Managing heath in a cold home – the case of childhood asthma

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

2. Urban hypothermia ‘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.

3. 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

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

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

6. 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

7. Multiple risk factors • 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

8. How cold is too cold? 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

9. 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

10. Childhood asthma and cold homes • Asthma globally • Asthma nationally • Asthma locally • Costs • 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)

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

12. 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.

13. 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

14. 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 • http://www.winterwarmthengland.co.uk