Misdirected benefits fail to cut winter deaths

The pensioners’ winter fuel payment - £250 per household, no means test, no questions asked - drops into the bank accounts of those over 60 during December.

It comes in handy for buying the grandchildren their Christmas presents, but appears to have very little effect in reducing deaths or helping those who cannot afford to heat their homes, its original purpose.

Last month the ONS published figures for Excess Winter Mortality (EWM) for 2008-09, which showed the highest number of excess deaths (36,700) since the winter of 1999-2000. There were 15,300 extra deaths in men and 21,400 in women.
This represented an increase of 49 per cent over 2007-08, the ONS reported. Broken down by age, there were 7,300 excess deaths in those under 75, and 29,400 among those aged over 75. EWM is calculated by defining the winter as December to March, counting the numbers of deaths in that period, and comparing them with the previous August to November and following April to July. EWM is then the difference between winter deaths and average non-winter deaths.
One reason why more women than men die during the winter is simply that there are more of them in the age groups at greatest risk. More than three times as many women as men survive past 80. In 2008-09, according to the provisional figures (read off from Figure 4 in the ONS bulletin) about 6,000 excess deaths were recorded in men over 85, and about twice as many in women of the same age. 
However, given the actual numbers of men and women in the age group, the actual risks of death are greater for men. ONS figures show that the death rate per million in 2008-09 was 6,860 for men, and 4,910 for women
Winter fuel payments were introduced in the winter of 1997-98, and extended in 2000-2001. The aim was to reduce “fuel poverty” (defined as a household needing to spend more than 10 per cent of income to achieve at temperature of 21C in the living room and 18C elsewhere for nine hours a day in the week and 16 hours a day at weekends.) Since 2000, the Audit Commission reported recently, the programme has cost over £20 billion. Annual costs now run at £2.7 billion.
This may well be one of the worst-targeted and least effective benefits ever devised. Only 12 per cent of those who qualify for fuel payments are in fuel poverty (Audit Commission), and of those who get it, 400,000 are higher-rate taxpayers. For them, a tax-free £250 is a worthwhile Christmas bonus. But it has little to do with alleviating poverty or reducing EWM.
The belief energetically propounded in the 1990s was the reducing fuel poverty would cut the number of winter deaths, but recent data hardly suggests any such effect. EWM has fallen steadily since the 50s but the affect of winter fuel payments is imperceptible (Figure 1, below, comes from the ONS bulletin).
Defenders of the payment might argue that the rise in EWM in 2008-09 was in part caused by rising levels of fuel poverty as fuel prices rose sharply. But in fact there does not appear to have been any clear link between EWM and average winter temperatures since 2004-05.(fig 2, below)
One might speculate that the method of payment used for cold winter payments may be the  culprit. There is no obligation to spend the money on fuel.  An alternative method might involve a “credit” for gas and electricity with the utility companies involved, or if that were to prove too complex, a simple waiving of all utility bills for December and January but with no possibility of a claw back in the following months.
But a payment for all pensioners to relieve a problem suffered by only 12 per cent of them is hard to defend: the Audit Commission said the system was “unsustainable” and the money would be better spent lagging, insulating, reglazing and modernising the homes of pensioners, which would have the additional benefit of reducing carbon emissions.
Teasing out data from the ONS files has its problems. Many separate inquiries have to be made to get an historical trend, many lead to dead ends, blank results, and in some instances the measuring tool varies. Figure 3, replete with gaps, epitomises the problems an occasional interrogator comes face to face with when hunting data for a customised comparison.

The top section gives deaths at the beginning of each decade beginning in 1950, when smog was a serous killer, through to 1990. Significant gains can be seen as EWM deaths fall in those 40 years. No perceptible trend is visible in recent years: 1998 to 2000 saw an increase in EWM, followed by a rapid decline and an equally rapid increase to last winter’s high figure.
If this data had been more easily accessible it might have added to our understanding but the amount of information that was compatible (and comparable) for the various years was very sparse and or too difficult to locate, as the table reveals.
Studies have shown that EWM is found everywhere, and is correlated with inequality, poor insulation standards, spending on public health, deprivation, and fuel poverty. A cross-country study by Dr J.D. Healy of University College Dublin, published in the Journal of Epidemiology and Community Health  in 2003, compared 14 EU countries.
The results, summarised in Table 4 (below) show less of a clear-cut relationship with fuel poverty than might be expected. The excess mortality in this table is expressed a coefficient, constructed by dividing the excess winter deaths by average summer deaths. The highest coefficients were found in Portugal, Spain and Ireland, but the data may now be out of date: the period covered was 1988 to 1997.
Clearly EWM is a complex problem with links to many socioeconomic variables, but fuel poverty does not stand out as especially important. Given that, and the way the benefit has been so ineptly targeted, it is hardly surprising that winter fuel payments to pensioners have failed to have much effect. Once given, however, such benefits are almost impossible to take away.