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"Energy insecurity" can have negative health consequences for families in poverty

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It's officially fall. The leaves are changing colors. Cooler temperatures on the way. And if you're like me, you're about to crank up the thermostat.

But for many low-income families, the heating season presents a "heat or eat" dilemma. They are forced to choose between buying food and paying for utilities.

In 2014, 69% of households reported choosing between paying for utilities and paying for food in the past year. Thirty-four percent reported making this choice every month, according to Feeding America.

It's a hard decision year-round, but can be especially difficult during cold months.

About 16 million U.S. households fall under a pattern sociologists call "energy insecurity." They struggle to afford electricity, heat, and cooling.

The bottom 20% of U.S. earners spend about 10% of their income on electricity each month, according to CityLab. That's more than seven times the share of income paid by the top 20% of earners. According to CityLab:

The share of income that low-income households spend on electricity rose by one third in the last decade, according to a new analysis by the nonprofit renewable energy advocacy group Groundswell. What’s notable is how that burden is distributed across the population: It disproportionately falls on black and poor residents. Fifty percent of all families that spend 10 percent of income on power bills are black. In addition, more than half of those energy insecure households are below the Federal Poverty Level.

Energy insecurity can have physiological, behavioral, and psychological effects on families experiencing it. It's linked to asthma attacks, chronic anxiety and stress, and depression.

And young children in energy-insecure households are more likely to be food insecure, be in fair or poor health, and be at risk for developmental delays, according to the non-partisan pediatric research center, Children's HealthWatch.

Diana Hernandez is a professor at Columbia University's Mailman School of Public Health. She conducted a study in which she interviewed 72 families struggling to keep their homes heated, cooled and lit. She told CityLab:

This expense and experience has largely been ignored, to the detriment of families dealing with this crisis every day. A lot of participants prioritized housing and food because they are such basic, basic human needs.

Hernandez also noted the resourcefulness families used to get around the hardship. According to CityLab:

Families in her study developed many methods to resolve energy insufficiencies, using space heaters, ovens, or tons of extra layers to keep warm. Some went without proper refrigeration during shut-offs, relying on tubs of ice. Others leveraged medical conditions to their advantage. But many of these solutions are themselves health hazards: candles used for illumination contribute to fatal house fires in poverty-stricken areas, as do unattended space heaters, open ovens, and other dangerous work-arounds. In the summer, heat-related illness and death disproportionately affect low-income households that lack access to air-conditioning.

Hernandez suggests stronger state laws to prevent shut-offs and more support for programs that help people pay utility bills as ways to begin providing more help to overlooked families experiencing energy insecurity. She told WBUR:

While this is often a hidden hardship it's also an addressable one. There are interventions that can happen — these programs exist, they just need to be expanded.

Rocco Perla is president of the Boston-based nonprofit, Health Leads. She said in an email to WBUR:

While this study is qualitative, it adds to mounting clinical evidence in support of interventions that connect patients to the basic resources they need to be healthy. More importantly, this study puts the actual voice of the population front and center so we can learn more about the realities of people’s lives who experience these needs on a regular basis. We’re no longer debating the connection between unmet social needs and health; it’s well-researched that the inability to plug in a nebulizer if you have asthma, or refrigerate your medication, is going to impact your health.

You can read Hernandez's full study here.

Paulette is a blogger for Michigan Radio's State of Opportunity project, which looks at kids from low-income families and what it takes to get them ahead. She previously interned as a reporter in the Michigan Radio newsroom.
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