Climate change, environmental sustainability and health

Many of the themes set out in the 2010 Marmot Review 'Fair society, healthy lives' are also covered by the Acheson Review. This was the last major independent review of health inequalities in the UK, published 12 years ago in 1998. But one aspect is absent entirely: the link between health inequalities and climate change.

Health inequalities and climate change: an emerging link

As far back as 1988, Margaret Thatcher, the then UK Prime Minister, called on the world's governments to start tackling climate change. But it has taken another 20 years to begin to understand who is more likely to suffer from the consequences of climate change - such as hotter summers, wetter winters, and more severe weather events - and what the implications will be for their health.

We are now at the point where, in May 2009, leading medical journal 'The Lancet' warned that "climate change could be the biggest global health threat of the 21st century".

Not surprisingly, those who are least in a position to protect themselves are likely to be most vulnerable, both internationally and domestically. In response to this Professor Sir Michael Marmot and his team argue that "tackling social inequalities in health and tackling climate change must go together."

The Sustainable Development Commission - the Government's independent adviser until March 2011 - has welcomed the work of the Marmot Review to highlight these links but adds its own caution:

"Measures intended to respond to climate change must not widen health inequalities. Similarly, efforts to reduce health inequalities should seek to reduce carbon emissions."

Responding to a new joined-up agenda

But how plausible is this in practice? While it is too early to point to fully-formed responses, the case studies in this series illustrate how councils and their partners in England are working out how to bring policy and action in these two areas together in ways that contribute to both agendas.

For example, Be Birmingham, the city's local strategic partnership, has set up a climate change adaptation partnership. The partnership is developing a climate change risk mapping tool, which includes information on health inequalities. This aims to assess what parts of the city are likely to be most vulnerable. The data gathered so far suggests that poorer people are more likely to live on flood plains. Flooding has been linked to a number of health impacts including the actual dangers facing people during a flood and the increased stress for people who have their property flooded.

Interestingly, some of the potential solutions could actually provide opportunities to address some of the social determinants of health. Creating more green spaces so that flood water has somewhere to dissipate could also be places near disadvantaged communities where people can be physically active and enjoy the mental health benefits of parks and other open spaces.

In Bristol, the city council and Avon and Wiltshire Mental Health Partnership NHS Trust have set up a scheme to encourage some community-based health teams reduce the number of miles they drive and switch to electric bikes and low-emission cars. Less fossil fuel consumption means lower carbon emissions. But it will also help to improve air quality in poorer areas. According to the Environment Agency, people living in the most deprived parts of England currently "experience the worst air quality".

Sheffield City Council's Sustainable Housing Affordable Warmth (SHAW) initiative is a city-wide scheme to insulate people's homes. SHAW has so far either insulated, or is booked to insulate, around 10,000 properties. This will result in a projected reduction in carbon emissions of up to 15,000 tonnes per year. The scheme will also reduce fuel poverty and contribute to reducing health inequalities, especially cardiovascular and respiratory diseases, which are exacerbated by cold and damp conditions.

Taking a broader view: environmental sustainability and health inequalities

Climate change fits within a broader sustainability agenda, which has also received a much higher profile in the last decade. Another delve into the Acheson Review of 1998 reveals that it does stress the importance of environments in determining health. But it fails to connect this with environmental sustainability and the imperative, for our own sake at least, to halt the steady degradation of the planet's ecosystems and the overconsumption of natural resources.

This omission is surprising as these links were already firmly established elsewhere. For example, the Ottawa Charter for Health Promotion was agreed in 1986 at the World Health Organization (WHO)'s international conference on health promotion. It called for a "socioecological approach to health" which, among other things, should emphasise "the conservation of natural resources throughout the world as a global responsibility".

Fast forward to 2010 and the Marmot Review: the review makes a compelling evidence-based case for dealing simultaneously with health inequalities and environmental sustainability:

"Much of what we recommend for reducing health inequalities - active travel (for example walking or cycling), public transport, energy-efficient houses, availability of green space, healthy eating, reduced carbon-based pollution - will also benefit the sustainability agenda."

Some of these practical themes are reinforced in the case studies in this section. For example, Camden's healthy and sustainable food strategy - Good Food for Camden - explicitly reinforces the links between health inequalities and environmental sustainability by arguing that:

"‘Good food' is food that is healthy, of good quality, nutritious, affordable, and sustainable, thereby contributing to reducing health inequalities while also minimising environmental impact."

The strategy is being implemented through a number of practical projects that bring together council and primary care trust (PCT) officers, voluntary sector workers and community members to increase the accessibility of ‘good food', especially in the poorest wards in the borough.

Blackburn with Darwen Borough Council's Four Seasons Garden project is a plant nursery that is being used to get people from deprived areas into work, partly as a way to improve their health. The project does not use pesticides and there are plans to make the premises more environmentally sustainable by installing solar panels and a ground source heat pump to generate energy onsite for heating the garden centre building and poly tunnels.

Oldham Council is working with a range of partners to provide a new high-quality green space along the Moston Brook corridor, which runs through the heart of an area of multiple deprivation. The revitalised space will have higher ecological value than it does now and will create opportunities for improving physical and mental health. Much of the current focus is on cleaning up the existing contaminated and polluted watercourse.

Strategies for survival: bringing Marmot to the mainstream?

The six case studies in this section are good examples of the sorts of links that the Marmot Review is calling for. They address social determinants of health and environmental sustainability and or climate change at the same time through projects that are locally specific but nationally applicable.

Despite this, a familiar theme that cropped up in all the interviews conducted for this series was how fragile officers felt these projects to be. The Comprehensive Spending Review - due a week after the time of writing - is likely to significantly erode the capacity of local authorities and their partners to continue to pursue these kinds of projects even as the Marmot Review makes the case for them to become mainstream practice.

One response to this vulnerability has been for officers to find ways of making environmental sustainability projects financially sustainable too.

For example, the next phase for Blackburn's Four Seasons project is to explore how it can become a social enterprise and make enough money through nursery sales to support its education, training and health programmes. Bristol's low-emissions scheme is finalising a self-financing model, which would also create jobs for people from disadvantaged parts of the city. The potential health benefits of creating jobs for people who have struggled to find work is one of the key drivers for both projects.

The other main response has been to continue to make the links between the project work that is being delivered and forthcoming strategic priorities. Looking ahead, many of the case study projects fit perfectly into two important aspirations of the coalition: to be the greenest Government ever and to transfer public health responsibilities back to local authorities. The case studies already demonstrate how local areas are working to achieve both at the same time: similar projects should continue to be supported up and down the country.

Sources and further reading

Fair society, healthy lives (Marmot Review) (2010)

Sustainable development: the key to tackling health inequalities (2010)

Managing the health effects of climate change (2009)

Addressing environmental inequalities (2004)

Independent inquiry into inequalities in health (Acheson Review) (1998)

Case studies

Zero petrol project
Bristol City Council and Avon and Wiltshire Mental Health Partnership NHS Trust

Prioritising vulnerable communities when adapting to climate change
Birmingham Climate Change Adaptation Partnership

Four Seasons Garden Project
Blackburn with Darwen Borough Council (with Twin Valley Homes)

Good Food for Camden strategy
Camden Council and NHS Camden

Cleaning up a polluted environment in an area of high deprivation
Oldham Council

Free insulation scheme
Sheffield City Council


19 November 2014

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