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    Up to a third of UK social class differences in health was probably caused by work 50 years ago. Since then, many hazardous jobs have been exported but new types of unhealthy work have emerged.
    Work can be bad for health but so is unemployment. The most disadvantaged suffer unemployment in recessions and poor-quality work during economic growth. Work in a safe and supportive environment benefits health.
    Chronic illness and disability often prevent obtaining such work, or lead to its loss. People with impairments should be employed for their abilities. Punitive ‘welfare to work’ policies damage health, cause stress and diminish self-respect.
    Profit-driven economic activity can damage health through pollution, environmental harm, unhealthy products and unhealthy lifestyles.
    Comprehensive occupational health services provide biological monitoring, employment rehabilitation, workplace clinical services and health promotion. They support workplace health and safety systems, identifying hazards, assessing risk, preventing occupational disease and supportively managing disability and sickness. They should also work with trade union health and safety representatives in the workplace.
    About a third of the workforce had a comprehensive occupational health service in the 1980s, a third had a partial service and a third had no service. 
    Most of the workforce today have no direct access to occupational health services.
    Occupational health services in the UK have never been statutory, but mostly employer-provided services. There have been campaigns to incorporate occupational health into the NHS, but by 1980 this was seen as medicalising the issue.
    But with no statutory duty on employers, occupational health services declined and were commercialised. Public ownership is essential to ensure accountability to workers’ health rather than to corporate interests.
    DiU (MPU) has often provided medical support to trade unions. Currently we offer solidarity and support through UNITE and the National Shop Stewards’ Network. We also liaise with the H&S representatives of other unions and the TUC.

    Doctors in UNITE (the Medical Practitioners’ Union) believes there should be National Occupational Health Services (NOHS) for England and devolved nations, including the following criteria:

    NOHS  should cover all workers, paid or unpaid.
    NOHS  should address occupational, environmental and commercial determinants of health.
    NOHS  would provide biological monitoring, employment rehabilitation, and health promotion, and support safety management. We will discuss later whether it should also provide clinical services at the workplace.
    NOHS  should normally be publicly provided, although where a satisfactory comprehensive occupational health service already exists in a particular workplace, and has the confidence of the trade unions, it could be publicly licensed and its role extended.
    NOHS  should be accountable to Parliament through a Minister for Industrial Health shared between DHSC, DWP and DBEIS.
    They should also be accountable to devolved Assemblies
    The existing national organisations for health and safety, employment of sick and disabled people, or control of pollution should be redesignated as part of the statutory comprehensive health service and should review ways to work together and fill gaps. This does not imply any major reorganisation.
    Locally NOHS should be controlled by workers (preferably through their trade unions), the appropriate regulatory agency (be that HSE or the local authority), consumer representatives and local communities. In a previous policy statement some years ago, we advocated joint control by employers, expert regulators and trade unions/ communities/ consumers, as that fitted with the tripartite model of health and safety current at the time. However, that model has not proved robust so we now feel NOHS must be controlled by those it serves.
    Professional independence is central.
    The issue of funding will be raised. In a previous statement we said this needs to come from employers, but funding from general taxation would enhance independence so increases in corporate tax would be better. As health services have a Keynesian multiplier in excess of the figure at which they become self-funding, it may actually not be an issue. At a Keynesian multiplier of 2.5, £1 spent generates £2.50 of growth which generates £1 of tax. Keynesian multipliers for health, education, welfare, recreation and cultural services, care, and social protection are significantly in excess of that – about 4.32 for health – implying that spending reduces the Government deficit.
    In smaller and medium sized workplaces, NOHS would be provided on a group basis. For the smallest workplaces (such as a corner shop) it might be provided by the kind of neighbourhood public health system which we have advocated in our paper “Public Health and Primary Care”.
    In creating safe and healthy systems of work and in biological monitoring NOHS would feed into a workplace health and safety system which managed the workplace environment, ensured safe systems of work and supported a supportive management of disability and sickness. This system must extend to contractors and volunteers as well as employees.
    NOHS and the workplace health and safety system must address stress at work not by victim-blaming “stress management” terms but through the factors in the workplace environment which we described earlier such as autonomy, social networking, training and resourcing of responsibilities, pleasant environments and work/life balance.
    There has been much debate about whether occupational health should also provide clinical services at the workplace. This must not dominate and take occupational health staff away from other roles. Many services described as “partial” in 1980 consisted of a factory nurse providing mainly clinical care. This led to doubts about the appropriateness of a clinical role. However, the workplace is a convenient place to provide certain types of health care, including screening, blood pressure measurement, stress counselling and treatment of minor injuries or minor illnesses manifesting at work. There needs to be a system for providing the simple front-line healthcare that in many countries would be provided by a “barefoot doctor” or “community health worker”. This should be planned on a universal basis, so as not to exclude retired or unemployed people, but for those who spend time at a workplace, either as an employee, a contractor or a voluntary worker, clinical care at the workplace could sensibly be a part. In providing such clinical services at the workplace NOHS would be linked to the NHS.
    In employment rehabilitation, NOHS would be linked to a Work and Health Service which would take over the disability functions of the DWP, would be part of the NHS (New Zealand is an interesting model here) and would offer employment-focused rehabilitation. Such services were previously operated by EMAS, by Employment Rehabilitation Centres and by Remploy but were inadequately resourced and only operated for the most severely disabled people – at the time we described it as “an excellent icing on a mouldy cake”. Government then shifted the function into a “welfare to work” model which operated too late in the process, missing the opportunity to retain people in work. Both of these systems were separate from the NHS clinical care of the patient, in which work needs to be a central factor.
    In addressing the environmental and commercial determinants of health NOHS would be linked to the public health system
    NOHS would have access to all levels of management and of regulation.
    NOHS needs specialist support from the NHS, laboratory services, environmental services, HSE, public health and academic institutions.
    NOHS should be part of the statutory health service. The 1948-74 terminology in which the statutory health service was called “the NHS” should be restored. Even with current terminology there are services NOHS should provide for the NHS, especially front-line health advice, health promotion and employment rehabilitation. NHS bodies may act as local providers of NOHS in some areas.



    Nottingham University Hospitals NHS Trust (NUH) is the first NHS trust to achieve the Soil Association’s Gold Food for Life Catering Mark for serving fresh, healthy meals – made with local, seasonal and organic ingredients. The Food for Life Catering Mark recognises food providers who prepare meals which meet high standards of traceability, freshness and provenance. The Gold Catering Mark means that at least 15% of total ingredient spend is on organic ingredients, and that menus make use of ingredients produced locally and in the UK.  77% of NUH’s raw ingredient spend is now on local ingredients. Meat, fresh produce, bakery products and milk are all sourced locally, ensuring security for local suppliers and helping the local economy. Switching to local suppliers has been cost neutral and allowed the Trust to invest £2m per year in local sustainable businesses.

    This means that NUH is able to supply patients, staff and visitors with high quality meals at an ingredient cost price of £4.53 per patient per day – this includes breakfast, lunch, supper snacks and seven beverages each day. NUH operates below the national average for patient day costs.


    Sustainable future?


    “…meeting our needs now…

    …without compromising the ability of others to meet their needs, now or in the future.

    Slow motion emergencies are usually hidden by noise, and our short term political / economic incentives –

    A slowly increasing baseline can suddenly increase the likelihood of extreme events – (those that exceed the red line)

    1.Experience is an important cause of ignorance.

    2.As much of the world becomes “wealthier”, it is often at the expense of others, both now and in the future. “Ecological paradox”

    3.There are very powerful anti-health and anti-fairness forces at work.

    Development as freedom

    To be healthy? means 

    …to have access to, and control over, those things that enable us to live lives that have value, purpose, and meaning…


    Creating the right environments for fair health:

    Human environment

    Who produces the greenhouse gases?

    Who bears the burden?

    40,000 early deaths across the UK per annum are attributable to air pollution. (60,000 if NOx from e.g. diesel engines included).  An average 8 month loss of life for every person, especially lung disease and stroke.

    “The opposite of poverty… isn’t wealth…

    Bryan Stevenson

    Bryan Stevenson

    … the opposite of poverty is justice.”

    Growth at all cost increases mental health problems1 and undermines equitable prosperity. The  Nuffield Foundation concluded: “What is striking is that, in a counter-intuitive way, rises in mental health problems seem to be associated with improvements in economic conditions and physical health.”


    StepO Meter

    It’s the law

    Climate Summit

    Climate Change Act 2008 and COP21, Paris 2015

    • Implementing the CCA08 is a legally binding agreement
    • An economy that is sustainable, fair and prosperous is not only possible, it’s happening:

    –one third of growth since recession is in the green economy

    –8% of the total economy

    • Off shore wind has halved in price in last 2 years (now cheaper than new gas)

    Public Services (Social Value) Act 2012:

    “…all public bodies in England and Wales are required to consider how the services they commission and procure might improve the economic, social and environmental well-being of the area.”

    Wellbeing of Future Generations Act

    The Global Goals

    Global Goals

    Merchants of Doubt

    More doctors smoke Camels

    Would you generally trust these people to tell the truth? (The Ipsos Mori Veracity Index 2016)

    Who do you trust?

    200 years of public health action

    200 years of public health action

    Priorities for government:

    1.Implement the existing laws that protect conditions that create and protect health and fairness.

    a)Polluter pays, zero carbon incentives, meeting climate change targets by rapid move to 100% renewables and a zero-carbon energy system.

    b)Social value through employment, procurement, investment, partnerships.

    2.Measure value and benefit, not just cost of sustainable interventions that deliver immediate AND long term health benefits (food, energy, travel)

    a)Infrastructure investments  (especially housing, food, and transport)

    b)Supply chains – legally mandated whole supply chain ethical auditing

    c)Alternative to traditional discounting rates of 3%, and 3 year ROI

    3.Redefine community health and prosperity beyond materialism

    4.Report by moving from Financial Reporting to Financial, social and environmental reporting (“Triple bottom line reporting”, “Integrated reporting”)

    This was presented at our conference Public Health Priorities for Labour

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    Climate change is here. With just over one degree of average global warming above pre-industrial levels we can already see the consequences including increased storms, droughts, heat-waves, polar and mountain ice loss and sea level rise. Atmospheric CO2 levels are now at a level higher than that experienced by any person ever. People worldwide are losing lives and livelihoods already.

    Fossil Free

    The 2015 Lancet Commission on Health and Climate Change concluded that, “climate change threatens to undermine the last half century of gains in development and global health”. They noted that,

    “The direct effects of climate change include increased heat stress, floods, drought, and increased frequency of intense storms, with the indirect threatening population health through adverse changes in air pollution, the spread of disease vectors, food insecurity and under-nutrition, displacement, and mental ill health.”

    We know that burning fossil fuels is the major contributor to CO2 pollution and global warming. For even a miserable 50/50 chance of avoiding 2 degrees of warming 80% of known fossil fuel reserves have to remain unburnt. This represents a “carbon bubble” of stranded assets.

    Yet the fossil fuel companies continue to seek new reserves and to exploit the existing ones. Many are also serial human rights abusers and climate change denial conspirators.

    Council pension funds collectively hold some £295 billion of assets invested mainly in stocks and shares. This provides returns from which pensions are paid. These investments include significant exposure to fossil fuels: £16.1B or 5.5% of their assets. There are also significant investments held by universities and health organisations such as the British Medical Association and the British Psychological Society.

    One the one hand, by continuing to plough funding into the fossil fuel industry, we remain locked into a fossil fuel future. On the other hand, if action is taken to prevent the exploitation of unburnable fossil fuels, then institutions are sitting on stranded assets (as the Bank of England has warned). In the case of pension funds, this means that the future of pensioners, future pensioners, their families and neighbours is threatened, as well as that for all citizens globally. Moreover, taking a financial hit on these assets will mean that to pay pensions, already stretched councils would have to dip into their budgets.

    Local government these days has public health responsibilities. It is this that has led to some funds divesting from tobacco (but not all – Hackney is increasing its tobacco investments). The reputational and liability risks are arguably there with fossil fuel investments too: already oil majors are facing collective lawsuits for their negligence and conspiracy. Discharging their “fiduciary duty” is consistent with taking climate and other environmental and social risks into account, thus going beyond a narrow focus on financial returns: The Pensions Regulator has confirmed this understanding following consultations by the Law Commission and the DCLG.

    Some pension funds in the local government scheme are showing the way with commitments to total or partial divestment: the Environment Agency Pension Fund, Haringey, Hackney, Waltham Forest, Southwark, and South Yorkshire. Others are dragging their feet with as much as 10% of their holdings in fossil fuels. Think what good those billions could do in the local and environmentally friendly economy, positively improving the health and well-being of the population.

    Already Unison and the TUC have adopted fossil fuel divestment as policy.

    Last weekend at its AGM, the SHA’s sister socialist society, SERA – the Labour Environment Campaign, also agreed to support these actions and work with the labour movement to promote fossil fuel divestment as a practical approach to reducing both environmental and financial risk.

    SHA members can support the fossil fuel divestment campaign in a number of ways.

    Fossil Free UK coordinates campaigns for local government pension funds to divest: find out how exposed your fund is at this link.

    Medact campaigns for fossil fuel divestment by health institutions and has an excellent practical guide at this link.

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    It is now widely argued that humanity has entered a new geological epoch – the Anthropocene – characterised by the unprecedented scale, scope and interactions of multiple human impacts on the biosphere.  Climate change is the most familiar of these impacts, but it is far from the only one, and understandings of what the concept of the Anthropocene means for health policy and public health practice are still at an early stage.  The idea of the Anthropocene can also serve as a ‘window’ into broader issues related to the connections between environment and health, in such contexts as the health consequences of urban air pollution and the health implications of how cities are designed and managed.

    In 2013, the normally cautious International Agency for Research on Cancer designated ambient air pollution as a Group 1 carcinogen, the category for which evidence of carcinogenicity from multiple research designs is strongest.  As Eugene Milne and I point out in the Autumn, 2017 issue of the Journal of Public Health (of which we are joint editors), this was probably the most under-reported public health story of 2013.  According to the World Health Organization, most of the millions of premature deaths attributable to ambient air pollution occur in low- and middle-income countries, but air pollution’s health impacts are not confined to far-away places.  Exposure to particulates and nitrogen dioxide in outdoor air pollution probably accounts for around 40,000 deaths per year in the UK, and they are unequally distributed.  ‘Residents of leafy suburbs’, we wrote, ‘do not face the same exposures as those living, working and walking in traffic-intensive urban settings; indeed that leafiness itself is to some degree protective’.

    A special section on environment and health in the new issue of the Journal foregrounds the findings of a massive effort by Annette Prüss-Ustün and colleagues to update WHO estimates of the global burden of disease attributable to environmental determinants of health.  They conclude that just under one-quarter of global deaths and disability-adjusted life years were attributable to environmental exposures in 2012 – although ambient air pollution exposures were only one contributor.  Especially critical from a policy and equity perspective is their observation that:  ‘The lower people’s socioeconomic status the more likely they are to be exposed to environmental risks … Poor people and communities are therefore likely to benefit most from environmental interventions as they are disproportionally affected by adverse environments’.

    The environmental justice movement in the United States has been making this point for quite a long time.  The importance of making the connection between unequal environmental exposures and broader socioeconomic factors is underscored by situations like the poisoning of residents of once-prosperous Flint, Michigan.  There, a one-two punch of deindustrialisation and cost-cutting in public services led to a situation in which residents, now predominantly African-American, were exposed to toxic levels of lead and other contaminants decades after all the scientific evidence was in place.  (A more extensive list of references on the Flint situation is available from the author.)

    In our editorial, we also argued that technical fixes like policies supporting or subsidising a shift to electric vehicles may be inadequate responses to the equity issues raised by how societies design transport systems and urban infrastructure more generally, revisiting the question asked in a 2011 Journal article: ‘Are cars the new tobacco?’  The authors concluded that they are.  The UK’s Sustainable Development Commission, now unfortunately disbanded, took an even more holistic and thoughtful view in a report on Fairness in a Car-Dependent Society that is still available online.  Like the broader idea of the Anthropocene, these perspectives direct our attention to the functional and ethical inadequacy of incremental solutions.

    These issues are in no way confined to the United Kingdom.  The illustration shows the realities of simultaneous exposure to risk of traffic injury and high levels of pollution in a low-income area where I used to work in downtown Ottawa, Canada’s national capital.  Think of the multiple exposures of the wheelchair user in the picture, and contrast them with the ‘epidemiological world’ of the occupants of air-conditioned vehicles just feet away.  Above and beyond such failures of humane planning, high-income countries continue to subsidise fossil fuel consumption in a variety of ways.  For instance, in 2014 the OECD pointed out that good, green Germany subsidised company cars through its tax system to the tune of almost €2,500 per car per year.  This is grotesque on both environmental and equity grounds.  Outside the high-income world, transport policy in many countries prioritises convenience and speed for a car-owning domestic minority and foreign investors and tourists who demand ‘world-class’ infrastructure – a global health equity issue that deserves far more attention than it has received.

    Encouragingly, at least in the academic world more attention is being paid to such questions.  A lead article in the September issue of The American Journal of Bioethics calls for integration of the fields of environmental ethics, public health ethics and bio(medical)ethics.  Today, despite shared values and overlapping concerns, people and institutions concerned with these areas often don’t talk to one another.  Coincidentally – well, not really – the new issue of the Journal of Public Health also includes a call for contributions to a special section on public health ethics, which will appear in 2018.

    This was first published on the Policies for Equitable Access to Health blog

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    This paper introduces a project (Live Sustainably – Live Well) to develop local arrangements supporting the attainment of the UN Sustainable Development Goals (2015)  as well as supporting the attainment of public health policy locally to WHO recommendation (2). It recommends the publication of local guidance on attaining the Goals and WHO Health Policy, drawing upon local, national and international sources. Such guidance could include links to appropriate resources and would allow for the participation of NGOs, faith communities, trade unions and neighbourhoods. It might also be extended to include the monitoring of health and sustainability indicators locally.

    The United Nations Sustainable Development Goals (2015) 

    The United Nations Rio+20 Summit (2012) committed all UN member nations to develop a set of universal sustainable development goals, to build on the millennium development goals , set to expire in 2015. The UN Sustainable Development Goals were published in September 2015. They seek to address Climate change and to avoid the dangers of crossing other planetary boundaries (boundaries describing a safe operating space for humanity in a period of massive human inspired change in the Biosphere), whilst creating a new global framework to eradicate extreme poverty, reduce inequality and expand opportunity. They seek to end hunger and food insecurity whilst ensuring healthy lives and wellbeing for all. The UN Human Development Report 2011 states that the success of such initiatives will be dependent on local action and support by communities.

    The introduction of the Goals was probably influenced by the work of climate scientists who had argued for the need to address not just Climate Change but a set of Planetary Boundaries designed to point to a safe operating space for humanity at a time of increased damage to the planet recognised as being caused by human activity.

    The Stockholm Resilience Centre observes that‘ In 2009, … a group of 28 internationally renowned scientists identified and quantified the first set of nine planetary boundaries within which they suggested, humanity can continue to develop and thrive for generations to come. Crossing these boundaries could generate abrupt or irreversible environmental changes. Respecting the boundaries reduces the risks to human society of crossing these thresholds’. The Boundaries also have a regional dimension (so local action is appropriate-implied)’

    Johan Rockstrom and W. Steffen have argued that: ‘The world needs a new paradigm for development, one that pursues alleviation of poverty and economic growth while staying within the safe planetary boundaries that define a stable and resilient planet’ Johan Rockstrom and Mattias Klum suggest the need: ‘…to give the world a new framework to redefine global development by reconnecting economies and societies to the planet’ ..‘Climate Change is not just an environmental issue it is an economic and social one. This means that any future climate solution would require action in our economies, financial systems, how we build our cities, produce food and relate to one another . ‘We know that sustainability not over exploitation is the real basis for human wellbeing’, ‘There is a need to define a safe operating space for humanity on a stable planet’

    Other influential writers have noted that:

    Research now indicates that humanity’s impact on Earth’s life support system is so great that further global environmental change risks undermining long-term prosperity and poverty eradication goals.’ (Griggs et al, 2015)

    Transgressing a boundary increases the risk that human activities could inadvertently drive the Earth System into a much less hospitable state, damaging efforts to reduce poverty and leading to a deterioration of human wellbeing in many parts of the world, including wealthy countries, ‘Professor Will Steffen, researcher at the Centre and the Australian National University, Canberra..

    The new Sustainable Development Goals ’ … support ‘ a comprehensive framework of goals and associated targets, which demonstrate that it is possible, and necessary, to develop integrated targets relating to food, energy, water, and ecosystem services goals; thus providing a neutral evidence-based approach to support the Goals’ (Griggs et al 2015) and their attainment.

    The UN Human Development Report (2011) believes that cities and communities have a major role to play in advancing this type of approach to sustainable development. It suggests that people must be given the opportunity to influence their future, claim their rights and voice their concerns. Democratic governance and full respect for human rights are key prerequisites for empowering people to make sustainable choices. Local communities must be encouraged to participate actively and consistently in conceptualizing, planning and executing sustainability policies. The long-term vision to eradicate poverty, reduce inequality and make growth inclusive, and production and consumption more sustainable, while combating climate change and respecting a range of other planetary boundaries.

    WHO Policy Framework – Health 2020 

    Healthy Lives and Wellbeing are also aims of the new WHO Policy Framework (Health 2020) influenced by the Marmot Reports.. This sees sustainable living as being essential for healthy lives. The Policy Framework calls for the creation of supportive environments and resilient communities which implies the need for local organisation and local action.

    British society is and has been characterised by extreme inequalities which bear upon health and, by implication upon access to sustainable lifestyles. These have been identified by several reports (Black Report (1980),  Acheson Report (1998), Marmot (2008 & 2010), by the ONS statistics and Multiple Deprivation Indices (published since 2000), and by several academic studies (Marmot and Wilkinson (2003), Wilkinson and Pickett (2009). The Marmot UK Report stresses the critical importance to health of sustainable living and supportive environments action as essential to reduce inequalities. The UN Sustainable Development Goals (2011) also call for action on inequalities. The recommendations of the Marmot Reports have been incorporated into the WHO Policy Framework ‘Health 2020’.

    Health 2020’ represents a consensus of health policy makers, practitioners and academics as to the best possible approach to health Improvement in modern conditions. It is ethical, rooted in the concept of health as a right and the idea that sustainable living represents the best platform for working for health improvement. It seeks to improve health and reduce Health Inequalities. Health 2020’ can be applied at any level including the local. It includes: two strategic objectives: 1) improving health for all and reducing health inequalities and 2) improving leadership and participatory governance for health.

    Health 20/20 identifies four priority areas these are;

    1. Invest in health through a life-course approach and empower citizens.
    2. Tackle Europe’s major disease burdens of noncommunicable and communicable diseases;
    3. Strengthen people-centred health systems and public health capacity, including preparedness and response capacity for dealing with emergencies;
    4. Create supportive environments and resilient communities.

    Many British cities such as Brighton, Manchester, Liverpool and Cardiff have committed to implementing ‘Health 2020’ as WHO Healthy Cities however their ability to implement the policy is restricted by severe public expenditure cuts. Implementation of Health 2020 would require the engagement of the wider community, NGOs, trade unions, faith communities and the third sector in the public health agenda. 

    Marilyn Rice and Trevor Hancock  write that “Although local government has a key role to play in creating a healthy community, it cannot play that role alone. Regardless of their priority area of concern – whether it be the environment, social activities, education, safety, public works, or any other – community members and organisations are also responsible for improving the living conditions, health and quality of life of the people living in their community and they are and need to be participants in that process”

    Health Policy and the Settings in which it Operates

    Health Policy has also been influenced by the Ottawa Charter on Health Promotion (1986), ‘Health is created and lived by people within the settings of their everyday life, where they learn, work, play and love’. .’People should not be seen in isolation of the larger social units in which they live’ (This is known as the Healthy Settings Approach).

    According to the Ottawa Charter, Health Promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but of all sections of society, it goes beyond healthy life-styles to well-being.

    The fundamental conditions and resources for health described by the Ottawa Charter for Health Promotion were: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity. Key strategies for health under the Charter included the need to build healthy policy, create supportive environments, strengthen community action and reorient health services which can be supported by local action.

    WHO Health Policy, which has been influenced by the Ottawa Charter and the Healthy Settings approach, has formed the basis of many successful international policy initiatives such as Healthy Cities and action to challenge the social determinants of health. This approach has also been used to create a health and supportive environment in some institutions such as Healthy Schools and Healthy Universities.

    The Transition REconomy Project as a example of Local Action on Economy

    The REconomy Project  is part of the Transition Network , a global grassroots movement of communities seeking to strengthen their resilience to problems including climate change, rising energy prices, economic uncertainty and inequality by transitioning to a low-carbon economy, relocalizing production for basic needs, reskilling and emphasising connectedness, the Movement believes that the most appropriate level for this work is the community. REconomy works at creating new livelihoods and enterprises, and expanding their area of influence deep into their local economic system.

    Public Health and Sustainable Living

    Professor Blake Poland of the University of Toronto has argued that; Climate change, Ecosystem degradation, Widening socio-economic inequities, Resource depletion and Energy insecurity, problems recognised by the Transition Movement, also pose major problems for public health. There is a need to;

    1. Understand and report on the health implications and impacts of our current unsustainable forms of development;
    2. Propose healthier public policies that support the transition;
    3. Communicate the importance of this issue, the health implications of our present path and the health benefits of the transition effectively with key stakeholders;
    4. Work with others (sectors, movements, communities) collaboratively to bring about desired (cultural, social, policy, practice) change.

    Marilyn Rice and Trevor Hancock  suggest that; “We also need to address … global ecological and social challenges through local action in the settings where people lead their lives – and cities provide the overarching setting and context for this by including their homes, schools and universities, workplaces, hospitals and communities. A key strategy needs to be linking ‘healthy setting’ initiatives and ‘sustainable setting’ initiatives through global, regional, national and local networks specific to this purpose”

    Rebecca Patrick, Mark Dooris and Blake Poland argue that;

    Healthy Cities (based on the Ottawa Charter) can;

    1. Help the Transition Movement broaden its understanding of health.
    2. Develop a Co-benefits approach progressing strategies and agendas that are win-win for public health, carbon reduction and ecological wellbeing
    3. Support shared learning.
    4. Strengthen community and political action

    This paper suggests that the application of the WHO Policy Framework ‘Health 2020’, the application of the Ottawa Charter for Health Promotion (1986) and the attainment of the UN Sustainable Development Goals (2015) could be facilitated by local action within a project with similarities to the ‘Reconomy Project’, such as ‘Live Sustainably –Live Well’. International and national policy requirements could be better communicated to local communities, trade unions, faith communities and NGOs leading to better and more informed decision making.

    The advantages of using the international policy frameworks for Public Health and Sustainable living locally are;

    1. Increased attention and focus given to the possibility of local decision making including the application of ‘Subsidiarity’, decisions which affect people’s lives being taken at the most appropriate local level.
    2. Better quality and better informed local decision making.
    3. Less reliance on the kind of vested interests, for instance, as identified by Ivan Illich and David Simon, as this approach should help people minimise their vulnerability to such interests.
    4. In decisions on food and nutrition this approach could support the better attainment of health and sustainability criteria. It would reduce the market impact of major organisations such as Asda, McDonalds and TESCO.
    5. It would tend to reduce the effects of the massive deficit in movement which lies at the heart of many health problems, whilst reducing the impact of carbon intensive forms of transport such as driving.
    6. It would support better co-ordination in achieving policy aims locally

    The World Health Organisation and health academics such as Sir Michael Marmot believe that there is a relationship a between Healthy and Sustainable Living so any local green economics process or local sustainable initiative needs to recognise this relationship or it is likely to create or exacerbate inefficiency and unfairness and this is likely to undermine its effectiveness. Decision making at every level is likely to be fairer and more efficient if the full health and sustainability effects are taken into account.

    This initiative (Live Sustainably – Live Well) might be structured around the UN Sustainable Development Goals and might include both national and local guidance on working to attain the Goals locally with links to appropriate resources. It might support the local monitoring of indicators. The Ottawa Charter points to the need for the inclusion of: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity. Health 2020 points to the inclusion of local action on reducing inequalities, the need for good governance, the need to address ageing as well as the health of mothers and children within a life-course approach and the importance of health systems and the need to address the determinants of health locally.


    This paper has suggested that local action to support the UN Sustainable Development 2015 and the WHO Policy Framework ‘Health 2020’ is appropriate to influence the local economy in a way which has similarities to the ‘REconomy’ Project of the Transition Network’, leading to better and more informed actions, decision making and monitoring locally, benefiting the locality . This project to be initially designated ‘Live Sustainably…Live Well’

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    Air pollution may increase cardiovascular disease risk by lowering levels of high-density lipoprotein (HDL), commonly known as “good cholesterol”, according to new research in the American Heart Association’s journal Arteriosclerosis, Thrombosis, and Vascular Biology.

    Scientists at the University of Washington found that higher exposure to black carbon (a marker of traffic-related pollution) averaged over a one year period was significantly associated with a lower “good” cholesterol level.

    The findings are part of an ongoing U.S. study examining the lifestyle factors that predict development of cardiovascular disease.

    This study follows a large, diverse population and looked at time and place to estimate air pollution exposure for each study participant.

    Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation, said:

    “There is an urgent need to fund more research that looks in to the dangerous effects of air pollution on the cardiovascular system. This silent killer is related to 40,000 deaths in the UK each year, with eight in ten caused by a heart attack or stroke.

    “This is an interesting study showing an association between higher air pollution and lower levels of HDL-cholesterol, often called ‘good cholesterol’. The effects are small and recent studies have questioned whether lower levels of HDL-cholesterol cause heart disease. Furthermore, air pollution causes a myriad of changes in the body – for example it also increases blood pressure  – and therefore it is difficult to know how much contribution, if any, the observed difference in HDL-cholesterol makes to the risk associated with air pollution.

    “This means it is still too early to say how these findings might fit in to the wider picture, but the underlying message is the same: air pollution poses a serious risk to heart health.”

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    The process of produced a plan on transport and the environment

    Problems with roads

    Air Quality

    Ambitions for the city – cycling

    Vision for the environment

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    Barts Health Trust case study


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    North West Leicestershire is about to publish its Local Plan. An inch thick, this pedestrian document tells us that this Council will co-ordinate a wide range of other organisations to ensure infrastructure is provided at the right time and in the right place to absorb the impact of new housing developments and provide for the health needs of people moving into the area.

    The best predictor of future behaviour is past behaviour.

    At a recent Policy Development Group, a cross-party committee of elected Members pursued the fate of £1.3M of developer contributions for health that remained unspent, some of it at risk of being paid back.

    Lacking a root cause analysis local GPs, NHS England and Council planners were involved in a blame game. The tangle of red tape, risked developers laughing at the public sector as they re-pocket money returned with interest.

    Teasing this mess apart has allowed some funds to escape the log-jam and NHS England we are now spending some s106 money on Long Lane Surgery in Coalville and on a surgery in Measham. But I am not taken in by this snippet of good news. Nor do I trust in future solutions such as moving to a Community Infrastructure Levy. My GP informants still describe a legal system that makes easing this money out of the bureaucracy so difficult that most clinicians give up.

    Remaining focused on funding GP premises, when so much else is pushing healthcare into the abyss, is almost certainly not enough. A Local Plan with vision would look beyond the immediate needs of service providers, such as GPs to the wider determinants of public health.

    Loneliness is a killer. Thanks to the developer-centric demands of the National Planning Policy Framework, the Council’s plans for cultural facilities in Policy IF2 grudgingly allow their expansion if the community can prove an increase in demand.

    After the closure of the iconic Snibston Discovery Museum perhaps I should not complain that the Plan appears to major instead on preventing existing community buildings from being demolished.

    My colleagues in public health should be pleased to see that the Plan does have a detailed section on transport infrastructure. The Royal College of Physicians reports that there are 40000 deaths a year due to poor air quality mostly from exacerbations of asthma and COPD. We know that we have road junctions that repeatedly breach air quality guidelines including the Copt Oak and Broom Leys junctions.

    According to the RAC North West Leicestershire along with neighbours South Derbyshire are in the top 10 Districts where working people are obliged to use their private car to go to work.

    It is axiomatic that wealthier communities are healthier communities. Ensuring people in North West Leicestershire can access properly paid employment has to be a key public health strategy.

    In supporting this Plan going forward for consultation, I am therefore particularly pleased to support Policy IF5 in which North West Leicestershire, in direct contrast to the County Council, commits itself to supporting the provision of public transport on the Leicester to Burton line.

    Providing East-West connectivity and putting the former mining town Coalville of back on the railway map, as HS2 looks increasingly unaffordable, it would be good to get national support for this important public health intervention.

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    In 2010, the Marmot Review highlighted the increasing evidence that environmental factors exacerbate health inequalities. The three year inquiry found that, in England, the lower a person’s social position, the worse his or her health. In 2016, the UK’s controversial breach of European air quality standards provides us with a very clear example of the ongoing health inequalities identified in the powerful 2010 report.

    Poor air quality, which is principally caused by emissions from vehicle engines and degrading tires, has accounted for between 40 and 50 thousand premature deaths in the past year. PM10 and PM2.5 particulates penetrate deep into the lungs and the cardiovascular system causing hundreds of thousands of citizens to need treatment from the NHS for heart disease, lung cancer and stroke. The nitrates and sulphites which are exhaled from diesel exhausts exacerbate asthma, cause lung disease and increase susceptibility to infections.

    A recent report from the World Health Organisation found that as much as 80 percent of the UK’s population has been exposed to harmful levels of noxious air, with 39 urban areas, including London, Glasgow, Leeds, Nottingham, Southampton and Oxford found to have breached safety levels.

    Within these cities it is the most deprived communities that are generally located in close proximity to high risk pollution hotspots – major transport axes such as railway stations or depots, main roads, busy junctions, airports and flight paths. The situation is made worse because the most vulnerable members of those communities are also the worst affected by poor environmental health: the young; the elderly and those who already suffer physical or mental health problems.

    And inequalities extend beyond the home to the work place where it is those in lower paid jobs and often working on the roadside, such as street cleaners, refuse workers and parking staff that are most at risk.

    In the longer term Government must comply with EU regulations and give local authorities the powers and resources needed to remove polluting vehicles from areas of high population, in particular schools, hospitals and GP surgeries. These powers would also allow local authorities to invoke licensing and procurement powers to drive more efficient technology standards in public transport, in particular buses.

    But whilst the politics of Westminster sorts itself out, the health sector has an important role to play in improving, as far as possible, local environmental conditions (the air we breathe) and workplace safety.

    Working with local authorities, through their Health and Welbeing Board, GPs and hospital managers can invest in programmes that raise awareness of the risks associated with air pollution. They can invest in better local monitoring of pollution levels and require contractors, such as street cleaning or refuse collection companies, not to put their workers at risk in the areas with the highest levels of pollutants. And they can support programmes, such as those delivered with Barts Health NHS Trust to provide the most vulnerable individuals with the information and stimulus needed to change their travel patterns and reduce their personal or family exposure. Results from this programme will be launched on 21st June.

    Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities, which currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs. It is also the basis of a fair society. But if we are to give every child the best start in life, create good work places for all and ensure a universally healthy standard of living, the health sector must play its part in delivering clean air right now.

    Hugh Goulbourne is a Director at environmental charity, Global Action Plan, and a policy adviser to Deputy Leader of the Labour Party, Tom Watson MP

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    Amid growing fears amongst Labour and Tories alike about the scale of the NHS deficit, it is more than a little surprising that the recent announcement of a £50m investment by the UK Green Investment Bank (GIB) into the energy efficiency of the NHS went almost unnoticed. Thankfully hope has come in the form of Labour’s Energy Green Paper. Launched in November it provides an opportunity for Labour to reflect on the growing evidence about the role of energy efficiency in staving off cuts and driving up staff and patient satisfaction within the NHS.

    The NHS is one of the UK’s most energy intensive organisations, spending more than £750m on energy costs each year. The GIB estimates that energy efficiency measures could, across the UK, cut the NHS’s current £750m bill by up to 20%, saving a substantial £150m each year.

    The GIB loan, which will also help the NHS to get back on track to make 34% cuts in carbon emissions across the NHS by 2020, will mean that a handful of lucky NHS Trusts and Health Boards won’t need to find capital upfront to cut their hefty annual energy bills. Instead the money saved by reducing their energy bills will be used to cover the cost of repayments to the GIB.

    The first project funded by the GIB will be at Queen’s Medical Centre, part of Nottingham University Hospitals NHS Trust, where £7.5m is being invested to finance the installation of a suite of new energy production and reduction measures. This investment is being made following a number of pilot projects, such as the Ashden Award winning Operation TLC project at Barts Hospital Trust in London.

    But investment in energy efficiency technologies is just part of a more holistic sustainability journey which could, if scaled up quickly, provide a wider solution to the funding problems of the NHS. The Operation TLC project at Barts Hospital Trust has proven that energy saving programmes empower frontline staff to take a different approach to the way that they improve patient care.

    Over a period of six months nurses were assisted by staff from environmental charity Global Action Plan, to create a more healing environment by switching off none essential machines, turning out lights and closing doors. These simple actions reduced excessive heat, noise and light pollution, improved patient safety and privacy and better-regulated room temperatures.

    The programme showed that where energy efficiency measures are matched with simple changes in the way that nurses and doctors use their hospitals then the results achieved go far beyond simply saving energy. At a time when there is a growing realisation that technology and drugs are not the panacea to our public health issues, the programme has empowered nurses to think creatively about how to improve patient care. With a 25% improvement in sleep and 30% improvement in restfulness for patients, Operation TLC has created a cultural shift within hospitals with nurses given permission to run their wards in a way that places a healing environment above all other interventions.

    The energy efficiency drive looks set to spark a change in the NHS that will cut its core costs, meet climate change targets and help hospital staff to become more innovative about reducing patient recovery times. But to achieve this the NHS needs a Labour Government that will raise the scale of investment ambition to three times the amount that was announced by the GIB last month. Between 2015 and 2020, £150million of investment a year would lock in a generation of savings of £150m across the NHS and improve patient care. Now that sounds like a manifesto pledge to unite the Labour movement and leave the Tories behind.

    First published on LabourList

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