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A health impact assessment of the Eastern Corridor proposals in Plymouth’s East End April 2009

www.plymouthpct.nhs.uk/healthandwellbeing

Published by the Public Health Development Unit. Plymouth NHS. 01752 315770

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A health impact assessment of the Eastern Corridor proposals in Plymouth’s East End ------------------------------------ Executive Summary ------------------------------------ 1. Introduction 2. A summary of the Eastern Corridor (East End Community Transport Improvements) proposals 3. Methods 4. Findings: a discussion of community judgments

− Community services − Community severance and cohesion (including community engagement etc)

− Construction-related impacts

− Economic impacts

− The pedestrian environment, including access to green space − Pollution

− Road traffic injuries

− Sustainability − Summary of the Council consultation regarding the Eastern Corridor

− Equalities issues and the distribution of prospective impacts 5. Conclusions References Appendices 1: A record of the stakeholder judgements 2: A health profile of the East End population 3: A rapid review of the published evidence concerning transport and health 4: Limitations of this study

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List of figures: 1. Overview map of the Eastern Corridor proposals for Plymouth 2. A map of the East End neighbourhood 3. The health map: a model of health determinants in relation to the built environment 4. Community services impacts 5. Community severance and cohesion (including community engagement etc) impacts 6. Construction-related impacts 7. Economic impacts 8. Pedestrian environment impacts, including access to green space 9. Pollution impacts 10. Road traffic injury impacts 11. Sustainability impacts 12. Logic framework for the Eastern Corridor health impact assessment 13. Health impacts assessment table 14. Life expectancy in the East End and Plymouth 15. Health data recorded by Health Visitors 2008 (and 2002)

Acknowledgements

The PHDU would like to thank everyone who contributed their time and views to this study.

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A health impact assessment of the ‘Eastern Corridor’ transport proposals in Plymouth’s East End – Executive Summary In 2008 the City Council (PCC) commissioned a health impact assessment (HIA) report from the Public Health Development Unit (part of Plymouth NHS) – to consider how the proposed ‘Eastern Corridor’ changes might affect the health of the population in the East End. The key changes proposed by the Council include:

• Making Gdynia Way a three lane road with two-way traffic - so this becomes the main eastern road exit from the city centre for Plympton/Marsh Mills bound traffic;

• Thereby reducing traffic on Embankment Road;

• Providing extra road capacity and therefore more priority to public transport on Embankment Road;

• Reducing traffic on Heles Terrace by creating a new link road to connect the Embankment with a new junction on Laira Bridge Road; and

• Improving pedestrian access and the public realm, especially on Embankment Road.

HIA reports are based on a broad ‘social’ model of health and include the consideration of local community views. Discussions were held at the local school, the Extra Care housing scheme, the ‘early years’ centre, a youth club and at a public meeting. The HIA also considered the published evidence base regarding transport and health issues, including specialist reports commissioned by the Council. The HIA conclusion is clear: that the Eastern Corridor plans should help improve the health and wellbeing of the East End population as a whole. The HIA produced 11 recommendations, which have been discussed with the Council’s Transport team:

1) To undertake a ‘mobility assessment’ of the area for people with ‘reduced mobility’.

2) To give the highest possible priority to improving pedestrian surface level

crossings, especially at Cattedown Roundabout and Heles Terrace.

3) To generally increase pedestrian priority in the area.

4) Improvements to the ‘public realm’ should include more greenery and landscaping on Embankment Road.

5) To take measures to mitigate Radford Park from the adverse impacts of additional

traffic on Gdynia Way.

6) As much as possible, to use local ‘procurement’ policies to create local employment opportunities during construction.

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7) To measure potential air pollution at the Nomony (early years) centre, and to take action if there are pollution problems.

8) To apply the best possible solutions (‘mitigation’) for air and noise pollution.

9) If construction working is required at night then residents should be given the

maximum possible notice, and easy methods for registering concerns and complaints.

10) To establish systematic pollution monitoring along Gdynia Way, and to explain

and publish the results as requested by local residents.

11) The Council and partners should continue communicating with all parts of the community (e.g. older residents, minority groups, residents more vulnerable to health inequalities and so on) regarding any changes to the neighbourhood.

The HIA also has two suggestions for discussion by the relevant organisations (Plymouth 2020, relevant Council Departments, NHS Plymouth, East End Partnership etc). Firstly, that when changes on Embankment Road are completed, to support a community celebration - encouraging people to be physically active and to celebrate their local neighbourhood. How about a car-free day? Secondly, to work together to provide continued resources for professional community development support in the neighbourhood (such as local newsletters, support for older people, activities in community buildings and youth services).

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1. Introduction In 2006, following requests from transport officers working in the ‘East End’ neighbourhood of the city, Plymouth City Council (PCC) agreed to commission a health impact assessment (HIA) of the proposed ‘Eastern Corridor’ transport changes – to consider how the Eastern Corridor changes might affect the health of the population in the inner-city East End. The Public Health Development Unit (PHDU), a Directorate of the Plymouth Primary Care Trust (now known as NHS Plymouth) was asked to undertake the HIA. . Following discussions between the Council and PHDU, it was agreed that this HIA would:

• use participative community workshops to assess the East End community’s judged

health impacts of the Eastern Corridor Transport Plan proposals;

• complement and be dovetailed into the outcomes for any statutory (eg environmental) assessments required for these proposals; and

• be delivered at the most appropriate time in the planning and decision-making process (when sufficiently detailed Eastern Corridor plans had been prepared).

In July 2008 that the Council commenced a large public consultation on more detailed transport improvement options for the whole of the Eastern Corridor, including the East End. The stated Eastern Corridor aim is to create a high quality public transport system to connect Langage Energy Park, Sherford New Community and Plymstock Quarry with the City Centre. The plans included a new Park and Ride site at Deep Lane Junction on the A38 (the main road connection between Plymouth (and Cornwall) and the rest of the country. In August 2008, Plymouth City Council was ‘shortlisted’ to bid for a £9.8 million Community Infrastructure Fund (CIF) grant, to bring forward the specific inner-city East End elements of the Eastern Corridor scheme. This is known as the ‘East End Community Transport Improvements’ scheme. The city began rapid preparations of a final business case for the end of October 2008 – with high chances of accessing the CIF funds from February 2009, and commencing the work thereafter. It was agreed in September 2008 by PCC and the PHDU that this would be the best moment to begin the HIA study. It appeared to be the best time to help provide a voice for local community health and well-being interests, and to be able to influence the design and development of the transport improvements, with the intention of maximising the prospective positive health and wellbeing impacts in the East End.

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2. A summary of the Eastern Corridor (East End Community Transport Improvements) proposals The Eastern Corridor proposals are an important strategic component of Plymouth’s Local Development Framework (LDF) Core Strategy (see below). Strategic and city-wide aims of the proposal The particular proposals for the East End neighbourhood are a critical component of the overall Eastern Corridor High Quality Public Transport Route (HQPT). It is proposed that this HQPT runs from the city centre out to the planned new community at Sherford, a new ‘park and ride’ site at Deep Lane on the A38, and finally onto the Langage Energy Park, which is expected to become a major employment site (see Figure 1). The Eastern Corridor proposals are included in the Regional Spatial Strategy and within the Regional Funding Allocation. These policies recognise that Plymouth is designated as a New Growth Point Area for the south west of England, with an expected significant increase of over 50,000 in the city’s population by 2026. Strategic transport infrastructure developments play an important role in the city’s new Local Development Framework (PCC: LDF Core Strategy, adopted April 07) and the Local Transport Plan 2. As the LDF states:

• ‘Communication links are vital to… economic prosperity and social wellbeing;

• (For example) to enhance connectivity with other parts of the region, the country and Europe;

• To improve our quality of life and local economic performance, we need to radically improve local accessibility – but in a manner which is sensitive to our unique environment; and

• There is a need to promote more journeys by foot, cycling or public transport (and less by private car).’

The Council’s Expression of Interest (EOI) (PCC 08) to the Community Infrastructure Fund describes how the East End “lies at one of the key gateway points for the city from the East… the existing (traffic congestion) problems…will be the first to be exacerbated by the new housing developments… this is a key point to unlocking the new residential development.” Aims for the local East End neighbourhood The Eastern Corridor plans include specific local objectives for the East End neighbourhood. As the city’s LDF states, there are generic and pressing needs to create ‘sustainable linked communities where services, employment and facilities are provided within easy walking distance of homes’ (PCC 07 p18). The LDF states that local (as well as city-wide/regional/national) ‘accessibility’ (PCC 07 p18) is critical to sustainable development. Specifically the Council’s submitted Expression of Interest described the existing transport-related problems in the East End as:

• a lack of public transport priority;

• a lack of journey time reliability for public transport ;

• traffic congestion;

• poor air quality on Embankment Road;

• noise pollution in particular areas; and • community severance.

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Figure 1: map of the proposed Eastern Corridor Scheme

The EOI does not dwell on the characteristics of the East End community, which is already recognised within the LDF as being one of the more deprived neighbourhoods in Plymouth, and an area of relatively poor health in comparison with the majority of city neighbourhoods. The EOI points out that an Area Action Plan is being developed which will propose a ‘significant amount of (new) development… including residential’ in the East End area. However, the EOI does specify benefits for the Prince Rock area within the East End neighbourhood stating that, because of restrictions linked to different regeneration funding allocations, Prince Rock has not received ‘the same benefits and opportunities available’ to other parts of the East End. (See Figure 2 for a map of the East End). Figure 2: a map of the East End neighbourhood

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According to the EOI, the Eastern Corridor improvements offer Prince Rock enhancement of the ‘local community’s travel options and… further opportunities to access employment, leisure and education facilities further a field’. It is anticipated that most East End residents will benefit from the proposed changes as fewer streets would be dominated by traffic and the attendant problems of air and noise etc. Description of the proposals There are six key elements for these proposals (see Figure 1 for an overview map). Widening of Gdynia Way This is currently a two-lane road with a single cycle track and grass verges, located in a cutting and slightly sunken below the levels of the surrounding residential areas. This is the main road westward into the city centre from the east of the city. Incoming traffic originates from the twin ‘satellite’ settlements of Plymstock and Plympton and from the A38 dual carriageway, which is the main road linking Plymouth with the rest of the country. The new communities of Sherford and Plymstock Quarry, containing over 7,000 new residential units, are also due to be built to the east of Plymouth. The proposed change is to introduce a third outbound lane for general traffic heading toward Marsh Mills/Plympton, i.e. an eastward lane alongside the existing traffic, and to re-route traffic accordingly. There would also be a future option to have ‘tidal flow operation’ management of the three lanes (i.e. the middle lane could be signalled as either east or westbound) to maximise the efficiency of road space. New junction on Laira Bridge Road This new junction would re-route Plymstock bound traffic from Heles Terrace to a new link road which follows the alignment of Embankment Lane. The Council states that this would remove a large amount of traffic from Heles Terrace, which is a residential street with sheltered accommodation. Public transport priority A new public transport priority route will be created between Cattedown Roundabout and Heles Terrace, running along Embankment Road and Laira Bridge Road. Embankment Road would become public transport and local traffic only between Florence Place and Lucas Terrace. Improved pedestrian access and mobility The described changes would enable improvements to pedestrian access in the area. In particular, there would be improved crossing facilities on Heles Terrace and on Gdynia Way near Cattedown Roundabout (although the exact plans are still unconfirmed regarding this latter crossing). Improved bicycle routes and access These proposals will involve the re-routing of some cycle lane facilities, the construction of some extra cycle lane facilities (which will be better connected with other cross-city cycling routes), and in general the creation of better cycling environments along many routes (because of reduced car usage, public transport only routes etc). Improvements to the public realm These changes should lead to significant improvements to the ‘public realm’ i.e. the publicly accessible streetscape environment, along Embankment Road in particular. There should be measurable improvements in air quality, noise levels, road safety, access to services and the connectivity of local neighbourhoods.

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Embankment Road is the main shopping area for the East End and the location of Prince Rock Primary School; the road currently has very high traffic levels and limited pedestrian crossing facilities; the road and local communities are literally divided in two by a large safety barrier railing. The school could be a particular beneficiary. Deciding not to promote alternative routes One previously considered alternative option had been to construct a new road through St Judes and Friary Yard; utilising an old railway line. However, the Council’s Eastern Corridor Project Board agreed on 6th May 2008 that further feasibility work for this potential route would not be pursued. The Board decided that the extra time and costs associated with researching and planning this new road could jeopardise the whole Major Scheme Bid (i.e. the funding available to make many of these transport changes right across Eastern Plymouth) and also due to the ongoing operational requirement of the existing rail track by Network Rail. There was also the possibility of needing to safeguard rail routes for future transport needs. Another possibility would have been the ‘Southern route’ through the industrial parts of Cattedown, to the south of the current scheme. Using these routes might increase journey times but would have the advantage of avoiding residential areas. Unfortunately in this case, there are some large-scale oil storage facilities near the Cattedown docks, and in the wake of the Buncefield oil depot incident at Hemel Hempstead in 2005 the Health and Safety Executive have tightened their regulations regarding development within the blast risk zone of large oil storage facilities. At the time of reporting, these regulations appear to pre-empt the possibility of the Southern route being utilised for the Eastern Corridor.

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3. Methods

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HIA principles

HIA is guided by the World Health Organisation (WHO 1946) definition of health as not just the absence of disease but the attainment of a complete state of mental and physical well being. The emphasis is upon factors that make people healthy and prevent them from becoming sick (health assets) rather than on those that help them once they are ill (healthcare).

This definition covers mental health and physical health and is affected by a broad range of factors including individual characteristics, such as age and gender, individual behaviours, such as levels of physical activity and the use of alcohol or tobacco, and broader social, economic and environmental factors. The broader factors include housing, employment status, transport, and the social and the built environments. All of these health factors are also known as the ‘determinants of health’ (see Figure 31 below).

Figure 3: The health map: a model of health determinants in relation to the built environment

Barton H, Grant M (2005) A health map for urban planners: towards a conceptual model for healthy sustainable settlements. Built Environment Vol 31 pp 339-355.

HIA may be defined as “a combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, programme or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects” (Quigley et al 2006).

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As this definition implies, HIA has a particular interest in the distribution of impacts and how health inequalities can be affected. The concept of health inequalities describes how some population groups – e.g. long-term unemployed people with fewer educational qualifications – will tend to experience far poorer health outcomes (e.g. life expectancy) than other groups.

As explained in the health profile of the East End neighbourhood (see Appendices), Plymouth experiences some significant health inequalities across the city. The aims of this HIA In 2006, following requests from Plymouth City Council (PCC) the Public Health Development Unit (PHDU, a Directorate of the Plymouth Teaching Primary Care Trust was commissioned to carry out a health impact assessment (HIA) of the proposed ‘Eastern Corridor’ transport changes in the East End neighbourhood. . Following discussions between the Council and PHDU, it was agreed that this HIA would:

(i) use participative community workshops to assess the East End community’s

judged health impacts of the Eastern Corridor Transport Plan proposals ;

(ii) produce a report to present the possible positive and negative health impacts

of the Eastern Corridor Transport Plan;

(iii) suggest proposals for positive health enhancement or negative mitigation

measures arising from the study; and

(iv) offer practical evidence-based health impact assessment findings to the

decision-makers (Plymouth Primary Care Trust 2006).

It was also agreed that there would be a written discussion of the findings of the HIA and the presentation of this information to the relevant decision-makers. Since 2006, the HIA Assessor attended several meetings of the East End Transport Liaison Group. This group had been established to keep the local community abreast of the Eastern Corridor proposals as they developed. The key features and plans for the HIA, as they were formed, were discussed with and reported to this group – although it should be noted that this group is not the ‘decision-making’ group for the Eastern Corridor proposals. Day to day decisions are taken by the Eastern Corridor project team and the key decision are made by the Eastern Corridor Project Board, to drive forward the Eastern Corridor scheme. Key decision-making roles for the Eastern Corridor can also be ascribed to decision-makers controlling resource allocations in central government (e.g. within the Department for Transport and Communities respectively) and regional Government Offices. Community engagement

Community engagement is an important element of HIA, and in this case the involvement of a good range of people from the local community was seen as particularly vital. The following methods were used to generate community views:

• an open to all participative workshop. This was held, after substantial advertising by various methods, in the early evening period (6.30-8.30pm) in the centrally-located Prince Rock School. About 22 local residents attended.

• A discussion with 25 children aged 10 and 11 during a classroom session at the local Primary School (the children also filled in a brief questionnaire).

• A brief presentation to and discussion with a group of c25 older residents, held at the Extra Care Scheme (sheltered housing) in Cattedown.

• Discussions with about 10 parents of pre-school children at the Nomony Childrens Centre, Cattedown.

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• A brief discussion with around 20 young people at the Coxside Youth Club. (However these young people were by and large based well away from the proposed changes and did not perceive the consultation as particularly relevant.)

The HIA also reviewed the Council’s own previous consultation on the Eastern Corridor scheme.

Assessment

During the community engagement, community stakeholders were asked to note down their judgements using sticky notes or, for the schoolchildren, questionnaire forms. Views were also recorded on flipcharts and by the assessor, and by colleagues supporting the HIA. All prospective health impacts identified were then written up by the assessor and reviewed, before being grouped under themes ‘emerging’ from all the data considered for this HIA. The stakeholder health impacts were classified in the impact tables presented in Chapter 6. The stakeholder data was then re-reviewed. A ‘logic framework’ for the assessment was also prepared. Based on work by the UCLA HIA project in the US (2004), this framework helps connect the Eastern Corridor proposals with the prospective health impacts, using the following sequence:

1. Project components 2. Proximal impacts 3. Intermediate outcomes 4. Health outcomes

(See Figure 12 in chapter 7.) From this process the assessor produced a Findings Table (see Figure 13). This presents the data in the following way:

Health determinant and/or pathway

Negative health impact

Positive health impact

Proposed additional mitigation/

enhancement The criteria for selecting or identifying these particular prospective impacts were:

• How important is the impact? How serious are the effects? Will health inequalities be worsened?

• How likely is the impact to happen? Very likely or less likely?

• How many people could be affected? A large number or a small group?

• Is it possible to propose effective mitigation or enhancement of the impact? Will the decision-makers take note?

These findings were also reviewed by and discussed with a health promotion and community development professional with specialist knowledge of the East End community. The findings were then discussed and reviewed with an experienced Consultant in Public Health. Provisional findings were presented to the operational decision-makers (i.e. senior transport planners within the City Council), and their feedback and clarifications were considered, before the findings of the HIA were finalised, as published in this report.

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4. Findings: a discussion of the community stakeholder judgments

As described in the Methods chapter, a wide range of community stakeholders participated in this HIA. However, the community stakeholders who have contributed to the HIA are largely “self-selecting”, and should not be seen as automatically representative of the whole neighbourhood. (Please see Appendix 4 for a discussion of the limitations of this study).

Notwithstanding the above limitations, the stakeholders provided essential information for this HIA. This chapter presents the main issues raised during stakeholder engagement, grouped by the main themes which emerged from stakeholder discussions. (A basic record of the stakeholder quotes, from different consultation events, is provided by Appendix 1.)

Stakeholder judgments of the prospective health impacts are presented in Tables according to the key themes identified earlier in this HIA.

In this chapter judgements are presented as described by stakeholders without any corrections of potential factual inaccuracies etc. Some stakeholder views can be seen as questions rather than definite views, yet they are still able to shed light on how health might be affected.

The conclusions of the HIA, which are informed by all of the relevant evidence, are presented in the next chapter.

Figure 4: access to community services

Positive health effects? Negative health effects?

Easier to get to school Disruption caused by closed roads etc during construction could cause inconvenience and stress for locals

Generally easier to access Embankment Road services

Will it still be almost impossible for wheelchair user to access Barbican Leisure Park?

All local bus services should get better which would help many locals (e.g. young people in Coxside)

Will the proposals overcome the existing difficulties in accessing the city centre for people with reduced mobility?

Easier pedestrian access at Cattedown roundabout is vital for good health effects

Will access to local facilities be preserved for those who need them most?

How can we improve access to the Doctors?

Need to have better access round the Extra Care Scheme (new housing)

Need to improve access to the co-op shop

Some stakeholders were concerned that the ‘construction’ phase for the East End transport improvements could cause a lot of disruption in the locality, which could be negative for health and wellbeing. The construction work would require some infrastructural works on Gdynia Way including the widening and strengthening of Elliot Road Bridge over Gdynia Way. There would also be the reconfiguration of key traffic junctions, temporary road closures and diversions. This could result in traffic congestion, and create difficulties for local residents wanting to access services and facilities etc.

Post-construction however many stakeholders recognised that the reduction of traffic on Embankment Road could help improve access to services in that area. .

Several schoolchildren in particular were clear that accessing the school would become easier and safer.

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Accessing not just the school but a range of shops and Astor Park (etc) from Embankment Road should become easier and significantly more pleasant; these judgements were often, but not exclusively made by residents on or nearby Embankment Road.

There was also recognition that the proposals could lead to future improvements in bus services in general, i.e. benefits would not be restricted to the new “high quality” bus service, which could improve access to services and facilities right across the city, and in particular this could benefit those groups less likely to own a car (younger people, older people etc), and so support the wellbeing of groups more vulnerable to health inequalities. Some young people in Coxside judged that reduced delays to the existing bus network (arising from the Eastern Corridor changes) would improve their ability to access the city centre and other areas.

Older people in particular also considered the current barriers many people feel they face regarding accessing services. Access to the city centre and the local cinema in particular was often judged to be poor if not impossible (e.g. for a wheelchair user). Some stakeholders argued that, apart from ‘generalised’ statements supporting improved access to community facilities in principle, the East End transport plans as presented to date are lacking important details in this respect.

Stakeholders judged the issue of pedestrian access at Cattedown Roundabout as critical for future health improvements.

Figure 5: community severance and cohesion (including community engagement etc)

Positive health effect? Negative health effect?

Should be less severance of the area if traffic is reduced on Embankment Road

Risk of extra commuter traffic on small residential roads: Elliot Road, Mainstone Avenue, South Milton Street, Coxside?

Less rubbish chucked from the cars Non-locals parking in the area causing anxiety and congestion (etc)

A nicer area! Will Heles Terrace remain busy with traffic particularly as perceived by older people?

More crossings for pedestrians? Gdynia Way is already visually depressing, so in the future…

It’s poor now…(so it should get better…?) You have made your minds up already (about the scheme)… don’t feel people have been listened to

Will HGV’s be diverted away from the area? The uncertainty causes me stress (& it’s been discussed for so many years)

How can you enforce local traffic only (on Embankment Road)?

Is there a risk of further severance for Radford Estate?

Will the bus stops be better? Will there be any effect for the diverse groups in this area?

Will there be more car parking in this/our area?

Doesn’t this go against local health priorities?

Severance was an over-arching issue of concern to many stakeholders. People recognised that severance is already a problem in the East End, with several busy roads cutting through local communities, harming people’s general wellbeing and sometimes causing stress. Stakeholders were therefore keen to explore the implications of the proposed transport changes, as some feared there could be the unintended creation of new “rat runs” (i.e. shortcuts on local roads utilised by through motorists trying to avoid congestion). Elliot Road, Mainstone Avenue. South

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Milton Street and the Coxside area were mentioned in particular. “Rat run” negative health impacts could include an increased risk of accidents, and noise impacts.

Particular factors affecting Heles Terrace residents were discussed in some depth, as the Council proposals claim they will benefit these residents by reducing traffic, yet some stakeholders were unsure, and concerned to point out that some residents (e.g. older people) were particularly vulnerable to negative traffic impacts.

Some stakeholders suggested that there could be more non-locals parking in the area, which could inconvenience local residents.

Notwithstanding these particular concerns, some stakeholders stated that overall the transport changes would be very likely to reduce severance in the area and improve community cohesion.

Some of the schoolchildren developed this theme, judging that there would be “less rubbish chucked from cars”, and in general the creation of “a nicer area”.

Some stakeholders noted that the HIA needed to consider the views of minority groups who did not appear to be represented in the stakeholder engagement sessions. The population profile indicates that there are increasing numbers of non-white British groups living in the area. Embankment Road is also the location for some of Plymouth’s more popular “international food” shops.

Figure 6: construction-related impacts

Positive health effect? Negative health effect?

Where will traffic go during construction?

Will local residents be particularly affected?

Stakeholder concerns about the health impacts of construction activities are summarised in Figure 6. There were obvious concerns that construction work on such busy roads could lead to increased traffic congestion. There were fears that this congestion would particularly and adversely affect residents of the East End.

Figure 7: economic impacts

Positive health effects? Negative health effects?

Increase value of houses in Embankment Road area?

Less trade for Embankment Road shops because of reduced traffic?

Decrease value of houses near Gdynia Way?

Loss of industrial units & local employment when Embankment Lane is built?

A few stakeholders expressed a concern that the Embankment Road shops would lose trade because of less passing traffic. One person was concerned that there would be a loss of industrial units when the new link road was built. Some residents proximate to Gdynia Way said that it would be negative if the increased traffic on Gdynia Way contributed to lowering the value of their property. Conversely, some residents from the Embankment Road vicinity judged that reduced traffic on Embankment Road would have a positive effect by increasing the value of their homes.

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Figure 8: impacts on the ‘pedestrian environment’, including access to green space

Positive health effects? Negative health effects?

More greenery on Embankment Road? To protect Radford Park from traffic impacts

Should encourage walkers and cyclists Will there be negative effects for local wildlife?

More green space in the area would be good

Will there be the loss of or any impact upon the local school sports fields?

Be good to have more cycle routes Will any green space be lost?

Will there be improvements for Heles Terrace?

Will it affect access to the football pitches?

Crossings on Embankment Road, & to the city centre, are very important

Will it make it easier to reduce obesity (in the area)?

Can we improve local green spaces?

Will you improve the public realm & shops on Embankment Road?

Will there be better screening for GW?

Need to improve pavement quality

There were plenty of stakeholder views about the potential impacts upon the local pedestrian environment and local green spaces (often described as the ‘public realm’ in the Council’s proposals).

Most judgements predicted positive impacts. The pedestrian environment along Embankment Road should be considerably improved which might encourage more walking and cycling. Children in particular hoped that there would be more green space and tree-planting as a result of the Eastern Corridor proposals. Community stakeholders also emphasised the importance of improved pedestrian road crossings in the area.

The main community concerns expressed relevant to the pedestrian environment focused upon possible negative impacts affecting Radford Park (which is located adjacent to Gdynia Way) and the playing fields used by the school and other groups; stakeholders wanted reassurance that the playing field access would be improved and not diminished.

Figure 9: pollution impacts

Positive health effects? Negative health effects?

Should be better for sleeping in houses near Embankment Road

Will Nomony Children Centre’s playground suffer from air and noise pollution?

Overall pollution should be reduced There’s too much pollution at the moment

There should be a good impact on children’s health

Won’t be able to use our gardens (near Gdynia Way)

Will you use quiet road surfacing? Are there enough measurements of air quality?

Less fumes Can’t sleep now (near Gdynia Way) so what about the future?

Less noise There are over 100 houses (near Gdynia Way) concerned about noise, air & vibration

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Will the scheme be safe from the industrial blast zone?

This was a major subject of concern for stakeholders. Residents near Gdynia Way were concerned about increasing air and noise pollution, including vibration. These residents were worried that their sleep would be disrupted and that it would be unpleasant or even unhealthy to use their gardens and (for example) to dry washing outside. Some people were uncertain as to how pollution levels were being monitored at the present time and in the future.

Some stakeholders also judged that the Embankment Road environment would become less polluted as traffic is diverted elsewhere. Some people felt that the school would particularly benefit.

Figure 10: road traffic injury impacts

Positive health effects? Negative health effects?

There are already too many accidents on Gdynia Way

Two-way traffic (on Gdynia Way) is more dangerous & will increase accident risk

Got to stop ‘rat-running’

Some stakeholders were concerned that having two-way traffic on Gdynia Way would increase accidents both for vehicle users and for pedestrians. (Despite the lack of pavements on Gdynia Way, some people noted that pedestrians do occasionally use this route.)

Most concern was expressed about the accident risks arising from ‘rat-running’ – i.e. when non-local commuter traffic uses East End residential streets for shortcuts and/or congestion avoidance.

Figure 11: sustainability impacts

Positive health effects? Negative health effects?

Will there be better park and rides for traffic to the city?

Is the city really going to grow as planned?

Keep the (disused) rail links for the future

What about road charging schemes?

Some stakeholder comments can be grouped under a ‘sustainability’ heading. Some people felt it was important for longer-term well-being to keep open the option of using currently unused railway lines. At least one person supported the use of road or congestion ‘charging’ schemes to reduce traffic in the area.

Some people emphasised the need to increase ‘park and ride’ options in the city suburbs in order to reduce traffic in the East End area.

Some people questioned whether the city would in fact increase its population over the next 20 years as anticipated by the Eastern Corridor plans.

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Summary of the PCC consultation regarding the Eastern Corridor

It is useful at this point to offer a brief summary of responses to the Council’s own public consultation on the EC scheme. The consultation occurred before PCC had been informed of the CIF opportunity of bidding to Government for resources for extra resources to undertake early EC works in the East End.

A total of 26,000 brochures and questionnaires were distributed, with a response rate of 11% (481 responses) in the East End. A majority of respondents agreed with the proposal to route traffic away from Embankment Road. For those who disagreed, the main concern was that the traffic would be displaced to Gdynia Way and not to another route away from residential areas (the ‘southern’ route: see the Conclusions chapter).

East End consultees tended to:

• Support more cycling routes (although few locals appeared to cycle themselves);

• Support better pedestrian access in the area;

• Some people supported the introduction of a resident parking scheme;

• Some people expressed pollution-related concerns regarding a busier Gdynia Way;

• Many people supported the proposed HQPT route; and

• Express concerns about commuters etc using residential streets for short-cuts and alternatives to the main routes.

Equalities issues and the distribution of prospective impacts

It is important to note that, broadly, different population groups emphasised different health and wellbeing issues during the HIA engagement.

Children

The children emphasised the benefits of quieter streets, cleaner air, greener environments, feeling ‘safe’, being able to easily cross the road (i.e. ‘severance’), cycle and walk and catch the bus easily.

Older people

The older people, many of whom were based at the Extra Care scheme, tended to emphasise the difficulties in travelling the area at present due to disability and severance (the severance issue they shared with the children).

‘General’ resident adults

It could be generalised that many of the adult residents (who attended the public workshop) were concerned both with their own ‘access’ issues (e.g. being able to use and park their own cars), as well as more general ‘shared’ issues such as pollution and severance.

Equality groups

UK legislation requires local authorities to assess the equality impacts of proposed schemes such as the Eastern Corridor. The law defines certain equality categories:

- Age;

- Disability;

- Gender;

- Ethnic identity;

- Religious belief; and

- Sexual orientation.

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As stated in chapter 3, HIA is also concerned with equality impacts. The HIA has identified some disability and age–related issues (see above and chapter 7).

It is regrettable that the HIA did not manage to engage with people from a Black and Minority Ethnic (BME) background. The population profile suggests there are relatively high numbers of BME people in the area, but it was not possible to organise an HIA engagement event to specifically target BME residents.

However the published evidence-bases do suggest that many BME households would experience the same impacts as other inner-city residents (pollution, severance, access to services considerations, etc).

Many BME residents may be relatively recent residents and arguably they might particularly benefit from the proposals because of the possibilities of reduced severance and increased opportunities to interact with other local residents.

In turn it can be suggested that community cohesion could benefit from the greater involvement of BME residents; this reasoning lends weight to the HIA conclusions (see chapter 7) regarding the importance of resourcing community development work in the area in the future.

5. Conclusions

After the stakeholder engagement, and before the submission deadline for the Council’s CIF funding bid, a general ‘un-analysed’ list of possible mitigation suggestions, directly derived from the stakeholder comments, was sent to the Eastern Corridor project team. The purpose was to give an early flavour of stakeholder views and an extra opportunity for the project managers to accordingly revise their bid.

The HIA was then concluded by reviewing all the data collected, in particular:

• The population health profile;

• The published evidence base;

• Stakeholder judgements; and

• Feedback from the decision-makers.

The HIA findings are based on a qualitative assessment of both qualitative and quantitative data and the interpretation and professional judgement of the specialist author.

A draft health impacts assessment table was discussed with the local community health worker and an experienced public health consultant.

A ‘logic framework’ was produced to map out the potential connections between the Eastern Corridor proposals and health outcomes. See Figure 12 below.

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Figure 12: logic framework for the Eastern Corridor HIA

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The logic framework helps to display the links between proposed activities and possible impacts, helping to identify the key health pathways by which health is affected.

There was then a meeting with the Eastern Corridor project team to discuss the provisional findings.

In general the Eastern Corridor project team accepted the HIA findings and were particularly willing to consider how the findings could be delivered in partnership with the relevant stakeholders, in order to achieve the best possible health and wellbeing results for the East End community.

After the meeting with the project team, the final findings table below was produced. The table presents:

• The relevant health determinant and/or the pathway by which this determinant affects health;

• The potential negative and/or positive health impacts; and

• The recommended actions for mitigating and/or enhancing the health impacts.

Figure 13: health impacts assessment table Health determinant and/or pathway

Negative health impacts?

Positive health impacts?

Proposed additional mitigation and/or enhancement of the health impacts

Access to community services (including leisure, local shops etc)

There will be some inevitable disruption for the local community and broader populations at different points during construction

Will improve access to the Embankment Road area New and improved bus services across the East End and through the city The potential to improve pedestrian/ cycle access to the centre

(1) to undertake a ‘mobility assessment’ of the area for people with reduced mobility (2) To give the highest possible priority to improving pedestrian surface level crossings, especially at Cattedown Roundabout and Heles Terrace

The pedestrian environment… includes access to green/open space….

An improved pedestrian environment is likely to encourage people to be more physically active, and is likely to support improved mental wellbeing

(3) Improvements to the public realm should include more greenery and landscaping on Embankment Road (4) To take measures to mitigate Radford Park from the adverse impacts of additional traffic on Gdynia Way

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Active travel Walking and cycling are encouraged

Community severance

More crossings on Embankment Road etc should reduce severance

(5) To generally increase pedestrian priority in the area

Economy, employment

There may be opportunities for local businesses and employment arising from a more active neighbourhood ‘centre’ i.e. Embankment Road

(6) As much as possible, to use local ‘procurement’ policies to create local employment opportunities during construction

Pollution (air/noise/ vibration)

Air and noise pollution may slightly worsen in the immediate vicinity of Gdynia Way Some overnight working is possible, and it may cause stress/anxiety for some (e.g. sleep disruption)

Less pollution is likely in the Embankment Road area including around the school More local people will benefit from reduced pollution (there will definitely be a net ‘gain’)

(7) To measure potential air pollution at the Nomony (early years) Centre, and to take action if there are pollution problems (8) To establish systematic pollution monitoring along Gdynia Way, and to explain and publish the results as requested by local residents (9) To apply the best possible solutions (‘mitigation’) for air and noise pollution (10) If construction working is required at night then residents should be given the maximum possible notice, and easy methods for registering concerns and complaints

Levels of community engagement/ participation and sense of community cohesion and pride, including equality and diversity issues (There can be connections between a person’s mental health and

“The changes in Embankment Road will make me happier” ‘Nicer area’

(11) The Council and partners should continue communicating with all parts of the community regarding any changes to the neighbourhood, including outreach to different parts of the community (e.g. BME groups, residents more vulnerable to health inequalities, older residents)

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their perceptions of ‘community’ etc)

Road traffic accidents

The area around the school should be safer for children. Because traffic will be more concentrated, more areas in the East End should become safer for pedestrians/ cyclists and traffic accidents should be reduced

Sustainable development (public health in the longer term)

Increasing support for public transport may help to change travel habits and reduce traffic levels over longer time periods

The HIA also has two suggestions for discussion by the relevant organisations (Plymouth 2020, relevant Council Department, NHS Plymouth, East End partnership etc.)

• Firstly, that when changes on Embankment Road are completed, to support a community celebration, encouraging people to be physically active and to celebrate their local neighbourhood. How about a car-free day?

• Secondly, to work together to provide continued resources for professional community development support in the neighbourhood (such as local newsletters, support for older people, community building activities and youth services).

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In conclusion, it is important to reiterate that the function of this HIA by the Plymouth PHDU is to provide an independent assessment of the Eastern Corridor plans, with the explicit aim of maximising the prospective health and wellbeing impacts. The Council’s Eastern Corridor plans as described in the CIF bid clearly state that they wish to promote the wellbeing of people in the East End. Many of the actions recommended by the HIA. are already being considered by the City Council. For example, the CIF bid included the explicit commitment to an ongoing bi-annual (at least) East End community newsletter. The overall conclusion of the HIA is clear: that the Eastern Corridor plans should help improve the health and wellbeing of the East End population as a whole. The PHDU hopes that discussion and delivery of the HIA recommendations can help improve population health and wellbeing in the East End and beyond.

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References Acheson, D., Barker, D., Chambers J, Graham, H., Marmot, M., and Whitehead, M. (1998) Independent inquiry into inequalities in health: 1998. London. The Stationery Office. 1-164 Association of Public Health Observatories and Department of Health (2008) Health Profile 2008: Plymouth Barton H, Grant M (2005) A health map for urban planners: towards a conceptual model for healthy sustainable settlements. Built Environment Vol 31 pp 339-355 Besser LM, Dannnenberg AL (2005) Walking to Public Transit American Journal of Preventative Medicine 2005 Cave B, Curtis S (2001) Health impact assessment for regeneration projects: Volume 2: Queen Mary College, University of London Committee on the Medical Effects of Air Pollutants (COMEAP). The health effects of air pollutants 2000 Department of Communities and Local Government (2007) Index of Multiple Deprivation. Department of the Environment, Food and Rural Affairs (05). Securing the Future: the UK Government sustainable development strategy. Cm 6467 2005. Department of the Environment Transport and the Regions (1997)Health effect noise assessment methods: a review and feasibility study. 1997. A review by the National Physical Laboratory and the Institute of Sound and Vibration Research for the Noise and Nuisance Policy Unit. Department of the Environment Transport and the Regions.(2000) Social exclusion and the provision and availability of public transport: summary report. Report by TRaC at the University of North London 2000. London. Crown Copyright. East End Partnership (2003) East End Regeneration Strategy Plymouth

Faculty of Public Health Medicine.(2000) Transport & Health study group. Carrying out a health impact assessment of a transport policy. Guidance from the THSG 2000

Douglas, M., Thomson, H., Jepson, R., Hurley, F., Higgins, M., Muirie, J., and Gorman, D. (2007) Health impact assessment of transport initiatives: a guide. 2007. Edinburgh. NHS Health Scotland.

Institute of Public Health in Ireland (2006) Health impacts of the built environment: a review

Jarup L et al (07) Hypertension and Exposure to Noise Near Airports, Environmental Health Perspectives: (available at: http://dx.doi.org)

Plymouth City Council (2008): Community Infrastructure Fun (Expression of Interest) East End Community Transport Improvements scheme. Plymouth City Council (2007) Local development Framework: Core Strategy April 07 Plymouth City Council (2002) Neighbourhood Renewal Strategy 2002-7: 2002 Plymouth: Plymouth City Council Plymouth Primary Care Trust (2006) Proposal for a community based Health Impact Assessment (HIA) of the ‘Eastern Corridor’ transport plans in the East End Plymouth Primary Care Trust (2008a): Overall population figures calculated from an adjusted version of the (NHS) GP population register 2007. Plymouth: Plymouth Primary Care Trust Plymouth Primary Care Trust (2008b) Plymouth neighbourhood analysis 2008: Health Visitors Pratt A (2003) A health impact assessment of the Community Village proposals in Plymouth’s East End Plymouth Primary Care Trust

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Quigley, R., den Broeder, L., Furu, P., Bond, A., Cave, B., and Bos, R. (2006) Health impact assessment. International best practice principles. Special publication series No. 5 International Association for Impact Assessment) Mind. (2007) Ecotherapy: the green agenda for mental health… Mind (National Association for Mental Health). Available at http://www.mind.org.uk/ Stansfeld, S. A., Haines, M., Curtis, S., Brentnall, S., and Brown, B. (2001) Rapid review on noise and health for London. Department of Psychiatry, Department of Geography, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary, University of London. Sustainable Development Commission (08) ‘how outdoor environments influence health-and well-being: a knowledge base’. University of California, Los Angeles (2004) Health impact assessment of the Buford Highway UK Public Health association (2008) Public health competencies for climate change mitigation (draft 17/11/2008) London World Health Organisation (1946) Preamble to the Constitution of the World Health Organisation as adopted by the International Health Conference, New York, 19-22 June, 1946 Yen, I. H. and Bhatia, R.(2002) How increasing the minimum wage might affect the health status of San Francisco residents: a discussion of the links between income and health, February. Working Paper 2002.

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Appendix 1: A record of the stakeholder judgements GENERAL

Accidents

Presently too many accidents from Leisure Park to Gdynia Way junction Access How will access to Doctors be improved? Children’s safety walking to school needs to be carefully considered Wheelchair users presently find steps etc prevent them from accessing Barbican Leisure Park

Air/noise

Too much pollution Reducing traffic on E road will cut overall pollution even if traffic increases on Gdynia Way x2 Negative effect for Mainstone Avenue residents, Julian Street, including use of gardens Effects on using gardens/outdoors/washing lines Are there enough measurements of air quality? Can’t sleep now….

Construction The time taken will cause discomfort Where will traffic go during this construction time? Community cohesion including severance Currently poor Rat-runs as problem (South Milton St; Mainstone Ave) often with terrible noise What are the implications for Coxside (rat-running, more traffic etc?) Implications for Elliot Road. Visual impact of Gdynia Way is depressing now… in the future?

Economy/employment

Will there be enough trade for Embankment Road shops? Blight on house values

Flooding

A risk on Gdynia Way Green/open space Will there be land take near Community Village to widen Gdynia Way?

Physical activity

Extend cycle routes

Stress

You have made your mind up already Uncertainty as stress Don’t feel people have been listened to

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SOME PRIORITISATION

Gdynia Way

100+ houses concerned about noise, air, vibration

Pedestrian Crossings

Especially to the centre Embankment road

Radford Estate

Is there a risk of further severance?

Heles Terrace

Will there be improvements here? Noise Concerns for people near Gdynia Way Economic Impacts on local businesses? Loss of employment if we lose industrial units (due to new road construction) Environment Air pollution Flooding Children’s health (nursery playground etc by Gdynia Way) Does the industrial blast zone impact on the proposed routes? Local wildlife impacts

Social

Loss of access to green space Will there be the loss of sports fields for local schools? How will this impact on the diverse groups who reside in the area? Will access to local facilities be preserved especially for those who need them most? Will more people be parking in this area rather than using P&R? Physical health Will this affect obesity (see above) Will there be more road traffic accidents (e.g. two way traffic more dangerous) More sleep problems for locals? (noise) This goes against local health initiatives

MITIGATION

Better services for local young people Replacement/improvement to of green space in the locality Parking permits for local area (free?) Restrictions on HGV’s in Elliot Road needed Stop rat runs Good to reduce Embankment Road traffic Better road crossings at Surface Level Impact on kid’s health Impact on respiratory diseases Introduce speed humps Mainstone Ave & Elliott Rd Good to divert Cattedown bound Lorries away from Heles Terrace Speed limit on Gdynia Way Air conditioning & triple glazing Junctions on Finnegans Way & Embankment with Laira Bridge road to be merged or coordinated What about access to football pitches?

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Better park and rides Opening Elliot Rd as a rat run will cut Prince Rock in half and cause a greater risk to children What about Pedestrians who use Gdynia Way Better screening for Gdynia Way Better signs for HGV’s Residents don’t want to pay for parking! Will trade suffer further on Embankment Road? Need to keep rail links for the long term future Will the city’s growth proceed as planned in the current situation? Could Plymstock etc traffic be routed via Finnegans Way to Shapters Road Use of tunnels Road charging? Road surfacing Home zone approaches Improve embankment road Speed zones Keep local parking Better bus stops Dredging the Plym to reduce flooding Better crossings for Extra Care Scheme vicinity Need dropped curves etc to ease access to cinema etc as well as centre etc Need good access to the Coop, Embankment Road (including for deliveries) How will industrial traffic from the Port leave the city? Cattedown roundabout as key to pedestrian access Are there enough accurate traffic predictions… to let people judge for themselves? Make Embankment Lane two-way to help mitigate against traffic on Heles Terrace Will there be good investment (from CIF?) to improve the public realm and buildings for the Embankment Rd shopping parade? What will happen to access to Cattedown Road off the roundabout (this is the main local access) Have the Council assessed the impacts of Chelson Meadows closure (i.e. more Lorries) and any corresponding structural damage? How enforce local traffic only Require community linkages to ensure that Radford rd does not become further isolated? Importance of mitigation for Community Village site (after £££ have been spent on it to improve health) Loss of employment if we lose industrial units (due to new road construction) Will there be loss of access to green space? Will there be the loss of sports fields for local schools? Will there be more road traffic accidents (e.g. two-way traffic more dangerous) Need residents only parking in Heles Terrace More traffic control needed for Cattedown road Improve pavement quality in the area Improve the environment for partially sighted/blind people Need more green space in the area (from the Prince Rock children) =======================================================================

Appendix 2 A health profile of the East End population The Plymouth health profile The Department of Health-produced 2008 Health Profile for the city shows that the city’s health is currently worse than the England average on a number of indicators. Mental health problems, drug misuse and hospital stays related top alcohol appear worse than the England average. There are health inequalities in the city by gender, deprivation, ethnicity and location (with the East End still remaining as one of the area more vulnerable to inequalities). Men living in the most deprived areas have, on average, 5 years less life expectancy than those in the least deprived. The estimated proportion of adults who smoke is worse in Plymouth than for England as a whole. There are around 450 deaths caused by smoking in Plymouth every year. Deprivation Plymouth’s East End has been identified by the City Council as one of the city’s 43 “natural neighbourhoods” (PCC, 2002), occupying a large part of the Sutton/Mount Gould Ward and comprising the

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recognised local areas of Cattedown, Coxside, Prince Rock and the southern section of St Judes. The neighbourhood covers an area of roughly 1.6 square kilometres or 0.62 square miles (the whole city of Plymouth covers an area of 28.8 square miles) and the latest 2007 estimate of the East End population is 5,426 people (PPCT 2008a). The East End was recognised as a disadvantaged area requiring regeneration and given priority, along with 13 other neighbourhoods, in the city’s Neighbourhood Renewal strategy (PCC, 2002). Although the Neighbourhood Renewal strategy has now been superseded by new approaches to promoting social inclusion and tackling deprivation, the city’s neighbourhoods are still routinely divided into the “most deprived”, the “middle group” or the “least deprived” categories. The East End is still grouped into the “most deprived” category. In 2003 the area regeneration strategy (East End Partnership) described the area as hosting a complex mixture of different uses, activities and buildings. The traditionally “strong” residential communities are situated alongside large-scale port and marine industries, big leisure attractions, large industrial complexes and a host of smaller back-street businesses. Over recent years the East End also has had several locations attracting significant new private sector investment, such as the large blocks of new flats at Coxside, which are aimed at private purchasers. A major feature of the neighbourhood is the presence of several major highways providing access to the city centre. These busy roads tend to divide up the area, causing significant air pollution and noise, with consequently pedestrian access across the area being very poor (EEP, 2003). According to both the Regeneration Strategy and Plymouth Council’s Neighbourhood Renewal Assessment of 1999, this area for many years suffered from un-coordinated planning and decision-making, and in the past a general lack of public and private investment, with poor access to community facilities etc. Recent improvements to the area The above neighbourhood descriptions are still relevant in parts, although there have also been notable improvements to the neighbourhood since 2003. The most obvious improvements have been the subsidised external renovations of a large number of privately-owned houses which were in poor condition, and the recent completion of the Community Village site - which was the subject of a 2003 HIA produced by PPCT. Along with other developments, the area is regarded as ‘improved’ by many stakeholders. As is discussed below, population health can also be shown to have improved over recent years, although these improvements cannot be causally attributed to specific regeneration initiatives etc. However the data indicates that some of the greatest improvement has occurred in the housing conditions experienced by families with young children (PPCT 2008b; see Figure 5 below). Current primary health care services (for the area most affected by the Eastern Corridor scheme) are supplied by GP’s and associated staff based in new purpose-built premises on the Community Village site.

Life expectancy

The population has risen by 294 people since 2002 (PPCT 2008a: 2002 data was used for the health profile published in the HIA of the Community Village in 2003). There are currently estimated to be 1089 residents aged over 55 years, and 351 residents under the age of 5 years.

In terms of life expectancy, a key indicator for population health, the Table below shows how health has improved for all groups in the city over a 16 year period. The data also suggests that the East End has seen greater improvements than some of the other deprived neighbourhoods. Figure 14: Life expectancy in the East End and Plymouth

East End Most deprived neighbourhoods

City average

Life expectancy in years 1991-1992

75.9 74.8 76.2

Life expectancy in years 2005-2007

79.7 78.1 79.6

% change since 1991 3.8% 3.3% 3.4%

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Deprivation and health data

Recent data still confirms the deprived status of the East End in comparison with the rest of the city. The Index for Multiple Deprivation (IMD, Department of Communities 2007) records data at local levels – known as “Super Output Areas” – over a number of “domains”:

• income;

• employment;

• health deprivation and disability;

• housing;

• barriers to employment; and

• education, skills and training.

There are 160 Super Output Areas for the city, and these can be ranked according to their overall IMD scores across all the described domains. In turn there are three Super Output Areas within the East End neighbourhood and, when all of the above domains are considered, they can be ranked at the ‘fairly deprived’ positions of 14

th, 25

th and 40

th - on a city scale whereby 1

st place is classed as most deprived and

160th is classed as least deprived.

The 2001 Census recorded a range of population data. For instance, back in 2001 people’s self-definitions of their health as “good” was measured as 62.9% in the East End as compared with 66.8% in Plymouth and 68.6% in England as a whole.

Families with young children

Plymouth’s Health Visitors keep regular records of their visits to all families with children under 1 year of age. These records provide a database of up to 27 different “Health Needs Factors” (an example being “the major wage-earner in the household is unemployed’).

Figure 15: health data recorded by Health Visitors 2008 (and 2002)

East End Most deprived neighbourhoods

Plymouth

Number of records 2008

(2002 figure in brackets)

251

(239)

4,747 11,792

(10,799)

Difficulties with English %

10

(3.3)

4.5 2.8

(1.5)

Low income, dependent on benefits %

29.9

(52.7)

35.8 21.6

(32.1)

Vulnerable families (families experiencing 4 or more “health needs”) %

21.9

(41.4)

26.9 16.9

(25)

Poor housing having a detrimental effect %

3.6

(33.9)

11.9 6.4

(8.7)

Depressed/mentally ill parents %

15.9

(15.9)

16.2 13.4

(16.1)

The health visitor data shows that, overall, health families with young children in the East End experience poorer health than ‘average’ families in Plymouth and England.

The data also suggest that health levels have improved for most Plymouth families with young children since 2002, and that in some cases the East End has shown greater improvements than other neighbourhoods. .

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Other groups potentially vulnerable to poorer health

Evidence suggests that older people living in disadvantaged areas are likely to experience greater poverty (Institute of Public Health in Ireland 2006). This is connected with the well-researched links between old age, low income, health problems, poor housing and poor services (such as public transport). The proportion of “Black and Minority Ethnic (BME)” people in the East End was recorded as 2.2% by the 2001 National census, which was similar to the 2001 city average of 2.1% (Table 1). However the Census estimate was probably too low as for example it would not have included many BME asylum-seekers or refugees who were arriving in the city at the time. The Health Visitor data of 2008 shows a marked rise in the proportion of families where speaking English can be problematic. This reinforces anecdotal information that the local BME population (including more recent migrants from Eastern Europe) is relatively high. Published evidence (Cave & Curtis 2001) suggests that BME individuals living in disadvantaged neighbourhoods can be more vulnerable to ill-health and poverty. =======================================================================

Appendix 3 A rapid review of the evidence concerning transport and health

Transport policies, developments and patterns or behaviours - how, where, and how often we travel - have important implications for the health of individuals and populations ( Department of the Environment Transport and the Regions, 2000).

Transport activities contribute both adversely and beneficially to health by shaping access to a range of goods, services, facilities and social interactions. Several transport-related health effects can also affect the psycho-social or mental rather than physical dimensions of people’s well-being. Two key overviews of the evidence which explore how transport factors affect health, and which consider how HIA can apply this evidence, are available from:

• the Transport and Health Study Group 2000; and

• the ‘HIA of transport initiatives’ (Douglas 07)

Both of these key overview studies raise a number of transport-related health issues or themes which have been identified as potentially relevant to the Eastern Corridor scheme. The issues are listed below alphabetically, with a brief description of the associated health ‘pathways’ and/or outcomes.

It is also useful to note that a previous Plymouth NHS HIA had been undertaken in the East End in 2003, considering the Community Village regeneration proposals (Pratt 2003). Although primarily concerned with the health impacts of developing a specific site, the Community Village HIA conclusions reflected the importance of transport/traffic issues across the East End by judging that there was: ‘a risk that traffic problems (such as traffic accidents, and air and noise pollution) will worsen in other parts of the East End. The Village site itself will include 88 new car-parking places. The HIA suggests that resources be committed to developing an effective traffic reduction strategy.’

Access/mobility regarding community services and facilities;

How people - including ‘people with reduced mobility’ - access education, work, shops, healthcare, leisure opportunities and social or friendship networks (etc) is very important for health.

Socially and economically disadvantaged groups in areas like the East End communities can be particularly at risk of detrimental transport-related health effects (eg the busy and noisy main roads) and so it is important to minimise or mitigate the potential negative health effects of transport development to avoid exacerbating these health inequalities. Lack of access to transport is experienced disproportionately by

• women;

• children;

• disabled people;

• people from minority ethnic groups;

• older people; and

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• people with low socio-economic status. (Acheson 1998)

These groups are less likely to own or drive a private vehicle. They can be more likely to experience restricted personal mobility because of their health or age (etc.). They are more likely to need to access public services and yet they find that they can face barriers when accessing services such as shops and health care. These groups can spend a higher proportion of their resources on transport (perhaps excepting the elderly).

Access to open/green space;

A growing body of evidence (e.g. a review from the Sustainable Development Commission (SDC) in 2008) suggests that health and well-being can benefit from improved access to green (natural) space and open space. The Eastern Corridor changes scheme may affect how local people access local green space.

The SDC review notes that some of the greatest contemporary health challenges (mental ill-health, obesity-related diseases) are related to the outdoor environment(s) in which we live. The review suggests that exposure to natural spaces is good for health in and of itself… the more green space there is in a neighbourhood, the better people’s health tends to be. Research undertaken by Mind (2007) in collaboration with the University of Essex into the mental health benefits of ecotherapy and green exercise suggests that individuals can thrive if ‘connecting with the natural world’ is a part of everyday life. The study compared a 30-minute walk in a country park with a walk in an indoor shopping centre for 20 individuals. After the country walk, 71% reported decreased levels of depression and said they felt less tense, while 90% reported increased self-esteem. This was in contrast to only 45% who experienced a decrease in depression after the shopping centre walk, after which 22% said they actually felt more depressed. Access to natural spaces can also encourage people to walk, cycle, play, be active. Accessing public spaces for leisure in particular can encourage people to meet and interact with others – isolation and self-absorption are typical causes and symptoms of mental ill-health.

Air Quality; Emissions to air from road transport in particular can affect health (Committee on the Medical Effects of Air Pollutants, 2000). Large-scale demolition and construction activities can also affect health by creating dust etc. In summary, air pollution:

• Has short term and long term damaging effects on health;

• Can worsen the condition of those with heart disease or lung disease;

• Can cause particular health problems for the very young and for older people; and

• Can aggravate (but does not appear to cause) asthma.

Community severance and/or cohesion; New transport routes, or substantial traffic increases on existing routes, can cut through communities and literally ‘sever’ connections, and particularly effecting access to services and social networks (Douglas 07). How easy it is for people to travel to see their friends; and do main roads or railways and transport congestion (etc.) deter people from interacting with other people? The latter issue is often referred to as “severance”. Conversely, transport infrastructure and systems can also contribute to cohesive communities where people have greater opportunities to interact, and where different communities including minorities are able to participate in public activity.

Congestion; Arguably, traffic congestion can sometimes be identified as a discreet health determinant – congestion can cause increased air pollution, noise, severance (see below), stress-related symptoms (for vehicle drivers, passengers, pedestrians, local residents etc) and economic ‘costs’ (lost time etc).

Economic and employment;

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Transport provides access to goods, services and employment, and transportation systems not only facilitate the movement of people, goods and services, but also have potentially wide-ranging impacts on land use, economic growth and quality of life. Access to employment and hence income is a major health determinant; income is one of the strongest and most consistent predictors of health and disease in public health research literature. The strong relationship between income and health is not limited to a single illness or disease (Yen and Batia 02). Significant health improvements and gains can be made via economic development and in particular by the provision of sustainable living wage employment for individuals and communities. While the mix and composition of employment is important for the whole population it is particularly important to ensure that the benefits reach people who are usually excluded from the employment market.

Noise and vibration; Noise ranks as a prominent environmental concern in cities; the leading source of ambient noise pollution in the UK is road traffic. Construction and demolition activities can also create noise. Noise, defined as unwanted sound, is likely to have certain physical characteristics (e.g., impulsive, high intensity, or high frequency) and depends on factors like volume of traffic, flow, speed, proportion of HGVs, road gradient and surface characteristics. It is well accepted that noise exposure and associated noise-induced hearing loss can severely impair the quality of life and lead to chronically elevated psychosocial stress levels. Noise guidance provided by the World Health Organisation states that “general daytime outdoor noise levels of less than 55 dB(A) Leq are desirable to prevent any significant community annoyance” (Stanfield 2001). Recent European studies have found that there are ‘statistically significant effects on blood pressure of night-time aircraft noise and average 24 hour road traffic noise exposure, the latter for men in particular’ (Jarup 2007) The most widespread subjective response to noise is annoyance, which may include fear and mild anger, relating to a belief that one is being avoidably harmed. Road traffic noise at 50 to 60 dBA intensity increases the time taken to fall asleep. In particular, the number of noise events seems important in this effect. A Department of the Environment Transport and the Regions report (1997) concludes that there is sufficient evidence that exposure to noise has detrimental effects on performance in school children.

Physical activity;

Public transport users tend to undertake more routine everyday activity than car-drivers; being physically active is good for physical and mental health. Transport systems and infrastructure can affect how physically active people are. Using public transport will often involve walking to interchange points and may help otherwise inactive groups gain more exercise (especially when compared with door-to-door car travel, Besser 2005). As already mentioned, issues such as ease of access to green space, and the easy avoidance of noisy and dangerous main roads, may encourage people to be more active.

Road Traffic Accidents;

Injuries are more likely for pedestrians and cyclists than drivers; greater volumes of traffic tend to lead to increased injury rates. There is also evidence to show that children in more deprived areas (such as the East End) and/or more deprived socio-economic groups are more vulnerable to road accidents than children living in more affluent areas, perhaps because they are more likely to live in an area near a main road, and are less likely to have access to private green space and/or their own family car. (Douglas 07).

Physical injuries are the main consequences of road traffic accidents, and the fear of accidents can be a major determinant of behaviour (e.g. where parents allow children to walk or play). Vulnerable users such as pedestrians and cyclists can be more vulnerable where minor roads intersect with arterial roads; roads near houses and schools can be high risk areas for children (Douglas 2007).

Sustainable development;

Public health policy in the UK is increasingly concerned to promote health now and in the future by promoting sustainability and in particular by reducing carbon emissions and the consumption of non-

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renewable natural resources. The Eastern Corridor scheme may affect the carbon emissions and resource consumption attributable to local communities (and the wider populations) which use the ‘corridor’. There are causal links between atmospheric conditions, weather patterns and mortality/morbidity and the contribution of social and environmental factors. The resilience of healthcare and essential services - including food availability and security - in the face of projected climate instability is a major longer-term wellbeing issue (UK Public Health association 2008). The UK Sustainable Development Strategy also recognises the links between sustainability and health. Whilst acknowledging that sustainability is vital because “climate change is the most serious global environmental threat” , sustainability can also promote new, modern, sustainable ways of living, working, producing and travelling (which) stand to achieve wider benefits to human health and well being” (Department of the Environment, Food and Rural Affairs 05). =======================================================================

Appendix 4: Limitations of the study This HIA is based on a qualitative assessment of the data, although it does also consider a range of quantitative data (e.g. from the environmental specialist studies). The HIA is inevitably influenced to some degree by the experience, knowledge and values of the assessor/author. A large part of the considered data has been generated by community stakeholders. These views can of course reflect a range of experiences and ‘biases’. It could also be speculated that many of the people giving their views had particular concerns and ‘negative’ views that they wished to express; it can be argued that local residents more in “favour” of the changes might have been less bothered to attend the HIA sessions and/or to express a view about the prospective positive health impacts. The community stakeholders who have contributed to the HIA are largely “self-selecting”, and should not be seen as automatically representative of the whole neighbourhood population.