Geothermal Energy and the Social Determinants of Health

Why energy belongs in a health conversation

Most people picture the social determinants of health as housing, food, income, and access to care. Energy rarely makes the headline list, yet it sits underneath several of the others. The temperature inside a home, the reliability of the power that runs a medical device, and the share of a household budget swallowed by a utility bill all shape health long before anyone reaches a clinic.

This primer makes a focused claim: the way a community heats and cools its buildings is a health intervention, and geothermal energy is one of the few options that can lower a household's energy burden and improve the conditions for health at the same time. It also makes an honest companion claim, that getting this wrong can deepen the very hardship it was meant to relieve. The technology choice matters, and so does the governance around it.

The clearest link: indoor temperature is a health variable

The relationship between cold housing and poor health is one of the better-established findings in environmental public health. The World Health Organization recommends a minimum indoor temperature of roughly 18°C, and a higher floor for homes with young children, older adults, or people who are already ill. Below that threshold, the evidence points consistently in one direction. Indoor temperatures in the mid-teens are associated with raised blood pressure and elevated cardiovascular strain, and colder still with greater respiratory infection risk. Cold, damp housing is also linked to worsened asthma and to the broad pattern of excess winter deaths.

The mechanism is not exotic. Cold raises blood pressure and stresses the cardiovascular system; damp and mold inflame the airways. Children and older adults absorb the most harm because they spend the most time indoors. Modeling work has gone so far as to estimate that eliminating cold housing would deliver cardiovascular health gains comparable to some established lifestyle and dietary interventions, which reframes home heating from a comfort question into a population-health one.

The practical takeaway is that warming a cold home reliably, and keeping it warm without forcing the household to choose between heat and other necessities, is a legitimate intervention on the social determinants of health. The studies on energy-efficiency upgrades in low-income housing bear this out: even where short-term physical-health gains were modest, residents reported better thermal satisfaction, less of the cold-enduring behavior that comes from trying to save on bills, fewer financial difficulties, and reduced social isolation. Those are the intermediate conditions through which better housing becomes better health over time.

The tension worth naming: electrification can backfire

Here the primer departs from the simple story. Electrifying home heating is widely promoted as a way to lower bills and improve health, and in many homes it does both. But the economics are not uniform. Research on low-income households in cold climates has found that a naive switch from natural gas to standard electric heat pumps can raise annual energy costs substantially, pushing an already-high energy burden higher still. A household that was spending an uncomfortable share of income on heating can end up spending more, not less, which is the opposite of a health intervention.

This is the energy-poverty trap, and it is the reason a health-minded energy strategy cannot stop at the word "electrify." The decisive question is not whether to move off combustion heating but which electric technology, installed under what financing, for whom. That is exactly where geothermal earns its place in the conversation.

Why ground-source specifically

Geothermal heat pumps, also called ground-source heat pumps, exchange heat with the relatively constant temperature of the ground rather than the swinging temperature of outdoor air. Because the subsurface stays near a stable temperature year-round, these systems run more efficiently than air-source units in exactly the cold conditions where the energy-poverty trap is worst, and they work in all fifty states. The efficiency edge in cold weather is what lets electrification lower a household's operating cost rather than raise it, which is the difference between a health benefit and a health harm.

This is not theoretical. A public-housing example documented by the Department of Energy, the Autumn Gardens complex operated by the City of Lockport Housing Authority, turned to geothermal after high utility bills strained both tenants and the authority's budget. A per-building design kept any single failure from taking down heat for the whole complex, kept construction disruption low for residents, and ran cheaper to operate than a centralized alternative. The features that made it attractive there, resilience, low disruption, and lower operating cost, are health features as much as engineering ones when the residents are low-income families, older adults, and people managing chronic conditions.

Beyond temperature: reliability and budget

Two further health channels deserve a mention, because they extend the argument past comfort.

The first is medical-device reliability. A growing number of people manage serious conditions at home with equipment that depends on steady power, from oxygen concentrators to home dialysis to refrigerated medication. For these households a resilient, efficient heating-and-cooling system is not only about warmth; it is part of the infrastructure that keeps home-based care viable. Energy reliability becomes a direct clinical concern.

The second is the budget itself. Energy burden, the share of household income spent on energy, is a social determinant in its own right. When that share is high, families ration heat, defer other necessities, and carry the chronic stress of a bill they cannot reliably pay. Lowering the burden durably frees both money and attention for food, care, and stability. Geo-spatial analyses developed by national-lab researchers have begun mapping precisely where ground-source heating would most relieve the energy burden of low- and middle-income households, which points toward targeting these investments where the health return is largest.

What this means for community health infrastructure

The reason this primer belongs in a health series, rather than an energy one, is that the binding constraints are not geological. The ground-source resource exists nationwide. What determines whether it reaches the households that would benefit most are questions of financing, ownership, maintenance, and governance: who pays the upfront cost, who maintains the loop field over decades, who holds the data that shows where the need is greatest, and who is accountable to the residents the system is meant to serve.

These are the questions Adloris treats as central across all of its work. A geothermal system installed in affordable housing is a piece of durable public infrastructure, and like any such asset it produces lasting benefit only if its stewardship is designed before the installation ribbon is cut. The pattern is familiar: communities are far more likely to keep the value of what they helped build when the arrangements for maintaining it, governing it, and holding it accountable are settled in advance rather than improvised after the funding moves on.

Geothermal energy, approached this way, is more than an energy line item. It is a way of warming homes that can lower household costs, steady the conditions for home-based care, and relieve a budget pressure that quietly shapes health, provided the technology fit and the governance are both right. That conjunction, the right system stewarded the right way, is where affordable energy and the social determinants of health meet.

References

1. World Health Organization. WHO Housing and Health Guidelines. Geneva: WHO; 2018. Recommends a minimum indoor temperature of 18°C and reviews evidence on cold housing and health. https://www.who.int/publications/i/item/9789241550376

2. WHO Housing and Health Guidelines. Report of the systematic review on the effect of indoor cold on health. Geneva: WHO; 2018. Cold housing below 18°C associated with raised blood pressure and respiratory harm. https://www.ncbi.nlm.nih.gov/books/NBK535290/

3. Environmental Health Indicators NZ. About the indoor environment and health. Indoor temperatures below 16°C raise respiratory infection risk; below 12°C stress the cardiovascular system. https://www.ehinz.ac.nz/indicators/indoor-environment/about-the-indoor-environment-and-health/

4. Estimating cardiovascular health gains from eradicating indoor cold in Australia. PMC. Modeled cardiovascular gains from warming cold homes comparable to some lifestyle and dietary interventions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9112519/

5. The short-term health and psychosocial impacts of domestic energy efficiency investments in low-income areas: a controlled before and after study. PMC. Efficiency upgrades linked to improved thermal satisfaction, reduced cold-enduring behavior, fewer financial difficulties, and less social isolation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282634/

6. Overcoming barriers to heat pump adoption in cold climates and avoiding the 'energy poverty trap.' ScienceDaily, reporting on research in Resources, Conservation & Recycling (2024). Naive electrification can raise low-income household energy burden. https://www.sciencedaily.com/releases/2024/05/240531145016.htm

7. U.S. Department of Energy, HGEO. Tax Credits, Incentives, and Technical Assistance for Geothermal Heat Pumps. Ground-source heat pumps use stable subsurface temperatures and work in all 50 states. https://www.energy.gov/hgeo/geothermal/tax-credits-incentives-and-technical-assistance-geothermal-heat-pumps

8. U.S. Department of Energy, HGEO. Geothermal Heat Pump Case Study: Autumn Gardens Apartment Complex. Public-housing geothermal installation by the City of Lockport Housing Authority. https://www.energy.gov/hgeo/geothermal/geothermal-heat-pump-case-study-autumn-gardens-apartment-complex

9. A geo-visual analysis for exploring the socioeconomic benefits of heating electrification using geothermal energy. OSTI.GOV (2022). National-lab dashboard mapping geothermal energy-burden relief for low- and middle-income households. https://www.osti.gov/biblio/1901632

10. Network for Public Health Law. Investments in Energy Efficient Heat Pumps Likely to Pay Off for Public Health (2024). Equitable access framing for heat pump health benefits. https://www.networkforphl.org/news-insights/investments-in-energy-efficient-heat-pumps-likely-to-pay-off-for-public-health/