Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Department of the Environment, Transport and the Regions (PH 93)


  1.  The Department of the Environment, Transport and the Regions (DETR) welcomes this opportunity to describe its role in improving public health, both directly through its own policies, and indirectly through the activities of its related bodies and its sponsorship of local bodies with major public health responsibilities.

  2.  DETR's connection with public health is rooted in history. The great advances in public health in Victorian times and the early 20th Century stemmed from activities-on part of individuals and organisations-that would today be under the general sponsorship of DETR. Now as in the past, local government is a key driver for improving public health, and as the sponsoring department DETR provides the framework for delivering many local public health services.

  3.  DETR endorses the widely held view that public health is about much more than the delivery of medical services through the National Health Service and the Department of Health. Protecting and improving the nation's health means taking a much broader approach. Together with our agencies, we are major proponents and deliverers of the preventative element of the government's strategy for better health and reducing health inequalities. Our work is a crucial complement to that of the Department of Health and the NHS, addressing the wider determinants of health through policies-to take just a few examples-on regeneration and renewal, on housing standards and fuel poverty, on clean air and water, on safe transport, and on safe and healthy workplaces. Our initiatives in all these and other areas are examined later in this memorandum.


  4. DETR's overall corporate aim is:

    "To improve everyone's quality of life, now and for the future, through:

    —  thriving, prosperous regions and communities

    —  better transport

    —  better housing

    —  a better environment

    —  safer, healthier surroundings; and

    —  prudent use of natural resources".

  5.  Closely linked to this aim is the cross-cutting theme of sustainable development. The UKs' strategy for sustainable development has at its heart the simple idea of ensuring a better quality of life for everyone, now and for generations to come. One of the four aims of sustainable development is "social progress which recognises the needs of everyone", and this in turn as a key component "improving the health of the population overall". The Government's main indicator of improvement in the overall health of the population is "expected years of healthy life". Thus public health and its improvement are at the heart of sustainable development, and hence at the heart of DETR's policy objectives

  6.  Once one accepts that health is in part the product of where people live and their environment, the choices they make, and the health-related services they receive, it follows that the role of DETR, with its agencies, is very important, even where our specific impact cannot be measured in precise terms. Some examples of major DETR policy areas with a public health impact are described below.

(a)  Environment

  Most broadly, a clean and healthy environment is essential to public health and quality of life, and is a key component of sustainable development. It is the primary aim of the Environment Agency, which DETR sponsors, to protect and enhance the environment and to contribute towards the delivery of sustainable development, through the integrated management of air, land and water. The way in which the Environment Agency, as a Non-Departmental Public Body sponsored by DETR, delivers quality of life and sustainable development was set out most recently in its fifth Corporate Plan, published in November 2000.

(b)  Transport

  The integrated transport White Paper A New Deal for Transport: Better for Everyone published in July 1998 made clear our aim of integrating transport policies with those on health. Transport policies impact on health in a number of ways through issues such as air quality, noise, road casualties, social exclusion and the encouragement of walking, which are covered separately below.

(c)  Water Quality

  DETR is vigilant in protecting people's health from unsafe drinking water. Quality compliance is achieved through audit and enforcement action by the Drinking Water Inspectorate, so that in 1999 compliance with drinking water standards was met in 99.8 per cent of around 2.8 million tests. New regulations, tightening the standards further, were laid before Parliament in December 2000.

  Investment in the sewerage infrastructure in recent years has substantially reduced contamination of bathing waters, and in 2000 a record level of 95 per cent compliance with EU standards was achieved. Further investment is in hand to meet the target of 97 per cent by 2005. DETR has also put in place programmes to improve the quality of shellfish waters, with the objective of bringing them all up to at least Class B under the system applied by the Food Standards Agency to classify shellfish harvesting areas for food safety purposes.

(d)  Air Quality

  Air pollution affects people's health directly. It can hit the most vulnerable in our society particularly hard, especially those who suffer from asthma or heart and lung diseases. Measures to improve air quality therefore produce direct health gains. DETR is responsible for the Air Quality Strategy which sets health-based objectives for eight air pollutants which can have significant effects on health. Local authorities are taking steps in pursuit of the objectives for local air pollutants through local air quality management arrangements. DETR is also responsible for national and EU legislation which controls emissions from sources of air pollutants, including industry and transport. The major transport investment announced in July 2000 in Transport 2010: The 10 Year Plan, will help deliver further improvements in air quality.

  Transport taxations takes account of the emission and health dimensions of different fuels and vehicle technologies. DETR advises HM Treasury on the design of fiscal structures which encourage vehicle users to buy and use cleaner fuels and vehicles. Incentives to date include lower duty rates on cleaner fuels, lower rates of vehicle excise duty (VED) for lorries meeting stringent pollution standards, a new structure to be introduced for lorry VED to strengthen the environmental signals built into VED rates, and a new structure of VED for new cars, and for company car tax, based on carbon dioxide emission levels, to start in March 2001 and April 2002 respectively. Alongside fiscal steps, DETR has announced a £69 million package of measures over the next three years to promote vehicles which are cleaner and more fuel efficient, with better health characteristics.

(e)  Land quality

  We also have a health role in relation to contaminated land. Contamination of the land on which people live, work, play and grow food can lead to unacceptable intakes of heavy metals and organic chemicals left behind by past industrial activities or waste disposal. In other cases, soils may contain high levels of asbestos, and landfill gases can create risks of fires and explosions in buildings. In April 2000, DETR introduced a new statutory regime for contaminated land. This regime gives local authorities and the Environment Agency strengthened duties to identify problem sites and to require them to be remediated to protect human health and the wider environment.

  The Regional Development Agencies also have responsibilities—and wide powers—to bring derelict land of this kind back into use.

(f)  Health and safety

  A key priority for DETR is the reduction of deaths and injuries caused by accidents and occupational ill-health. Work-related accidents and illness cost 2.1-2.6 per cent of GDP each year—equivalent to between

£14.5 billion and £18.1 billion. In June 2000, we issued, jointly with the Health and Safety Commission (HSC), a key strategy statement on the action we will take, in concert with other stakeholders, to improve health and safety over the coming years. Revitalising Health and Safety has at its heart challenging targets, reflected in the Public Service Agreement targets set as part of the 2000 spending review. The Government, the HSC and local authorities will work together to cut the incidence of deaths and major injuries, reduce the rate of work related ill-health, and cut the rate of working days lost from work-related injury and ill-health.

  Occupational health is a major part of Revitalising Health and Safety. In July 2000, the HSC and the Health and Safety Executive launched a new long-term occupational health strategy for Great Britain, Securing Health Together. This sets targets for reducing ill-health for both workers and the public, cutting the number of working days lost to work-related ill-health, and fostering a culture of rehabilitation at work.

  Road safety is a particular priority. Although the number of deaths and serious injuries on our roads has fallen dramatically in the last 20 years, there are still about 3,400 people dying on our roads every year (about one in four of all accidental deaths). In March 2000, we launched a new road safety strategy with a target of reducing deaths and serious injuries by 40 per cent by 2010 compared with the 1994-98 average. This target incorporates a reduction of child deaths and serious injuries by 50 per cent. There are also health inequality implications for road safety. For example, research shows that children from poorer families are five times more likely to be killed in road accidents when out walking than children from other families. We are also concerned that children from minority ethnic groups also suffer disproportionately from road accident injuries. DETR is committed to finding solutions to these problems.

  The Queen's Speech on 6 December 2000 announced that a bill would be drafted to provide for safer travel on the railways, in the air, at sea and on the roads, and would take forward proposals for revitalising health and safety at work.

  This will be the vehicle for further improvements in the transport safety regime in the UK.

(g)  Noise

  Another factor that can influence public health is the prevalence and level of noise. Noise is a particular problem for urban dwellers, and DETR is responsible for developing strategies to combat it, including sponsoring research to understand the problems better and evaluate possible solutions. Thus on noise nuisance at night, the Department recently published a consultation paper, following a review of the Noise Act 1996, setting out further options for local authorities to use in tackling noisy neighbour problems.

  Noise from various types of transport activity can also cause distress. Even though overall noise levels from aircraft have decreased over the past 20 years, DETR is committed to finding practical ways of further improving the quality of life for people who live around airports. New proposals for enhancing aircraft noise control are now under consideration following a consultation exercise launched in July 2000. The Department is implementing measures to reduce road noise from motorways and other major routes, including the use of quieter road surfaces where opportunities arise. Contracts for all new roads and most resurfacing schemes now specify the use of quieter road surfaces as a matter of course and by 2010 these surfaces will be installed on over 60 per cent of the strategic road network, including all concrete stretches. Present-day welded railway track is quieter than previous jointed track, but DETR is working with other EU Member-States on railway noise reduction issues.

(h)  Radon

  The Department has a long-established programme to tackle the risks from radon, a naturally occurring radioactive gas, which is the second most important cause of lung cancer after smoking. Following completion of the campaign to offer a free measurement to every household in England with a greater than 5% probability of being above the radon "action level", the emphasis of the programme changed to encouraging radon remediation works. Pilot studies have been carried out with three local authorities in order to help and encourage householders to take action to reduce radon levels in their homes. Under a new programme building on experience from the pilot studies, the Department is now working in partnership with 31 local authorities to reduce radon levels in homes in radon-affected areas across the country.

(i)  Planning

  Land use planning largely originated with concern for public health and it has maintained that link. Planning policy is concerned with encouraging healthier lifestyles by, for example, promoting greater use of walking and cycling as safe transport modes (see below) and securing sufficient provision of open space and recreational provision in, especially, urban areas. It also has benefits in terms of social inclusion which may indirectly promote better health, for example by ensuring that jobs, shopping and services are located where they are easily accessible to those who do not have access to a car.

(j)  Housing

  Good quality housing is a major contributor to good public health. DETR's Housing Policy Statement, Quality and Choice; A decent home for all—the way forward for housing, published in December 2000, confirms the comprehensive strategy set out in the Housing Green Paper for improving the condition of the country's housing stock. It includes a range of investment and ownership options for local authority housing which will help achieve the target of bringing all social housing up to a decent standard within 10 years. These options are backed up by a significant increase in resources: by 2003-04, capital investment in housing will have risen to more than £4 billion, compared with planned spending of £1.5 billion in 1997-98. The extra resources will also increase the delivery of good quality affordable housing where it is needed. £250 million will be invested over the next three years in the Starter Home Initiative, which is designed not only to help key workers such as nurses, teachers and police afford homes in areas where their services are vital, but also to promote sustainable communities.

  The Supporting People programme to be launched in 2003 is designed to improve the quality of support services to vulnerable people by focusing provision on local need. In addition to £138 million implementation funding over the next three years, £137 million is being provided through the Safer Communities Supported Housing Fund to generate additional services for specific groups including drug and alcohol users and young people at risk.

  The Housing Policy Statement set out a range of actions to improve the condition of stock in the private sector, including proposals to give local authorities more freedom to assist owners of poor quality private housing. The disabled facilities grant programme, which funds adaptations to enable disabled people to remain in comfort and safety in their own homes, will increase by £15 million (20 per cent) from 2001-02. DETR funding for Home Improvement Agencies, which provide practical help and advice to elderly, disabled and vulnerable home-owners, is also being increased by over 25 per cent.

  DETR's recognition of the close relationship between housing and health is illustrated by the decision to replace the housing fitness standard as the basis for action to deal with unacceptable housing conditions. The standard no longer reflects a modern understanding of the health and safety risks within dwellings, and we have published a new, evidence-based rating system for assessing the severity of such hazards. We will be introducing legislation to allow authorities to use the rating system as the basis for their enforcement decisions as soon as the opportunity arises.

(k)  Regeneration

  Improving health features as one of the key outcome areas for the Department's regeneration programmes—alongside raising educational attainment, tackling worklessness, reducing crime and improving the physical environment. New Deal for Community (NDC) and Single Regeneration Budget (SRB) partnerships are encouraged to develop their long term strategies around delivering change in these key areas.

  Over the three-year period to 2003-04, DETR is spending over £6.5bn to regenerate communities and combat social exclusion, mainly through the NDC (£1.2bn) and the Regional Development Agencies (RDAs) (£4bn). These programmes support health-related projects where these are part of a local regeneration strategy for the area, and DETR has emphasised the importance both of improving health through integrated regeneration strategies, and of reducing inequalities in health and access to health and social care. Where appropriate, regeneration partnerships involve the local Health Authority at a strategic level and Primary Care Groups and local service providers at a more operational level in putting together projects. They also link with and reinforce targeted health related initiatives such as Healthy Living Centres and Health Action Zones.

  The eight RDAs and the London Development Agency manage the Single Regeneration Budget and the physical regeneration programme and have a remit to take an integrated approach to deal with economic underachievement in the regions. The RDAs have worked with regional partners to develop regional strategies which address, amongst other things, health issues. The RDAs' various budgets, including SRB, are being brought together into a Single Budget from April 2002 to improve their ability to deliver the regional strategies. Also £150m of extra funding has been made available to the RDAs for 2001-2002, and substantially greater sums for the following two years.

(l)  Neighbourhood Renewal

  The National Strategy for Neighbourhood Renewal Action Plan launched on 15 January 2001 will be a blueprint for action over the next 10-20 years on tackling deprivation and raising standards, including standards for health, in the most deprived areas. The new Neighbourhood Renewal Unit, which will be charged with implementing this strategy, will be based in DETR but will have a cross-cutting remit to join up relevant activity throughout government and the rest of the public sector, as well as the voluntary/community and private sectors. A new Neighbourhood Renewal Fund, worth £800 million over three years, will help target services at the most deprived areas.

(m)  Building Regulations

  DETR is responsible for the Building Regulations, which apply in England and Wales (other comparable sets of regulations apply in Scotland and Northern Ireland and are the responsibility of the devolved administrations there). The Regulations apply to the construction of most new buildings and other defined kinds of building work. The regulations play a key part in securing the health, safety and welfare of building users, by addressing such issues as structural safety, fire safety, as well as energy efficiency and access and facilities for disabled people. Of particularly direct relevance are the provisions with regard to hygiene, ventilation and dampness.

  Several reviews of the technical requirements of the regulations are presently in hand. They include ones addressing energy efficiency (with implications both for climate change and the welfare of building users); sound insulation (both against external noise and against noise from within the building); drainage and waste disposal (where there are issues of sustainability as well as the more obvious relevance to public health); and requirements with regard to heat producing appliances, where satisfactory provision for the removal of products of combustion is essential to prevent carbon monoxide poisoning. Requirements on access and facilities for disabled people were extended to new homes from October 1999, and the requirements of the regulations on access and facilities for disabled people in non-domestic buildings are currently under review.

(n)  Green Spaces

  Access to countryside and open spaces reduces stress and promotes wellbeing. Providing well managed public open spaces, including children's play areas and recreational and sporting areas, gives people the opportunity to have a healthier life style. A DETR Minister is responsible for overseeing the development of a vision and proposals for the sorts of parks, play areas and open spaces we want to see created in the future and how they should be managed. DETR is also responsible for policies for the countryside—which is of course an enormous recreational asset—including helping all sections of the community enjoy the countryside. The recent White Paper Our countryside: the future, a fair deal for rural England sets out measures to improve transport and mobility to ensure access to services in rural areas. These include support for community transport and other measures to improve personal mobility as well as increased financial support for rural public transport.

(o)  Walking and cycling

  The Department of Health recommends that all adults should participate in at least 30 minutes of moderately intense physical activity, such as brisk walking, five times a week. DETR is responsible for the promotion of walking and cycling as forms of transport in England. It is one of the aims of Transport 2010 to make them more viable, attractive and safer, and the new road safety strategy includes a chapter on how we aim to improve the safety of pedestrians, cyclists and horse riders. The Urban White Paper Our Towns and Cities: The Future published in November 2000 calls for patterns of development that make walking and cycling more attractive options. The Department promotes and encourages walking and cycling in various other forms of guidance which it issues.

  7.  There are many other areas where DETR makes an important contribution to public health. The provision of good quality public transport helps to provide greater mobility and reduces isolation. Public transport links to medical facilities are also important in cases where medical intervention is required. Policies that stimulate the development of healthy and secure urban environments, and effective waste disposal, also contribute to general health and wellbeing.

  8.  At the macro level, DETR has the UK Government lead on climate change, which could lead to an increase in water-borne infections, food poisoning, heat-related illness and deaths and even vector-transmitted disease. The UK Government has played a leading role in global efforts to tackle climate change and will continue to do so. UK scientists, many of which receive funding from DETR, have been at the forefront in the development of the global climate models for climate prediction that underpin the policy debate. DETR has also co-operated with the Department of Health on their assessment of the national implications of climate change on human health within the framework of the DETR-funded UK Climate Impacts Programme.


  9.  The Memorandum to the Select Committee by the Department of Health, and memoranda from other expert organisations, provide evidence of the existence of health inequalities in the UK. DETR acknowledges the connections between health inequalities and other aspects of social policy, and is willing to work with relevant partners in addressing these complex issues.

  10.  One particularly important issue is the link between death rates and deprivation. Recent Office of National Statistics figures show that for those aged 20 to 64 who met three of the four criteria for deprivation (that they are in social class IV or V, live in rented accommodation, have no access to a car and are unemployed) mortality rates are double the national average. The urban characteristics of deprivation are also striking. Of the 60 high mortality rate areas, 49 are in areas classified as "coalfields", "manufacturing centres", or "ports and industry". Such areas have many of the characteristics of deprivation and a large proportion of the population with a limited long-term illness. Our Towns and Cities is thus a key step in the fight against health inequalities.

  11.  Improvements in several of the general policy areas referred to above will help reduce health inequality. For example, better public transport will increase mobility, and provide better access to facilities, including health facilities, for the less well off. The major package of proposals in Our Towns and Cities also bears more directly upon health inequalities, given the intensity of deprivation in certain urban areas. The new indices of deprivation published by DETR in August 2000 provide more pointers to the nature and distribution of deprivation in England. One of the six "domains" aggregated together to form the overall indices measures health deprivation and disability, and identifies people whose quality of life is impaired by either poor health or disability. It recognises that while poor health is closely inter-related to other aspects of deprivation, it is also an important aspect of deprivation in its own right. Premature death is the ultimate manifestation of this, but chronic ill health and disability also greatly impair the quality of people's lives.

  12. DETR has a number of policy initiative which are specifically aimed at addressing health inequalities. To take just two examples:

        We lead the wider Government efforts to tackle the problem of fuel poverty. This is thought to be a major contributor to the annual excess winter death toll amongst older householders, and may increase the risk of respiratory illness amongst the young. DETR is working the social landlords to improve the heating and insulation of council properties, and the new Home Energy Efficiency Scheme is designed to help older households and others particularly vulnerable to cold-related ill-health, living in the owner-occupied or private rented sectors. The scheme provides grants of up to £2,000 for packages of insulation and heating improvements, including central heating systems for low-income older households. Local referral networks are used to reach householders, involving health professionals, social workers and others active in the community.

        Those sleeping rough are especially vulnerable to health problems—mental illness, drug and alcohol problems and extremely high early mortality rates—and some will have become rough sleepers as a result of such problems. The Rough Sleepers Unit has a target to reduce the number of people sleeping rough in England by at least two thirds between June 1998 and April 2002. Help in finding accommodation, tackling drug and alcohol problems and building a new life will have important benefits in public health terms, as will the emphasis on preventing more people becoming rough sleepers.

        The Rough Sleepers Unit is in particular undertaking a project designed to improve access to primary health care for people sleeping rough, who generally have very poor physical health and experience difficulties getting the help they need.


  13. DETR believes that the way to ensure that public health is tackled in the round is through effective "joined up" policy making and delivery of health related services at every level, rather than through changing the machinery of government. DETR ministers and officials work alongside those of the Department of Health in policy formulation relevant to health. Examples include air pollution (where the Expert Panel on Air Quality Standards has a joint DETR/Department of Health Secretariat), noise, environmental chemicals, radiation (the Secretary of State for the Environment, Transport and the Regions, and the Secretary of State for Health each has statutory responsibilities in relation to the authorisation of radioactive discharges by the Environment Agency), sustainable development, and fuel poverty. DETR and Department of Health officials have also worked together to produce the first housing strategy for older people, which aims to provide an ongoing focus for addressing and responding to their particular housing and social care needs.

  14.  DETR recognises that the proliferation of initiatives and "zones" to deal with specific issues can produce overlap and confusion. The integrating role of the Regional Development Agencies in managing the Government's regeneration programme and the Single Regeneration Budget has already been described. We also support the setting up of the Regional Co-ordination Unit (RCU), and the new measures it introduced in November 2000 to improve the co-ordination of area based initiatives.

  15.  The RCU's action plan, published in October 2000, reiterates the NHS Plan commitment to establish single, integrated public health groups across NHS regional offices and the Government Offices for the Regions. More generally, RCU and Government Office officials are exploring with Department of Health colleagues how the Government Offices can contribute to implementing the NHS plan and reducing health inequalities. This is closely linked to other Departments' work, not least DETR's own, in supporting the health improvement agenda and it will also do much to address social exclusion. Areas where it is anticipated that closer working in the regions will have an impact include children and young people's services including teenage pregnancy and parenthood, older people services, community involvement and development, economic and social regeneration and more generally the broader development of Local Strategic Partnerships (see below). The RCU is also taking an interest in the commitment in the Modernising Government White Paper to review the co-terminosity of NHS and Government Office boundaries in 2002.

  16.  DETR also supports measures to simplify and clarify responsibilities at the local level. We believe it is essential for local authority and health authority officials to work together in the field of public health improvement. The Health Act 1999 already provides local authorities and health authorities with powers to carry out functions on behalf of one another, by agreement. The Local Government Act 2000 contains a new power which provides councils with the powers to extend this partnership approach to other bodies, in addition to the NHS. The Local Government Act 2000 also requires local authorities to work together with other bodies to produce strategies for promoting the wellbeing of their local communities. These community strategies will be developed by Local Strategic Partnerships to look at all aspects that contribute to quality of life, to agree priorities for action and to co-ordinate the work of partnerships dealing with particular neighbourhoods or specific issues.

  17.  The work of Local Strategic Partnerships and the development of community strategies should enable local service deliverers to secure public health improvements more effectively. DETR is encouraged by the enthusiastic reaction to these new provisions and is not convinced that institutional solutions, such as transferring Directors of Public Health from the health authority to a local authority, is necessary to deliver significant public health improvements. The structure DETR is promoting gives local leaders freedom to work in partnership, to make whatever organisational changes they consider necessary to improve the delivery of services.

  18.  DETR welcomes the establishment of the Health Development Agency (HDA). We believe the Agency can play a major role in disseminating guidance based on evidence and best practice, and in facilitating public health improvements. DETR worked with the HDA's predecessor's the Health Education Authority on the publication Making THE Links, which provides guidance to public health practitioners on integrating sustainable transport, health and environmental policies. This is an excellent example of joint work which DETR commends to the Select Committee. DETR is a member of the Policy Advisory Group of the HDA, and is currently exploring a number of proposals for making an active contribution to the Agency's future work. DETR is also represented at a senior level on the National Governing Board of Public Health Observatories.

  19.  DETR has established a "health agenda network" within the Department itself, to bring together officials whose different policy responsibilities bear upon the public health. This network, whose meetings are attended by Department of Health officials, is also a useful sounding board for consideration of public health issues in DETR. We also undertake work jointly with the Department of Health in the international arena. DETR and DoH Ministers are parties to the Charter on transport, environment and health agreed at the WHO Europe conference on environment and health in June 1999. DETR and DoH officials took a prominent role in the development and drafting of the Charter and are now actively involved in promoting its implementation.

  20.  DETR has an important role as a sponsor of research and supplier of information and guidance. As well as the Indices of Deprivation mentioned previously, the Department produces much guidance of relevance to public health practitioners, for example local sustainable development indicators. As part of the cross-government drive towards modernising the policy making processes, it is reviewing its procedures for assessing evidence and commissioning further research. DETR acknowledges that there is sometimes frustration at the local level if guidance provided by different departments is not properly targeted or co-ordinated. It is also therefore making much greater efforts to ensure that "joining up" occurs at a national level.


  21.  This Memorandum has sought to describe the extent of DETR's involvement in delivering the Government's public health improvement programme. It has attempted to illustrate that public health improvements can only be delivered effectively by action across Government, at all levels of government, and by means which are not often or always recognised as `public health' initiatives.

  22.  The Department would be happy to explore any of the issues raised in this Memorandum in more detail.

January 2001

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