While the exceptionally hard winter we New Englanders and many others across this nation recently experienced is fading into remote, faint memories for most of us, for others its effects still linger. Even though we have packed away our winter coats and pulled out our T-shirts, shorts and tank tops, many families are still struggling to pay back utility bill arrearages accumulated over the cold winter months. Now the deferred heating bills threaten many families’ ability to pay for cooling their homes in the hot summer days ahead.

In Boston, where I work to alleviate hardships faced by young children, Heating Degree Days (HDDs), a measure of how many days we need to heat our homes, and thus how much energy we need to buy to heat them, averaged 7.3% above normal each month from November through February.  In other parts of the state and region HDDs were even higher. While even “normal” New England winters are hard for many, this past winter was especially difficult because of unusual cold weather and snow, and lingering “hard times” for the state and national economies.

Children’s HealthWatch has found in several studies that household energy insecurity, indicated by threats of utility shut-off or actual shut-off, or refusal of delivery of heating oil because the household is not able to pay the bill, is very harmful to young children’s health. In data we’ve collected at teaching hospitals in five cities (Boston, Baltimore, Little Rock, Minneapolis, and Philadelphia), we find household energy insecurity related to higher likelihood that children under the age of 4 are in poor health, have substandard weight for age, have been hospitalized, are at risk for developmental delays, and are food insecure. We also find that children in households that receive LIHEAP (fuel assistance) are significantly less likely to suffer some of the worst of these health effects compared to those whose households are eligible but don’t receive LIHEAP.

Unlike many states, Massachusetts has legal shut-off protections that prohibit utility companies from disconnecting electricity or natural gas in households with a sick child or elderly person during the winter months. Pediatricians at Boston Medical Center understand very well that energy insecurity is particularly harmful to young children, especially those who are already sick.  They are accustomed to writing shut-off protection letters that utility companies are legally required to honor during winter months. But shut-off protection provisions have two major drawbacks: they don’t apply to heating fuel deliveries, and once winter officially ends the household is still legally responsible for the unpaid utility bills. This can lead to very difficult financial situations for families who accumulate several months of arrearages, and are expected to pay them off once winter is over. Even with utility company “payment plans” many families find it nearly impossible to catch up in the spring and summer.

And that’s partially why Children’s HealthWatch research finds that energy-insecure households are also more likely to be food insecure than those that are energy secure. We’ve found that even households that only receive threats of shut-off, and don’t actually have their electric or gas service shut off, are still almost twice as likely to be food insecure as those that are energy secure. For many families, receiving a letter from the gas or electric company threatening to shut off utility service leads to the “heat or eat” dilemma. They can either pay the utility bill and keep the heat on, or buy food, but not both. And many decide to cut back on food purchases to keep the heat on, and become food insecure as a result.

One of the most disappointing of a very poor set of outcomes of the national Farm Bill passed and signed into law this past February was the fate of the so-called “heat and eat” provision. For families that met the eligibility guidelines for both SNAP and LIHEAP this provision improved SNAP coverage by allowing states to make a minimal LIHEAP benefit payment (as low as $1.00 per month) to families for fuel assistance.  That small LIHEAP benefit then qualified SNAP-recipient families to receive approximately $90 per month in additional SNAP benefits. It also saved the states money in administrative costs by streamlining both LIHEAP and SNAP application and certification procedures.

In Farm Bill “negotiations”, opponents of both the “heat and eat” provision and SNAP succeeded in raising the minimum state LIHEAP contribution to $20.00 per household per month, expecting that state governments would refuse to make the higher minimum contribution. That in turn would ostensibly reduce SNAP funding and lead to “savings” of about $8 Billion over 10 years. To the surprise of those who supported the increased minimum “heat and eat” contribution, 8 state governments, including Massachusetts, Pennsylvania, and the District of Columbia, agreed to provide the additional $19/mo per eligible recipient household.

We congratulate governors and legislators in those state governments for making that very wise decision. The “heat and eat” provision has helped many families pay their heating bills and continue to buy much-needed food. But what is really interesting is that the increased state revenues resulting from additional SNAP spending in each state, and the health care and education cost savings to the state resulting from lower energy and food insecurity, will very likely exceed the states’ expenditures to enable families to both “heat and eat.” Now that is a win-win, for state governments and for all the people in cold weather states participating in “heat and eat”.

Now I want you to think about your own children, or children you know, or have cared for when they were babies or toddlers. Remember a time when they were cold and needed your help to warm up. And think about a time when they were hungry, and cranky and out-of sorts, and needed you to get some food in their bellies. There was no question what your top priorities were at that moment; turn up the heat and get some food together! Fast!

We all want our children to have what they need, when they need it, so they can grow up healthy and happy and strong, in body, mind and spirit. And we’ve created a number of very effective social infrastructures to help us achieve that for ourselves and our children, and for our neighbors, so we can have a healthy, strong public. Those infrastructures include our public libraries, our public schools, our community health centers, parks and playgrounds. And they also include SNAP, LIHEAP/fuel assistance, WIC, school lunch and breakfast, the Child and Adult Care Food Program, and many others. They are there for all of us when we need them, and we all benefit from them even if we never use them ourselves. They enable us to keep the public healthy and strong. And that helps us keep our democracy healthy and strong.

Children’s HealthWatch recently published a report* on its website showing results from simulations of some of the health consequences of household energy insecurity likely to emerge among children and elderly in the state of New York if energy prices continue to increase. Results of those simulations showed that, under the mid-range price-growth scenario, by 2030 New York State residents would likely pay nearly $1 Billion more per year, just for hospitalizations and “physician and clinical services” alone, as a result of increased energy insecurity. By 2040 these two types of health care costs would be $1.4 Billion per year higher in New York State.

Those estimates don’t include cost increases among people ages 18-64 years, nor increases in the other eight or so health care expenditure categories in addition to hospitalizations and physician and clinical services, though these two categories represent about half of all personal health care costs. But also keep in mind that these are just the additional costs for one state, New York. Now imagine adding the other forty-nine states, and Washington, DC into the picture, and all the 18-64 year olds. And you can imagine that the national costs of health care resources needed because of energy insecurity are huge. Those costs make the $5.1 Billion historic high annual funding level for LIHEAP in 2009 seem pretty pitiful. And they also really help us understand the importance of SNAP, and our other social infrastructures. They help keep us all healthy, so we can enjoy life and give back to our country, and make a healthy, prosperous future for our children and grand children.