sleep and affect mental health.
• Heat stress: Exposure to extreme heat can lead to health complications such as heat exhaustion, heatstroke, and heat rashes.
• Hypothermia: Exposure to extreme cold can cause hypothermia. Hypothermia can affect the heart, lungs, and brain, and can be life threatening.
• Low sleep quality: Sleep deprivation can lead to complications, such as stroke, high blood pressure, and heart attack.
• Food insecurity: High energy bills can reduce a person’s financial resources for other necessities like food. Food insecurity may contribute to health complications, including diabetes, heart disease, and mental health disorders.
• Medical equipment failure: Unstable or expensive energy threatens a person’s ability to sustain essential medical equipment, such as ventilators.

According to Health Affairs, children from energy-insecure homes may be more likely to experience:

• food insecurity
• hospitalization
• developmental issues
• depressive behaviors
• behavioral issues, such as rule-breaking

Children in energy-insecure households may also be at higher risk of:

• household accidents
• respiratory illnesses
• minor illnesses, such as colds and flu
• impaired learning

Some people may use methods to cope with energy insecurity that can increase the risks of injuries and health complications.

These include using secondary heating equipment, such as space heaters, stoves, or ovens. This can increase the risk of exposure to toxic gasses, fire, and injury.

People may also forego necessities such as medical care and food to pay energy bills, which can lead to worsening health conditions and unbalanced nutrition.

According to a survey by the Energy Information Administration, over 33 million U.S. households were energy insecure in 2020, and almost 25 million households reduced or sacrificed food and medication to pay for energy.

Another survey found that in 2020, 25% of low income households could not afford to pay their energy bills, and utility providers sent disconnection notices to over 25% of people who participated in the study.

Energy insecurity is more likely to affect certain groups of people. Various research suggests that groups who are most at risk include:

• Black and Latino households
• lower income groups
• people who rent their homes
• people with children
• people who live in rural areas
• mobile home occupants

Various factors contribute to an increased risk of energy insecurity, including structural racism, government policies, and climate change.

Historic practices such as redlining, which systematically denied mortgages to people based on their race or ethnicity, have led to continued unfavorable housing and health outcomes for Black people and people of color in the United States.

Governmental policies and climate change have also led to higher energy costs and changes in energy availability. These changes affect certain vulnerable groups more severely, including lower income communities.

People experiencing energy insecurity could discuss their concerns with a healthcare professional to learn about resources in their area and ways to manage their healthcare needs.

To help people experiencing energy insecurity, updated policies that consider the effects of climate change, changes in energy technology, and disparities between certain population groups are necessary.

However, various federal, state, and local programs and initiatives aim to address energy insecurity.

Federal programs to address energy insecurity include:

• The Weatherization Assistance Program (WAP): The WAP provides low interest loans and grants to help low and moderate income households improve their energy efficiency.
• The Inflation Reduction Act of 2022: This act helps low income households upgrade energy efficiency to transition toward clean energy.
• The Justice40 initiative: This initiative directs at least 40% of clean energy investments toward low income and Black, Indigenous, and people of color (BIPOC) households.
• The Low Income Home Energy Assistance Program: This program provides crisis relief for people facing energy shutoffs, and heating and cooling assistance.

Policies to reduce energy insecurity vary by state.

Several states, including Washington, New York, Colorado, and Pennsylvania, have introduced programs and goals to address the energy burden.

In California, the Public Utilities Commission passed a decision in 2020 to reduce the number of shutoffs and increase protections based on affordability, medical vulnerability, age, and extreme weather.

Some states have also introduced tiered energy pricing and accommodations based on a percentage of a person’s income.

Local initiatives to address energy insecurity include:

• Localized electrical grids: Localized networks can distribute energy to users away from the traditional grid, which could allow for lower costs. However, economic and regulatory barriers prevent their widespread use.
• Community solar programs: Community solar panel programs help renters and low income households benefit from clean energy at lower rates.

Energy insecurity occurs when households cannot access enough affordable or reliable energy for their basic needs. This may include heating and cooling, cooking, and lighting.

Energy insecurity can be physical, as energy-inefficient homes contribute to higher energy bills. It can also be economic, as lower income households often have to allocate a higher percentage of their income toward energy bills.

Poverty, structural racism, and other barriers contribute to energy insecurity. Certain groups are at higher risk, including Black and Latino and lower income communities.

Energy insecurity may contribute to mental and physical health issues and certain pediatric health risks. People experiencing energy insecurity can access federal, state, and local aid programs, but more initiatives are necessary.