An academic paediatrician at the University of Edinburgh is unpicking the links between energy use, net zero policies and child health. Her current question: what is the role of underheated homes in respiratory infections in children? 

Dr Olivia Swann

About Dr Olivia Swann 

Olivia Swann, MBChB, PhD, MRes, MRCPCH, DTM&H, is a Senior Clinical Research Fellow in Paediatric Infectious Disease at the College of Medicine & Veterinary Medicine, University of Edinburgh. Dr Swann was the first doctor to train in Paediatric Infectious Diseases in Scotland, and has worked internationally including periods in Malawi, Ethiopia and Nepal, which ignited her passion for reducing health inequalities. 

After treating children with cerebral malaria in a children’s hospital in Malawi, Dr Swann felt compelled to bring research into her clinical work as a way to improve the health of as many children as possible. As a clinical academic, she now juggles the demands of balancing both hospital work and academia. With experience in a clinical laboratory and data science, the ability to transfer skills across disciplines is key to her work. 

Women in data science 

Alongside her work to reduce health inequalities, Dr Swann is also an avid champion of data science, particularly for women. At present, the Royal Statistical Society estimates that for every four analyst/data scientist roles filled by men, there are 0.68 positions filled by women. While the World Economic Forum predicts that by 2025, there will be 149 million new jobs in data, AI and tech that will be created, the UK currently has only 17% of girls undertaking STEM-related fields in school . Professionals like Dr Swann are working to combat this disparity.  

“Data science is a fantastic career for women and those with caring responsibilities, it gives you so much autonomy, flexibility and it’s really exciting,” Dr Swann says. “I love it when people tell me I don’t look like a data scientist as it gives me the opportunity to debunk some stereotypes!”. 

See Dr Swann’s recent short video for the University of Edinburgh’s International Women in Science Day. 

Heat sensor shows heat loss from windows of a house

Tiu Makkonen

Health impacts of energy poverty  

Motivated by her passion for data and health, Dr Swann is now focusing her attention on the associations between energy poverty and acute respiratory infections (‘ARIs’) in young children. Poorly heated, damp and mouldy housing is associated with ARIs in preschool-age children. Underheating is a major issue in Scotland, with 20% of Scottish homes affected. Meanwhile, ARIs are the leading cause of hospital admissions and antibiotic prescriptions in preschool children in the UK. The early years of a child’s life are crucial for their growth and development, and has a significant impact on their adult health. ARIs can contribute to childhood asthma and premature adult death. Lung function worsens with every 1-degree Celsius drop below 9°C of indoor temperature for children with asthma, according to WHO 

“Children under age five are almost like canaries in the coal mine,” Dr Swann said. “Their home environment has a disproportionate effect on their health because they spend so much time in their homes.”  

Meanwhile, older children and adults often spend large periods of their day outside of the home, either at school or work. Their bodies get breaks from the potentially harmful air quality in the home, which young children usually do not get. 

More and more in her clinical practice, Dr Swann is seeing young children with respiratory infections whose parents are struggling to afford to heat their homes or reporting problems with mould.  

“It is very upsetting. As a clinician, you treat these children and send them home, but all you’re doing is putting a sticking plaster on it; you’re not addressing the underlying problem.” 

Many factors contribute to underheating which include energy efficiency, family income and increasing energy costs. One-third of the UK’s carbon footprint is accumulated from heating homes. In an attempt to meet nNet Zzero targets, the Scottish Government funds retrofitting of older homes to improve home energy efficiency (‘HEE’). HEE improvements usually involve either reducing energy costs without affecting airtightness (e.g. boiler replacements) or reducing heat loss by increasing air tightness (e.g. improved insulation). However, improved airtightness in the home may increase ARI risk by trapping indoor air pollutants and increasing mould.  

“There is also concerning evidence that tightly insulating a home could actually worsen respiratory health” Dr Swann says. “We urgently need to examine this in more detail.” 

Net Zero policy implications 

Achieving Scotland’s plans for a just transition to net zero must consider the impact that different retrofitting approaches have on the risk of ARIs. Pursuing nNet Zzero policies without addressing the health impacts could ultimately worsen health inequalities. 

“The health impacts of policies can’t just be afterthoughts” Dr Swann says. “We need to know what is the best way to make a home warmer AND reduce respiratory infections. Without considering health perspectives of policies, we could otherwise end up with a bigger problem than we started with.” The words of the Chair of the NHS Confederation, Lord Victor Adebowale, also resonate strongly with her: “We need a ‘health in all policies’ approach.” 

This association between HEE measures and health has largely been left unexplored in the UK. As noted by the National Institute for Health and Care Excellence, there is a lack of rigorous, UK-based epidemiological evidence on the degree to which different housing energy efficiency interventions modify the risk of cold temperature-related deaths and illnesses. 

Energy transitions necessitate interdisciplinary approach 

The UK’s National Energy Action found that the rates of fuel poverty in the UK have risen from 4.5 million in 2021 to 6.3 million 2023.  Although home heating plays a key role in the well-being and health of households, it is often the area which experiences household cutbacks to make ends meet.  

Dr Swann’s work demonstrates the importance and success that come from bridging different disciplines together. Meeting people face to face in different disciplines and perspectives, improves future outlooks for all. As she explains “If you try and answer your question in a silo, you don’t get the whole answer. We’ve seen it done again and again, where people keep trying to answer questions from their own viewpoints, but actually, what we need is more complex, interdisciplinary research, which is harder to do.” 

Dr Swann praises that “this topic is a wonderful opportunity to bring together cross-sectoral researchers will all their different skills to do something that’s bigger than the sum of its parts.”