Power for the people: Examining energy insecurity as a hidden dimension of risk among vulnerable populations

The World Health Organization recognizes household energy as a “prerequisite for good health” and admonishes the very inadequate attention this issue has received to date. The emerging concept of energy insecurity (EI) is a multi-dimensional construct that describes the interplay between structural conditions of housing and the costs of household energy. The relevance of EI is demonstrated in the fact that lower-income householders are more likely than their more privileged counterparts to: a) live in housing with heating and electrical problems, (b) experience multiple heating equipment breakdowns, (c) endure utility service interruptions, (d) sustain inadequate insulation and insufficient heating capacity, and (d) report being uncomfortably cold for more than 24 hours in winter. Furthermore, energy costs are comparatively higher for lower income groups thus reducing their ability to purchase other basic necessities such as food while facing the “heat or eat” dilemma. EI is characterized by downward cycles in which householders experience substandard home temperatures despite spending scarce resources and perpetuating risk by using hazardous and inefficient space heaters and ovens to warm a cold home. As a producer of cycles of structural poverty, EI also contributes to health disparities such as asthma. These problems are emblematic of a neglected phenomenon that burdens an estimated 16 million households in the US, a disproportionate share of which are Black and Latino and low-income. Notwithstanding their significance to public health, circumstances related to EI are largely outside of the public's consciousness, ignored in the scientific literature and overlooked in public policy.