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Archive for the ‘Urban health’ Category

In these troubled times we need a progressive health movement

Posted in Brexit, Housing, Mental Health, Urban health, violence, War on September 18, 2017| Leave a Comment »

By Prof John Middleton, FPH President

John Middleton 2 web

August was a stock-take month for me. I held several meetings which all pointed to the need for public health and the woeful neglect of public health expertise by local, national and international policy makers.

Early in August we held a productive session of the Global Violence Prevention Special Interest Group which resolved to look at training tools for work in conflict and post-conflict areas – how to make rapid needs assessments, how we build alliances with public health resources in conflict areas and how we make sense of prevention and resolution of conflict through working with political scientists, theologians, international lawyers and aid non-governmental organisations. The work is being led by Daniel Flecknoe and Bayad Nozad. We plan to join up this work with that of Brian McCloskey and David Heymann for Chatham House (Royal Institute of International Affairs) looking at emergency responses in conflict zones. Mark Bellis’s work for the Commonwealth will also play a key part. The FPH statement says our unique role is in preventing violence and building and implementing the evidence base – locally, nationally and internationally. Economic inequality and unequal power-sharing are major causes of violence at local, regional and international level, and major challenges for the public health community, whether in relation to violence, childhood obesity or premature mortality. It is clear to me that FPH can play a greater role in violence prevention by harnessing the disparate skills of our members, from the frontline to high-level international policy – in emergency preparedness, health protection and health services organisation and in public mental health and community development.

In August I also met with David Ross from the armed forces public health services. They clearly have much expertise to contribute – in relation to international conflicts and closer to home. We have resolved to have a meeting with forces colleagues in the new year. The root causes of violent behaviour are also often the root causes of accidental violent injury. This was never more demonstrated than with the Grenfell Tower disaster. I am pleased that we could respond to the terms of reference consultation for the inquiry. Sadly our representations were not heeded and a limited range has been set for the inquiry with a junior minister leading consultation on the implications for social housing and some superficial examination of the causes of the causes. Nevertheless, I am extremely grateful to the FPH members who responded rapidly to our request for help on the Grenfell submission and particularly to Ruth Gelletlie who put together our response on the terms of reference. We received a wealth of material on every aspect from health protection and response, public mental health responses, health inequalities and the London housing market, building design, regulation and controls and social issues regarding migration and homelessness. Ruth and colleagues in the revitalised Housing and Health Special Interest Group will be drawing on this material for our formal submission to the inquiry (and for a listening minister…?)

A sustainability and transformation partnership has announced a £2.7million contract with the private sector for a year’s support for an accountable care organisation. It’s a mind-numbing figure and would buy an awful lot of public health health-care expertise and analysis. We will follow this programme carefully and see what it teaches… and in the meantime, continue our work to rebuild training and capacity in healthcare public health.

As we return from the summer holidays, FPH will once again get into full swing with major policy-planning days. Our workforce strategy is nearing completion and will be formally signed off in November. We are much exercised by the need to build our membership and would urge you to invite all your colleagues to join us – we have a category for virtually everyone working in public health or associated with our work. I will also be involved in the Academy of Medical Royal Colleges planning days. Our policy team priorities on Brexit and public health funding are taking shape. I will be at the Public Health England conference in Warwick at which we will launch the Public Health Prevention Concordat for good mental health. I will also be speaking at MEDACT’s conference in York with the International Physicians for the Prevention of Nuclear War on the theme of the progressive-health movement. I will also be speaking at the Oxford public health registrars symposium on the theme of partnership in public health. I believe there are still places available at all of these meetings.

As the US President flexes his nuclear options, and our government stumbles over complex imponderables of Brexit, it is clear to me we absolutely need a progressive health movement which addresses inequalities in income, in opportunity, in education and environment, which understands and builds new programmes for public mental health and conflict resolution, which stands strongly for non-violent resolution of problems, which looks at the health impacts of all policies and across future generations, and which believes in partnership, in shared benefits and better outcomes for all.

Can I draw your attention to an exciting event coming up which provides a unique opportunity to share learnings about advocacy. Mike Daube, Professor of Health Policy at Curtin University, Perth, Australia, will be delivering the DARE Lecture entitled ‘Not a Spectator Sport: public health advocacy and the commercial determinants of health’ on 27 September in London.

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Reflections on a public health trip to Japan

Posted in Asia, Global Health, Japan, Obesity, transport, Urban health, Wales on September 1, 2017| Leave a Comment »

By Claire Beynon MFPH

BACP Travelling Fellowship
Every two years the Faculty of Public Health (FPH) awards a BACP travelling fellowship to assist members of FPH in training to undertake educational travel. This fund was established in 1994, using funds donated by the British Association of Community Physicians (BACP) on its dissolution.

At the FPH Conference in Telford in June I was delighted to receive the travelling fellowship funding based on my application to travel to Japan to experience its culture and make observations about why its levels of childhood obesity were so much lower than those in the UK, and to present my public health work at a conference in Japan.

Observations on Childhood Obesity in Japan
Before I left for Japan I read many articles that explored the differences between childhood obesity rates in the USA and Japan. Their focus was on lifestyle factors including diet and physical activity.

Whilst in Japan I met with several academics who specialised in obesity, physical activity and diet. They were all most welcoming and shared their research and experiences readily.

The key points they raised were:

  • Younger children spend less time in school. As age increases so does the length of the school day. This gives more free time for outdoor play.
  • 90% of children walk to school daily.
  • Children do three hours of physical activity each week in school time.
  • There are no cleaners in Japanese schools; part of a child’s everyday activities includes cleaning their own school – children are active when cleaning.
  • Schools often have before-school sports clubs as well as after-school sports clubs.
  • Between each lesson there is a five-minute break to allow children to run around in the play area. This is in addition to morning break, lunch and afternoon break.
  • There are multiple opportunities in school for competitive sports, with regular competitions and celebrations. Children spend time practising for these with friends.
  • Children have three hot meals a day at breakfast, lunch time and in the evening.
  • Children serve each other a cooked meal at lunch time and sit and eat this hot meal together.

Further Observations
Whilst travelling in Japan I observed a number of additional environmental factors that tip the balance in favour of walking and cycling:

  • Priority is given to the pedestrian, then cyclist, then the motor vehicle. Encouraging walking and cycling. By giving priority to more vulnerable road users speed of motor vehicles is also decreased.
  • Cyclists and pedestrians share the pavement area, which is often separated from the road with a barrier and/or low-level bushes. This makes for a safer cycling experience than the UK where cycle lanes are often shared with buses.
  • There were a number of covered shopping areas, which were accessible only to cyclists and pedestrians and proved very popular thoroughfares.

    Shopping area in Japan

    Covered shopping area where pedestrians and cyclists share space

  • There was consistent and regular signage for cyclists and pedestrians, including details of directions and distances to the nearest public transport options.
Example of road, cycling and walking space in Tokyo

Example of road, cycling and walking space in Tokyo

• The number of employed people working on any urban street was much higher than the UK, with police highly visible, construction staff, cleaners, car park attendants and others all adding to the sense that the street was a safe place.

 

Policeman on the street in Japan

Presence on streets of local police make a space feel safe

• Public art installations make walking and cycling spaces more interesting and appealing.

Street art in Japan

Example of simple art installation

We know from the 2007 Foresight Report that obesity is a complex issue with multiple factors influencing obesity levels in adults and children. My own research looking at the risk factors for obesity in children in Wales using Welsh Health Survey data showed a reduced risk of obesity for children who met the one-hour physical activity guideline.

 

The new experiences and culture that I have experienced from this educational trip make me more determined than ever to tackle childhood obesity in Wales. I am looking forward to being involved in the drafting of an obesity strategy for Wales as part of my placement with the Welsh Government and will share my experiences with other registrars and colleagues at every opportunity.

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2040 is too long to wait for air-quality improvements

Posted in Academic, air pollution, Chronic Disease, Climate change, Europe, Health Inequalities, Health Protection, local authorities, transport, Urban health on August 3, 2017| Leave a Comment »

By Dr Jennifer Mindell, Reader in Public Health, Research Department of Epidemiology and Public Health, University College London

The government is proposing to ban the sale of diesel and petrol vehicles from 2040, to address air pollution in the UK that regularly breaches health-based EU regulations.

There are three main ways to improve UK air quality: reducing emissions from vehicles; driving less; and dealing with other sources of air pollution. The government’s preferred approach seems to be ‘business as usual, but less pollution from existing travel patterns’. Yet, even with this route, they are not committing to a scrappage scheme for diesel. This would produce air-quality benefits in the short-term, instead of in the 2040s – or even the 2050s and 2060s, as some individuals and businesses keep their vehicles for a long time. A scrappage scheme needs to be available to all individuals and businesses, regardless of size, and needs to encompass vehicles of all ages. Although older vehicles are known to be very polluting, no-one really knows about new vehicles! This could be complemented by financial help for retrofitting, particularly for older buses and lorries, if replacement isn’t an option.

Drivers of diesel cars are understandably aggrieved. They were urged to buy diesel engines by previous governments and given financial incentives to do so, because of the lower CO2 emissions per km. The higher emissions of other pollutants were ignored. Those with newer vehicles have no idea what their car really emits, due to the scandalous behaviour of manufacturers. This is yet another parallel with the tobacco industry (1) which designed cigarettes to produce low tar and nicotine in the laboratory but not when used by actual smokers.

Chargeable clean-air zones (low or ultra-low emission zones) are, according to a technical report issued by the government earlier this year, the most effective mechanism, but we understand that the government’s strategy will restrict charging to the last, not the first, resort. This is one of the areas, along with improved infrastructure for transport options other than private car use, that local authorities can contribute to greatly, but they need adequate powers and adequate resources. As air pollution costs the country £20 billion annually (2), the proposed figure of £255million to local authorities is a drop in the ocean.

The government is apparently also going to urge local authorities to speed traffic flows, by amending traffic-light settings and removing speed humps. What is actually needed is more calming, not less, to support smoother driving. It is not speed humps but the marked acceleration and braking that many drivers do that increases pollution. Greater use and enforcement of, and adherence to, area-wide 20mph limits without traffic calming would be better still.

Lower speeds, which would also support more and more pleasant walking and cycling, bring me to the better approach. Instead of persuading (in the next two decades) or requiring (from 2040) people to replace their existing car with an electric car, the health gains would be far greater if people travelled by public transport, walked or cycled whenever possible. As well as reducing pollution and carbon emissions, this generally increases physical activity and can improve wellbeing and reduce obesity and its consequences.

Reductions in pollutant emissions can also be achieved by reducing the need to travel. If people who could do so worked at home once a week, that would reduce their commuting by 20%. Land-use planning that encourages mixed use can shorten journeys sufficiently to make non-car options more feasible, although this will take longer. But as the government proposal for banning sales of diesel and petrol cars is to start in 2040, they are talking longer term anyway.

The government also needs to acknowledge that, although mobile sources are the largest category of pollutants, they are not the only ones. Two major contributors are buildings, including both homes and businesses, and transboundary industrial pollution from mainland Europe. Ministerial engagement with European countries will be necessary to deal with the latter. Local authorities need to be given the powers to address the former.
Air pollution is a major contributor to health inequalities. Poorer people are more likely to be exposed to higher pollutant levels. They are also more susceptible to the harmful effects of pollutants as they are more likely to have circulatory diseases (particularly heart disease and strokes) and respiratory diseases, such as chronic bronchitis or emphysema (now called chronic obstructive pulmonary disease) or asthma. Improving air quality is an important factor in reducing health inequalities.

The other option that we trust the government won’t take is to move the goal posts when (or if?) the UK is no longer bound by EU legislation. That would really be a cynical approach to the population’s health.

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1. Mindell J. Lessons from tobacco control for advocates of healthy transport. J Public Health Med. 2001; 23:91-7.

2. Royal College of Physicians, Royal College of Paediatrics and Child Health. Every breath we take: the lifelong impact of air pollution. London: RCP, 2016.

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Welfare reform is a reality

Posted in austerity, Health Inequalities, PH Spending, poverty, Urban health on September 30, 2013| 5 Comments »

by Paul Southon

  • Public Health Development Manager
  • UK Healthy Cities Network Local Coordinator

Welfare reform is a reality. Reviews of the likely health impacts suggest that they will be significant, are starting now and will last for a generation. (1) (2)

Work to quantify the financial implications for local areas shows that the financial impact will be disproportionately felt by the areas with the largest health inequalities. (3) There is also evidence that the impacts on already disadvantaged sections of communities – such as disabled people, black and minority ethnic groups and women – will be disproportionate. (4) (5)

All of this is happening at a time of major reductions in budgets and staffing across the public sector which limits the local ability to respond. This has been described as a perfect storm for local government. It will also have significant impacts across health services.

Over the longer term there is likely to be an increase in mental health problems, non-communicable diseases and related disabilities which will be felt across the health and social care system. Increasing poverty, especially child poverty, will have long term and generational impacts on child development, health outcomes and life expectancy.

GPs are reporting an increase in people with mental health problems. They are also reporting increasing numbers of requests for support with appeals against Work Capability Assessment decisions and the changes to disability benefits.

Currently the most visible part of the welfare reforms is the spare room subsidy or ‘bedroom tax’. Families on housing benefit who are defined as having extra bedrooms suffer a financial penalty. There is a severe shortage of available smaller properties for these families to move into. Their options are to move into the private rented sector, which may be more expensive, or stay where they are with a reduced income. Families are also moving to areas with lower rents, losing their social and support networks.

Councils are already reporting increases in rent arrears.(6)It is likely that this will lead to increased stress and family tensions, which could be exacerbated by the loss of social and support networks. A concern is that these families will resort to using alternative lenders, such as pay day loans, to cover shortfalls. One payday loan company has recently increased its typical APR to 5,835%.

For families experiencing poverty food becomes a major problem, both in access to enough food and in the quality of the food available. The rapid rise in food banks is testament to the difficulty families have in buying food. (7)

They also have to rely on the cheapest food which is often poor in nutrition and high in fats, including trans-fats. With the current food environment eating healthily is not a cheap option.

So, welfare reform is a reality. The evidence suggests that it is likely to have a major negative impact on public health and inequalities. It is now time to ask the key question: What can local areas do about it and what is the role of public health?

Much of the focus in councils has been on setting up the local systems to manage what were previously national benefit systems, the social and crisis fund payments and council tax benefits. Now these are operational the wider impacts of the reforms are being considered.

Many councils are mapping the local impact of welfare reforms to better understand the local challenges. (8) However, the scope to tackle these challenges at a local level is limited.

One of the stated aims of the welfare reforms is to encourage people into work. This is a laudable aim. Supporting someone into good quality work is a major public health win. The main way to reduce the numbers of people reliant on benefits will be to increase local employment.

However, increasing local employment is challenging in the areas where welfare reform will have the largest impact. Many of these areas have poor levels of educational attainment. Much of the available employment is low paid and insecure. A recent report estimates the local financial impact.

For example, Sandwell will lose around £119 million from the economy each year resulting in less money spent within the local economy, affecting local business and resulting in fewer local jobs.

With the limited scope for minimising the impacts of welfare reform at a local level it is essential that the most is made of local resources. This will need joined up working across councils, health, voluntary and community sectors and local businesses.

Public health has a role in raising awareness of the changes and the health impacts across all parts of the council and partners. It can also support the mapping and analysis of local impact, helping identify the local priorities for action and ensuring local plans are evidence based and monitored effectively.

Welfare reform is here, it comes with a real risk of significant negative impacts on health and inequalities at both local and national levels. Public health in councils needs to recognise this and ensure that it is fully involved in local efforts to minimise these impacts. At a regional and national level public health must lobby for changes to policy to protect population health and the disproportionate effects on the most vulnerable.

(1)Institute of Health Equity (2012). The impact of the economic downturn and policy changes on health inequalities in London.

(3) Beatty C, Fothergill S. Hitting the poorest places hardest: the local and regional impact of welfare reform. Centre for Regional Economic and Social Research. 2013

(4) Oxfam GB. (2010) A gender perspective on 21st century welfare reform.

(5) Welsh Government. (2013) Analysing the impact of the UK Government’s welfare reforms in Wales – Stage 3 analysis.

(6) Inside Housing (2013) Rent arrears up in wake of bedroom tax.

(7) Trussel Trust (2013) Increasing numbers turning to food banks since April’s welfare reforms.

(8) Sandwell Trends: Welfare Reform Topic Page (2013).

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Time for city cyclists to get their own tube network?

Posted in Obesity, Urban health, tagged , , on November 8, 2011| 2 Comments »

by Dr Geraint Lewis

For the past eight years, I have had the sometimes-dubious pleasure of living in London’s King’s Cross neighbourhood.  Being so close to the centre of the city, I do my best to cycle as often as I can around town. However, my repertoire of safe cycle routes is rather limited, and I dread straying too far away from my familiar routes and ending up somewhere where I have to battle my way home through the frenzied London traffic. The result is that I cycle less often, and less far than I would like to.

To be fair, these days there is a wealth of websites and apps that could help me navigate safely around London by bike.  The trouble, though, is that the safe bike routes themselves are just too complicated.

Take an example. Let’s say I wanted to cycle from my home in King’s Cross to St. Thomas’s hospital near Waterloo.  Although I know the walking route I would take to get there, I have no idea how reach the hospital safely by bike.  Go to the Transport for London  (TfL) website and it suggests a route that involves no fewer than 57 stages—as compared with two stages for the same journey by tube (Piccadilly line to Leicester Square, then the Northern line to Waterloo).

Indeed, London’s cycle network is so complicated that TfL appears incapable of displaying it as a complete map on its website.  Instead cyclists must order 14 paper maps to cover the whole city, plus a separate PDF for each of the new cycle superhighways that are currently being built.  Even where individuals have gallantly tried to produce simplified bike maps of London, the end result still bears too much resemblance to a plate of spaghetti.

Other cities have had a go at creating much simpler cycle maps aimed at encouraging more people to cycle. In Edinburgh, for example, Mark Sydenham and Martin Baillie have developed a tube map for bikes.  But the reality is that Londoners, like the citizens of many large cities, actually use the public transport network as their “mental map” for getting around their city.

The idea that Tim Miller and I suggested is that planners should build a bike network that recreates this mental map we are all so familiar with.  London’s bike network would directly resemble the tube map; Newcastle’s would follow the metro map, and so on.  In the jargon, what we are calling for are cycle networks that are “homeomorphic” or “topologically equivalent” to their public transport network. So in London, the cycle network we would like to see built would join up every tube station using analogous bike lanes to the tube lines – sharing the same names, colour codes and destinations as the tube lines.

So in this new world, my journey from King’s Cross to St. Thomas’s would simply involve taking the “Piccadilly bike lane” to Leicester Square, and turning left to go down the “Northern bike lane” to Waterloo.

What would be the costs and benefits of this proposal? Clearly, to build a network of safe cycle routes would take a large, sustained investment.  It would require building tens of kilometres of off-road bike lanes and closing off a considerable number of streets to through vehicular traffic.

However, the London tube map is a fixed asset that will be with us for generations to come, so this expenditure should be viewed as a very long-term investment. Just as with the tube network’s 150 year history, we would need to start small and build up the cycle network slowly, bike lane by bike lane and tube stop by tube stop.

From a public health perspective, I suspect the benefits of this proposed scheme would be at least fivefold.  First, it would encourage more people, including visitors to the city, to make longer journeys across town because they would now have more confidence that they could get to where they were going and be able to find their way back in one piece.  Second, it could reduce fatalities if more cyclists used off-road cycle lanes and quiet roads that had been closed to through vehicular traffic.

Third, it would reduce the city’s carbon footprint. Fourth, it would encourage cross-modal journeys because the cycle network and the rail network would now be inextricably linked. But finally, and rather sneakily, we might be able to increase journey distances from point A to point B by designing cycle routes between tube stations that were slightly more circuitous than were strictly necessary.

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Listen to Cityscapes – How do we create healthier cities for 2020?

Posted in Health Inequalities, Public Health Events, Urban health, tagged , , , , , , on July 8, 2010| Leave a Comment »

Afternoon parallel session at the Faculty of Public Health annual conference, on Wednesday 7 July.

Chaired by Alastair McLellan, Editor of the HSJ, and panel members Martin McKee, Professor of European Public Health at London School of Hygiene and Tropical Medicine, Michael Hagen, Merseyside Fire and Rescue Service, Stephen Hewitt, Specialist Professional Planner at Bristol City Council and Ed Cox, Director at IPPR North.

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