Health and Household-Related Benefits of DOE's WAP

June 29, 2016

A version of this article appears in the Fall 2016 issue of Home Energy Magazine.

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DOE’s Weatherization Assistance Program (WAP) invests public funds to weatherize privately owned low-income housing. There is an active debate about the value of this program. Weatherizing low-income homes can help to alleviate energy poverty, which is a significant problem in the United States and worldwide, and it also provides health, safety, and household-related benefits. These benefits outweigh the costs.

Key evaluation findings show that WAP

reduces the need for urgent health care associated with thermal stress and asthma;
provides cobenefits of weatherization that are substantially greater than program costs; and
decreases asthma-related Medicaid claims and costs.

Lives are saved and significant health, safety, and household-related benefits are realized when low-income homes are improved through weatherization. Improving the thermal performance of the building envelope reduces thermal stress (that is, medical conditions associated with exposure to extreme temperatures) experienced by occupants. Installing a comprehensive set of weatherization measures can synergistically reduce exposure to numerous environmental asthma triggers. Improved health, in turn, can reduce missed days of work and lead to household financial benefits that then are invested to produce additional household and societal benefits.

DOE’s WAP is the leading low-income weatherization program in the United States. It provides grants to over 50 state weatherization offices, which then provide grants to approximately 900 local weatherization agencies to weatherize low-income, owner- and renter-occupied, homes. Priority is given to households that contain children, a person with disabilities, or the elderly.

Table 1. Summary of WAP Household Heating and Cooling System Findings

Table 2. Physical Condition of the Home

Table 3. Health Issues Pre- and Postweatherization

Table 4. Monetized Health and Household Benefits

Table 5. Total Benefits and Costs for WAP

Non-Energy-Related Benefits of Weatherization

Figure 1. This figure illustrates the pathways between non-energy-related benefits of weatherization. Solid lines represent direct, or first-order, pathways. Dotted lines represent indirect, or second-order, pathways.

WAP funds weatherization activities in every state and climate zone in the country, and for all types of housing. All homes receive an energy audit. Only energy conservation measures that have a savings-investment ratio (SIR) of 1:1 or greater may be installed. That is, lifetime energy cost savings divided by the cost of the measure must equal at least 1. Typical measures include air sealing the building envelope, insulating walls and attics, repairing or replacing furnaces, sealing and insulating ducts, and improving ventilation. In addition to these energy conservation measures, a percentage of costs, typically 15%, can be applied to health and safety measures. All homes are inspected postweatherization.

A recently completed interdisciplinary, two-year evaluation of WAP conducted by Oak Ridge National Laboratory (ORNL) estimated energy savings attributable to the program, as well as its environmental emissions and health and household-related cobenefits. The two years in question were Program Year (PY) 2008 and PY 2010. The latter year fell within the American Recovery and Reinvestment Act of 2009 (ARRA) period. DOE funding for WAP during PY 2008 was $236 million and ARRA funding for WAP in PY 2010 was $2 billion. All told, 98 thousand units were weatherized in PY 2008, and 332 thousand units were weatherized in PY 2010. Most of the units weatherized in both years were site-built single-family homes heated with natural gas.

Cobenefits of Weatherization

The term cobenefits refers to benefits other than energy savings. These include environmental benefits, health and safety benefits, and miscellaneous other household benefits. The ORNL study evaluated each of these cobenefits.

The cornerstone of ORNL’s research on the health benefits of weatherization was a national occupant survey of a random and representative sample of single-family (SF) homes and mobile homes (MH). The occupant survey was administered to a treatment group in two phases, both pre- and post-weatherization, along with a comparison group.

Descriptive statistics generated from this survey suggest that health and household-related benefits accrue postweatherization. After their homes were weatherized, fewer clients reported that their heating and cooling systems were broken, that they used portable heaters, that they used their ovens for heat, or that they burned poor-quality materials (see Table 1). All of these changes improve indoor environmental quality, occupant health, and home safety. Physical condition of the home itself was improved by a reported increase in thermal comfort, and a decrease in draftiness, moisture, mildew, and mold (see Table 2). Finally, the results of the national survey show that one year postweatherization, respondents experienced a wide range of health and well-being benefits. These benefits included fewer instances of seeking medical treatment related to asthma and thermal stress, and fewer days when respondents’ reported “bad” physical/mental health or bad sleep/rest days (see Table 3).

In addition to the cobenefits described above, respondents reported that they and other members of their households suffered fewer persistent colds and headaches after weatherization. They were better able to pay energy and medical bills, and to buy nourishing food. Additionally, occupants of weatherized houses experienced less food poisoning and fewer burns from hot water, and the weatherized homes were safer, because faulty combustion appliances were repaired or replaced, and CO and smoke detectors were installed.

Authors of a social network study described in an earlier issue of Home Energy conducted as part of the national WAP evaluation (see “The Weatherization Experiences Project: A Social Network Study,” HE Nov/Dec ’14, p. 32) found that close to half of respondents who had weatherization work completed through WAP reported fewer drafts, and less humidity and dust in the home and said that the air just “seemed cleaner.” Fifteen percent of respondents in this same study reported feeling healthier in general postweatherization, and 14% reported fewer episodes of shortness of breath; fewer symptoms of asthma, allergies, or persistent colds; and fewer episodes of lung irritation or cough. Case studies of 15 high-performing weatherization agencies were also conducted further supporting these anecdotes. Several dozen WAP recipients shared powerful personal stories describing health benefits, both physical and mental, that they attributed to weatherization.

The list of potential non-energy-related benefits of low-income weatherization is extensive. Weatherization can directly increase household disposable income by decreasing energy bills, and in other ways as well. For example, fewer illnesses in the household may mean fewer missed days at work; this provides a direct income benefit because many low-income jobs do not provide sick leave. These incremental increases in income, along with reductions in energy costs, may allow households to avoid taking out costly short-term loans. These and other non-energy-related benefits of low-income weatherization are shown in Figure 1.

Monetization of Weatherization Cobenefits

The ORNL evaluation included the monetization of 12 health- and household-related cobenefits. Study authors estimated the monetary value of each of these 12 cobenefits. These estimates were based on changes measured through the national occupant survey findings cited earlier, on weatherization measures installed, on secondary databases containing national estimates of health care costs, and on other secondary sources. The 12 cobenefits are listed in Table 4, together with the estimated monetary value of each benefit.

preventing of a human lifeocusiusehold BenefitsPto extreme temperatures within the home n and health homes interventions focusiThe highest benefit accrues from decreased exposure to extreme cold temperatures. The national occupant survey found that the number of treatment homes never kept at unsafe or unhealthy temperatures increased by 12% following weatherization. The survey also found that fewer occupants sought medical attention postweatherization because their homes were too cold or too hot. It is well known that death rates from exposure to extreme temperatures are highest among disadvantaged and vulnerable populations, such as those served by WAP. Therefore, included in this benefit is the value of human life; this analysis adopted the value utilized by the U.S. Environmental Protection Agency for benefit-cost calculations of $7.5 million.

Benefits also accrued from improving prescription adherence and helping pregnant women avoid the heat-or-eat choice—a choice that research has shown may lead to low birth weight babies.

It should be noted that the grand total presented in Table 4 is likely to be an underestimate of the monetary value of weatherization with respect to health-related issues. This is because the ORNL study evaluated only weatherized SF and MH, and because the asthma study described below considered only the respondent, rather than all of the members of the household. Furthermore, several additional health-related benefits were not monetized. These benefits include the prevention of trips and falls, and the replacement of defective refrigerators, which may prevent food poisoning. The subjective benefits of increased occupant comfort, improved mental and physical health, and improved pest control were not monetized either. There are a number of uncertainties associated with these estimates, but they are worthy of future exploration.

To give an idea of the value of these benefits, the average weatherization cost per unit in PY 2008 was $4,675. The present value per unit of health-related benefits is estimated to be $14,148 (Table 4). The main contributors to this estimate are (1) avoided deaths from thermal stress, CO poisoning, and home fires; (2) avoided hospitalizations and emergency department visits related to these three areas as well as other direct and indirect asthma-related costs; (3) increased ability to afford prescriptions; and (4) increased financial gain from fewer missed days at work.

Combining the monetary value of non-energy-related benefits with energy cost savings and with environmental emissions- and water-related benefits, gives a more complete picture of the total costs versus the total benefits of WAP. Table 5 presents the present value of energy cost savings accrued to households and accrued to ratepayers. It compares these with the value of environmental emissions- and water-related benefits, and with the value of non-energy-related benefits (shown in Table 5 as health- and household-related benefits). Present values per unit and present values for the program as a whole are shown for PY 2008 and PY 2010. Note that some of these energy cost savings accrue to utility ratepayers for weatherization recipients who are on percentage of income payment programs (PIPP). The table shows total per-unit and program costs, and shows how much of each of these costs is paid directly by DOE and with leveraged funds, respectively.

Impact of Weatherization on Asthma Symptoms

An additional special study was conducted on the potential effects of weatherization and healthy homes interventions on asthma symptoms. This study examined evidence-based asthma triggers in children in a small cohort in northwestern Washington State. The research team was comprised of staff from ORNL and the Opportunity Council. The Opportunity Council is a Community Action Agency (CAA) located in northwestern Washington State, where it has operated a Weatherization Plus Health program since 2000.

Impacts were based on caregiver-reported information, field observations, and Medicaid claims and costs. Comparing pre- and post-intervention data for three study groups that received healthy homes interventions only, Weatherization Plus Health interventions, or WAP measures only revealed that both weatherization and healthy housing interventions (e.g., flooring replacement, ventilation upgrades, providing dust mite mattress and pillow covers, and general education) were impactful with respect to improving dwelling quality and reducing home-source asthma triggers. All households within the two groups that received healthy homes interventions and 82% of the group that received WAP measures only reported that children “seemed to feel better” postintervention. All households within the Weatherization Plus Health group, 94% of the healthy homes group, and 64% of the WAP group reported that children in their care “could run and play longer” postintervention. These results support the claim that both weatherization and healthy homes interventions improve dwelling quality, and suggest that WAP measures specifically and healthy homes interventions provide synergistic benefits

Furthermore, the results of this study indicate that Medicaid-insured study participants experienced statistically significant decreases in health care costs postintervention. Specifically, a statistically significant decrease of slightly more than $400 was observed in annualized asthma-related Medicaid costs for all study groups combined. The average number of claims paid by the Washington State Medicaid program also decreased significantly within the Weatherization Plus Health and WAP- only groups, by 0.42 and 0.91 claims per month, respectively. Overall, the services delivered by participating agencies in this exploratory study were associated with significantly reduced health care costs for the asthmatic children participating in the study. It should be noted that these results are 2 times greater than national estimates.

Conclusions

In summary, the non-energy-related cobenefits framework developed to guide this research suggests that weatherization could have a positive ripple effect on quality of life indicators and household budgets postweatherization, and that this could save both society at large and individual households many thousands of dollars. As a whole, investments in low-income weatherization result in a comprehensive set of benefits. Homes are physically changed in ways that reduce energy use, and consequently, environmental emissions. Weatherization also increases indoor environmental quality and occupant health and safety. This in turn decreases use of health care services (such as Medicaid and Medicare) by low-income households. These households are typically the “superutilizers” of the health care system because they experience a disproportionate number of health problems. Still, weatherization is deferred for many homes because funds from state and federal agencies are insufficient to finance it. Furthermore, DOE has no funds to address specific health issues, such as asthma in homes. We need to identify ways in which WAP and its grantees and subgrantees can collaborate with health-based organizations and/or leverage other federal, state, and even nongovernmental funds to better address health and safety issues in the homes that WAP serves.

learn more

See all of ORNL’s reports produced from their national evaluation of WAP, including those from which results are drawn for this article.

Three³ continues its groundbreaking research on the non-energy-related impacts of weatherization. Currently, it is conducting a study specific to the recipients of energy efficiency services residing in income-eligible households in Massachusetts. For more on the organization and its work.

Moving Forward

Weatherization can be a major player in addressing public health. We have long known that weatherization provides direct benefits to households and indirect benefits to society and ratepayers. Weatherization addresses social justice in several ways. It eases the energy burden of all households; it improves housing quality for low-income households; and it decreases health disparities. An expanded view— one that takes new environmental health research into account—suggests that weatherization could also address public health issues associated with extreme weather events, outdoor air pollution, a broader range of indoor air pollutants, indoor infiltration of outdoor noise, and the mental health and well-being of occupants.

Additional scientific and policy-related research is needed in this general area. For example, we need definitive studies that directly establish relationships between the installation of individual or combined weatherization measures and reductions in fire risk and asthma-related symptoms. More data are needed on the long-term impacts—both positive and negative—of weatherization on health. This article describes many such positive impacts. An example of a negative impact would be air sealing that increases indoor air pollution. In addition, computationally intensive data-mining initiatives could focus on estimating national changes in actual medical costs (such as Medicaid and Medicare) for households that receive weatherization services.

Beth Hawkins and Bruce Tonn are cofounders of Three3 (ThreeCubed), a research and educational nonprofit organization located in Knoxville, Tennessee. Three3's mission is to foster equitable, sustainable futures focusing on social equity and environmental justice issues at a local and national level. Prior to helping found Three<³, Hawkins and Tonn worked at ORNL, where, along with contributing author Erin Rose, they managed the two evaluations of DOE’s WAP.