What are environmental inequalities?
In the UK people living in the most deprived communities are more likely to experience poorer environmental quality than those living in the least deprived areas. The Marmot Review identified that environmental factors, such as air quality, access to green space and housing are crucial in driving health inequalities in the UK. This article explores how improving physical environments can help to reduce health inequalities, with examples of initiatives from across the UK and globally.
Air pollution, transport and traffic
The World Health Organisation estimate that air pollution kills 500,000 people in Europe each year.
Exposure to poor air quality can exacerbate conditions for those with existing health problems. For example, the most common pollutants, Nitrogen Dioxide (NO2) and Particulate Matter (PM), can irritate airways of the lungs and worsen lung and heart diseases. In London, there is a positive correlation between exposure to these pollutants and area-level deprivation. 46% of the Layer Super Output Areas within the most deprived 10% of London have concentrations above the NO2 EU limit value, compared to 2% above the NO2 EU limit value in the 10% least deprived areas. Residing in areas close to roads and industrial areas, which is affected by income, poverty and social exclusion, is associated with greater exposure to air pollution.
Individuals living in more deprived urban areas are more likely to have limited access to public transport and safe infrastructure for active mobility. Deprivation also increases the risk of road and traffic-related injury and death. Recent research in the UK found that Black, Asian and minority ethnic pedestrians living in poorer areas were 3x more likely to be injured or die than White people in more affluent areas.
What has worked to reduce air pollution?
Public Health England suggest prioritising interventions that prevent or reduce air pollution. Creating environments that promote active travel, such as restricting motor vehicle access, greater pedestrian space for walking and cycling, more road crossings and safer routes to school can help to prevent and reduce air pollution caused by transport and traffic. In the UK, a number of initiatives have been implemented to help reduce air pollution. These have largely involved reducing emissions from vehicles and transport and the pedestrianisation of areas. For example:
- Between 2014-2018, Brighton & Hove City Council achieved a 25% reduction in roadside NO2 and a 3µg/m3 reduction in roadside levels of Particulate Matter on the busiest lanes by exhaust retrofitting double deck buses and converting single deck buses to electric operation.
- The ECO (Efficient Cleaner Operations) Stars Fleet Recognition Scheme established in South Yorkshire in 2009, aims to reduce emissions from heavy duty vehicles including buses, coaches, HGV fleets and taxis. The scheme’s benefits have included a 12% NO2, 41% PM and 12% CO2 savings in emissions and fuel savings of at least 5%.
Access to green space
Access to green space, such as parks, woodlands, fields and allotments; is associated with a range of physical, social and mental health benefits. These include reduced levels of stress, increased physical activity, better community and social cohesion and improved air quality.
In the UK, there is evidence that those from economically deprived areas have less access to greenspace, are less likely to visit green space and are more likely to live close to busy roads. The percentage of homes without a garden is also higher among minority ethnic groups, with Black people in England almost four times as likely as White people to have no outdoor space at home.
How can access to green space in deprived neighbourhoods be improved?
A recent systematic review found that green space had greater protective effects for people from lower socioeconomic backgrounds than for more affluent groups.
Friends of the Earth recommend the following to tackle green space deprivation in England: protecting existing green space; introducing requirements to create new green space where provision is lacking; strengthening England’s land-use planning system; investing in green spaces to level up the benefits; factoring in cost savings and benefits to policies and decisions; ensuring quality and quantity of provision; making parks, green spaces and green infrastructure a properly funded statutory service; ensuring green space is provided for and with people of all backgrounds and making green space hubs for learning and skills.
What can be done to reduce housing inequality?
Internal housing conditions, neighbourhood characteristics and housing tenure can influence health. Rising house prices, inflation and Covid-19 are amongst some of the factors contributing to poor living standards and income inequality.
The Equality Trust suggest that to reduce housing inequality, the UK needs to replace the council tax system with a progressive property tax and to build more affordable housing.
A systematic review found that interventions that focus on moving disadvantaged people to lower poverty areas (such as tenant-based rental assistance programmes providing rent subsidies in the private sector or housing vouchers allowing low SES access to more expensive areas) may have some success in improving health outcomes and potentially alleviate health inequalities for those assisted. However, this may not help to improve overall conditions in these areas, leaving the remaining residents to struggle with the continuing problems.
Some European countries have initiatives in place that prioritise accessibility to affordable housing for lower income groups. For example, Vienna has kept housing affordable across the city by using municipal developments to keep the costs of renting down. Austria provides supply-side housing subsidies aimed primarily at the multi-storey sector, as well as single-family housing through the Limited-Profit Housing Associations (LPHA). The focus on supply-side subsidisation has kept Austria’s expenditure on social-housing by percentage of GDP lower than the UK and many other EU countries, with demand-side subsidies helping only the lowest income families.
Food environments have been linked to health outcomes. Obesogenic environments contribute to health inequalities. For example, in England the density of fast-food outlets in local authorities ranges from 26 to 232 per 100,000 population depending on their deprivation score (the higher the deprivation score, the greater the density of fast-food outlets).
The prevalence of obesity in adults and children is twice as high in deprived areas compared to those in less deprived areas. The following polices addressing the food environment have been proposed to reduce obesity and inequalities at a population level:
- Restricting broadcast and non-broadcast marketing for HFSS products
- There is evidence of a social gradient in junk food marketing exposure and recall.
- Greater support for local authorities to improve food environments
- Some local authorities in London have implemented planning policies on new fast-food outlets opening near schools. These locally enacted regulatory policies aim to limit the opportunities that young people have to eat ‘fast food’, although the direct impact on obesity and reducing inequalities is not yet known.
- Fiscal measures taxing unhealthy products and subsidising healthier options
- There is some evidence that increasing the price of sugary drinks and snacks, could reduce obesity and consumption amongst lower socioeconomic groups.
- The Healthy Start scheme in the UK targets pregnant women and families on benefits or with low incomes and provides vouchers that can be used to buy milk, fresh or frozen fruit and vegetables. The scheme has resulted in increased spending on fruit and vegetables by £2.43/month, equivalent to a 15.5% increase in spending compared to pre-reform levels.
Some local initiatives have been successful in reducing obesity amongst children from the most deprived socioeconomic groups. These include HENRY in Leeds, EPODE in France and JOGG in the Netherlands. However, overall, obesity levels continue to rise nationally. A whole systems approach addressing socio-cultural, living and working conditions and broader environmental conditions is necessary to improve diet, especially among those from lower income households.
Environmental health inequalities are widely prevalent across the UK and have serious implications for public health. To tackle environmental inequalities, local and national investment in urban and transport planning should be prioritised in deprived communities.
- Prioritising prevention of air pollution
- Ensuring better access and distance to safe green space areas
- Improving the supply of adequate social housing
- Increasing the National Living Wage to better assure a minimum income for healthy living and reduce in-work poverty
- Enacting policies that promote accessibility to and affordability of healthy food
Whilst policies to improve environments are crucial, local communities must be involved in decision-making to promote engagement and the sustainability of initiatives and policies.
Nicole Musuwo, July 2021