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Triple jeopardy: environmental and health inequalitiesA Clearer Future: 18/19 Sept 2008 Dr Jeremy Wight Joint Director of Public Health NHS Sheffield/Sheffield City Council
Biophysical and ecological systems of the natural environment are fundamental to human health • Mounting pressures on the environment are disrupting and depleting these systems • Resulting health risks will particularly affect vulnerable and poorly resourced populations
Globally & Locally
Who you are • Age, gender, ethnicity, income • are known to be main predictors of health and health related behaviour • BUT….
Where you live also matters • Shown for: • Total and CHD mortality • CHD prevalence + risk factors • Morbidity • Depression • Diet, physical activity , smoking, alcohol consumption
Living: • Down wind • Down hill • Down stream • Most deprived are more likely to live near industrial pollution, derelict land, flood hazards & in areas of heavy traffic, noise and poor air quality
Outdoor environment and health INDIRECT HEALTH IMPACTS Safety and incivilitiesGeneral healthObesityPhysical activity Social contact Natural spacesPhysical activity Social contact Psychological well-being DIRECT HEALTH IMPACTS Natural spaces General healthMental healthBlood pressureCholesterolStress & anxiety Recovery rates Air pollution Cardiovascular disease Mortality Cancer Male fertility INDIVIDUAL/ COMMUNITY Floods Respiratory illnessStomach upsetsBlood pressurePsychological well-being Noise Heart diseaseHearing impairmentMental healthReading abilities in children Mixed land useObesitySocial contactPhysical activity Street designPhysical activityObesity Road Traffic Accidents Deaths AccessibilityObesitySocial contact
Direct impacts • People living in most deprived areas are exposed to poorer air quality than people living in more affluent areas
Short term impacts air pollution • Particles, NO2, SO2, ozone, CO • Exacerbation respiratory symptoms • Hospital admissions • Cardiovascular mortality • Days of restricted activity/off work
Long term impacts air pollution • Particles: especially PM 2.5 • Mortality: from all causes, lung cancer & cardio pulmonary mortality: 8 months decrease in life expectancy • In utero/childhood exposure leading to hypertension, type 2 diabetes, heart disease in later life • Low birth weight • Poor lung function development in children • Recent study evidence of impact on IQ • No threshold
Children & young people are most affected as more children and young people live in deprived areas
Triple jeopardy • Socio economic deprivation + • Poorer air quality + • Greater susceptibility to poor air quality
Triple jeopardy • Greater susceptibility due to: • Increased exposure to other pollutants and allergens - incl environmental tobacco smoke • Existing chronic disease • Unhealthy behaviours – diet alcohol • Chronic stress – (raised inflammatory disease markers)
Tackle the root causes • Recognise the connections between environmental • and health inequalities • Which increase risk of diabetes, heart and lung disease, risks which are increased by poor air quality caused by cars, traffic transport, development & planning policies & decisions …. • Air quality is a symptom of cars, traffic, transport, development • & planning policies and decisions • Which reduce social interaction, green space, & opportunities for physical activity • Which in turn lead to chronic stress & obesity,
Climate change • Air pollution is one symptom of a high carbon economy • No longer sustainable for health or environment • Local Area Agreement: national indicator on carbon emissions • Sheffield has target to reduce carbon emissions by 10% by 2011 – will require a reduction of 414K tonnes CO2 over next 3 years
Our challenge • Ecological footprint action research in Sheffield • Locally, as globally, those most affected by environmental and health inequalities tend to have smaller ecological (and carbon) footprints
Our challenge • To reduce carbon and reduce inequality • Housing: affordable warmth programme • Transport: low emissions strategy • Planning & urban design to encourage less car dependence/modal shift • A clearer & fairer future