Façade insulation retrofitting policy implementation process and its effects on health equity determinants: A realist review

Fuel poverty and cold housing constitute a significant public health problem. Energy efficiency interventions, such as façade retrofitting, address the problem from a structural and long-term perspective. Despite evidence of the health benefits of insulation, little is known about the political and social contexts that contribute to social inequalities in receiving and experiencing health benefits from these interventions. We used a realist review methodology to better understand the mechanisms that explain how and why variations across different social groups appear in receiving energy efficiency façade retrofitting interventions and in their impact on health determinants. We considered the four stages of the policy implementation framework: public policy approach; policy; receiving intervention and impact on health determinants. We found strong evidence that certain social groups (low-income, renters, elderly) suffering most from fuel poverty, experience more barriers for undertaking a building retrofitting (due to factors such as upfront costs, "presentism" thinking, split incentives, disruption and lack of control), and that some public policies on housing energy efficiency may exacerbate these inequalities. This can be avoided if such policies specifically aim at tackling fuel poverty or social inequities, are completely free to users, target the most affected groups and are adapted to their needs.