Energy Assistance as Extreme Temperature Adaptation: Health Effects of LIHEAP Heating and Cooling Policy Variation

• In Event: Power, Heat, and Well-Being: Energy Access as a Social Determinant of Health

Abstract

Extreme temperatures pose significant risks to human health, increasing both mortality and morbidity. Low-income households who are energy insecure are especially vulnerable, with poorer baseline health and limited ability to afford energy-intensive adaptation such as heating and cooling. The Low-Income Home Energy Assistance Program (LIHEAP) is the primary federal program designed to reduce energy burdens for low-income households, yet its allocation formula prioritizes winter heating over summer cooling. As heatwaves become more frequent, this winter-oriented allocation may leave energy-poor households with insufficient support to maintain adequate cooling. While recent work calls attention to the need to modernize LIHEAP to address rising heat-related risks, there is limited evidence on whether the program mitigates temperature-related health consequences, particularly during hot weather.

In this paper, we examine whether LIHEAP reduces temperature-related mortality and estimate the health tradeoffs of reallocating program funds between winter heating and summer cooling. We construct a county-day panel for Indiana from 2010 to 2019 linking mortality records, emergency department encounters, daily weather data, and LIHEAP policy variation. Our empirical strategy exploits Indiana’s 2019 elimination of summer LIHEAP cooling assistance to estimate how the temperature–health relationship changes when cooling support is unavailable, and to evaluate the health tradeoffs implied by LIHEAP’s seasonal allocation between summer cooling and winter heating. We further assess LIHEAP’s role by comparing effects across counties with different levels of LIHEAP participation.

Our preliminary results suggest that Indiana’s 2019 policy change, which eliminated summer cooling assistance and reallocated funds toward winter heating, shifted mortality risks accordingly across hot and cold days. Compared to years with both summer and winter assistance, the removal of cooling assistance increased three-day hot-day mortality by 0.67 deaths per 100,000 population (95% CI: 0.10, 1.24) in counties with high LIHEAP penetration, while counties with low penetration show no comparable effect. Similar baseline mortality across groups suggests that LIHEAP cooling assistance was protective rather than proxying for vulnerability. At the same time, the reallocation toward heating assistance reduced three-day cold-day mortality by about 1.0 to 1.2 deaths per 100,000 population in high-LIHEAP counties. These estimates imply approximately 4 additional deaths per hot day from lost cooling and 6 to 8 fewer deaths per cold day from increased heating, with the annual reallocation of roughly $15 million yielding a cost per life saved well below standard benchmarks under either channel. LIHEAP therefore provides an important health buffer against temperature-related mortality on both hot and cold days, and more climate-aligned allocation of LIHEAP funding could be acost-effective way to address changing energy needs.

Author

• Saiwen Zhang, Indiana University
  Presenting Author