Obesogenic environments: Role of planning and transport

in Healthy Weight

The Cornwall Healthy Weight Conference,

Eden Project,

17th October 2012

Introduction

• 1 hour session • Cover the health impacts of planning and

transport focusing on healthy weight or obesity• What are the issues?• Transport and Health – Sustrans viewpoint• Spatial Planning and Health• What can we do to overcome the barriers –

recommendations for action

Obesogenic Environments

• Where we live – our built and natural environment – affects our health

• Obesogenic environments are defined as:• ‘the sum of influences that the surroundings,

opportunities, or conditions of life have on promoting obesity in individuals or populations’

• Prevention and treatment of obesity has focused on pharmacological, educational and behavioural interventions, with limited overall success

• Shaping the environment to better support healthful decisions has the potential to be a key aspect of a successful obesity prevention intervention

Physical Activity: a miracle cure

• ‘The potential benefits of physical activity to health are huge. If a medication existed which had a

similar effect, it would be regarded as a “wonder drug” or “miracle cure”.’

• Sir Liam Donaldson – Chief Medical Officer (Annual Report of the Chief Medical Officer 2009,

Department of Health, March 2010)

Physical Activity and Health

• Inactive lifestyles are contributing to an obesity epidemic.• Physical Activity is critical to good health:

– Increasing levels of physical activity contributes to achieving reductions in risks of coronary heart disease and obesity, hypertension, cancer, osteoporosis, depression and anxiety.

– Reduces risk of CHD, Stroke, Type 2 Diabetes by up to 50%, risk of premature death by 20-30%;

– Improves well-being and mental health, particularly beneficial for maintaining independence and good health of older people.

Physical Activity recommended levels

• Chief Medical Officer’s recommendations for health enhancing physical activity (minimum):

– Children & young people: a total of 60mins of moderate intensity physical activity a day;

– Adults: a total of 30mins a day of moderate intensity physical activity five times a week. Moderate intensity physical activity includes cycling or brisk walking.

• Regular moderate physical activity, including walking and cycling, can help prevent and reduce the risk of:

• Cardiovascular Disease; Cancer; Obesity; Diabetes; Strokes; Mental Health Problems; High Blood Pressure; Musculoskeletal disorders

Physical Activity levels in Cornwall

• But inactivity is a major public health problem:

• Only 13% of adults meet minimum recommended level of physical activity (5 x 30 min)

• 25% adults are obese (Cornwall figures).

Local Area Walking and Cycling Statistics

• The statistics in this release are based on results from the Active People Survey Cornwall sample n=500

• 9 per cent of adults in Cornwall cycle at least once per week, (South West 11%; England 10%).

• The proportion of people cycling in Cornwall is lower than the South West across all frequencies, but very similar to England

• Residents who walk or cycle for utility purposes in Cornwall is 29%, (South west 35%; England 36%).

• 70 per cent of adults walk for at least half an hour, at least once per month. (South West 74% ;England 71%.

• Tables produced comparing Cornwall with the South West and England.

Increase in Obesity

So what can we do?

• Spatial Planning – design of the built environment

• Transport modes and active travel

Planning and Health

• “Local planning has a huge potential to positively affect health through the design of neighbourhoods.”

Marmot Review: Implications for Spatial Planning (Allen et al 2011)

• “While planning is not the panacea to solving all health and well-being issues, it is a powerful lever and major contributor in influencing the wider determinants of health.”

Spatial Planning and Health (TCPA 2011)• “Spatial planning in its broad sense, and the character of

settlements, are part of the UK problem, and need to become part of the solution.”

Professor Hugh Barton, Professor of Planning, Health and Sustainability, University of West of England (2009)

How planning can improve health

• Planning can contribute to improving health and reducing health

inequalities. Areas for action are: • reducing health inequalities• Improve levels of physical activity – therefore reduce

obesity and coronary heart diseases• reducing respiratory diseases• improving mental health and wellbeing• reducing road traffic fatalities and injuries • improving access to healthy food• Improve social cohesion / inclusion

• reducing carbon emissions

Environmental conditions affecting health

• Air and Noise Pollution• Access to green and open space• Transport and active travel routes• Food environment• Housing• Community participation and social isolation • Aligned agendas:

– Health inequalities– Climate change and sustainability

Pollution• Air pollution

• Linked with cardio-respiratory mortality/morbidity• Poorer communities tend to experience higher

concentrations of air pollution and have a higher prevalence of cardio-respiratory and other diseases.

• Strong evidence that reductions in traffic to reduce air pollution are successful in improving health.

• Noise pollution• Effects Mental health• Educational attainment – children• Hypertension – adults• Noise levels increase in areas of Deprivation

Green and open spaces

• Access to good quality green space results in– Physical and mental health benefits

• Decrease in blood pressure/cholesterol/stress, increase in ability to face problems

– Social interaction/integration– Space for physical activity and play– 35 per cent of people in the lowest social economic group visit green

spaces infrequently (less than once a month), which is likely to be due to both the low availability and bad quality of green space in deprived areas.

– Strong evidence that provision of green space effectively improves mental health. Less strong evidence that provision of green space improves levels of physical activity

Active travel

• Pavements/footpaths and cycling infrastructure– Presence and quality essential– Increase in walking/cycling trips

• Increase in physical activity– reduction in casualties

• Most people could meet recommended physical activity levels simply by including more walking or cycling in their daily lives.

• Chief Medical Officer’s recommendations for health enhancing physical activity

Wider benefits• More walking and cycling can support a wide range of

local and national objectives, including:• Increase physical activity therefore improve overall health

• Reducing carbon emissions• Reduce car use -Improving air quality & reducing noise levels• Improving accessibility & road safety & reducing congestion• Improving quality of life & sense of community• Improve environment and image of Cornwall (eg as tourist

destination)

Housing

• Clustering of houses in certain areas• Affordable housing shortage

– Mental health• Fuel poverty

– Cardiovascular and respiratory health– Mental health – Children’s educational attainment

• Children in bad housing are more likely to have mental health problems, such as anxiety and depression, and a range of other ill health effects – cold housing can affect the numbers of winter deaths and respiratory diseases

• Evidence that targeting home improvements at low-income households significantly improves social functioning as well as physical and emotional wellbeing

Food environment

• Greater access to unhealthy ‘junk’ food in deprived areas: 4 times as many McDonalds outlets in the most deprived census output areas in England than in the least.

• Current activity – Waltham Forest food outlets Alcohol/corner shops limits

• Low income and area deprivation are both barriers to purchasing fresh or unfamiliar foods

• Anecdotal evidence that local access to healthy foods improves diets – need more research

Social isolation / Community participation

• Neighbourhood design e.g. street crossing (fear of traffic) and quality of public spaces (fear of crime)

• Psychosocial and practical effects of strong social networks resulting in positive health outcomes:

• Socially isolated 2-5 times more likely to die prematurely than those with strong social ties

• Protective factor against cognitive decline• Reduces risk of depression• Social networks can help you recover when you become ill

• Community Participation:• Involvement in local decision-making can improve health outcomes• Interventions designed with input from the community tend to be

more effective

Traffic calming measures

• 20mph zones have been shown to reduce speed and volume of traffic– 40% reduction in road injuries– Modelling exercises concluded that 20mph zones halved the

number of casualties (580 deaths in 1 year) in the most deprived populations

• Also provides better environment for active travel • Location and availability of crossings

– Children are four times more likely to be hit by a car in the 10 per cent most deprived wards than in the least deprived wards.

– Strong evidence that traffic interventions reduce road accidents. Some evidence that traffic interventions improve physical activity.

Integrating health into planningThe NICE review ‘spatial planning and health’ found that

the following elements help integrate health into planning:• engaging health agencies early on can influence the objectives of

plans from the outset• building health and planning collaboration (for example, through

joint appraisal mechanisms)• Integrating health into policy e.g. healthy policy in the Local

Plan / Core Strategy• integrating health into development management • making joint appointments (for example, a dedicated officer with

responsibility for integrating health into planning) • utilising health assessment procedures as early as possible in a

plan, project or appraisal process e.g. HIA • engaging communities.

Health impacts of Transport: Health Damaging

Injuries Sedentary lifestylesPollution:

particulates, carbon monoxide and nitrogen oxides hydrocarbon and ozone, carbon dioxide, lead, benzene

Climate change Noise and vibrationStress and anxietyTraffic dangerLoss of land and planning blightSeverance of communities by motor trafficInequalities: all affect deprived areas more

Transport: Health Promoting

• Enables Access to:• Employment, shops, goods,

services• Including health services,• Education• Leisure, recreation• Outdoor, green spaces• Social support networks• Contribute to Well-being

DOMAIN 3: Health Protection

Objective: The population’s health is

protected from major incidents and other threats,

whilst reducing health inequalities

DOMAIN 4: Health-care Public Health &

Preventing Premature Mortality

Objective: Reduced numbers of people

living with preventable ill health and people dying

prematurely, whilst reducing

the gap between communities.

IndicatorsIndicatorsIndicators

Domains

Vision: To improve and protect the nation’s health and wellbeing and improve the health of the poorest fastest

Outcome 1: Increased healthy life-expectancyTaking account of the health quality as well as the length of life. (Note: This measure uses a self-reported health assessment, applied to life expectancy.)

Outcome 2: Reduced differences in life expectancy & healthy life expectancy between communities Through greater improvements in more disadvantaged communities. (Note: These two measures would work as a package covering both morbidity and mortality, addressing within-area differences and between area differences)

DOMAIN 2: Health Improvement

Objective: People are helped to live healthy lifestyles, make

healthy choices and reduce health inequalities

IndicatorsIndicatorsIndicators

Across the life course

IndicatorsIndicatorsIndicators

Across the life course

Across the life course

THE PUBLIC HEALTH OUTCOMES FRAMEWORK

DOMAIN 1: Improving the Wider

Determinants of Health

Objective: Improvements against wider

factors which affect health and wellbeing and health

inequalities

IndicatorsIndicatorsIndicators

Across the life course

Public Health Outcomes Framework

Public Health Outcomes Relating to Healthy Weights

• 1.10 Killed and seriously injured casualties on England's roads

• 1.16 Utilisation of green space for exercise/health reasons

• 2.02 Breastfeeding• 2.05 Child development at 2-2.5 years (Placeholder)• 2.06 Excess weight in 4-5 and 10-11 year olds• 2.11 Diet (Placeholder)• 2.12 Excess weight in adults• 2.13 Proportion of physically active and inactive adults• 2.17 Recorded diabetes• 4.02 Tooth decay in Children• 4.04 Mortality from cardiovascular diseases

The Health and Wellbeing Strategy

• The Health and Wellbeing Strategy will inform and influence commissioning decisions across local services.

• Influence the commissioning of local services beyond health and care to make a real impact on wider / socail determinants such as housing and transport.

• The strategy sets out a vision for working together to transform and improve health and care

• It consists of three main outcomes and twelve wide ranging priorities.

The HWB Strategy Outcomes and Priorities

Outcome 1: Helping people to live longer, happier and healthier lives

• Healthy Weights and Diet• Reducing harm from alcohol and substance misuse• Active people and environments • Smoke Free communities Outcome 2: Improving the quality of people’s lives • Support for people with Long-term conditions • Improved support for Carers• Support for Independent living• Improve support for community social networksOutcome 3: Fairer life chances for all • Improve access to safe, warm and secure homes• Improve skills education and employment• Improve the availability of information, advice and support• Healthier Children and Families

Guidance • PHO8 guidance makes recommendations on ‘Promoting and

creating built or natural environments that encourage and support physical activity

• Local Government public health briefing (2010): Physical Activity

• This briefing summarises NICE's recommendations for local authorities and partner organisations on how to encourage people to be physically active. It is particularly relevant to health and wellbeing boards.

• Physical activity is not only fun and enjoyable, it is essential for good health, helping to prevent or manage over 20 conditions and diseases. This includes heart disease, diabetes, some cancers and obesity. It can also help improve people's mental health and wellbeing

• http://publications.nice.org.uk/physical-activity-phb3

References : Planning and Health

• Allen et al (2011) The Marmot review: Implications for Spatial Planning. London, NICE. 

• Barton and Grant (2010) Shaping Neighbourhoods. Routledge.•  Delivering healthy communities (2009) RTPI.•  Gloucestershire Active Travel Toolkit. (Gloucestershire Council and NHS)•  Health and Urban Planning Toolkit (2010) HUDU, London.• Integrating health into the core strategy (2010) HUDU London• Physical Activity – Local Government public health briefing (2012) National

Institute of Health and Clinical excellence (NICE)• Physical activity and the environment (PH8) (2009) NICE• Planning for Healthy Communities (2005) Planning Advisory Service.• Plugging health into Planning (2011) Local Government Association.• Reuniting Health into Planning (2012) TCPA / Andrew Ross• Steps to Healthy Planning (2011) Spatial Planning and Health Group • Town and country Planning Association (2011) Spatial Planning and Health.

References Transport and Health• Active Travel: The Miracle Cure (DoT / DoH, 2010)• A walking and cycling action plan for Wales (WAG, 2009)• Chief Medical Officers Annual Report 2009 (CMO, 2009)• Cycling and Health- What’s the Evidence? (Cycle England, 2010)• Healthy Transport, Healthy Lives (BMA, 2012)• Health on the Move 2 (Transport and Health Study group, 2011) • Making the case: Improving health through transport (HDA, 2005)• NICE Guidance PH08 Physical Activity and the Environment (2008)• Public Spaces for All : Summary of evidence sources on active travel (Sustrans,

2010)• Physical Activity pathway – local government briefing PHB3 (NICE,2012)• Road Traffic collisions and causalities in the North West (NWPHO,2011)• Submission to the South West Regional Select Committee Inquiry into transport in the

region from Dr Gabriel Scally, Regional Director of Public Health• Soft measures, hard facts: Value for Money: An economic assessment of investment

in walking and cycling (NHS South West, 2011)• Take action on Active Travel (Sustrans, 2010)• Transport and Health (BMA, 2009)• UK Active Travel Strategy (2010)• Walking and Cycling Statistics 2010/2011 (ONS, 2012)

Group discussion

• What are the main infrastructure / environmental barriers to everyday physical activity and active travel?

• How can we overcome the barriers, especially through planning and transport policy and practice?

• Take away three key messages from this session.