Energy and health programme in New Zealand
After a pilot study that demonstrated the efficacy of insulating homes and providing efficient heat sources, the New Zealand government committed NZD340 million to the nationwide roll-out of the Warm Up New Zealand: Heat Smart (WUNZ: HS) scheme in July 2009. It represented an attempt to reduce energy use - through more efficient heating - and improve health outcomes by making homes warmer. It was directed by the Energy Efficiency and Conservation Authority (EECA), a Crown agency that is mandated to promote energy efficiency and conservation and the use of renewables.
As well as its specific objectives of promoting green energy and improving health, it was hoped that WUNZ: HS would stimulate the economy by generating jobs in firms that produce and install insulation and clean heating. WUNZ: HS by providing “funding for insulation retrofits and clean, efficient heating grants for New Zealand households”. 
“In late 2013, WUNZ:HS was succeeded by Warm Up New Zealand: Healthy Homes, which narrowed its focus to providing insulation solely to low-income homes.” 
Inadequate housing is a well-known contributory factor in ill health, particularly poor respiratory health. The World Health Organization (WHO) notes that 40 percent more people die during the winter when homes are inadequately heated. “The existing WHO references and recommendations for safe temperature ranges (18-22°C, depending on room function) are weak and not well known to the public as well as to policymakers.” 
The presence of insulation and efficient heat sources in homes enables people to stay warm without using excessive energy, and has follow-on health benefits. “The quality of housing affects the health of the population. Improvements to housing could potentially prevent ill health, especially in sections of the population exposed to substandard housing. People in developed countries spend more than 90% of their time indoors, most of it in their own homes.” 
Although New Zealand is a developed country, it has relatively poor housing stock. Only a third of houses are insulated, thanks in part to a building code that does not require insulation in houses built before 1978, and most people only heat their living rooms. The temperature in the average New Zealand home is well below the WHO's recommended safe lower limit at all times during winter months. It is thought that poor housing contributes to New Zealand's high incidence of rheumatic fever, asthma, pneumonia and other respiratory illnesses, and to the increase in winter hospital admissions.
The public impact
The public impact should be assessed in terms of the two main objectives: energy and health. “While the cost of warming a newly insulated house was reduced, the study found that electricity and gas use fell by only about one percent, indicating that most participants chose to maintain their previous energy expenses, but get more warmth for their buck. 
“On the health side, the insulation had far more impact: the group discovered a significant reduction in mortality, especially in those aged over 65 who had a pre-existing respiratory or circulatory condition. This particular result, which was largely unforeseen, is a testament to the importance of conducting the evaluation ... The benefits of the scheme were more pronounced for lower-income households.” This last finding was the main reason for the change of emphasis in 2013 (see The initiative above).
There are many stakeholders involved: national government through the Ministry of Economic Development and the EECA; and local government administrations, such as local councils, including Auckland, Greater Wellington and Hawke's Bay, who offered generous repayment schemes for ratepayers who chose to insulate their homes.
Researchers from ‘healthy homes He Kainga Oranga' at the University of Otago and other organisations analysed the impact on health and the likely cost-savings that resulted. Another cost-benefit analysis of WUNZ: HS was commissioned by the Ministry of Economic Development and carried out by a consortium including the NZ Centre for Sustainable Cities. There were a number of community partners, including Otara Health, the Crown Public Health Unit and the Maori Women's Welfare League, while Quotable Value provided data on all homes in the country.
Political commitmentThis is a national initiative which has received significant ongoing financial support: “WUNZ:HS is a NZD340 million dollar multi-year year programme funded by the New Zealand government that provides funding for insulation retrofits and clean, efficient heating grants for New Zealand households”.  It received support from Ministries concerned with economics and health as well as the EECA, which focused on sustainable energy.
WUNZ: HS does not appear to have polled New Zealanders to establish their confidence in the measure. However, the high uptake of subsidised insulation and efficient heating appliances suggests that New Zealanders were confident about the scheme. This point was made by the Hon. Gerry Brownlee (then Minister for Energy and Resources) in Parliament in 2010: “I think that 57,908 retrofits indicates a very high level of public confidence in the scheme”. 
News media reports on the scheme were also supportive and quoted the number of households that took up the WUNZ: HS offering. “Over the past three years, 150,000 households have made use of a government grant to improve the efficiency and health of their homes.” 
Clarity of objectivesThe objectives were clear and addressed the relevant issues. WUNZ: HS had specific goals with regard to energy conservation and health improvement along with an indirect aim of encouraging employment. The means of achieving the intended results was well thought out. When it was discovered where the true benefits of the programme lay, there was an appropriate adjustment of focus four years in – to low-income households, which had benefited most from WUNZ: HS.
Strength of evidenceThe scheme was devised with reference to evidence taken from numerous academic studies on the links between health, energy, and housing. In particular, the Otago University pilot study was carried out by comparing the energy use and health outcomes of the occupiers of a sample of newly-insulated homes to the outcomes of people living in a matched sample of uninsulated homes. “A nominal 1400 households in 7 regions throughout the country, participated in the study by making subjective temperature assessments daily and filling in questionnaires on their house and health; they also allowed us to access objective measures:- we collected dust, and measured temperature and humidity in their homes; and retrieved data on the number of hospital/GP visits and information on energy usage from power and gas companies.”  The results showed that the newly-insulated households benefited in terms of energy savings and health improvement.
FeasibilitySeveral cost-benefit analyses were conducted to identify the key factors for the feasibility of WUNZ: HS. As a result of the pilot study conducted in 2001, the ongoing benefit could be valued at about NZD450 per year per insulated household. The EECA estimated the costs and manpower required to implement the programme in 2009-2010. They also estimated the number the households to be covered under the programme.
The EECA, which is governed by a board appointed by the Minister of Energy and Resources, imposed high standards of quality control. The Ministry of Business, Innovation and Employment (MBIE) is EECA's monitoring agency, and advises the government on energy policy. “Quality is strictly monitored. The service providers who deliver the scheme are contracted to meet certain installation standards. They must self audit and EECA the randomly audits between 5%-10% of jobs done. The current pass rate is above 90%.” 
The evaluation was carried out by a very experienced and knowledgeable team at the University of Otago, who had already been responsible for the very successful and well-regarded pilot study.
Policymakers used several parameters, e.g., energy usage and health indicators to measure the impact. The NZ Centre for Sustainable Cities analysed “the impacts on monthly metered electricity and reticulated gas use of the houses retrofitted with insulation or clean heat source under the New Zealand Insulation Fund (NZIF) programme, titled ‘Warm Up New Zealand: Heat Smart'”.  There were other energy indicators measured, such as temperature and humidity. The EECA was engaged in continuous monitoring of the programme.
In addition, the health outcomes were measured: the number of hospital admissions and GP visits of citizens involved in the scheme, and their use of pharmaceuticals.
AlignmentAll the actors shared a common interest in the achievement of the objectives and all the actors were equipped to execute their part. It was coordinated and delivered by the EECA. It was supported by various business and community partners and local councils, and there were high levels of participation by New Zealand’s households. It was expertly monitored by academic researchers.
Effect of insulating existing houses on health inequality: cluster randomised study in the community, Philippa Howden-Chapman, Anna Matheson, Julian Crane, Helen Viggers, Malcolm Cunningham, Tony Blakely, professor,3 Chris Cunningham, Alistair Woodward, Kay Saville-Smith, Des O'Dea, Martin Kennedy, Michael Baker, Nick Waipara, Ralph Chapman and Gabrielle Davie, 26 February 2007, British Medical Journal
Evaluation of the Warm Up New Zealand: Heat Smart programme, May 2012, New Zealand Centre for Sustainable Cities
Cost Benefit Analysis of the Warm Up New Zealand: Heat Smart Programme Final Report, October 2011, Arthur Grimes, Tim Denne, Philippa Howden-Chapman, Richard Arnold, Lucy Telfar-Barnard, Nicholas Preval and Chris Young, Motu, Wellington; Covec; He Kainga Oranga/Housing and Health Research Programme, University of Otago, Department of Mathematics, Victoria University of Wellington
EVALUATING THE GOVERNMENT'S “WARM UP NEW ZEALAND: HEAT SMART” PROGRAMME, MOTU ECONOMIC & PUBLIC POLICY RESEARCH
Housing, Insulation and Health Study, He Kainga Oranga/Housing and Health Research Programme, University of Otago
Cool? Collaboratively exploring youth experiences of cold housing, 2015, He Kainga Oranga/Housing and Health Research Programme, University of Otago
Warm Up New Zealand: Heat Smart—Number of Houses Insulated, Questions for oral answer, August 2010, New Zealand Parliament
HOUSING, ENERGY AND THERMAL COMFORT: A review of 10 countries within the WHO European Region, 2007, WHO
Monitoring and evaluating the Warm Up New Zealand: Heat Smart Programme, 2015, Robert Linterman, Energy Efficiency Conservation Authority, New Zealand
HOME TRUTHS AND COOL ADMISSIONS: New Zealand housing attributes and excess winter hospitalisation, Lucy Telfar Barnard, 29 September 2009, University of Otago, Dunedin, New Zealand
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