An unfavorable indoor environment as mediator between fuel poverty and health: an exploration

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 2022 Dutch Health Survey were enriched with some registration data from the 2020 Monitor Fuel Poverty, resulting in a study population of 16,210 adults. Using Structural Equation Modeling in R, the mediation effect of an unfavorable indoor environment on the relationship between fuel poverty and various health outcomes was examined. An unfavorable indoor environment was defined as moisture, mold, and/or inadequate ventilation, as indicators of housing quality. Analyses were adjusted for various demographic factors: age, gender, property ownership (tenants or not), level of education, household with or with no 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 of housing corporations, the mediation proportion ranges from 8.3 to 20.1%.

An unfavorable housing quality with moisture, mold, 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, of which the indoor environment is an integral part. Connecting fuel poverty, housing quality, and health is necessary in both research and policy addressing fuel poverty.