Centre for Health Services Studies Making Canterbury a healthier place to live: current issues and future solutions Professor Stephen Peckham

Centre for Health Services Studies chss 2 Canterbury: a healthy place?

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4 Main underlying cause of death: all ages - Canterbury 2014 Cancer Cardiovascular Other Respiratory England

Centre for Health Services Studies chss 5 Mortality from all causes Persons under 75

Centre for Health Services Studies chss 6 The Social Determinants of Health

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Centre for Health Services Studies chss 8 And spatial issues -

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Centre for Health Services Studies chss 11 Excess winter deaths Canterbury District already has higher excess winter mortality and this is likely to be exacerbated by the proposals in the District Plan. In the period Canterbury had the highest excess winter death ratio (22.7) in the County

Centre for Health Services Studies chss 12 General Fertility Rate(Live births per 1,000 women aged 15-44):

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Centre for Health Services Studies chss 15 Gap in life expectancy Life expectancy at birth: data

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Centre for Health Services Studies chss 17 Traffic and health

Centre for Health Services Studies chss 18 The traffic problem Transport plan: Do nothing scenario leads to an 18% increase in traffic flows Plan is to manage this to an increase of 10% However, increases will be concentrated in a few specific transport corridors: A291/A28 New Dover Road Shifting people from cars involves substantial investment in alternatives Problems with traffic modelling: It was based on fewer than 16,000 houses Does not take account of other developments Most schools are in Canterbury city Currently approx. 160,000 vehicle trips a day in Canterbury

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Centre for Health Services Studies chss 21 Canterbury : Average PM 10 levels (ug/m 3 ) by day and time in 2015 Statutory limitsMax days PM1050 µg/m324 hours35 40 µg/m31 yearn/a Maximum

Centre for Health Services Studies chss 22 Canterbury: Average and Max ozone levels (ug/m 3 ) by day and time in 2015 Average Maximum Statutory limits Max days Ozone120 µg/m3 Maximum daily 8 hour mean 25 days averaged over 3 years In 2015 Canterbury exceeded maximum levels (120ug/m 3 ) on 11 days

Centre for Health Services Studies chss 23 Canterbury : Average and maximum NO 2 levels by day and time in 2015 Statutory limitsMax days Nitrogen dioxide (NO2) 200 µg/m31 hour18 40 µg/m31 yearn/a Average Maximum

Centre for Health Services Studies chss 24 Canterbury St Peters Place site: Average NO 2 levels (ug/m 3 ) by day and time in 2015 Statutory limitsMax days Nitrogen dioxide (NO2) 200 µg/m31 hour18 40 µg/m31 yearn/a Average Maximum

Centre for Health Services Studies chss 25 Air pollution a leading cause of ill health In 2014 Public Health England estimated that air pollution in Canterbury contributes to 748 life years lost and an excess mortality of 81 people. Nationally the figure was 28,500 deaths. In September 2015 it was estimated that there are an additional 29,500 deaths due to diesel emissions. This would more than double the number of excess deaths in Canterbury and given links of diesel pollution to major health problems substantially more than double the number of life years lost.

Centre for Health Services Studies chss 26 Effect of NO 2 on children’s lung function Increased air pollution leads to both increased prevalence and severity of asthma – especially in children - placing substantial demands on local health services and poor quality of life for sufferers and their families.

Centre for Health Services Studies chss 27 And not just asthma… Exposure to fine particulate air pollution has adverse effects on cardio- pulmonary health leading to increased morbidity and mortality. A 10 μg/m3 increase in 24 h NO2 has been associated with increases in all-cause, cardiovascular and respiratory mortality, and with hospital admissions for respiratory and cardiovascular diseases. The International Agency for Research on Cancer (IARC) has classified outdoor air pollution as a class I carcinogen based on an association between PM 2.5 in outdoor air and lung cancer incidence or mortality. There are significant associations between long-term exposure to PM air pollution and lung cancer incidence in over 300,000 European subjects. “Air pollution levels should therefore be taken into account when considering the wider determinants of public health and the impact that changes in air pollution might have on the health of a population.” Bennett O, Kandala N-B, Ji C, et al. Spatial variation of heart failure and air pollution in Warwickshire, UK: an investigation of small scale variation at the ward-level. BMJ Open 2014;4:e doi: /bmjopen

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Centre for Health Services Studies chss 30 Why planning is critical to a healthy urban future Promoting Healthy Cities “… planning needs to be a critical part of our collective responses to the urban health challenge in the twenty-first century. Indeed, more generally, these papers demonstrate how the future of planning is critical to our collective future.” Cath Ranson MRTPI RTPI President

Centre for Health Services Studies chss 31 Healthy cities current priorities Core themes for Health 2020: Investing in health throughout people’s lives Tackling the major health challenges of infectious and non-communicable diseases Strengthening people-centred systems and public health capacity Creating resilient communities and supportive environments

Centre for Health Services Studies chss 32 Development and health There are strong links between spatial planning decisions and health outcomes. The need for rapid growth of new housing and associated facilities in the UK offers an opportunity to improve local outcomes through the delivery of high quality urban developments. The National Planning Policy Framework, Localism Act and Health and Social Care Act all contribute to increasing opportunities or requirements for joint-working between public health and planning.National Planning Policy FrameworkLocalism Act There is clear evidence that planning decisions can help create urban areas that promote health. Access to green space, high quality housing, safe and active transport and clean air are a few examples where there is strong evidence from research.

Centre for Health Services Studies chss 33 Achieving a Healthy Canterbury? Tackle inequalities – housing, education and poverty Tackling pollution and road accidents: Broaden approaches to reduce motor vehicle traffic Speed restrictions Diesel restrictions Improving housing: Access to affordable housing (estimated need over 490 houses a year) High standards of sustainability and energy efficiency Creating open spaces: Green spaces, tree planting Place health and the heart of planning and development: Reduce exposure to pollution Plan for health – the new healthy towns initiative

Centre for Health Services Studies chss 34 Should Canterbury join the Healthy Cities Network? Carlisle Population 75,000

Centre for Health Services Studies chss 35 What next? Establish a healthy city partnership: Local health organisations City Council County Council Universities Community and voluntary groups Local businesses Call for a Health Impact Assessment of the District Plan: Work towards sustainable development Aim for fairness and equality for all Target disadvantaged and marginalised groups Encourage the full participation of those to be affected by the plan Make use of evidence.

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