1. Climate Change, Health and Communities: New times, New challenges Chris Church Community Environment Associates March 2013

2. Health and Environment: Making the links  These links are still poorly developed  Some specific issues provide focus  Energy / climate change  Fuel poverty, damp homes  Air Pollution  Thousands dying early each year, UK in breach of WHO standards  Transport  Not just air pollution – modal shift away from cars to cyclic and walking with demonstrable benefits

3. The Oxford Transport Study and Child health  Done by National Heart and Lung Institute at Imperial College  Oxford Transport Strategy (OTS), makes changes designed to reduce congestion in the city centre  1389 children aged 6–10 years attending first schools in Oxford are studied.  2–3 times a year for 5-day periods over 2 years. On each day of each visit children had their lung functions measured and were asked about their respiratory symptoms.  Findings suggest that traffic management may lead to localised improvements in childhood respiratory health  Benefits notably to children with respiratory problems and those from less affluent backgrounds.

4. An integrated approach: WHO Europe Processes as well as issues  WHO Europe’s ‘Third European Ministerial Conference on Environment and Health’ set out a full agenda:  Transport, Environment and Health  Water and Health  Children’s health and the environment  Human health effects of climate change  Economics, environment and health  Local Environment and Health Implementation  Access to information and justice in environment and health matters

5. Cumulative and Multiple Impacts This concept is critical to work on Health and Wellbeing. There are increasing concerns over cumulative and/or multiple environmental exposures and the way in which the risk resulting from exposure to one problem may be made worse by exposure to another. “Environmental problems may accumulate in four ways: i) spatial concentrations at particular geographical scales and localities; ii) through multiple health impacts; iii) the existence of particularly vulnerable groups (e.g. the very poor, the very young and very old); and, iv) as a result of ‘knock-on’ effects”

6. Health, Climate Change & the NHS  Saving Carbon, Improving Health, the “NHS CARBON REDUCTION STRATEGY FOR ENGLAND” – launched 2009  Why worry?  The need to take action on climate change  The impact of the NHS. WHY WORRY? (really!) The Lancet states that:  “Climate change is the biggest global health threat of the 21st century”  Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk.

7. New challenges  Climate Change presents us all with new challenges and new opportunities  Creating a low carbon society offers us a pathway to a socially just and healthy society  It is questionable whether we can achieve these goals without tackling public health

8. The challenges:  To work across disciplines  To work for the long term  To link the global, the national, the local...  A personal challenge...

9. The inter-disciplinary challenge The problems for inter-disciplinary working:  The relationships (and the power)  Timing and resources  Language and attitude  The boundaries and the complexity (7 sides to every story, JRF / CDF)

10. The health / environment interface Some extra problems....  Research suggested that the most developed disciplines – those with highly qualified professionals, institutions and traditions – may put up the most barriers, often without thinking.  Environmental Health, Public Health, ‘Environment and Health’, and Sustainable Development: four disciplines with different core work areas and cultures even though they overlap to a great extent.

11. From barriers to opportunities  The barriers (‘silos’) serve partly to protect those inside from stress and overload.  Any inter-disciplinary project that causes extra overload is unlikely to be successful  Inter-disciplinary work is most likely to be work if it develops adjacent to core areas and does not, certainly at first, seek to transform that core work.

12. The long-term challenge  Climate Change will be a problem for at least the next two generations  There will be a need for  Learning and remembering  Being ready to move on from accepted wisdom  This is an area where health professionals may have more experience than those working on environmental issues

13. Health and Wellbeing: risks and justice  Every individual and community is exposed to varying degrees of environmental health risks  Many of these are related to the ‘benefits’ of society – e.g. power production, transport  We need to be able to assess and minimise those risks  Some communities may receive a ‘disproportionate impact’ of certain risks

14. A range of environmental inequalities? Depending on circumstances these include:  Air Pollution  Industrial Pollution  Transport and Public Transport Access  Access to Safe Natural Green Spaces and Biodiversity  Noise

15. Other issues for Health and Wellbeing  Overall perceptions of local environment  Housing quality  Level of local activity on environmental issues?  Presence of local ‘environmental hub’ e.g. city farm etc.?  Contaminated land  Level of car ownership  Flood risk  Provision of recycling facilities  Cleanliness of streets

16. Moving forward  Health and Wellbeing Boards in the ‘new NHS’  HealthWatch as new agency: public involvement networks developed by some Boards  Public Health back on local council agendas  Community activity demonstrating results  Noise  Fuel Poverty  Air Pollution

17. Thankyou  See you at:  ‘Effective Local Action on Air Pollution in London’  University College London, April 17th  Community and expert speakers  C.church@mappingforchange.org.uk