Retrofitting houses with insulation: a cost–benefit analysis of a randomised community trial
Abstract
Background: Housing is an important environmental influence on population health, and there is growing evidence of health effects from indoor environment characteristics such as low indoor temperatures. However, there is relatively little research, and thus little firm guidance, on the cost-effectiveness of public policies to retrospectively improve the standards of houses. The purpose of this study was to value the health, energy and environmental benefits of retrofitting insulation, through assessing a number of forms of possible benefit: a reduced number of visits to GPs, hospitalisations, days off school, days off work, energy savings and CO 2 savings. Methods: All these metrics are used in a cluster randomised trial—the “Housing, Insulation and Health Study”—of retrofitting insulation in 1350 houses, in which at least one person had symptoms of respiratory disease, in predominantly low-income communities in New Zealand. Results: Valuing the health gains, and energy and CO 2 emissions savings, suggests that total benefits in “present value” (discounted) terms are one and a half to two times the magnitude of the cost of retrofitting insulation. Conclusion: This study points to the need to consider as wide a range of benefits as possible, including health and environmental benefits, when assessing the value for money of an intervention to improve housing quality. From an environmental, energy and health perspective, the value for money of improving housing quality by retrofitting insulation is compelling.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A cost-benefit analysis of the Housing, Insulation and Health Study found that benefits exceeded costs by a ratio of 1.8:1.
“a cost-benefit analysis found that benefits exceeded costs by a ratio of 1.8:1 (21).”
From Review of the Impact of Housing Quality on Inequalities in Health and Well-Being (2023) · cites this paper as [21]
Cites
Housing and Health: Time Again for Public Health Action
Krieger, J., & Higgins, D. L. (2002) · American Journal of Public Health · doi:10.2105/ajph.92.5.758 · Cited by 1,550 · see citing works
It's about time: A comparison of Canadian and American time–activity patterns
Leech, J. A., Nelson, W. C., Burnett, R. T., Aaron, S. D., & Raizenne, M. E. (2002) · Journal of Exposure Science & Environmental Epidemiology · doi:10.1038/sj.jea.7500244 · Cited by 705 · see citing works
McGeehin, M. A., & Mirabelli, M. (2001) · Environmental Health Perspectives · doi:10.1289/ehp.109-1240665 · Cited by 669 · see citing works
August 2003 Heat Wave in France: Risk Factors for Death of Elderly People Living at Home
Vandentorren, S., Bretin, P., Zeghnoun, A., MANDEREAU, L., Croisier, A., Cochet, C., Ribéron, J., Siberan, I., Declercq, B., & Ledrans, M. (2006) · European Journal of Public Health · doi:10.1093/eurpub/ckl063 · Cited by 630 · see citing works
Excess winter mortality in Europe: a cross country analysis identifying key risk factors
Healy, J. (2003) · Journal of Epidemiology & Community Health · doi:10.1136/jech.57.10.784 · Cited by 623 · see citing works
Effect of insulating existing houses on health inequality: cluster randomised study in the community
Howden-Chapman, P., Matheson, A., Crane, J., Viggers, H., Cunningham, M., Blakely, T., Cunningham, C., Woodward, A., Saville-Smith, K., O'Dea, D., et al. (2007) · BMJ · doi:10.1136/bmj.39070.573032.80 · Cited by 521 · see citing works
Self-citationMcGeehin, M. A., & Mirabelli, M. C. (2001) · Environmental Health Perspectives · doi:10.2307/3435008 · Cited by 414 · see citing works
Health effects of housing improvement: systematic review of intervention studies
Thomson, H., Petticrew, M. P., & Morrison, D. S. (2001) · BMJ · doi:10.1136/bmj.323.7306.187 · Cited by 378 · see citing works
Public health and economic impact of dampness and mold
Mudarri, D. H., & Fisk, W. J. (2007) · Indoor Air · doi:10.1111/j.1600-0668.2007.00474.x · Cited by 320 · see citing works
The Relationship Between School Absence, Academic Performance, and Asthma Status
Moonie, S. A., Sterling, D. A., Figgs, L. W., & Castro, M. (2008) · Journal of School Health · doi:10.1111/j.1746-1561.2007.00276.x · Cited by 273 · see citing works
A global perspective on energy: health effects and injustices
Wilkinson, P., Smith, K. R., Joffe, M., & Haines, A. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61252-5 · Cited by 238 · see citing works
Housing, Fuel Poverty and Health: A Pan-European Analysis
Healy, J. (2004) · Cited by 141 · see citing works
Trends and determinants of excess winter mortality in New Zealand: 1980 to 2000
Davie, G. S., Baker, M. G., Hales, S., & Carlin, J. B. (2007) · BMC Public Health · doi:10.1186/1471-2458-7-263 · Cited by 123 · see citing works
Howden‐Chapman, P., Crane, J., Matheson, A., Viggers, H. E., Cunningham, M. J., Blakely, T. A., O’Dea, D., Cunningham, C. W., Woodward, A. J., Saville‐Smith, K., et al. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.04.049 · Cited by 109 · see citing works
Self-citationThe Economics of Social Problems
Grand, J. L., & Robinson, R. (1976) · Palgrave Macmillan UK eBooks · doi:10.1007/978-1-349-15632-0 · Cited by 99 · see citing works
The Economics of Social Problems
Grand, J. L., Propper, C., & Robinson, R. (1992) · doi:10.1007/978-1-349-21930-8 · Cited by 56 · see citing works
Schweitzer, M., & Tonn, B. E. (2003) · Applied Energy · doi:10.1016/s0306-2619(03)00003-5 · Cited by 54 · see citing works
Cost-benefit analysis of energy efficiency in urban low-cost housing
Winkler, H., Spalding-Fecher, R., Tyani, L., et al. (2002) · Development Southern Africa · doi:10.1080/03768835022000019383 · Cited by 48 · see citing works
The public health benefits of insulation retrofits in existing housing in the United States
Levy, J. I., Nishioka, Y., & Spengler, J. D. (2003) · Environmental Health · doi:10.1186/1476-069x-2-4 · Cited by 48 · see citing works
From local concern to randomized trial: the Watcombe Housing Project
Somerville, M., Basham, M., Foy, C. J. W., Ballinger, G., Gay, T., Barton, A., & on behalf of the Torbay Healthy Housing Group (2002) · Health Expectations · doi:10.1046/j.1369-6513.2002.00167.x · Cited by 40 · see citing works
Determining the Discount Rate for Government ProjectsPreprint
Young, L. (2002) · RePEc: Research Papers in Economics · Cited by 34 · see citing works
The Mortality of New Zealand Housing Stock
Johnstone, I. M. (1994) · Architectural Science Review · doi:10.1080/00038628.1994.9697345 · Cited by 28 · see citing works
On the edge of adulthood: young people’s school and out-of-school experiences at 16
Wylie, C. (2009) · Cited by 18 · see citing works
Promoting energy efficiency in the private rented sector
Wilkinson, S. J., & Goodacre, C. (2002) · Property Management · doi:10.1108/02637470210418960 · Cited by 17 · see citing works
Decent homes : better health : Ealing Decent Homes Health Impact Assessment
Gilbertson, J., Green, G., Ormandy, D., et al. (2008) · SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) · doi:10.82444/warw.33708262 · Cited by 13 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Global scenarios of urban density and its impacts on building energy use through 2050
Güneralp, B., Zhou, Y., Ürge-Vorsatz, D., Gupta, M., Yu, S., Patel, P. L., Fragkias, M., Li, X., & Seto, K. C. (2017) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1606035114 · Cited by 543 · see citing works
Effect of insulating existing houses on health inequality: cluster randomised study in the community
Howden-Chapman, P., Matheson, A., Crane, J., Viggers, H., Cunningham, M., Blakely, T., Cunningham, C., Woodward, A., Saville-Smith, K., O'Dea, D., et al. (2007) · BMJ · doi:10.1136/bmj.39070.573032.80 · Cited by 521 · see citing works
Self-citationMeasuring the Co-Benefits of Climate Change Mitigation
Ürge-Vorsatz, D., Herrero, S. T., Dubash, N. K., & Lecocq, F. (2014) · Annual Review of Environment and Resources · doi:10.1146/annurev-environ-031312-125456 · Cited by 273 · see citing works
Keall, M. D., Pierse, N., Howden-Chapman, P., Cunningham, C., Cunningham, M., Guria, J., & Baker, M. G. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61006-0 · Cited by 226 · see citing works
Self-citationReview of the Impact of Housing Quality on Inequalities in Health and Well-Being
Howden-Chapman, P., Bennett, J., Edwards, R., Jacobs, D., Nathan, K., & Ormandy, D. (2023) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-071521-111836 · Cited by 153 · see citing works
Self-citationAssessing housing quality and its impact on health, safety and sustainability
Keall, M., Baker, M. G., Howden-Chapman, P., Cunningham, M., & Ormandy, D. (2010) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2009.100701 · Cited by 88 · see citing works
Self-citationPreval, N., Chapman, R., Pierse, N., & Howden-Chapman, P. (2010) · Energy Policy · doi:10.1016/j.enpol.2010.03.020 · Cited by 54 · see citing works
Self-citationMeasuring the productivity impacts of energy-efficiency: The case of high-efficiency buildings
Chatterjee, S., & Ürge-Vorsatz, D. (2021) · Journal of Cleaner Production · doi:10.1016/j.jclepro.2021.128535 · Cited by 36 · see citing works
Viggers, H., Howden-Chapman, P., Ingham, T., Chapman, R., Pene, G., Davies, C., Currie, A., Pierse, N., Wilson, H., Zhang, J., et al. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-176 · Cited by 29 · see citing works
Self-citationKeall, M. D., Tupara, H., Pierse, N., Wilkie, M., Baker, M. G., Howden-Chapman, P., & Cunningham, C. (2021) · The Lancet Public Health · doi:10.1016/s2468-2667(21)00135-3 · Cited by 26 · see citing works
Self-citationFormulating a programme of repairs to structural home injury hazards in New Zealand
Keall, M. D., Howden-Chapman, P., Baker, M. G., Kamalesh, V., Cunningham, M., Cunningham, C., Guria, J., Draper, R., & Skelton, P. (2013) · Accident Analysis & Prevention · doi:10.1016/j.aap.2013.04.011 · Cited by 18 · see citing works
Self-citation
- Authors
- Chapman, R., Howden-Chapman, P., Viggers, H., O’Dea, D., & Kennedy, M.
- Affiliations
- Victoria University of Wellington (NZ)
- University of Otago (NZ)
- Ministry of Health (NZ)
- Corresponding author
- Chapman, R
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 2009-03-18
- Volume
- 63
- Issue
- 4
- Pages
- 271-277
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- OpenAlex
- W2024876235
- Cited by
- 169
- References
- 25
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 5 · 2023: 12 · 2022: 7 · 2021: 10 · 2020: 8 · 2019: 8 · 2018: 4 · 2017: 16 · 2016: 15 · 2015: 8 · 2014: 6 · 2013: 14 · 2012: 8
- FWCI
- 10.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Epidemiology & Community Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- cost-effectiveness, housing quality, indoor temperature, respiratory diseases, low-income housing, energy conservation, CO2 emission reduction, health benefits valuation, present value, value for money, housing policy, New Zealand
- MeSH terms
- Absenteeism, Adolescent, Child, Conservation of Energy Resources, Construction Materials, Cost-Benefit Analysis, Health Services Needs and Demand, Health Status, Hospitalization, Housing, Humans, Poverty Areas, Greenhouse Effect, Sick Leave
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
