Child Health Impact Assessment of Energy Costs and the Low Income Home Energy Assistance Program (LIHEAP)

Authors: Child Health Impact Working Group (Boston Medical Center), Lauren Smith, MD, MPH

Location: Boston, Massachusetts, United States

Completion Date: April 2007

HIA Report: Unhealthy Consequences: Energy Costs and Child Health

Summary of the HIA

Proposed Policy or Project

Rising energy costs put young children’s health at risk as low-income families struggle to pay utility bills and provide necessities. The Low Income Home Energy Assistance Program (LIHEAP) is a federal program created by Congress in 1981 to assist low-income households, especially those that must spend higher proportions of their income on home energy costs.  Each state, such as Massachusetts, determines eligibility requirements within the guidelines set by the federal government. In 1994, LIHEAP was amended to specifically target the most vulnerable households, defined as those with at least one member who is:

  • a child under age 5
  • an individual with disabilities, or
  • an adult over age 65.

Even with these grants, many vulnerable families with children in Massachusetts fail to receive LIHEAP or receive less than the maximum benefits and barely enough to monetary assistance to cover half of the average home heating costs. This energy burden experienced by many low-income families impact child health and this health impact assessment looks at how budget-trade-offs impact the health of children.

Background and Policy Context

In the 2006 program year, 143,309 Massachusetts households received assistance from LIHEAP, though there were 189,600 low-income households with children who were eligible. There are over 400,000 children in low-income families, 173,099 of whom live below the poverty line and 56,715 who were 5 years or younger. Nationally, low-income families spend approximately 14% of their budget on home energy compared to 3% for more well off families. And in the northeastern US, home heating makes up about 44% of a household’s total energy expenditures that includes space and water heating, space cooling, refrigeration, and other electric appliances. That is a substantial energy burden for low income families where many are faced with the “heat or eat” dilemma, making these families more likely to suffer from food insecurity.

It is the issue of how high energy costs, increasing household budgets, unemployment, stagnant wages, and increasing prices for food have health implications. When low-income families end up spending a large portion of their income on these, they may fail to provide the basic needs to their families.

Scope and Methods

Some of the pathways examined in this HIA in conjunction with child health include:

  • indoor air quality
  • nutrition as impacted by food insecurity
  • access to regular checkups which are essential for children under the age of 5
  • mental health issues that arise due to housing instability

Summary of Findings

Based on a survey conducted by the National Energy Assistance Directors Association (NEADA) in 2005, LIHEAP participants in the Northeast reported making budget trade-offs due to high energy costs:

  • 73% reported that they reduced spending on household necessities because they did not have enough money to pay energy bills
  • 20% went without food
  • 28% went without medical or dental care
  • 23% did not make full rent or mortgage payment at least once.

This demonstrates that current LIHEAP benefits were helpful but not sufficient in buffering families from the impact of high energy costs.

The energy burden many vulnerable low-income households face impact child health in several ways:

  • low income families facing high energy costs are forced to make household trade-offs that jeopardize child health
  • these families may resort to alternative heating sources, such as portable heater, kitchen stoves or fireplaces, which endanger child health and safety
  • high energy costs and unaffordable housing may force low-income families to reside in unhealthy housing conditions such as pest infestation, mold and lead, which increase the likelihood of these children having asthma, lead poisoning, infectious diseases and injuries.
  • The growing gap between rising energy costs and LIHEAP benefits maens that more Massachusetts families accumulate unpaid utility bills that can lead to eviction and homelessness, threatening child physical and mental health.

Decisions/Actions following the release of the HIA

Members of the Child Health Impact Assessment Working Group presented their findings to the state legislature in testimony before the joint committee on housing.

Project Inputs

FTE-months of effort (Manager/Senior Researchers): 

Products Produced

Number of Pages in Final Report: 


Lauren Smith, MD, MPH