Abstract
This dissertation examines the cost-effectiveness of various policy interventions designed to reduce hardship during periods of economic crisis, with particular focus on the United Kingdom context. Through a systematic synthesis of contemporary literature, the study evaluates which interventions deliver the greatest reduction in hardship per pound sterling spent and identifies the population groups that benefit most from each approach. The analysis reveals that targeted energy support and home efficiency improvements demonstrate particularly strong cost-effectiveness for vulnerable households, whilst strengthened ongoing income support consistently outperforms one-off payments in reducing both material deprivation and psychological distress. Integrated welfare advice services, such as Citizens Advice on Prescription programmes, yield substantial social returns on investment, estimated at £3.40–£4.70 per pound spent. The evidence indicates that marginal pounds achieve greatest impact when directed towards individuals already experiencing or approaching poverty, focused on structural costs rather than temporary relief, and coupled with mechanisms to improve benefit take-up. These findings have significant implications for policymakers seeking to maximise the protective effects of limited fiscal resources during cost-of-living crises.
Introduction
The cost-of-living crisis that has affected the United Kingdom and comparable high-income nations since 2021 represents one of the most significant economic shocks experienced by households in recent decades. Driven by unprecedented increases in energy prices, rising food costs, and broader inflationary pressures, this crisis has exposed millions of individuals and families to material hardship, fuel poverty, and food insecurity (Meadows et al., 2024). The consequences extend far beyond immediate financial strain, with robust evidence demonstrating clear pathways from economic hardship to adverse health outcomes, including increased psychological distress, respiratory illness, and cardiovascular disease (Broadbent et al., 2023; Jackson et al., 2024).
Governments have responded with various policy interventions, ranging from universal energy bill rebates to targeted support payments for vulnerable groups. However, the fiscal constraints facing public finances demand careful consideration of which approaches deliver the greatest reduction in hardship for each pound of public expenditure. This question carries both practical and ethical dimensions: policymakers must balance the immediate need for broad-based support against the potential for more targeted approaches to achieve greater impact per unit of spending.
The academic significance of this inquiry lies in its potential to inform evidence-based policymaking during periods of economic crisis. Whilst substantial literature exists examining individual interventions in isolation, comparative analysis of cost-effectiveness across different intervention types remains limited. Understanding which approaches work best, and for whom, enables more efficient allocation of scarce resources and more effective protection of the most vulnerable members of society.
The social importance of this research cannot be overstated. Cold, damp homes represent one of the clearest, well-evidenced pathways from economic hardship to excess morbidity and mortality, particularly affecting young children, older adults, and people with multiple long-term conditions (Meadows et al., 2024; Broadbent et al., 2023). Food insecurity compromises dietary quality and exacerbates existing health inequalities (Stone et al., 2024). Financial hardship demonstrates strong associations with moderate-to-severe psychological distress across all population groups (Jackson et al., 2024). Identifying the most cost-effective interventions therefore represents not merely an academic exercise but a matter of considerable public health importance.
This dissertation synthesises current evidence to address these questions systematically, drawing upon peer-reviewed research, governmental reports, and systematic reviews to evaluate the relative merits of different approaches to hardship reduction.
Aim and objectives
Primary aim
The primary aim of this dissertation is to evaluate the comparative cost-effectiveness of policy interventions designed to reduce hardship during the cost-of-living crisis, identifying which approaches deliver the greatest reduction in hardship per pound spent and determining which population groups benefit most from each intervention type.
Objectives
To achieve this aim, the following specific objectives guide the investigation:
1. To review and synthesise current evidence regarding the effectiveness of targeted energy support and home energy efficiency interventions in reducing hardship among vulnerable populations.
2. To compare the relative effectiveness of ongoing income support mechanisms with one-off payment approaches in addressing material deprivation and psychological distress.
3. To evaluate the cost-effectiveness of integrated welfare advice and social prescribing programmes in reducing financial insecurity and improving wellbeing.
4. To examine evidence regarding food insecurity interventions and permanent supportive housing programmes as components of comprehensive anti-hardship strategies.
5. To identify common characteristics of interventions that maximise hardship reduction per pound spent, including optimal targeting criteria and delivery mechanisms.
6. To develop evidence-based recommendations for policymakers regarding prioritisation of anti-hardship interventions within constrained fiscal environments.
Methodology
This dissertation employs a systematic literature synthesis methodology to address the stated aim and objectives. Given the breadth of the research question and the diversity of intervention types under examination, this approach enables comprehensive evaluation of existing evidence whilst acknowledging the methodological heterogeneity that characterises this field.
Search strategy and source selection
The evidence base for this synthesis comprises peer-reviewed journal articles, systematic reviews, governmental reports, and publications from reputable international organisations. Primary attention was directed towards literature published between 2020 and 2025, reflecting the contemporary nature of the cost-of-living crisis and ensuring relevance to current policy contexts. However, foundational literature from earlier periods was included where it provided essential theoretical or empirical grounding.
Sources were identified through systematic database searches, with particular emphasis on public health, social policy, and health economics literature. Search terms included combinations of “cost-of-living crisis,” “fuel poverty,” “energy hardship,” “income support,” “welfare reform,” “food insecurity,” “homelessness interventions,” and “cost-effectiveness.” Additional sources were identified through citation tracking and examination of reference lists from key publications.
Inclusion and exclusion criteria
Studies were included if they examined interventions designed to reduce material hardship, fuel poverty, food insecurity, or housing instability, and provided evidence regarding either effectiveness or cost-effectiveness. Studies conducted in high-income country contexts were prioritised given their relevance to United Kingdom policy considerations. Methodological approaches accepted included randomised controlled trials, quasi-experimental designs, observational studies, economic evaluations, systematic reviews, and qualitative research exploring lived experience.
Sources were excluded if they derived from non-peer-reviewed blogs, opinion pieces without empirical grounding, or publications from organisations lacking established credibility. Grey literature was included only where it originated from governmental bodies or recognised research institutions.
Analytical approach
The synthesis adopted a narrative approach, organising findings thematically according to intervention type. For each intervention category, evidence was examined regarding: the primary hardship domains addressed; the population groups demonstrating greatest benefit; available cost-effectiveness estimates or signals; and the strength and consistency of the evidence base.
Where quantitative cost-effectiveness data were available, these were reported alongside qualitative assessments of intervention value. However, it should be acknowledged that direct comparisons across intervention types are constrained by methodological heterogeneity, varying outcome measures, and differences in study contexts. The synthesis therefore emphasises relative rankings and general principles rather than precise quantitative comparisons.
Limitations of the methodology
Several limitations warrant acknowledgement. The evidence base for comparative cost-effectiveness across diverse intervention types remains limited, with robust economic evaluations particularly sparse for food insecurity interventions and local hardship schemes. The recency of the cost-of-living crisis means that longer-term outcome data are not yet available for many interventions. Additionally, the synthesis necessarily relies upon studies conducted in specific contexts, and findings may not transfer directly to all settings.
Literature review
The cost-of-living crisis and its health consequences
The cost-of-living crisis has generated substantial research attention regarding its impacts on population health and wellbeing. Meadows et al. (2024) conducted a rapid evidence review examining how the crisis affects health outcomes across the United Kingdom population, identifying multiple pathways through which economic hardship translates into adverse health consequences. Their findings highlight the particular vulnerability of certain demographic groups, including lone parents, multigenerational families, people living alone, women, disabled people, and those already residing in cold or mouldy housing.
Broadbent et al. (2023) employed simulation modelling to outline the mechanisms connecting cost-of-living pressures to health outcomes, demonstrating that cold, damp homes represent one of the clearest pathways from economic hardship to excess illness and death. Their analysis indicates that respiratory and cardiovascular diseases are particularly affected, with young children, older adults, and people with multimorbidity facing heightened risks. Critically, their modelling suggests that targeting support on vulnerable households, rather than implementing universal measures, protects health and avoids widening inequalities more effectively for a given budget.
Jackson et al. (2024) examined the relationship between financial hardship and psychological distress using large-scale survey data collected during the crisis. Their findings demonstrate strong associations between financial hardship and moderate-to-severe psychological distress across all population groups, though the magnitude of effect varied by pre-existing circumstances. These findings align with broader literature linking economic insecurity to mental health deterioration and underscore the psychological dimensions of cost-of-living pressures.
Targeted energy support and home efficiency interventions
Energy hardship has emerged as a central concern within cost-of-living research, with substantial evidence supporting the effectiveness of targeted interventions. Rotmann, Ashby and Mundaca (2025) conducted a systematic cross-country policy analysis of energy hardship programmes, examining initiatives designed to address equity and access to low-carbon energy services. Their analysis indicates that retrofits and efficiency measures in very low-income, high-burden homes yield particularly high cost-effectiveness, primarily because baseline energy bills and ill-health are substantially elevated in these households.
The evidence regarding specific mechanisms is compelling. Direct energy-bill support and energy-efficiency home improvements reduce respiratory infections and other cold-related morbidity and mortality in vulnerable groups (Meadows et al., 2024; Broadbent et al., 2023). The programme logic is straightforward: reducing energy costs enables households to maintain adequate warmth, which in turn prevents the cascade of health consequences associated with cold exposure.
Priority populations for these interventions include households with very low incomes occupying energy-inefficient properties, elderly residents, young children, and individuals with multiple health conditions. The targeting rationale reflects both the heightened vulnerability of these groups to cold-related illness and the greater potential for improvement from elevated baseline levels of hardship.
Income support mechanisms: ongoing support versus one-off payments
The relative merits of different income support approaches have generated considerable debate within the policy literature. Jordan et al. (2025) conducted participatory research exploring the lived realities of poverty during the crisis, providing valuable qualitative insights into how different forms of support were experienced by recipients. Their findings highlight that one-off, flat-rate cost-of-living payments, such as the £900 support provided to qualifying households in the United Kingdom, reduced hardship only temporarily. These payments often missed larger families and those positioned just above eligibility thresholds, leaving recipients in chronic insecurity despite receiving support.
Hick and Collins (2023) examined the policy responses to inflation in the United Kingdom and Ireland, focusing particularly on indexation mechanisms and one-off payments. Their analysis suggests that one-off payments, whilst politically attractive and administratively straightforward, fail to address the ongoing nature of increased living costs. The temporary relief provided by such payments contrasts unfavourably with the sustained protection offered by properly uprated regular benefits.
Quasi-experimental evidence provides further support for the value of stable income support. England et al. (2024) reviewed methodological approaches to measuring mental health impacts during the crisis, synthesising evidence regarding welfare reforms such as the “bedroom tax” and Universal Credit. Their review demonstrates that adverse welfare changes worsen mental health, implying that the reverse—more generous, predictable income support—would yield sizeable mental health benefits.
The Irish experience offers complementary insights. Ceallaigh et al. (2024) examined responses of low-income households to the crisis in Ireland, documenting the strategies employed to manage increased costs and the adequacy of policy support. Their findings reinforce the importance of addressing take-up barriers and ensuring that support reaches those with greatest need.
Integrated welfare advice and social prescribing
A particularly promising area of intervention involves the integration of welfare advice with healthcare services. Granger et al. (2025) conducted a Social Return on Investment evaluation of the Citizens Advice on Prescription programme, which combines welfare advice with link-worker support within healthcare settings. Their analysis calculated a social return on investment of approximately £3.40–£4.70 per pound spent, with benefits accruing primarily through improved wellbeing and enhanced financial security.
The mechanism underlying these programmes involves addressing the substantial gap between benefit entitlements and actual take-up. Many individuals experiencing hardship remain unaware of support for which they qualify or face barriers in navigating application processes. By embedding welfare advice within trusted healthcare environments and providing personal support, these programmes overcome take-up barriers and connect people with existing entitlements (Meadows et al., 2024).
Such services appear particularly cost-effective when deployed in deprived areas and among populations already in contact with health services. The marginal cost of adding welfare advice to existing healthcare contacts is modest, whilst the potential gains from securing benefit entitlements and reducing money-related distress are substantial.
Food insecurity interventions
Food insecurity represents a critical dimension of hardship that has received increasing attention. Stone et al. (2024) examined the impact of the cost-of-living crisis on food purchasing behaviours and food preparation practices among people living with obesity. Their findings demonstrate tight linkages between food insecurity, obesity, and poor diet quality among low-income individuals, with many cutting essentials and relying on cheaper, less healthy foods to manage constrained budgets.
Jordan et al. (2025) noted that no major United Kingdom policy specifically addressed rising food prices during the crisis, with local hardship funds proving patchy and short-term. This policy gap highlights the need for more systematic approaches to food security within anti-hardship strategies.
Universal free school meals have emerged as a promising intervention, though robust cost-effectiveness estimates remain sparse. Meadows et al. (2024) identified policies improving the affordability of healthier foods for low-income households as warranting further investigation. The challenge lies in developing interventions that address immediate food access needs whilst promoting longer-term dietary improvements.
Permanent supportive housing for homeless populations
Homelessness represents an extreme form of hardship with substantial costs to individuals and public services. Aubry et al. (2020) conducted a systematic review examining the effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries. Their findings demonstrate that these approaches substantially increase long-term housing stability, though effects on health outcomes are more variable.
The cost argument for supportive housing programmes is compelling. Given the very high costs associated with homelessness—including emergency healthcare utilisation, criminal justice involvement, and repeated engagement with temporary accommodation services—permanent housing solutions often compare favourably on cost grounds, particularly for individuals with high support needs who cycle repeatedly through crisis services.
Cross-cutting findings regarding targeting and delivery
Several themes emerge consistently across the reviewed literature regarding the characteristics of effective interventions. Grailey et al. (2024) surveyed perceptions of the crisis across Italy, Germany, Sweden, and the United Kingdom, highlighting common patterns in how individuals experience and respond to economic pressure. Their findings reinforce the importance of understanding target populations’ circumstances and tailoring interventions accordingly.
The evidence consistently indicates that marginal pounds achieve greatest impact when focused on people already in or near poverty, directed towards structural costs rather than short-term relief, and coupled with access support to overcome take-up barriers (Jordan et al., 2025; Broadbent et al., 2023; Hick and Collins, 2023).
Discussion
Comparative cost-effectiveness across intervention types
The synthesis reveals meaningful variation in the cost-effectiveness of different approaches to hardship reduction, though precise quantitative comparisons remain constrained by methodological heterogeneity. Targeted energy-bill support and home energy efficiency improvements demonstrate particularly strong cost-effectiveness signals when focused on vulnerable populations. The programme logic is robust: very low-income households occupying energy-inefficient properties experience substantially elevated baseline costs and health risks, creating greater scope for improvement. Interventions addressing these conditions therefore yield larger absolute gains than similar interventions directed towards less vulnerable populations.
Income support mechanisms present a more nuanced picture. The evidence strongly favours ongoing, targeted support over one-off payments, with the latter providing only temporary relief and failing to address chronic insecurity. This finding has important implications for policy design: whilst one-off payments may offer administrative simplicity and political visibility, they appear to deliver inferior hardship reduction per pound compared to sustained benefit increases or enhanced social security provision.
Integrated welfare advice services demonstrate impressive social returns on investment, with the Citizens Advice on Prescription model achieving returns of £3.40–£4.70 per pound spent. These programmes are notable for their efficiency in connecting people with existing entitlements, suggesting that substantial hardship reduction can be achieved through improved take-up rather than new spending on benefits themselves.
Differential impacts across population groups
A consistent finding across the reviewed literature is that certain population groups benefit disproportionately from anti-hardship interventions. Low-income families, particularly single parents and larger households, represent a priority group across multiple intervention types. Disabled people face elevated living costs and reduced earning capacity, positioning them among those with greatest potential to benefit from targeted support. Renters, who lack the buffering capacity that housing wealth provides to owner-occupiers, demonstrate particular vulnerability to income shocks.
People with pre-existing mental health conditions warrant specific attention. The bidirectional relationship between financial hardship and psychological distress creates a concerning cycle in which economic pressures exacerbate mental health difficulties, which in turn impair capacity to manage financial challenges. Interventions that address both financial and psychological dimensions—such as integrated welfare advice services—may be particularly valuable for this group.
Those already in cold or mouldy housing represent a clearly defined target population for energy interventions, with the condition of the dwelling providing an objective criterion for prioritisation. Similarly, households with young children or elderly members face elevated health risks from cold exposure, justifying their inclusion among priority groups.
The importance of targeting versus universalism
The evidence synthesis illuminates the ongoing debate between targeted and universal approaches to social protection. Universal interventions offer advantages in terms of administrative simplicity, reduced stigma, and avoidance of cliff-edge effects at eligibility thresholds. However, within constrained fiscal environments, the evidence suggests that targeting support on the most vulnerable households achieves greater hardship reduction per pound spent.
Broadbent et al. (2023) explicitly modelled this trade-off, finding that targeted approaches protect health and avoid widening inequalities more effectively than universal measures for a given budget. This finding does not invalidate universal approaches but suggests that, when resources are limited, prioritising the most vulnerable represents a more efficient use of public expenditure.
The practical challenge lies in designing targeting mechanisms that successfully reach intended beneficiaries without creating excessive complexity or excluding people through administrative barriers. The evidence regarding take-up gaps underscores this concern: many individuals entitled to means-tested support fail to claim, whether through lack of awareness, stigma, or administrative obstacles. Effective targeting therefore requires complementary investment in access support and simplified administration.
Addressing structural costs versus providing temporary relief
A crucial distinction emerges between interventions addressing structural costs and those providing temporary relief. Energy efficiency improvements, strengthened income floors, and permanent supportive housing address underlying determinants of hardship, whilst one-off payments and emergency hardship funds provide temporary amelioration without altering fundamental circumstances.
The evidence consistently favours structural approaches. One-off payments, whilst providing welcome short-term relief, leave recipients facing unchanged circumstances once the payment is exhausted. Energy efficiency improvements, by contrast, generate ongoing savings that compound over time. Increased regular benefit levels provide sustained protection against material deprivation.
This analysis suggests a hierarchy in which structural interventions should receive priority, with temporary relief measures serving as complements rather than substitutes. The political attraction of visible one-off interventions should not obscure their inferior long-term cost-effectiveness relative to less prominent structural improvements.
The role of access support and administrative simplification
The substantial returns demonstrated by welfare advice programmes highlight the importance of addressing take-up barriers within existing support systems. Significant resources are allocated to means-tested benefits that substantial proportions of eligible individuals fail to claim. Investing in mechanisms that improve take-up—whether through embedded welfare advice, simplified application processes, or proactive identification of eligible households—represents a highly cost-effective approach to hardship reduction.
This finding has implications for the design of new support mechanisms. Interventions requiring complex applications or imposing substantial administrative burdens on claimants are likely to achieve lower effective coverage than anticipated. Policymakers should consider take-up rates and administrative accessibility alongside nominal eligibility criteria when estimating intervention reach and cost-effectiveness.
Limitations of the evidence base
Several limitations in the current evidence base warrant acknowledgement. Directly comparable cost-effectiveness estimates across different intervention types remain scarce, with studies employing varying methodologies, outcome measures, and time horizons. Food insecurity interventions and local hardship schemes are particularly under-evaluated, limiting confidence in recommendations regarding these approaches.
The recency of the cost-of-living crisis constrains the availability of longer-term outcome data. Many interventions implemented during the crisis have been evaluated only in terms of immediate effects, whilst the durability of benefits and potential for delayed impacts remain uncertain.
Publication bias may affect the evidence base, with positive findings potentially over-represented relative to null or negative results. Additionally, the generalisability of findings from specific national contexts to other settings requires careful consideration, as social security systems, housing markets, and energy infrastructure vary substantially across countries.
Meeting the stated objectives
The analysis successfully addresses the stated objectives. Regarding energy interventions (Objective 1), the evidence demonstrates strong cost-effectiveness for targeted support focused on vulnerable households occupying inefficient properties. Regarding income support mechanisms (Objective 2), ongoing targeted support substantially outperforms one-off payments in reducing material and psychological hardship. Integrated welfare advice (Objective 3) achieves impressive social returns through improved benefit take-up and reduced financial distress. Food insecurity and housing interventions (Objective 4) represent important components of comprehensive strategies, though evidence quality varies.
The common characteristics maximising cost-effectiveness (Objective 5) include tight targeting on vulnerable populations, focus on structural costs, and coupling with access support mechanisms. These findings enable evidence-based recommendations (Objective 6) regarding intervention prioritisation within constrained fiscal environments.
Conclusions
This dissertation has examined the comparative cost-effectiveness of policy interventions designed to reduce hardship during the cost-of-living crisis, synthesising evidence regarding which approaches deliver the greatest reduction in hardship per pound spent and which population groups benefit most.
The analysis yields several clear conclusions. First, targeted energy support and home efficiency improvements demonstrate particularly strong cost-effectiveness when focused on very low-income households occupying energy-inefficient properties, especially those containing elderly residents, young children, or individuals with multiple health conditions. The robust programme logic connecting warm housing to improved health outcomes, combined with the elevated baseline hardship in target populations, generates substantial value per pound invested.
Second, strengthening means-tested income support and reducing administrative barriers consistently outperforms one-off payment approaches in reducing both material deprivation and psychological distress. One-off payments provide only temporary relief, whilst enhanced regular support addresses chronic insecurity. This finding has important implications for policy design, suggesting that the administrative convenience of lump-sum interventions should not outweigh their inferior sustained effectiveness.
Third, integrated welfare advice and social prescribing services deliver impressive social returns on investment, achieving approximately £3.40–£4.70 per pound spent through improved wellbeing and financial security. These programmes represent highly cost-effective mechanisms for connecting eligible individuals with existing support systems, addressing the substantial gap between entitlement and take-up.
Fourth, food insecurity interventions and permanent supportive housing warrant inclusion within comprehensive anti-hardship strategies, though robust cost-effectiveness estimates remain less developed than for other intervention types.
The evidence consistently indicates that marginal pounds achieve greatest impact when focused on people already in or near poverty; directed towards structural costs rather than short-term, loosely targeted relief; and coupled with access support to overcome take-up barriers. Priority populations include low-income families (especially single parents and larger households), disabled people, renters, and those with pre-existing mental health problems.
Within current evidence, a plausible priority ordering for United Kingdom-style contexts positions targeted energy and housing support first, followed by strengthened means-tested income support, scaled integrated welfare-advice services, targeted food-security measures, and permanent supportive housing for homeless populations.
Future research should prioritise rigorous economic evaluations of under-examined intervention types, particularly food insecurity programmes and local hardship schemes. Longer-term follow-up studies would illuminate the durability of intervention effects and potential for delayed impacts. Comparative analyses across different national contexts would enhance understanding of how cost-effectiveness findings transfer to varying institutional settings. Additionally, implementation research examining how to scale effective interventions whilst maintaining fidelity represents an important practical priority.
The cost-of-living crisis has exposed fundamental questions about how societies protect their most vulnerable members from economic shocks. The evidence synthesised in this dissertation provides a foundation for more efficient allocation of scarce public resources, enabling policymakers to maximise the protective effects of anti-hardship interventions within constrained fiscal environments.
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