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