A Northland paediatrician is calling for targeted benefits, or coupons, to allow poor families to heat their homes.
Roger Tuck said he admired the bravery of the coroner Brandt Shortland who last week linked an unheated home to the death of Auckland toddler Emma-Lita Bourne.
She died from a condition triggered by pneumonia.
Dr Tuck said he sees sick children from damp or cold houses, who have rheumatic heart disease, serious skin infections or bronchiectasis, a chronic and life-shortening lung condition.
He said there was a close association between hardship, cold housing, overcrowding and those diseases.
"Northland has close to the highest rate of rheumatic fever in New Zealand - and there is no evidence that our efforts to reduce it are having any effect.
"Every so often we get a lull in cases and we think things are improving. But then there's another cluster of cases, as there has been this winter."
The government funded the insulation of more than 7000 homes in Northland over the past six years in the Healthy Homes Tai Tokerau project.
But the work had thrown light on just how poor much of the Northland housing stock was.
At least 12,000 sub-standard houses still needed insulation, and the government funding for the scheme will run out in June next year.
Dr Tuck said when he asks parents about conditions at home, most tell him they are cold.
"People talk about the winterless north - it's a myth," he said.
"It can get very cold and damp up here. And even an insulated home is going to be cold if you can't afford to turn the heater on."
Dr Tuck said he was not entirely comfortable with the idea of giving low-income families heating vouchers.
"The problem is at the end of the week, when the money's running out and it's a choice of feeding the kids or running the heater ... there's simply not enough to go around."
Dr Tuck said Ministry of Social Development heating grants or coupons would be money well-invested.
A survey of sick children in Whangarei hospital in 2013 found 70 percent had mould or damp in their homes, and 47 percent were crowded.
Half of the homes did not have enough bedrooms, and in the other half, families were sleeping in one room in winter to keep warm.