SD-scene: Issue 11; Dec / Jan 2008

SD-scene is the bi-monthly newsletter highlighting progress being made in sustainable development. To sign up for the newsletter, enter your details on the home page.

Health Outlook

Walkers Health is a key component of sustainable development (SD). One of the guiding principles of the Government’s strategy for sustainable development is “ensuring a strong, healthy and just society”, and Securing the Future (2005) specifically highlights the important links between access to a safe, clean and attractive environment and the ability of individuals to lead healthy, active lifestyles. Here we explore the connections between health and sustainable development, discover just some of the policies and programmes being introduced to tackle these complex and interconnected issues, and talk to some of the key figures leading the change.

Seeing the connections

There are obvious links between sustainable development and health. Discussions last year at the World Health Organisation centred on the “significant and emerging threat to public health from climate change”. September’s report from the Intergovernmental Panel on Climate Change highlighted a wide range of implications for human health including direct threats from natural disasters, such as heatwaves, as well as indirect pressures, such as the availability of fresh water; the spread of diseases; and worsening air quality. In March this year, a study on the urban environment by the Royal Commission on Environmental Pollution, reported that air pollution is responsible for 24,000 premature deaths in Britain every year.

The connections between health and the five key principles of sustainable development as set out in Securing the Future are also strong, linking as it does the wellbeing agenda with a healthy society. As well as environmental factors, it’s clear that health is also affected by social factors, such as poor housing conditions, stress and social exclusion, as well as an individual’s economic situation, through unemployment, poverty and insecurity. Since it is the poor who take the brunt of lack of sustainability - whether through increased pollution, fewer green spaces, or barriers to accessing healthy food - action towards sustainable development is directly linked to addressing social inequalities.

Angela Mawle, chief executive of the UK Public Health Association (UKPHA) explains why SD is a health issue.
The UKHPA is a coming together of people who want to take forward public health in a creative way. When it was set up, three ‘missions’ were agreed for the organisation: to challenge anti-health forces, reduce health inequalities and promote SD. Climate change is a huge public health issue. Clearly it will bring things like vector changes in disease and heat-related deaths, but also mental health and infrastructure issues around flooding and the global issue of the movement of populations brought about by resource insufficiency. It won’t happen next year, but in the same way as the public health visionaries of the 19th century, we should be brave enough to look that far ahead. Clearly, if the eco system on which we depend is attacked, then we as a species cannot survive. Climate change will affect health, wellbeing and security. UKPHA has Special Interest Groups working in a number of areas. For example, our fuel poverty initiative is about to launch a two-year project in Salford (jointly funded by DH and the region) to address fuel poverty, how to access the fuel poor and reduce carbon emissions. Some 25,000 excess deaths are caused every year because of fuel poverty.

One of the most pressing and challenging public health issues in the UK is the rising rate of obesity. Here too there are connections with SD. The recent Foresight report, Tackling Obesities: Future Choices (October 2007), which concludes that 60 per cent of men and 40 per cent of women could be clinically obese by 2050, highlights how environmental factors play a vital role in determining body weight. Sir David King, the Government’s Chief Scientific Adviser and head of the Foresight Programme said: “Only change across many elements of our society will help us tackle obesity.” The report notes, however, that policies needed to tackle obesity have striking similarities with those necessary to combat environmental problems, notably climate change. In other words, many climate change solutions – measures to reduce traffic congestion, increase cycling or the design of sustainable communities - would also help prevent obesity and improve health.

Public health development manager for Nottingham City Primary Care Trust, Helen Ross, talks about her job identifying and addressing the environmental causes of ill health and health inequalities.
Greater Nottingham’s Environment and Health Partnership works on three key themes relating to health and environment; transport, affordable warmth and food. On transport, we know that if people walk and cycle rather than using their cars it’s better for their health, there are fewer emissions, and air quality is improved. It has environmental, health and economic benefits. We’ve done a lot of work, funding and developing a social enterprise cycle training service – RideWise. It began by teaching adults how to ride safely, the reason being that, even with cycle training for children, if the parents think that it’s dangerous they won’t let their children cycle. We’re also just about to launch a national pilot Cycling for Health project with Cycling England with funding from the Department for Transport. It will focus on travel planning for the PCT, and encourage employees to cycle more instead of using their cars. Doing it ourselves at the PCT gives people a far stronger message. With the affordable warmth area of work, we’ve developed the Healthy Housing Referral Service, to help improve particularly vulnerable people’s housing. And on food, we’ve carried out a whole range of projects through our Food, Health and Environment Strategy, looking at things like healthy eating, growing your own, and encouraging organisations and individuals to eat more sustainably. Finally, we are about to update the SD and Health Strategy for Greater Nottingham’s Environment and Health Partnership with the UK Public Health Association. We need to look at the various ways that partner organisations can contribute to reducing CO2 emissions, including what the PCT can do. The NHS is such a major employer that if we shift our spend and resources even slightly it’s going to have a huge impact on emissions.

Improving health… sustainably

Department of Health (DH) policies have been contributing to SD for many years. For example, its policies focusing on communities and health inequalities; its work to encourage the choice of good food and enjoyment of an active lifestyle; and its recognition of the link between poverty and ill health. The UK’s SD Strategy defined five key policy commitments made by DH to meet the dual goal of improved health and sustainable development, including work in the areas of food, transport, and sustainable communities.

Announcing the Government’s anti-obesity strategy for England, Healthy Weight, Healthy Lives, on 23 January this year, Secretary of State for Health, Alan Johnson said: “Tackling obesity is the most significant public and personal health challenge facing our society. The core of the problem is simple – we eat too much and we do too little exercise.” The solution, he noted, is more complex. “From the nature of the food that we eat, to the built environment, through to the way our children lead their lives - it is harder to avoid obesity in the modern environment.”

The five key elements of the strategy are: the healthy growth and development of children; promoting healthier food choices; building physical activity into our lives; creating incentives for better health; and personalised advice and support. Specific proposals in the strategy include the investment of £30 million in “Healthy Towns”, which will see selected towns and cities use infrastructure and whole town approaches to promoting physical activity; proposals to develop a single, simple and effective approach to food labelling in partnership with the food and drink industry; and a £75 million marketing campaign to support and empower parents to make changes to their children’s diet and increase levels of physical activity.

In June this year, Natural England – the integrated countryside and land management agency formed in October 2006 - launched its health campaign, led by Dr William Bird, health advisor to Natural England. As part of the campaign, in partnership with DH and NHS London, the agency has just launched a physical activity pilot scheme in the capital. Its aim is to encourage adults who lead sedentary lifestyles to “get moving”. The programme, which is initially being trialed through eight GP surgeries across five London Primary Care Trusts, will see GPs guiding patients through a Physical Activity Care Pathway, giving advice to patients on exercise, information on local activities they can join, and support throughout, as well as measuring and monitoring their activity levels.

Dr William Bird, Health Advisor to Natural England, explains why regular contact with the natural environment is crucial to health.
If we are going to tackle obesity and health inequalities in this country we’ve got to use the natural environment. As a GP trying to get my diabetic patients to exercise, I found they didn’t like going to the gym. When we think about exercise, our immediate thought is about services – gyms, swimming pools etc – but we’re less aware of the natural environment around us. I was in a practice where we had green space but people had become disassociated from it. So we started doing health walks from the practice. Contact with nature affects the brain - it reduces stress and helps levels of concentration. Also, people keep up walking because it’s connected to their community and it’s part of their identity. Natural England’s 'Walking the way to Health Initiative’ with the British Heart Foundation aims to get more people walking in their own communities. So far, it has trained an army of 31,000 volunteers to lead walks, and helped to create over 400 local health walk schemes. Some 500-600 walks now take place across the country every month.
As well as the physical activity pilot scheme (see left), Natural England is involved in green exercise pilots; a Ray Mears type of course around the country with teenage girls, a group that has seen a significant rise in the rate of obesity; and green gyms, which involve exercise through conservation work.
More information on Natural England’s Health Campaign(PDF, 208kb)

Operations: making them sustainable

The Department of Health is also committed to sustainable development within its own business and in the NHS. Both Securing the future (2005) and the Choosing Health white paper (2004) outline this commitment, and the revised NHS principles now encourage organisations providing care to NHS patients to take sustainable development into account.

The sheer scale of the NHS in the UK means it has a vital role to play in encouraging sustainable development by supporting local economies, social cohesion and a healthy environment. With the largest property portfolio and workforce in Europe, and a budget of over £92 billion, the NHS has the potential to make a very significant contribution. It is also acknowledged that the service will be put under increasing pressure from environmental issues like climate change as a report, Taking the temperature: Towards an NHS response to global warming (PDF), by the NHS Confederation and the new economics foundation outlines.

Neil Cumberlidge, Deputy Regional Director: Environment in the Government Office for the North West, talks about what can happen when public health and the environment come together.
Over the past year we’ve been working with Department of Health colleagues in the Government Office on improving the sustainability of the health service. In the first instance, we’ve been working alongside the public health team and strategic health authority to consider how all the NHS bodies in the region can improve the sustainability of their operations. Awareness of sustainability issues is at an all time high and we’re now seeing interest from ‘mainstream’ people – directors of public procurement, for example – wanting to do more. This culminated in a Green NHS Summit in Blackpool in December, at which all the primary care and hospital trusts were represented at a senior level. The event ended with NHS chiefs personally signing a charter pledging to put in place plans to address the ten areas identified by the Sustainable Development Commission as key to making a lasting positive impact on the environment. The ten-point plan focuses on issues such as transport, building management and energy use as well as broader ones such as community engagement. It’s fantastic simply because of the size of the NHS - it contributes around 9% to our region’s GDP – and the sheer reach is enormous. We’ve also joined with the public health team to support a piece of research looking at returning public parks to their public health roots. The NW has a rich legacy of urban parks – mainly from the 19th century - that could be better used to benefit health by, for example, increasing levels of exercise and tackling obesity, and improving mental health/wellbeing through access to outside space. The report makes a number of proposals such as getting better information to people about the region’s parks and broadening the role of park wardens to include more of a public health remit. The research is aimed mainly at local authorities and primary care trusts. In Rochdale, for example, the borough council and primary care trust are very interested in making more of these connections between the borough’s green space and the wider benefits that increased usage can bring.

The NHS is currently subject to mandatory climate change-related targets set by DH in 2001, which require the NHS in England to cut energy consumption by 15 per cent by 2010 (against 2000 levels). These could save the NHS in England alone around £50 million. It is also working extensively with the Sustainable Development Commission (SDC), through its Healthy Futures programme. A key part of this programme is the Good Corporate Citizenship Assessment Model, a web-based self-assessment model launched in February 2006 by DH and SDC to help NHS organisations assess progress towards becoming more sustainable through the way they manage their day-to-day business. By summer 2007 some 25 per cent of NHS Trusts had registered to use the model.

Paul Cosford, lead regional director of public health on sustainable development in the NHS, talks about why sustainability makes sense for the country’s largest employer.
The work the SDC has done with the Good Corporate Citizenship toolkit for the NHS has enabled us to identify some fantastic examples of good practice. It focuses on 6 areas of action that NHS organisations can take; direct energy use, estates, production and waste, the workforce, procurement, and importantly transport, which is a very important part of the equation. Emissions from transport on NHS business in terms of carbon are greater than the direct emissions from the NHS estate. For instance Addenbrooke's in Cambridge has worked with the local authority and the bus services so that a very large number of buses now stop at the hospital. As a result, the Trust has reduced the proportion of journeys made to it by car from 60 per cent to 42 per cent in a period of about 5 years. There’s also a lot of work on combined heat and power plants within Trusts. Guys and St Thomas’ Trust replaced their boiler system and have not only reduced very significantly their carbon output but they’ve also cut their energy bill by about £350,000 a year as a result. There’s a business benefit and an environmental benefit. And on local food procurement, there’s some very good work down in the South West in the Cornwall Hospitals Trust. But what we’ve not yet got is systematic implementation or sustainability across the NHS. The NHS Management Board has just agreed to establish an NHS Sustainable Development Unit, which will be set up as of April 08. This will support the NHS in taking the examples of excellent practice and make sure that we are implementing them systematically and comprehensively across the country. My overarching vision is that the NHS will be seen as the leading example of a public sector organisation acting sustainably, minimising its impact on the environment and on climate change. It will have benefits for patients, for staff, for local communities. It makes sense, and that’s the point.

Finally, the Department of Health (DH), in common with all Government departments, has produced a Sustainable Development Action Plan (SDAP), the latest of which sets out how the DH will include sustainable development in its policies, operation, people, procurement and in the running of its business during 2007/08. Key to this is the production of the Department’s first SD strategy, which it has made a priority for 2008.

Updated: 4 November 2008