Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

B. Suzi Ruhl

Second Advisor

Daniel Carrión


The Low-Income Home Energy Assistance Program (LIHEAP) does not currently meet the demands of households across the country, and by one estimate, “funding would need to increase 10 to 20 times above 2021 levels in order to cover the energy costs of all eligible low-income families” (Castillo & Daniel, 2022, para. 2). Despite the inadequate coverage, more than 5.5 million households relied on LIHEAP funds to support the payment of heating costs in FY2022 (ACF Office of Community Services, n.d.). Financial barriers to energy access among low-income households is not an issue that should be analyzed as a financial circumstance mutually exclusive from other social determinants of health (SDOHs). In fact, research has shown that the “heat or eat” effect, the tradeoff made between paying for heating bills or food, is associated with decreases in caloric intake of 10% among lower-income families, an effect not seen in families with higher incomes (Bhattacharya et al., 2003).

As Jessel et al. (2019) note, there are various terms that are used when discussing energy access, such as fuel poverty, energy insecurity, and energy burden. This report will often focus on energy burden, which is the percentage of a household’s income that is used to pay for energy-related expenses (DOE Office of State and Community Energy Programs, n.d.-b). When analyzing the impact of energy burden, it is important to note that there are differences in the threshold used for the consideration of high energy burden (Applied Public Policy Research Institute for Study Evaluation, 2005). For the purpose of the spatial analysis in the report, 6% will be used to remain consistent with the threshold cited by the U.S. Department of Energy’s Office of State and Community Energy Programs (n.d.-b; Drehobl et al., 2020).

This report aims to add to the energy and health literature by exploring these topics at the federal and state levels, with a focus on Connecticut, to guide energy assistance policy decisions. Recommendations for policy span federal and state governments and include the expansion of Z-code usage, increased reporting requirements for LIHEAP grantees, the creation of a Health and Energy Assistance Advisory Committee, the addition of a health professional on the Low-Income Energy Assistance Board (LIEAB), amendments to the definition of ‘vulnerable household’, and additional considerations for the National Environmental Policy Act’s (NEPA) role in LIHEAP.

This report does not serve to quantify and/or evaluate the effectiveness of the current policies on improving health outcomes. Yet, there is tremendous potential for energy assistance programs to not only provide the financial support necessary to alleviate the financial burden among those who cannot afford their current energy expenditures but also to improve health outcomes.


This is an Open Access Thesis.

Open Access

This Article is Open Access