Air-conditioning and antibiotics: Demand management insights from problematic health and household cooling practices Larissa Nicholls n , Yolande Strengers Centre for Urban Research, RMIT University, GPO Box 2476, Melbourne, Victoria 3001, Australia HIGHLIGHTS  Over-use of antibiotics and air-conditioning has social health implications.  Focusing on financial incentives limits the potential of demand management programs.  Explaining peak demand to households shifts the meanings of cooling practices.  Emphasising the social health implications of antibiotics and air-conditioning may resurrect alternative practices.  Analysing policy with social practice theory offers insights into policy approaches. article info Article history: Received 19 August 2013 Received in revised form 19 November 2013 Accepted 25 November 2013 Available online 21 December 2013 Keywords: Peak demand Electricity Demand management Social practices abstract Air-conditioners and antibiotics are two technologies that have both been traditionally framed around individual health and comfort needs, despite aspects of their use contributing to social health problems. The imprudent use of antibiotics is threatening the capacity of the healthcare system internationally. Similarly, in Australia the increasing reliance on air-conditioning to maintain thermal comfort is contributing to rising peak demand and electricity prices, and is placing an inequitable health and financial burden on vulnerable heat-stressed households. This paper analyses policy responses to these problems through the lens of social practice theory. In the health sector, campaigns are attempting to emphasise the social health implications of antibiotic use. In considering this approach in relation to the problem of air- conditioned cooling and how to change the ways in which people keep cool during peak times, our analysis draws on interviews with 80 Australian households. We find that the problem of peak electricity demand may be reduced through attention to the social health implications of air-conditioned cooling on very hot days. We conclude that social practice theory offers a fruitful analytical route for identifying new avenues for research and informing policy responses to emerging health and environmental problems. & 2013 Elsevier Ltd. All rights reserved. 1. Introduction While not immediately obvious, the synergies between air- conditioning and antibiotics are striking. Both are individually administered and consumed, and both exacerbate global health and environmental problems such as antibiotic resistance, climate change and peak electricity demand. In particular, the imprudent use of antibiotics to treat minor infections, such as the common cold, is contributing to the emergence of antibiotic resistant microbes which can cause largely untreatable serious infections. Increasing antibiotic resistance is making societies vulnerable to outbreaks of infection and leading to a dramatic decline in healthcare capabilities. This is similar to the ways in which the increasing use of air-conditioning on hot summer days increases the complexity and costs of meeting peak electricity demand (Faruqui and Palmer, 2011). Peak electricity demand is creating serious health concerns, particularly for low- income households, where many of those most vulnerable to heat stress reside (Bi et al., 2011; Klinenberg, 2002). Some of those most in need of air-conditioning to maintain health are struggling with rapidly increasing electricity costs and either cannot afford to install an air-conditioner, or opt not to use an existing air-conditioner or fan during extreme heat events due to their concern about the impact on their electricity bill (Farbotko and Waitt, 2011; Sheridan, 2007). Furthermore, low-income homes are often affected by poor urban design and insufficient thermal insulation and ventilation which can exacerbate high temperatures and heat-related health impacts in summer (Bonnefoy et al., 2004; Morris and Simmonds, 2000). The different policy responses to the problems of antibiotics and air-conditioning provide important insights for energy policy makers. The issue of peak electricity demand has prompted a suite Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/enpol Energy Policy 0301-4215/$ - see front matter & 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.enpol.2013.11.076 n Corresponding author. Tel.: þ61 3 9925 9012. E-mail addresses: larissa.nicholls@rmit.edu.au (L. Nicholls), yolande.strengers@rmit.edu.au (Y. Strengers). Energy Policy 67 (2014) 673–681