Health is a human right

Do something

Do more

Do better Sorcha Daly – Institute of Health Equity

Source: WHO Review of Social Determinants and the Health Divide in the European Region

To cover:

• Health inequalities and the role of the physical

and social environment

• The high street and health

• Interventions and approaches

• Resources and practical tools

Health inequalities and the role

of the physical environment

Social Gradient in Health Life expectancy and disability-free life expectancy (DFLE) at birth, males by

neighborhood deprivation, England, 1999–2003 and 2009-2013

Health inequalities and the role of the physical

and social environment

• Physical and social environments shape health

• Housing, transport, social environment, healthy

food, and greenspace

• People who are poor and lack control over their

lives are more likely to live in a poor quality

environment

• Those living in areas of deprivation are more likely

to be exposed to a variety of adverse conditions

Housing – inequalities in access to good

quality housing and impacts on health

Housing – pathways to poor health

Housing

Conditions

Disrepair

General housing

conditions

Over crowding

Temperature

Condensation,

damp and mould

Other poor

housing

conditions

• Causal Pathway

• Fuel poverty

• Stress and lack of

control

• Social isolation

• Self worth

• Relationships

• Employment and

education

Direct impact

Respiratory and circulatory conditions

Excess winter deaths

Insufficient infant weight gain

Slower cognitive and physical development

Higher risk of meningitis

Increased risk of tuberculosis

Increased mortality rates

Indirect impact

Poor mental health

including depression

and anxiety

• 35% of the poorest quintile of households experience fuel

poverty

• Older people, children, people with disabilities or long term

illnesses, unemployed more at risk of the impact of fuel

poverty.

• 12% of ethnic minority households are classified as over

crowded.

• Those at risk of poverty have an increased rate of over

crowding.

• Private rental sector more at risk of poor housing

conditions

Green Space

• 20% of most affluent neighbourhoods have 5

times the amount of green space than the most

deprived 10% of neighbourhoods

• Income deprivation related health inequalities are

lower in populations living in the greenest areas

• Use of green space may be declining – 29%

spending less time in parks

Green space and health

• Reduced hospital admissions for mental health

• Improved mood, reduced stress and anxiety and

severity of ADHD

• Improved physical health – reduced risk of some

cancers, type 2 diabetes, heart disease, obesity,

dementia, hip fractures

• Reduced all cause mortality in low income

communities

Transport and traffic – factors that impact on health

• Active Travel

• Public Transport

• Car traffic

Active Travel

Barriers to walking

and cycling: Higher crime rates (perceived

or actual)

Less attractive streets

Lack of pavements or

pedestrianised streets

Inaccessibility of amenities,

services, education or

employment

High levels of traffic

Lack of cycle lanes

Inequalities – poorer

communities: Increased rates of graffitti, fly

tipping and litter

Increased rates of crime and

fear of crime

Increased levels of noise and

air pollution

Higher levels of road traffic

accidents

Inequalities – other

groups: Older people

Mothers with young children

Carers

People with disabilities

Impacts on health: Overweight and obesity

Heart disease and diabetes

Stroke, cancer,

musculoskeletal conditions

Mental health

Employment sick leave

Public transport

• No clear social gradient in the use of public transport

• Low income and high public transport costs can

prevent people from using public transport

• Rural areas – difficulties in accessing good local

public transport

• Reduce access to the high street leading to an

increased risk of social isolation and reduced access

to employment, education and health care

• People with disabilities more likely to be affected by

inadequate transport links

Health benefits of effective and affordable

public transport

• Opportunities to work

• Access to education

• Access to other services, including health

• Improved social interaction and community

cohesion

• Increased physical activity

Car traffic

• Higher levels of pollution

• Road traffic accidents

• Reduced active travel rates

Pollution • follows a social gradient

• 66% of carcinogenic chemicals that are emitted

are released into the 10% of most deprived areas

• Noise pollution – high density housing and rented

accommodation

Road Traffic Accidents

• Road traffic accidents – children in deprived areas

4 times more likely to be hit by a car

• The single major avoidable cause of death for

children over five is unintentional injury on the

roads and the social class gradient in injury

across all ages is steeper than for any other

cause of death or long term disability

• Impact on family members who are bereaved or

supporting those with injuries

• Post traumatic stress

Car traffic, pollution and health

• Increase in hospital admissions

• Worsening of symptoms in cardio respiratory

conditions

• Increase in number of GP visits

• Cardio-respiratory morbidity and mortality

• Mental and physical health

• Increased stress and hypertension in adults

• Reduced educational attainment by children

Health and the High

Street

• Historically the locus for highest levels of human

activity and social interaction and therefore have

the potential to positively impact on the health of

all community groups.

• High streets play an important role in the health of

local communities and their residents and can be

a critical instrument for local economic growth,

and health promotion.

• High streets also have the potential to

demonstrate some of the most visible signs of

changes within local communities.

• Changes in retail habits, lack of investment, rise

of ‘clone’ towns, local and central Government

funding cuts, and a lack health promoting

services, education and employment.

• Exclusion – BME groups, older people, people

with disabilities, parents with young children,

carers and those who live in deprived areas.

Features of unhealthy high streets and impacts (1)

Poorly maintained and

cluttered pavements

Create pinch points, prevent

people from navigating

successfully, increase the

risks of trips, falls and injury

Lack of seating areas,

shelter, communal

resting points

Inaccessible to older people,

families, people with

disabilities

High levels of crime, or

fear of crime

Inaccessible to all, but

particular groups – women,

older people, disabilities

Features of unhealthy high streets and impacts (2)

Lack of foot fall, or over

crowding

Fear of crime, inability to

linger and rest

Poor air quality, high

levels of noise and litter

Impact on physical and

mental health / increase in

anti social behaviour

Lack of diversity in the

retail, food and service

outlets

Insecure economy, poor diet,

social exclusion

Features of unhealthy high streets and impacts (3)

Poor walkability or

cycle-ability

Physical inactivity, lack of

foot fall for services and retail

and other outlets

Lack of good quality

public transport to and

from the high street

Social exclusion, inc

education, employment,

services (inc health), social

and civic participation

Royal Society for Public health – 10 indicators

Interventions

Clean Air

Transport for London

Introducing or expanding low emission zones

Investing in hybrid, low emission buses, or retro fitting

existing fleets

Focusing cleanest buses in most polluted areas

Supported business to reduce emissions

Free trials of electric delivery cars and cargo bikes

Discounts on car club memberships

Travel planning advice for public transport use, walking or

cycling

Interventions

People choose to walk

or cycle

Kensington High Street (1)

Simplified road markings

Recalculation of traffic signal timings

Introduction of additional pedestrian crossings

Widening footways and narrowing carriageways

New pavings, trees and cycle parking

Removed street clutter and guard railing

Kensington High Street (2)

Pedestrian flows increased by 7% overall

Cycle flows increased (30% at peak morning times)

Traffic flows decreased

Traffic casualties and collisions reduced by almost

49% (nearly 11% more that borough average

reduction)

User surveys – wheel chair users, partially sighted,

parents with push chairs, 65+ - more attractive,

cleaner and safe

Approaches

• Asset based

• Holistic and collaborative

• Historical and biographical

• Diverse

Holistic and collaborative

Historical and Biographical

To ensure high streets are re-imagined and

developed as inclusive and health promoting public

spaces, planners, architects and policy makers must

first acknowledge and understand the biographies

and histories of people and places, and the

relationship between the physical, social and

political environments that impact on health.

Diverse

• Historical policy focus on economic

and retail functions

• High street as a transport link given

priority over high street as a

‘community place’

• Diverse, mixed use, flexible high

streets adapt and survive

Good Planning as Public Health Intervention

• There is a clear opportunity for Public Health and

Planning to work together for improved public

health.

• Multiple levers available to local government to

shape the natural and built environments,

including the planning process

• National Planning Policy Framework – improving

health and well being

• Interventions in the environment – cost effective

6 Evidence Reviews funded by the Department of Health (1)

1. The impact of adverse experiences in the home

on the health of children and young people

2. Healthy School Transitions

3. The Impact of Physical Housing Conditions on

Mental Health

4. Working for Health Equity – Role of Health

Professionals

5. Social Inequalities in the Leading Causes of

Early Death

6. Inequalities in mental health, cognitive

impairment and dementia amongst older people

Evidence Review reports for PHE (1)

Early interventions

Good quality parenting programmes and the home to school transition

Education

Building children and young people’s resilience in schools

Reducing the number of young people not in employment, education or

training

Adult learning services

Employment

Increasing employment opportunities and improving workplace health

• Healthy living standard

• Health inequalities and the living wage

• Healthy environment

• Fuel poverty and cold home and related health problems

• Improving access to green spaces

• Implementation

• Understanding the economics of investments in the social determinants of health

• Tackling health inequalities through action on SDH – lessons from experience

Health Equity Evidence Review Reports for PHE (2)

All of these reports are available on our

website:

www.instituteofhealthequity.org