The Lancet Public Health | Effect of energy-efficient homes on residents' health evidence from a natural experiment in the Netherlands
Vincent P Roberdel, Ioulia V Ossokina, Jos van Ommeren, Theo A Arentze
DOI: 10.1016/S2468-2667(26)00023-X
Background
Many governments around the world subsidise upgrades to poorly insulated homes, yet the extent to which these energy-efficiency improvements reduce health risks remains unclear. This study aimed to provide the first large-scale evidence on whether such retrofits lower the use of respiratory health-care services, particularly for children and other vulnerable individuals.
Methods
A large-scale natural experiment was leveraged in which public housing units across the Netherlands were retrofitted between 2012 and 2021. Upgrades included insulation and mechanical ventilation, targeting homes with poor energy efficiency and constructed before the early 1990s. Treatment assignment was based on technical factors unrelated to health outcomes, and opting out was not possible. The study followed 2 million individuals over 10 years (approximately 12 million person-years), providing high statistical power. Individual-level medication data were obtained from health insurers. Outcomes among 180,000 tenants in retrofitted homes were compared with those in not-yet-retrofitted homes using a staggered difference-in-differences design with individual fixed effects. Primary outcomes included prescription respiratory-system medications such as asthma or chronic obstructive pulmonary disease drugs, cough remedies, and antihistamines.
Results
Antihistamine use declined by 1.87% (95% CI 0.19–3.55; p=0.029) after retrofits. Among children younger than 18 years, respiratory medication use decreased by 3.76% (1.04–6.48; p=0.0067). After 5 years, asthma medication use was reduced by 6.91% (–0.04 to 13.85; p=0.051). No statistically significant effects were observed for non-respiratory medication outcomes or health-care costs.
Fig. 1 Effects of home upgrade on respiratory medication
Conclusion
Energy-efficiency upgrades led to measurable reductions in respiratory medication use, especially among children. These benefits likely reflect reduced exposure to indoor dampness and poor air quality. Reduction in childhood asthma represents an important co-benefit of energy-efficiency home improvements.
Reference
Roberdel, V.P., Ossokina, I.V., van Ommeren, J. and Arentze, T.A. (2026). Effect of energy-efficient homes on residents’ health: evidence from a natural experiment in the Netherlands. The Lancet Public Health, [online] 11(4), pp.e245–e252. doi:https://doi.org/10.1016/s2468-2667(26)00023-x.
