by Kim Krisberg

It was a lucky winter for Becky Belmont. The weather was on her side.

As the director of energy and weatherization at West Central Minnesota Communities Action Inc., Belmont was sure the agency would run out of energy assistance funds to help all those in need. But fortunately, a mild Minnesota winter translated into fewer residents who needed help keeping their homes warm this year.

Today, Belmont seems pretty optimistic that even with declining funds, the agency will have enough funding to last through May 31, which marks the end of its Energy Assistance Program year. This year, Minnesota received $116 million in federal energy assistance funds — the previous year, funding was at $152 million.

“If you can’t stay in your home and be warm, there’s going to have to be other arrangements made for you,” Belmont said. “What that would be and who would be responsible for that is a very difficult question.”

That’s because most of the residents Belmont and her colleagues help via energy assistance funds are the elderly and people living with disabilities. According to Belmont, senior households represent 33 percent of those helped, 26 percent are disabled and 23 percent are households with children younger than six. Since October, the agency has helped more than 5,000 households throughout seven counties in west-central Minnesota, where winters can get as cold as 20 below zero.

During our phone conversation, Belmont read me passages from thank-you notes she’s received. Some letter-writers say they couldn’t have stayed in their homes without help paying the heating bill.

“It makes quite a difference for the elderly,” Belmont said. “They’re a group that really feels the pinch.”

Belmont’s funding concerns can be traced back to the federal Low-Income Home Energy Assistance Program, or LIHEAP, a block grant program that provides energy assistance funds based on a state’s weather and low-income population. The program is housed within the U.S. Administration for Children & Families, and applicants must have an income of less than 150 percent of the poverty level (that’s less than $33,000 a year for a family of four).

In fiscal year 2012, federal LIHEAP funds totaled $3.47 billion; the previous year, it was $4.7 billion. In fiscal year 2010, LIHEAP was at $5.1 billion — a high mark for the program overall, according to Brandon Avila, spokesperson at the Campaign for Home Energy Assistance. For 2013, President Obama has proposed about $3 billion for LIHEAP. While a small number of states pitch in their own LIHEAP funds, the bulk of resources have to come from federal policy-makers, Avila said.

“We have a pretty strong bipartisan group of supporters,” he said. “It’s not as a politically charged program…if you’re from cold regions or hot regions, if you’re Republican or Democrat, you can understand that if you can’t pay your energy bills, it can be a life or death situation.”

Avila said that while LIHEAP’s roots go back to the county’s colder regions, its recent $5.1 billion funding level “really made it a program of national scope,” active in both cold- and hot-weather states. Still, even at $5.1 billion, only one out of five eligible households was being served, Avila told me.

“This year, not getting less (funding) than the previous year is all we can ask for,” he said. “I don’t think we can take any more cuts.”

Fuel for good health

It’s not administered by health departments, but LIHEAP says “public health” all over it. It helps people in vulnerable situations maintain healthy living environments– a fundamental social determinant of a person’s health. At its very core, LIHEAP isn’t about keeping homes warm or cool; it’s about keeping the people and families who live inside them healthy.

“It’s not just a phrase that people cut back on other needs (to compensate for rising energy costs), it actually happens,” said George Coling, executive director of the National Fuel Funds Network, a charitable program that raises about $150 million a year in utility assistance. “Families cut back on other expenses — food, clothing, medicines.”

In stories collected by the 2009 National Energy Assistance Survey, nearly one third of survey participants reported that they went without food, over 40 percent sacrificed medical care, and one-quarter had someone in the home who become sick because the home was too cold. About 64 percent reported that they would have kept their home at unsafe or unhealthy temperatures or had their electricity or home heating fuel discontinued if not for LIHEAP. A 2010 report from the AARP Public Policy Institute noted that lower socioeconomic status is tied to a greater risk of temperature-related death, especially among older adults.

“[Energy assistance] prevents much higher spending concurrently,” said Deborah Frank, founder and principal investigator at Children’s HealthWatch in Boston. “If we’re trying to save health care costs, you have to attend to the social determinants of health. This isn’t a matter of comfort…it is truly a health issue.”

In researching the issue, Frank and her colleagues have found that when compared to toddlers and infants living in energy-secure homes, infants and toddlers living with severe energy insecurity are 36 percent more likely to be reported in fair or poor health. They’re also more than 82 percent more likely to be at risk for developmental delays. Even infants and toddlers living with moderate energy insecurity are 34 percent more likely to be reported in fair or poor health.

“We need to connect the dots for the policy-makers,” said Frank, who is also a professor of child health and well-being at Boston University School of Medicine. “I don’t think they see beyond the budget choices. We see the health impacts and real-life impacts…we should use our credentials to help them connect the dots.”

Staying cool

A 2008 study examining natural hazard mortality in the United States from 1970 to 2004 found that heat and drought cause almost 20 percent of total deaths from natural hazards — more than earthquakes, hurricanes, tornadoes, winter weather and flooding. And according to data from the Centers for Disease Control and Prevention, nearly 3,500 people died due to extreme heat from 1999 to 2003, with the agency reporting that such numbers are likely underestimated.

In Arizona, where residents typically endure more than 100 days of over 100-degree temperatures from May through September, the health department’s primary role is education and awareness. Data collected by the department found that between 1992 and 2009, nearly 1,500 deaths occurred in Arizona due to exposure to heat.

“For the most part, people know how to deal with it,” said Diane Eckles, chief of the Office of Environmental Health at the Arizona Department of Health Services. “When we have about 90 degrees at night and the weather service starts issuing advisories, that’s when we know we might start having some problems we don’t routinely have.”

Hot nights mean a person’s body — and his or her home — doesn’t get a chance to cool down and recuperate from scorching daytime temperatures.

During extreme weather days, the Arizona health department sends out heat advisories and prevention tips, especially to facilities serving vulnerable populations, such as long-term care facilities, hospitals and day care centers, Eckles told me. The biggest issue, she said, is reaching tourists, who might not be aware of just how dangerous Arizona’s heat can be.

In Arizona, LIHEAP funds were at more than $23 million for fiscal year 2012. In 2011, the program was funded at $33.8 million and provided more than 36,000 Arizona households with assistance. Unfortunately, many advocates say hot-weather states get the short end of the stick when it comes to utility assistance — for example, in 2005, less than 3 percent of federal LIHEAP funds were spent on cooling assistance. Frank, at Children’s HealthWatch, lamented a LIHEAP funding formula that has states competing with each other for enough funding to keep their residents healthy — “we should be protecting all citizens from these (weather) extremes,” she said.

To the east in Texas, where last summer marked the hottest one on record, LIHEAP funds have dropped from more than $184 million in 2011 to $129.8 million in 2012. At Central Texas Opportunities Inc., which administers the LIHEAP program throughout a seven-county rural region, funds have declined by about $1.5 million, according to Hanna Adams, community services director at the nonprofit. Due to such funding cuts, eligibility for LIHEAP in Texas has been narrowed from 200 percent of poverty to 125 percent.

However, the need for utility assistance is only going up in central Texas, and Adams reports that her organization is simply unable to keep up with demand. In fact, Adams said that in some of the counties she serves, “there’s greater need than I’ve ever seen before.”

“My biggest concern with the majority of the population (we serve) is health,” she said. “The people getting our assistance really do need it.”

To learn more about LIHEAP, visit www.liheap.org. For tips on how to stay safe and healthy in the coming summer heat, visit www.bt.cdc.gov/disasters/extremeheat/heat_guide.asp.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for a decade.