Energy insecurity, defined as the inability to meet household energy needs, has multiple economic, physical, and coping dimensions that affect health. We conducted the first citywide representative survey of energy insecurity and health in a sample of 1,950 New York City residents in 2022. We compiled ten indicators that characterize energy insecurity as experienced in New York City housing settings and then examined associations between number and types of indicators and health conditions.

Energy insecurity, defined as the “inability to meet basic household energy needs,”[1] can be both a chronic and an acute problem.[2] Chronic energy insecurity manifests as an inability to access or afford adequate supplies of energy, while acute energy insecurity arises when infrastructural, maintenance, environmental, or other external sources disrupt or impede access to energy.[3] A substantial number of individuals and families across the United States experience energy insecurity, which can lead to a variety of adverse consequences including residential instability and poor health outcomes.[4]

Prior to 2020, little was known about how energy insecurity varies across U.S. states. The recent release of energy insecurity data from the Energy Information Administration facilitates the exploration of energy insecurity at the state level using the Residential Energy Consumption Survey. In this visualization, the authors use choropleth maps to show spatial variation in (1) forgoing basic necessities such as food or medicine to pay an energy bill and (2) keeping the home at an unhealthy temperature. Both are strategies used by households to prevent energy insecurity. The visualization highlights the state-level prevalence of each indicator.

Energy insecurity research has described the prevalence and circumstances of household energy unaffordability, as well as its impacts on health. Previous studies have also noted coping strategies that result from energy insecurity. In 2020, we conducted in-depth interviews with 30 participant households enrolled in one or more energy assistance programs in Washington D·C. Participants were asked about housing conditions, approaches to energy consumption and cost-reduction strategies, experiences acquiring energy assistance services, and environmental concerns. Qualitative analysis revealed the underpinnings of "vigilant conservation," which characterizes how individuals experience energy insecurity and navigate energy assistance services.

Energy insecurity can have important implications for health and health equity. Many long-standing programs to address energy insecurity need to be refreshed in light of climate change, the recognition of unacceptable disparities, and the impending transition to clean energy.

In summer 2020, New York City (NYC) implemented a free air conditioner (AC) distribution program in response to the threats of extreme heat and COVID-19. The program distributed and installed ACs in the homes of nearly 73,000 older, low-income residents of public and private housing. To evaluate the program’s impact, survey data were collected from October 2020 to February 2021 via mail and online from 1447 program participants and 902 non-participating low-income NYC adults without AC as a comparison group. Data were examined by calculating frequencies, proportions, and logistic regression models.