Een ongunstig binnenmilieu als mediërende variabele tussen energiearmoede en gezondheid: een verkenning

The objective of this study is to gain insight into the extent to which an unfavorable indoor environment mediates the association between fuel poverty and health.

Data from the Health Survey 2022 were enriched with some registration data from the Monitor Fuel Poverty 2020, resulting in a study population of 16,210 adults in a Dutch region. Using Structural Equation Modeling (SEM) in R, the mediating effect of an unfavorable indoor environment on the relationship between fuel poverty and various health outcomes was examined. An unfavorable indoor environment is defined as moisture, mould, and/or inadequate ventilation as indicators of housing quality. Analyses were adjusted for various demographic factors: age, gender, ownership of the house (tenants or not), level of education, household with or without children and level of urbanity of the residence.

Fuel poverty is negatively associated with the absence of mental health issues and with social capital, and positively associated with the risk of anxiety or depression, a negative self-rated health, physical limitations in daily life, loneliness, and stress. These associations are partially mediated by an unfavorable indoor environment (mediation proportion: 5.5–10.8%). In a subgroup analysis of tenants in housing associations, the mediation proportion ranges between 8.3 and 20.1%.

An unfavorable housing quality with moisture, mould and/or inadequate ventilation is a mediating factor in the relationship between fuel poverty and health. Addressing the health effects of fuel poverty requires a comprehensive and structural approach, where the indoor environment is an integral part. Connecting fuel poverty, housing quality and health is necessary in both research and policy addressing fuel poverty.