Power Dynamic: Energy Insecurity and Health

Linda Daniels of Newark, NJ, died on July 5. For her family and friends, the loss was heartbreaking, not least of all because it was preventable. While the cause of death was listed as heart failure, in fact, she died of another all too common condition: energy insecurity. Daniels, who was 68 years old and lived with several chronic health conditions, fell behind on her electricity bills, according to a New York Times story. When her energy provider cut off service, she couldn’t use her electric oxygen machine. Breathing was difficult, especially as temperatures climbed into the 90s.

A 2015 report by the Department of Energy estimates that one in three American households faces a challenge in paying energy bills or sustaining adequate heating and cooling in their home. Families living with energy insecurity routinely forgo basic needs such as food and medicine to pay their energy bill, keep their homes at unhealthy temperatures, receive disconnection notices, and experience shutoffs.

Diana Hernández, PhD, assistant professor of Sociomedical Sciences, has studied energy insecurity over the past decade. Her pioneering research—carried out in collaboration with graduate students in Sociomedical Sciences, Epidemiology, and Environmental Health Sciences—has uncovered the ways energy insecurity acts as a stressor, leading to a host of adverse health outcomes, from anxiety and depression to respiratory symptoms and poor sleep quality. The NAACP and TURN: The Utility Reform Network have cited her work in policy reports using the evidence as a basis for advocacy efforts.

“No one should have to die from failing to pay their electric bill,” says Hernández. “Every day, millions of Americans are affected by energy insecurity, particularly the elderly, people of color, and other vulnerable groups. By and large, however, theirs is an invisible problem and they often suffer in the privacy of their homes. As a result, this important issue is sadly ignored.”

According to research conducted by Hernández and colleagues, African-American and Latino families experience the highest rates of energy insecurity, spending upwards of 10 percent of their income on power. Energy insecurity goes hand-in-hand with other hardships such as housing insecurity. Families paying a third or half their income to their rent are less able to pay for their electricity in full leading to arrearages and, eventually, shutoffs. In many states, if you don’t have your utilities on, you can’t stay in your rental unit.

“A sudden setback like illness or unemployment can lead to a negative spiral of mounting bills, disconnection notices, evictions, and homelessness,” she says. “Too often families have to choose between basic necessities—whether to pay the rent, heat their apartment, eat a meal, or purchase medications.”

Living With Energy Insecurity

In an ongoing study, Hernández is interviewing low-income families in 10 states around the country to understand their experience of energy insecurity. Repeatedly, she hears how degrading the experience of living without power or on the brink of a shutoff is. In Philadelphia, she interviewed a retired schoolteacher who was without gas service for three weeks—an experience she called “incredibly dehumanizing.” A survivor of Hurricane Maria in Puerto Rico said being without electricity for eight months left him desperate and depressed.

The federal government offers financial support through the Low Income Home Energy Assistance Program and the Weatherization Assistance Program. But according to Hernández, too few people are aware of the option or aren’t able to clear the bureaucratic hurdles to secure assistance or prevent a utility from discontinuing service. Linda Daniels’ family members and her doctor both petitioned her utility to restore her power on the basis of New Jersey consumer protections for medical emergencies. By the time power was restored, it was too late.

Beating the Heat

Most energy assistance programs are geared toward assistance for only part of the year—during the cold weather months. For many low-income families, April through October is “shutoff season,” when utilities cut residential power to force families to pay their bills—a strategy Hernández says has become increasingly common over the last decade. In extreme cases, those whose credit is ruined by repeated shutoffs are forced to reinstate power using the name and Social Security number belonging to their son or daughter—a common form of child identity theft.

The summer is a time when families are most reliant on electricity: children are home from school and air conditioning is on—when families can afford it. A study co-authored by Jeffrey Shaman, PhD, associate professor of Environmental Health Sciences, found most of a sample of New Yorkers surveyed reported the cost of air conditioning “a major concern.” A hot home translates to disrupted sleep and other health risks. (To fall asleep, our bodies need to cool by a degree or two.)  In a community survey of Washington Heights, Hernández uncovered high rates of disrupted sleep among community members, which may stem from thermal discomfort or the worry of a high energy bill.

In the coming years, climate change will only exacerbate energy insecurity as families are forced to cope with increasingly severe weather. Cities are particularly vulnerable due to the urban heat island effect, a phenomenon in which concrete and asphalt trap the sun’s energy, making a city sidewalk several degrees warmer on average than outlying countryside. As the population ages, cities will have greater numbers of older people with heightened vulnerability to temperature extremes. One study estimates that New York City could see as many as 3,300 heat-related deaths every year by the 2080s if significant steps aren’t taken to reduce greenhouse gas emissions.

New York City’s $106 million “Cool Neighborhoods” plan aims to mitigate the extreme heat using strategies such as encouraging the use of cooling centers, painting surfaces white, and planting more trees. “It could mean, by the 2080s, the difference between a 15-degree hotter summer day and just a 3- or 4-degree hotter day—something we can cope with as a society versus something that we will be very challenged to cope with,” Kim Knowlton, DrPH ‘05, a faculty member in Environmental Health Sciences, told Grist. “It’s a great opportunity to do the right thing.”

Searching for Solutions

When it comes to energy insecurity, there are no easy answers. In New York State, some are proposing a cap on energy costs at 6 percent of a family’s income. A community-based organization in Stockton, California, Fathers and Families of San Joaquin, is experimenting with “utility advocates” who help families to negotiate the energy bureaucracy to ensure they don’t have power interruptions like the kind experienced by Linda Daniels. Across the country, the Green and Healthy Homes Initiative works to weatherize homes, which can cut utility bills by 20 percent. A Hernandez collaborator, Jamal Lewis, MPH ’18, works at the organization’s headquarters in Baltimore.

More broadly, energy justice advocates propose that everyone has a right to uninterrupted service because household energy is integral to our rights to housing, food, and health.

“We need to understand that energy insecurity isn’t an isolated issue; it is systemic,” says Hernández. “Household energy is more than a basic utility, it’s a lifeline and a prerequisite for health.”