Summary

The IMD measures levels of deprivation using a range of indicators under different areas or ‘domains’. The domain for ‘Deprivation and the Physical Environment’ is split into two subdomains: the ‘indoors’ physical environment which measures the quality of housing, and the ‘outdoors’ physical environment, which contains two measures relating to air quality and road traffic accidents.

There are 44 areas that fall within the 20% most deprived for the physical environment in Merton. In terms of reduction in Killed or Seriously Injured (KSI) casualties, Merton has made significant progress in reducing the number of KSIs and further progress is expected. A reduction of 58% was achieved between the 1994-1998 five year average and 2009 (compared with an average reduction across all boroughs of 52%). Fatalities fell by 16% (159 to 134), KSI casualties increased by 8% in 2012 to 3,018 compared with 2011. Within this, the number of serious injuries increased by 9% (2,646 to 2,884). Slight injuries fell by 3% (26,452 to 25,762) and overall casualties in 2012 fell by 2%, compared with 2011.

Air quality is an important public health issue in London. Poor air quality contributes to shortening the life expectancy of all Londoners, disproportionately impacting on the most vulnerable. Air quality in London is the worst in the country. Poor air quality exacerbates heart and lung conditions such as asthma, and chronic obstructive pulmonary disease. Local authorities have a statutory duty to manage local air quality and are required to carry out regular reviews and assessments of air quality. The main issue with our local air quality has been found to be emissions (relating to NO2and PM10) emanating from road vehicles. Based on the nonautomatic monitoring and assessments undertaken it was found that some of the air quality objectives would be exceeded in areas where there was relevant exposure. As a consequence the Council designated the whole of the borough as an Air Quality Management Area (AQMA) for annual mean objective and 24hour mean PM10 objective.

The Council currently maintains one NO2 automatic monitoring station located on the first floor of Morden Civic Centre, which therefore falls into the category of a roadside location. Sampling is taken 4m from ground level, at a distance of 3m from the kerbside. There is no automatic particulate monitoring.

Local recommendations

  • Embed HIA into existing assessment processes in the local authority.
  • Expand access to green space.
  • Prioritise policies and interventions that both reduce health inequalities and mitigate climate change, by improving:
    • active travel across the social gradient
    • the quality of open and green spaces across the social gradient
    • the quality of food in local areas across the social gradient
    • the energy efficiency of housing across the social gradient.
  • Fully integrate the planning, transport, housing, environmental and health systems to address the social determinants of health in each locality
  • Support locally developed and evidence-based community regeneration programmes that use spatial planning to remove barriers to community participation and action and reduce social isolation.
  • Use the Healthy Placesresource, an online tool put together by a team from the UK Health Forum. This tool highlights how local authorities can use existing laws ‘that have the potential to change local environments and encourage more active lifestyles and better diets

Key facts on deprivation and the physical environment

The IMD measures levels of deprivation using a range of indicators under different areas or ‘domains’. The domain for ‘Deprivation and the Physical Environment’ is split into two subdomains: the ‘indoors’ physical environment which measures the quality of housing, and the ‘outdoors’ physical environment, which contains two measures relating to air quality and road traffic accidents.

There are 44 areas that fall within the 20% most deprived for the physical environment in Merton.

Addressing inequalities in Merton – IMD: Physical Environment.

 

Lower Super Output Areas (SOAs) by National Rank Quintiles

Source:Department for Communities and Local Government

©Crown copyright 2012. All rights reserved. ©1994-2012 ACTIVE Solutions Europe Ltd

Key facts on transport

Risk of death and serious injury on the roads

The Mayor's Transport Strategy (MTS) sets out his transport vision for London and details how Transport for London and partners will deliver the plan over the next 20 years (2010-2030) –road traffic casualty reduction is of the highest priority.

From Police STATS19 forms information (recorded when the police attend a collision) the main causal factors in road traffic accidents are attributed to human error. These are issues of failing to look properly, reckless or in a hurry and poor manoeuvring of vehicle. In certain incidents street lighting and weather conditions were also contributory factors. Mention is made in the Mayor’s Plan of Haddon’s Matrix which is a system advising how, when and where to act in reducing casualties

Factors listed of pre-crash, crash and post-crash interventions show that Merton already provides the human and environment recommendations of education, training, campaigns and enforcement as detailed below.

Of significant concern is the average cost per reported road accident casualty and per reported road accident: GB 2011 (see table below).

Cost per casualty and per road accident (GB 2011)

Category Cost per casualty Cost per accident
Fatal £1,686,532 £1,877,583
Serious £189,519 £216,203
Slight £14,611 £23,136

Source: Department for Transport. A valuation of road accidents and casualties in Great Britain in 2011

The Mayor’s new target is a 40% reduction in Killed or Seriously Injured (KSI) casualties, from a baseline figure of 65 (2005-09 year average).

The reduction in road traffic KSIs from the new Mayoral baseline of 65 casualties to 45 should be achievable, based on Merton’s previous actions on delivering casualty reduction targets including:

  • Reduction of road traffic casualties is a priority for the Council (e.g. Merton’s Community Plan)
  • Merton’s LIP2 includes a proposed MP1 specifically to address reducing road traffic casualties
  • The Mayor’s Safe Streets for London Action Plan provides an improved methodology for tackling casualty reduction.

Merton has made significant progress in reducing the number of KSIs and further progress is expected.

A reduction of 58% was achieved between the 1994-98 five year average and 2009 (compared with an average reduction across all boroughs of 52%).  

Fatalities fell by 16% (159 to 134), KSI casualties increased by 8% in 2012 to 3,018) compared with 2011. Within this, the number of serious injuries increased by 9% (2,646 to 2,884). Slight injuries fell by 3% (26,452 to 25,762) and overall casualties in 2012 fell by 2%, compared with 2011.

In 2012 overall casualty figures rose in nearly all sectors but most significantly for pedal cyclists, car drivers (and passengers) and bus/coach drivers (and passengers). Cyclist statistics rose by 31% over the previous year with no fatalities but 50% more KSIs recorded. Most collisions occurred at “T” or staggered junctions, which make the proposed work to these junctions appropriate.  

Other areas of concern were at give way or uncontrolled junctions and also incidences of skidding. This could be addressed with a mixture of education and maintenance measures. The majority of car driver (and passenger) casualties occurred at T- and staggered and give way/uncontrolled junctions and most collisions involved drivers aged 25-59 years old.  

Merton performance indicators and targets: road traffic accidents

 

What works and current services in the public realm and active travel

Promoting and enabling sustainable ‘active’ travel modes such as walking, cycling and using public transport enable people to integrate increased physical activity levels into their everyday lives. Against a backdrop of gradually falling car trips in outer London,1the impact of the economic recession and population growth provides the optimum opportunity to encourage reduction in private car trips and increase in more sustainable modes particularly walking and cycling. The long term target has therefore been retained until a clearer picture becomes available.

Over the past three years, much of Merton’s delivery programme has been directed towards tackling access issues across a range of modes. The majority of schemes contained significant pedestrian improvements to support this target. Schemes were typically located in areas with higher footfalls and defined walking problems where the greatest benefit could be achieved, busy movement corridors and those locations where notable barriers to movement were apparent.  

Merton transport performance indicators and targets

 

Examples include Destination Wimbledon, Merton High Street, South Wimbledon Business Park and Lower Downs Road Railway Tunnel Other interventions, such as new crossing points or dropped kerbs, were targeted towards more localisation, but nevertheless were important areas where movement problems had been identified.

 

The Smiles programme also developed walks for health. Supporting these scheme based interventions the Council has delivered 20km of improved footways through its maintenance programme and delivered an extensive programme of educational and road safety courses focused towards ensuring that people have the right skills needed to walk safely.

 

Key facts on air quality

Air quality is an important public health issue in London. Poor air quality contributes to shortening the life expectancy of all Londoners, disproportionately impacting on the most vulnerable.

Air quality in London is the worst in the country. Poor air quality exacerbates heart and lung conditions such as asthma, and chronic obstructive pulmonary disease. It is thought that the effects of air pollution contribute to many thousands of premature deaths of people who have serious illnesses. PM10 (particulate matter) and PM2.5 can penetrate deep into the lungs and even pass in the bloodstream and cause oxidative stress. Therefore minimising emissions of key pollutants and reducing concentration are essential for good health. The UK average mortality attributable to long term exposure to PM2.5 is 5.6%.2

The GLA estimated that in 2008 there were 4,267 deaths attributable to long-term exposure to small particles. The new Public Health Outcomes Framework includes an indicator for air quality which local authorities will be expected to show progress on.3

National air quality standards

The Government’s Air Quality Strategy sets air quality standards for a range of pollutants and for PM10 and NO2:

 

Air quality standards for PM10and NO2 (µg/m3means ‘micrograms per cubic metre’)

Nitrogen Dioxide Annual mean not exceeding 40 µg/m3
Nitrogen Dioxide 200 µg/m3 not to be exceeded more than 18 times a year when measured as an hourly mean value
PM10 Particulate Annual mean less than 40 µg/m3
PM10 Particulate 50 µg/m3 not to be exceeded more than 35 times a year when measured as a daily mean value

 

Standards for air pollution are concentrations over a given time period that are considered to be acceptable in the light of what is known about the effects of each pollutant on health and on the environment. They can also be used as a benchmark to see if air pollution is getting better or worse.

Air quality focus areas

In 2011, the GLA identified four Air Quality Focus Areas within LBM, outlined in the map below (represented by yellow area with description in yellow box). These areas are not necessarily situated at the same locations as the monitoring equipment (represented by an orange arrow), the location of which was chosen for a number of reasons including ease of access.

 

Air quality focus areas have been selected by the GLA as areas where there is the most potential for improvements in air quality within the Capital. These areas have been selected through an analysis of the following factors:

  • Baseline air quality for NO2 and PM10by 20m grid resolution
  • Locations where air pollution limit values have been exceeded
  • Level of human exposure
  • Local geography and topography
  • Local sources of air pollution
  • Traffic patterns
  • Future predicted air quality trends.

 

LBM focus areas and air quality monitors, London Atmospheric Emissions Inventory.

 

 

NOx emissions from transport sources in LBM ID area

ID Area Description Taxi Car Bus LGV HGV
165 Raynes Park junctions Kingston Road/Bushey Road 1 29 31 12 27
166 Wimbledon The Broadway/Merton Road/Morden Road/Kingston Road 1 25 34 10 31
167 Morden Morden Road/ London Road/Morden Hall Road/Martin Way 1 23 46 9 21
168 Mitcham London Road A216 from Cricket Green to Streatham Road Junction 1 25 38 11 25

Source: http://data.london.gov.uk/laei-2008

 

Annual mean concentrations of PM10in LBM 2011

 

Annual mean concentrations of NO2in LBM 2011

 

Fraction of mortality attributable to long term exposure to PM2.5by London borough

Local Authority Fraction (%) of mortality attributable
to long term exposure to PM
2.5
Bromley 6.3
Havering 6.3
Harrow 6.4
Sutton 6.4
Croydon 6.5
Hillingdon 6.5
Bexley 6.6
Enfield 6.6
Kingston upon Thames 6.7
Barnet 6.8
Richmond upon Thames 6.8
Merton 6.9
Redbridge 7
Barking & Dagenham 7.1
Haringey 7.1
Hounslow 7.1
Brent 7.2
Ealing 7.2
Greenwich 7.2
Lewisham 7.2
Waltham Forest 7.3
Wandsworth 7.3
Newham 7.6
Camden 7.7
Lambeth 7.7
Hackney 7.8
Hammersmith and Fulham 7.9
Islington 7.9
Southwark 7.9
Tower Hamlets 8.1
Kensington and Chelsea 8.3
Westminster 8.3
City of London 9

 

Number of deaths attributed to exposure to PM2.5 pollution in 2008 in wards in the London Borough of Merton

Ward Total Population Annual deaths attributable
to exposure to PM
2.5
Abbey 10,866 6
Cannon Hill 9,347 5
Colliers Wood 11,222 6
Cricket Green 10,633 6
Dundonald 9,412 5
Figge's Marsh 10,344 6
Graveney 9,758 5
Hillside 9,590 5
Lavender Fields 10,165 6
Longthornton 10,086 5
Lower Morden 8,675 5
Merton Park 9,694 5
Pollards 10,260 6
Ravensbury 9,808 5
Raynes Park 9,887 5
St. Helier 9,460 5
Trinity 9,217 5
Village 9,418 5
West Barnes 9,791 5
Wimbledon 10,435 6
Total   107

 

Benefits of air quality improvement

 

 

Source: GLA 2013, Air Quality in Merton A Guide for Public Health Professionals

 

 

Local air quality management

The Council declared the borough an Air Quality Management Area (AQMA) in 2003 as the review and assessment process showed that air quality in the borough was not likely to meet the National Air Quality Strategy objectives by the target dates.

 

Local measures

Local authorities have a statutory duty to manage local air quality and are required to carry out regular reviews and assessments of air quality.

 

The main issue with our local air quality has been found to be emissions (relating to NO2 and PM10) emanating from road vehicles. Based on the nonautomatic monitoring and assessments undertaken it was found that some of the air quality objectives would be exceeded in areas where there was relevant exposure. As a consequence the Council designated the whole of the borough as an AQMA for annual mean objective and 24hour mean PM10objective.

 

The Council currently maintains one NO2 automatic monitoring station located on the first floor of Morden Civic Centre, which therefore falls into the category of a roadside location. Sampling is taken 4m from ground level, at a distance of 3m from the kerbside. There is no automatic particulate monitoring.

 

Pollution data is recorded on the London Air Quality Network(LAQN) website. Results for the Civic Centre site to date (October 2011) show that recorded levels remain within the Government’s Air Quality Strategy objectives.

 

Predominately, passive diffusion tubes monitor air quality in Merton. The diffusion tube network demonstrates that there are exceedances of the annual objective at the majority of sites. In two separate locations (Colliers Wood High Street (HA) and Plough Lane (PA), the diffusion tube data has read as being over 60μg/m3 indicating that there could be exceedances of the hourly objective.

 

 

Spatial planning and health

What is spatial planning?

Spatial planning is a process of place shaping and delivery. It aims to:

 

  • produce a vision for the future of places that respond to the local challenges and opportunities, and is based on evidence, a sense of local distinctiveness and community derived objectives, within the overall framework of national policy and regional strategies
  • translate this vision into a set of priorities, programmes, policies, and land allocations together with the public sector resources to deliver them
  • create a framework for private investment and regeneration that promotes economic, environmental and social wellbeing for the area
  • coordinate and deliver the public sector components of this vision with other agencies and processes [e.g. Local Area Agreements (LAAs)]
  • create a positive framework for action on climate change
  • contribute to the achievement of sustainable development.

 

Good use of spatial planning offers opportunities to change the environment in which people make choices about their health, making it easier to choose the healthy option. The Marmot review of health inequalities in 2010 identified a convergence in policies aimed at improving health and wellbeing with those designed to advance sustainability and address climate change. For example, a well-designed public realm with high quality green open space will encourage physical exercise, improve mental health, and increase biodiversity. The case for delivering improvements to health and wellbeing through spatial planning policy should therefore be seen as part of the wider case for delivering sustainable communities.

 

One study showed that in areas in England with more green spaces the gradient in deaths from circulatory disease by income deprivation is reduced. This suggests that the amount and the distribution of green space have great potential to reduce health inequalities.

 

Links between spatial planning and health date from rapid urbanisation in the 19th century, which created health and social problems that led to the passage of legislation promoting sanitary and healthy living conditions. As the burden of ill health moved from communicable diseases to chronic diseases associated with unhealthy lifestyles in the 20th century, attention moved away from the built environment to individual behaviours. However there is now strong evidence that the built environment continues to shape health outcomes. This explains in part why the Coalition Government moved public health professionals back to local authorities. High quality healthy environment is unlikely to emerge spontaneously and integrated decision making across a range of service areas is more likely to deliver real outcomes. With local public health now in local government opportunities are available to join up actions to address some of the behavioural, social and environmental factors linked with health.

 

As part of the remit of spatial planning, policy measures as different as they may be on housing, transport, economy, industry and commerce, built and natural environment, waste, pollution, water and energy must now take health into account.

 

 

What works for spatial planning?

Planning decisions made adopting a spatial planning approach have a greater capacity not only to overtly change environments, but also to create new environments which encourage people to lead healthier lives.

 

Evidence of effective interventions

  • Evidence is good for integrated appraisal in one statutory process including health, social and environmental considerations, with involvement through the whole plan, policy or project process, so that health objectives are integrated into the thinking from the outset.
  • There is strong evidence that spatial planning for open space that is safe and easy to get to increases the amount that people exercise and that it improves mental health.
  • The NHS’s London Healthy Urban Development Unit (HUDU) planning development tool provides one effective approach. Integrating health into spatial planning is cost-effective. It needs to happen through consultation with communities. There are potentially very large gains to be obtained from effective integration of health and planning for whole-town infrastructure for walking and cycling and the retrofit of home zones that will often far outweigh the cost of incorporating health considerations early in the planning process.
  • Spatial planning linked into the Joint Strategic Needs Assessment process will secure the long term wellbeing of communities. JSNAs to produce more location-specific profiles should enable a more targeted approach to planning interventions. This will help to improve local health and wellbeing in relation to issues such as access to quality primary care services, and also issues such as access to fresh food, reducing obesity, and health links to deprivation, air and noise pollution.
  • The largest opportunity to make a difference in improving the health and well-being of people and communities lies at local and neighbourhood (and ward) levels. The development management process offers opportunities for both the JSNA as health evidence and local NHS organisations to be influential in the outcome of decisions. Examples of opportunities include in the master planning process, pre-application discussions, consultation on planning applications, and playing a role in delivery and implementation.

 

Local recommendations

  • Embed HIA into existing assessment processes in the local authority.
  • Expand access to green space.
  • Prioritise policies and interventions that both reduce health inequalities and mitigate climate change, by improving:
  • active travel across the social gradient
  • the quality of open and green spaces across the social gradient
  • the quality of food in local areas across the social gradient
  • the energy efficiency of housing across the social gradient.
  • Fully integrate the planning, transport, housing, environmental and health systems to address the social determinants of health in each locality.
  • Support locally developed and evidence-based community regeneration programmes that use spatial planning to remove barriers to community participation and action and reduce social isolation.
  • Use the Healthy Places resource, an online tool put together by a team from the National Heart Forum. This tool highlights how local authorities can use existing laws ‘that have the potential to change local environments and encourage more active lifestyles and better diets’.
  • Review health outcomes through local planning documents (as set out in table below) to identify existing local examples and gaps for improving health outcomes through local planning.

Supporting health outcomes through local planning documents

Source: The Marmot Review: Implications for Spatial Planning. The Marmot Review Team. Report authors: Ilaria Geddes, Jessica Allen, Matilda Allen, Lucy Morrisey

References

1. ^ Transport for London (2012). Travel in London. Report 5.

2.^ GLA (2013).

3. ^ Public Health Action Support Team (PHAST) (2010). Final Project Report: London TB Service Review and Health Needs Assessment.