Health impacts of housing retrofit programmes: a modelling analysis of targeting for health inequality reduction

Background Governments are scaling up investment in housing improvements to meet net zero targets. These improvements are likely to reduce emergency hospital admissions but evidence on the health and inequality benefits of alternative targeting approaches remains limited. Data and methods We constructed a Monte Carlo simulation to compare the impacts of a housing retrofit programme under different targeting scenarios on respiratory, cardiovascular, injury and all-cause emergency hospital admissions. Using data on retrofits delivered to 5,263 properties in the Liverpool City Region (North West England), 2021–2023, we estimated the impacts of the actual distribution—targeted using measures of poverty and energy efficiency—against an alternative scenario that also incorporated health need. Effects on health inequality were assessed by comparing the change in the admissions gap between the most and least deprived neighbourhood quintiles. Findings were extrapolated to a national projection aligned with England’s five-million-property Warm Homes Plan. Results The actual allocation was estimated to prevent 229 emergency admissions per year (95% uncertainty interval: 178–277) compared with no retrofit and to reduce the admissions inequality gap by 13%. Incorporating health need into targeting, while maintaining the programme size, prevented a further 24 admissions annually (10% additional gain) and reduced the inequality gap by 26% in total. National projections suggest incorporating health need into the Warm Homes Plan could prevent an additional 11,600 admissions. Conclusions Incorporating health need into retrofit targeting criteria, alongside existing energy efficiency and income eligibility, could enhance population health benefits and reduce health inequalities without additional resources.