Major energy efficiency refurbishment of the UK housing stock is needed to help attain emission reduction targets of greenhouse gases. Such measures typically entail some planned or incidental reduction of uncontrolled ventilation in dwellings. This paper examines the trade-offs for health and sustainability objectives of typical retrofit refurbishments in UK homes. While reducing ventilation can help protect against the ingress of harmful pollutants from the outdoor air, our results demonstrate that reducing permeability to low levels, without additional purpose-provided ventilation, is likely to lead to substantial increases in pollutants derived from indoor sources, including indoor-generated particles, radon and environmental tobacco smoke. The monetised equivalent cost of the health dis-benefits associated with these exposures may exceed the potential benefits of reducing energy costs and greenhouse gas emissions. Practical application: Reducing uncontrolled ventilation of dwellings helps to improve energy efficiency and can protect against the ingress of pollutants from the outdoor environment. However, simulation studies suggest that at high degrees of airtightness (very low permeability) there is a potentially steep rise in pollutants of indoor origin, whose adverse effects on health may outweigh the benefits of reduced energy use, lower CO₂ emissions and protection against outdoor pollution. Though the optimal permeability level for a given dwelling will vary with local circumstances, considerations of health protection suggest the need to avoid reducing permeability to low levels.