Chronic prebound energy use and multidimensional health outcomes: Evidence from public housing residents in Seoul, South Korea

초록

Public housing residents, often socioeconomically disadvantaged, frequently engage in prebound energy use behaviors-reducing heating or cooling despite available facilities-primarily as a coping strategy against financial constraints. While energy poverty is known to be associated with poor health, little is understood about the chronic and cumulative effects of such behaviors, particularly in Seoul, South Korea. Using four waves of the Seoul Public Rental Housing Panel Survey (2016-2022), this study analyzed 5599 residents (14,146 person-year observations). Prebound heating and cooling behaviors were measured as underuse of available facilities, and cumulative exposure was captured through consecutive waves of such behaviors. Health outcomes included selfrated health, stress, outpatient visits, and inpatient days. Individual fixed-effects regression models were employed to control for unobserved time-invariant heterogeneity. At onset, prebound behaviors were significantly associated with poorer self-rated health and higher stress, but not with healthcare utilization. Chronic prebound heating use predicted deteriorations in self-rated health and increased stress, alongside higher outpatient visits after two or more consecutive waves. In contrast, cooling-related prebound behaviors were consistently linked to self-rated health and stress but not to healthcare utilization. Neither heating nor cooling behaviors were associated with inpatient days. Findings highlight prebound energy use as a chronic condition with cumulative health risks, particularly for public housing residents. Policy interventions should extend beyond temporary relief to long-term measures such as improving housing energy efficiency, expanding access to energy subsidies, and strengthening preventive healthcare responses to mitigate the health consequences of chronic energy deprivation.

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