About a quarter of New Zealand households are estimated to be in fuel poverty. NZ has a poor history of housing regulation, so existing houses are often poorly insulated and rental properties are not required to have insulation or heating. Average indoor temperatures are cold by international standards and occupants regularly report they are cold, because they cannot afford to heat their houses. Fuel poverty is thought to be a factor in NZ's high rate of excess winter mortality (16%, about 1600 deaths a year) and excess winter hospitalisations (8%). We examined the link between indoor cold and health in two community trials, the Housing, Insulation, and Health Study and the Housing. Heating, and Health Study and both interventions demonstrated encouraging benefit/cost ratios. NZ governments have translated this and other research into major policy programmes designed to retrofit insulation and efficient heating into existing houses. However, houses are predominantly electrical resistance heated and a largely unregulated electricity market has seen rapidly rising residential electricity prices. These rising energy prices, combined with low rates of economic growth, rising unemployment and generally rising income inequality, are likely to further increase levels of fuel poverty in NZ, unless broader policy action is taken. (C) 2011 Elsevier Ltd. All rights reserved.