Weatherization assistance program
Evidence Ratings
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results. Learn more about our methods
Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Evidence Ratings
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results. Learn more about our methods
Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Disparity Ratings
Potential to decrease disparities: Strategies with this rating have the potential to decrease or eliminate disparities between subgroups. Rating is suggested by evidence, expert opinion or strategy design.
Potential for mixed impact on disparities: Strategies with this rating could increase and decrease disparities between subgroups. Rating is suggested by evidence or expert opinion.
Potential to increase disparities: Strategies with this rating have the potential to increase or exacerbate disparities between subgroups. Rating is suggested by evidence, expert opinion or strategy design.
Inconclusive impact on disparities: Strategies with this rating do not have enough evidence to assess potential impact on disparities.
Strategies with this rating have the potential to decrease or eliminate disparities between subgroups. Rating is suggested by evidence, expert opinion or strategy design.
Health factors shape the health of individuals and communities. Everything from our education to our environments impacts our health. Modifying these clinical, behavioral, social, economic, and environmental factors can influence how long and how well people live, now and in the future.
Weatherization assistance programs provide support for families with low incomes to make their homes more energy-efficient and permanently reduce energy bills. Programs often support insulation of walls, ceilings, and attics; heating, ventilation, air conditioning (HVAC) repair and replacement; air sealing around doors and windows, along with repairs or replacements; furnace repair and replacement; and refrigerator replacement1. At the federal level, the U.S. Department of Energy runs a weatherization assistance program to help families with low incomes. Federal funds are allocated to each state based on the percentage of residents with low incomes, climatic conditions (heating and cooling degree-days), and residential energy expenditures by households with low incomes2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Improved health outcomes
Improved well-being
Increased energy efficiency
Reduced energy expenditures
Improved mental health
Reduced absenteeism
Reduced hospitalizations
What does the research say about effectiveness?
There is strong evidence that weatherization assistance programs improve health and well-being by increasing warmth through insulation and energy efficiency measures for families with low incomes1, 3, 4, 5, 6. Housing improvements that increase warmth have shown consistent positive effects on well-being and health, including respiratory, mental health, and self-rated general health3, 4, 5, 6. Such improvements have also been shown to reduce children’s absences from school, adult absences from work, doctor’s visits, and hospitalizations3, 6. Available evidence shows that households experiencing energy insecurity usually include children, racial or ethnic minorities, and long-term residents of neighborhoods with homes in poor condition, and that weatherization assistance programs can reduce the disproportionate burden of energy insecurity on these households7, 8.
Poor housing conditions associated with energy insecurity include inadequate heating and cooling, mold, and dampness, all of which contribute to negative respiratory and mental health outcomes (e.g., pneumonia, asthma, depression, and poor-quality sleep)7. Lower heating costs are associated with reduced national mortality rates in the winter9, which suggests programs designed to reduce energy insecurity and costs for households with low incomes, such as weatherization assistance programs, may have significant health benefits7, 9, 10. Available evidence suggests that weatherization assistance programs combined with financial support programs, such as the Low Income Home Energy Assistance Program (LIHEAP), may contribute to reduced energy use and costs, along with improved health outcomes10.
A Knoxville, Tennessee-based study of homeowners with low incomes participating in a weatherization assistance program found that homes were more likely to be maintained at healthy temperatures; contained less mold, dust, and drafts; and families were more likely to have funds available to pay their home energy bills and purchase their prescriptions1.
Cost benefit analysis shows a high value return for the cost of retrofitting homes with insulation11. Reports suggest the federal Weatherization Assistance Program generates significant annual household energy and cost savings12, 13, 14. By reducing spending on heating needs, weatherization assistance programs may increase food security and decrease the need for other government assistance related to high-energy heating needs1.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by expert opinion.
Weatherization assistance programs are a suggested strategy to reduce disparities in energy security between households with low incomes and those with high incomes7, 8. Experts suggest weatherization assistance programs designed to reduce energy insecurity and costs for households with low incomes may have significant health benefits1, 7, 9, 10, including reducing disparities in respiratory and mental health outcomes between households with low incomes, with children, or identifying as a racial or ethnic minority, and households with higher incomes, without children, or identifying as white7.
Across the nation, households that identify as Black, Native American, or Hispanic; have members that are children or older adults; reside in manufactured housing, multi-family homes, older buildings, or homes in poor condition; and rural households experience higher financial energy burdens than others7, 16, 17. Black households experience the most severe energy insecurity, and experts suggest energy insecurity may be a product of racial residential segregation and housing discrimination7, 8. Multi-component programs that include weatherization assistance and energy efficiency investments, in addition to financial support for energy bills, are suggested to address the disproportionate burden of energy insecurity on Black households, to improve housing quality, to increase housing stock values, to increase the potential for wealth accumulation, and to help reduce the racial wealth gap8.
Older adults are more susceptible to the health effects of extreme changes in heat or cold and experience even larger energy cost burdens if they reside in older homes in formerly redlined neighborhoods. Since property values for homes in formerly redlined neighborhoods remain low, older residents have fewer resources to use for repairs, energy efficient upgrades, or modifications to make their homes more accessible so they can age in place18, 19. Cities in the Southeast and West experience the greatest disparities in temperature between formerly redlined and non-redlined neighborhoods, exposing vulnerable communities to ever more extreme heat waves due to the effects of climate change20.
What is the relevant historical background?
Weatherization assistance programs are tailored to help homeowners with low incomes reduce their energy costs. The energy costs to heat and cool a home can consume a large portion of a family’s income, especially during extreme weather events such as blizzards or heat waves21. There are significant disparities in homeownership in the U.S. The Federal Housing Administration (FHA) established redlining policies that were the most influential factor in entrenching racial residential segregation. Redlining denied people of color access to government-insured mortgages and severely limited their homeownership opportunities22. By the 1960s, many urban neighborhoods and rural areas were suffering from the effects of disinvestment, concentrated poverty, and high segregation levels23. The Fair Housing Act of 1968 was passed to reduce housing discrimination, but it has not stopped housing discrimination against people of color or helped rebuild the marginalized neighborhoods created by residential segregation24. In the 1970s, heating oil prices skyrocketed in the U.S.21. Efforts to conserve energy at home through untested insulation materials or by sealing homes often created toxic environments where chemical and biologic pollutants and moisture builds up inside, unable to be removed by outside air. Many of these toxins are still present in older homes and have contributed to the ill health of residents for decades25. At the federal level, the Weatherization Assistance Program was established in 1976, as part of the Energy and Conservation Production Act, to fund efforts by states, territories, and Native American tribes to reduce the energy costs of homeowners with low incomes12.
In the present day, formerly redlined neighborhoods remain more likely to include older homes in poorer condition. These homes generally have inefficient energy systems; lead paint, soil, or pipes; mold and other allergens; repair needs; challenges with heating and cooling; and more. Formerly redlined neighborhoods are often near sources of pollution, toxins, and other health hazards, such as coal-fired power plants or hazardous waste disposal sites26. Formerly redlined neighborhoods usually contain more paved surfaces than green spaces and tree coverage, creating urban heat islands that can rapidly increase temperatures beyond what older, energy inefficient home heating and cooling systems can handle27. This exacerbates the disproportionately high energy burden for families and individuals with low incomes who already have hard decisions about how to allocate their paychecks28.
Equity Considerations
- What partnerships can weatherization assistance programs build with community organizations, health care providers, and social service agencies to reach households that would benefit the most from participation?
- How can program administrators increase funding for weatherization assistance programs? Who is involved in deciding how much funding to allocate to local weatherization assistance efforts? How can your community ensure that each household has the resources (e.g., financial, material, labor, etc.) they need to make needed improvements and repairs to their homes?
- What efforts can your community make to invest in formerly redlined neighborhoods with older homes in disrepair? Can your local weatherization assistance program be incorporated into a multi-component initiative to improve housing quality and support homeownership in these neighborhoods?
Implementation Examples
Weatherization assistance programs exist across the nation. At the federal level, the U.S. Department of Energy’s Weatherization Assistance Program (WAP) allocates funds to all 50 states to supplement local programs2. Numerous states have established their own programs to support energy efficiency efforts by homeowners with low incomes, many of which have also passed legislation to increase state funding for both the Weatherization Assistance Program and the Low Income Home Energy Assistance program (LIHEAP), including Arizona, California, Colorado, Connecticut, Illinois, Iowa, Michigan, Minnesota, Montana, New Jersey, Ohio, Oregon, Vermont, Virginia, Washington, and Wisconsin12.
The American Council for an Energy Efficient Economy (ACEEE) has an interactive database map of state and local energy-efficient policies and programs, which includes information on WAP and LIHEAP15.
Implementation Resources
‡ Resources with a focus on equity.
ACEEE-Smarter House - American Council for an Energy-Efficient Economy (ACEEE). Smarter House: Reduce your impact and home energy breakdown.
US DOE-WAP - U.S. Department of Energy (U.S. DOE), Office of State and Community Energy Programs. Weatherization assistance program (WAP).
WAP-NH - New Hampshire Office of Energy and Planning. Weatherization Assistance Program (WAP) frequently asked questions.
Footnotes
* Journal subscription may be required for access.
1 Tonn 2021a - Tonn B, Rose E, Hawkins B, Marincic M. Health and financial benefits of weatherizing low-income homes in the southeastern United States. Building and Environment. 2021;197:107847.
2 US DOE-WAP Formula - U.S. Department of Energy (U.S. DOE). Weatherization assistance program (WAP) allocation formula.
3 Thomson 2015 - Thomson H, Thomas S. Developing empirically supported theories of change for housing investment and health. Social Science & Medicine. 2015;124:205-214.
4 Maidment 2014 - Maidment CD, Jones CR, Webb TL, Hathway EA, Gilbertson JM. The impact of household energy efficiency measures on health: A meta-analysis. Energy Policy. 2014;65:583-593.
5 Curl 2015 - Curl A, Kearns A. Can housing improvements cure or prevent the onset of health conditions over time in deprived areas? BMC Public Health. 2015;15(1):1191.
6 Howden-Chapman 2007 - Howden-Chapman P, Matheson A, Crane J, et al. Effect of insulating existing houses on health inequality: Cluster randomized study in the community. BMJ. 2007;334(7591):460.
7 Hernandez 2019 - Hernández D, Siegel E. Energy insecurity and its ill health effects: A community perspective on the energy-health nexus in New York City. Energy Research and Social Science. 2019;47:78-83.
8 Lewis 2019 - Lewis J, Hernández D, Geronimus AT. Energy efficiency as energy justice: Addressing racial inequities through investments in people and places. Energy Efficiency. 2019;13(3):419-432.
9 NBER-Chirakijja 2019 - Chirakijja J, Jayachandran S, Ong P. Inexpensive heating reduces winter mortality. National Bureau of Economic Research (NBER). 2021: Working Paper 25681.
10 Tonn 2021 - Tonn B, Hawkins B, Rose E, Marincic M. Income, housing and health: Poverty in the United States through the prism of residential energy efficiency programs. Energy Research and Social Science. 2021;73:101945.
11 Chapman 2009 - Chapman R, Howden-Chapman P, Viggers H, O’Dea D, Kennedy M. Retrofitting houses with insulation: A cost-benefit analysis of a randomised community trial. Journal of Epidemiology and Community Health. 2009;63(4):271-277.
12 NCSL-Shields 2020 - Shields L. Bolstering federal energy assistance and weatherization with state clean energy programs. National Conference of State Legislators (NCSL); 2020.
13 Schweitzer 2005 - Schweitzer M. Estimating the national effects of the U.S. Department of Energy’s Weatherization Assistance Program with state-level data: A meta-evaluation using studies from 1993 to 2005. Oak Ridge: Oak Ridge National Laboratory (ORNL); 2005: ORNL/CON-493.
14 US DOE-WAP - U.S. Department of Energy (U.S. DOE), Office of State and Community Energy Programs. Weatherization assistance program (WAP).
15 ACEEE-Energy policies - American Council for an Energy-Efficient Economy (ACEEE). State and local policy database of energy efficiency policies and programs.
16 ACEEE-Drehobl 2020 - Drehobl A, Ross L, Ayala R. How high are household energy burdens? An assessment of national and metropolitan energy burden across the United States. American Council for an Energy-Efficient Economy (ACEEE); 2020.
17 ACEEE-Ross 2018 - Ross L, Drehobl A, Stickles B. The high cost of energy in rural America: Household energy burdens and opportunities for energy efficiency. American Council for an Energy-Efficient Economy (ACEEE); 2018.
18 Sanders 2020 - Sanders A. Housing: Often overlooked but a critical pillar for older adults. Generations Journal. 2020;44(2).
19 ACEEE-Nadel 2020 - Nadel S. Weatherization and home improvements: A promising path for improving health and reducing medical costs for older adults. American Council for an Energy-Efficient Economy (ACEEE); 2020.
20 Hoffman 2020 - Hoffman JS, Shandas V, Pendleton N. The effects of historical housing policies on resident exposure to intra-urban heat: A study of 108 U.S. urban areas. Climate. 2020;8(12):1-15.
21 CRS-Perl 2019 - Perl L. The LIHEAP formula. Congressional Research Service (CRS) RL33275; 2019.
22 Kaplan 2007 - Kaplan J, Valls A. Housing discrimination as a basis for Black reparations. Public Affairs Quarterly. 2007;21(3):255-273.
23 Zdenek 2017 - Zdenek RO, Walsh D. Navigating community development: Harnessing comparative advantages to create strategic partnerships. Chapter: The background and history of community development organizations. New York: Palgrave Macmillan; 2017.
24 Urban-Reynolds 2021 - Reynolds K, Lo L, Boshart A, Galvez MM. Federal reforms to strengthen housing stability, affordability, and choice. Washington, D.C.: Urban Institute; 2021.
25 CDC-US HUD-Healthy housing - Centers for Disease Control and Prevention (CDC) and U.S. Department of Housing and Urban Development (U.S. HUD). Healthy housing reference manual. Atlanta: U.S. Department of Health and Human Services; 2006.
26 Braveman 2022 - Braveman PA, Arkin E, Proctor D, Kauh T, Holm N. Systemic and structural racism: Definitions, examples, health damages, and approaches to dismantling. Health Affairs. 2022;41(2):171-178.
27 NC HFA-Constantine 2020 - Constantine L. Historically redlined neighborhoods experience worse heat. North Carolina Housing Finance Agency (NC HFA); 2020.
28 US DHHS OCS-Howard 2021 - Howard L. LIHEAP American Rescue Plan funding: Racial and economic justice is also equity in energy. The Family Room Blog. Office of Community Services (OCS): An Office of the Administration for Children & Families (ACF), U.S. Department of Health and Human Services (U.S. DHHS); 2021.
Related What Works for Health Strategies
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