BETTER ENVIRONMENT, BETTER HEALTH 
A GLA guide for London's Boroughs London Borough of Harrow-Annette 
 

## Copyright Greater London Authority November 2013

Published by Greater London Authority City Hall The Queen's Walk More London London SE1 2AA 
www.london.gov.uk enquiries 020 7983 4100 minicom 020 7983 4458 ISBN 
 
Photographs © Copies of this report are available from www.london.gov.uk 

## Please Print And Circulate Widely Contents

 
CONTENTS 
1 
FOREWORD 
2 
INTRODUCTION 
3 
GREEN SPACES 
5 
ACTIVE TRAVEL & TRANSPORT 
8 
SURFACE WATER FLOOD RISK 
12 
AIR QUALITY 
15 
HEALTHY FOOD 
18 
FUEL POVERTY 
21 
OVERHEATING 
24 
REFERENCES 
28 
FURTHER READING 
31 
PUBLIC HEALTH OUTCOMES FRAMEWORK 
32 
DATA APPENDIX 
35 
ACKNOWLEDGEMENTS 
42 
 

## Foreword

 The Mayor's vision is for London to be the 'greatest city on earth' - this means making the city a great place for Londoners to live, relax, work and raise a family, whilst being attractive to investors. However there are significant inequalities in the health and quality of Londoners' lives. 2009-11 ONS figures show that average *healthy* life expectancy  reduces by almost one year for every stop eastwards on the District Line between the boroughs of Richmond and Tower Hamlets - a difference of 18 years. The reasons for this are complex but the evidence points strongly to the important impact of the wider determinants of health. This inequality means some Londoners are unable to benefit from and contribute to the city's dynamism because of preventable health problems. The Mayor wants to ensure all Londoners have the chance to participate in what London has to offer. Furthermore, if we are to maintain and improve London's position as the attractive world city it is, we need to create a resilient city, able to deal with extreme weather events, and a city that offers a high quality of life with green spaces, a fantastic public realm and a pleasant, healthy environment. Local authorities have a unique role to play in achieving these goals, and with their new responsibilities for public health they have a new set of capabilities and levers for catalysing change. Better Environment, Better Health offers a bespoke guide to each of London's thirty three boroughs, describing the impact of seven wider environmental determinants of health on their specific populations and highlighting possible actions that could be taken to promote a better environment leading to better health and well-being, overall, for Londoners. For example we know that by encouraging walking and cycling we are not only helping to improve London's air quality but also cardiovascular health, whilst reducing levels of obesity. The guides demonstrate how such an approach can be taken on a range of issues, without necessarily adding to the financial burden on boroughs' already squeezed budgets, just by doing things differently. We hope you will find value in the guide and will use it to drive improvements locally to create strong environments which promote health and well-being, and are resilient. Finally, we would like to thank the project team for writing the guides and their drive in taking this project forward. 

                                                
 
Victoria Borwick 


Matthew Pencharz Deputy Mayor of London Senior Advisor for Environment  
and Mayoral Health Advisor and Energy 
 

## Introduction

 What is likely to shape the health of our communities over the next twenty or thirty years? What will improve quality of life? What will help people live longer, particularly those most likely to die early? What will improve people's quality of life, reducing years lost to disability and poor mental and physical health? What will improve the health and wellbeing of children and young people? The United States Center for Disease Control and Prevention (CDC) has argued that in the 20th century public health measures added 25 years to the life of an average American.1 In its list of top ten interventions half are closely connected to the environment. The same list would be likely to apply to the UK and London. In the 21st century public health measures, including measures seeking to improve the environment, are likely to be as important in supporting good health as improvements in healthcare. We need to prepare, assess and plan for extreme weather events and their impacts not just to improve Londoners' health and wellbeing but to increase economic prosperity, for business and service continuity and to strengthen community resilience. In this guide we focus on seven environmental issues and their relationship to health: 

- 
Green spaces 
- 
Active travel & transport 
- 
Surface water flood risk 
- 
Air quality 
- 
Healthy food 
- 
Fuel poverty 
- 
Overheating 
 For each of these we ask certain questions: 

- 
What is the issue and how do we measure it? 
- 
What is its impact on health? What is the evidence? 
- 
Who will experience the impact most? 
- 
What is the local borough picture? 
- 
What are the key actions to promote good health?  
 We also provide links to the Public Health Outcomes Framework and suggested further reading. The aim of the bespoke borough guides is to maximise opportunities for improving health and wellbeing, as well as enhancing community resilience. They are aimed at professionals working in health, environment, regeneration, economic development or any aspect of shaping local places, as well as local people interested in improving the quality of life in their communities. Where issues are locally relevant we hope this document will help to start a conversation which enables them to be identified and addressed in borough Joint Strategic Needs Assessments (JSNA) and health and wellbeing strategies. These guides do not cover all of the wider environmental determinants of health. For example, they do not look at some aspects of housing (such as overcrowding), workplace health, wider resource use, access to services, water resource management or noise pollution. More broadly, issues of planning and environmental control tie many of these areas together. How we shape ongoing development and use of our town centres, neighbourhoods and business districts presents opportunities to maximise the health of users: residents, employees and visitors. Similarly, environmental consideration provides the scope to address potential risk to resilience, health and wellbeing as well as promoting good practice amongst, for example, businesses, landlords and facilities managers. 

 

## Green Spaces

Accessible green space has long been recognised as a wider environmental determinant of good health.  Wide ranging research shows strong evidence that outdoor spaces have a beneficial impact on both physical and mental well-being2.  When considering green space it is helpful to think about both access and **use:** availability being a necessary but insufficient indicator and determinant of use. A 
range of data are available on both access and use including the Natural England MENE survey 
(frequency, mode of access, reasons3); London.gov.data: 'Access to Public Open Space and Access to Nature by Ward'4; and Sport England: Active people Survey (physical activity rate)5. 

  
What is the impact on health?  
Accessible, safe green space is shown to reduce mental distress, depression and Attention Deficit- Hyperactivity Disorder (ADHD) symptoms in children.  Access to a garden or living a short distance to/from green areas, as well as having the potential to lead to improvements in the environment, are associated with a general improvement in mental health and wellbeing.6  Both the Marmot Review and NICE have highlighted evidence that the presence of good quality outdoor green spaces encourages physical activity7 which is important across a wide range of health issues such as cardiovascular diseases, obesity, type 2 diabetes and mental/physical health. Increasing and improving the proportion of green spaces in urban centres also has a secondary positive impact on health through other wider environment determinants of health such as urban heat-island effect, surface flood risk and air quality. Who will experience the greatest impact? 

 
Urban residents (through impact on quality of life) 
 
Older people and children 
 
People suffering from obesity, cardio-vascular diseases, diabetes  
 
People suffering from mental distress and depression. 

## The Harrow Picture

- 
35 per cent of the borough surface has green space coverage; 4 per cent below the London 
average.8 
- 
Within Harrow, more than 50 per cent of households in 8 out of 21 wards, have deficient access to 
nature.9 
- 
17 per cent of Harrow's population participate 5 times per week in physical activity for at least 30 
minutes and nearly 52 per cent participate once a week which is below the London average.10 
- 
Harrow's adult obesity prevalence is 19 per cent, which is lower than the London rate, 21 per cent, 
and the national rate, 24 per cent.11 
 Pink coloured areas are defined as area of deficiency in access to local, small and pocket parks. Proximity rate is +/- 400m from households. 

 
 
http://www.gigl.org.uk/Ourdatasets/Openspace/tabid/117/Default.aspx Potential actions: 
Given the significant relationship between health and green spaces in the urban environment some key actions can be identified to improve quality and proximity in order to enhance access and use. This includes considering: 
- All London Green Grid Supplementary Planning Guidance to improve *biodiversity* function and 

connectivity of green spaces;12  
- The Green Flag Award system to improve quality and promote access to green spaces.13 - Promoting physical activity in outdoor spaces through "outdoor gyms" and "guided walking 
exercise prescription" as a way to recover from cardiovascular diseases and illness.14 
See also sections on surface water flood risk and healthy food. 

Case Study: Regenerating Burgess Park, London Borough of Southwark The regeneration of Burgess Park, in Southwark, was underpinned by a comprehensive  plan that made the focus of the park a place for healthy living, showing how to combine ' natural' regeneration with health promotion15. This has also included opportunities for investment, growth and jobs. For example improved access to, and routes through, the park, alongside enhancements to the lakes, planting, lighting and on-site facilities, has made the park a much more attractive and welcoming place, encouraging play and informal recreation. The park also has over 10 km of running, cycling and fitness routes and a new BMX track, to cater for more formal sport and physical activity. Contact: Ruth Miller, Burgess Park Project Manager ruth.miller@southwark.gov.uk 

## Suggested Further Reading Links To Public Health Outcomes Framework

- Planning for Health (2009) HUDU - The Marmot review (2010) 
www.instituteofhealthequity.org 
- www.nice.org.uk 
 
- Benefit of Urban Parks, IFpra (2013): - www.ecehh.org 
 
Primary 
1.16 Utilisation of outdoor space for exercise/health reasons 
Additional (for example) 
2.6 Excess weight in 4-5 and 10-11 year olds 2.13 Proportion of physically active and inactive adults 2.23 Self-reported well-being  
- www.naturalengland.org.uk - www.hphpcentral.com 
 
- CMO (2011) Start Active, Stay Active 

## Active Travel & Transport

Travel is essential for connecting people to employment, recreation, education and health and community services. Most people travel in some way every day, making it part of everyday life and therefore a factor that can greatly affect the health of all London's citizens16. Travel includes walking and cycling, use of private vehicles, public transport and goods vehicles. In London more than 80 per cent of journeys take place on roads either by motor vehicle, bike or on foot; therefore road transport and street environments have a very significant impact on health and wellbeing17. There are inequalities in the impact of transport upon health, with the most deprived people and those using the most heavily trafficked roads experiencing the most negative health impacts18. Only a few London boroughs include a dedicated transport focus in their Joint Strategic Needs Assessment (JSNA), suggesting the impact of travel on health may be underestimated. 

What is its impact on health?   
A comprehensive public transport network provides many health benefits including access to services, reducing social isolation and increasing work and social opportunities. A major benefit of travel in London is that it enables people to maintain regular physical activity via walking (particularly as part of public transport trips) and cycling. Only around 20 per cent of Londoners currently meet the minimum recommendation for physical activity of 150 minutes per week19. Everyday physical activity is essential for good physical and mental health, contributing to the prevention of over 20 diseases including obesity, type 2 diabetes, cardiovascular disease and some cancers20. Cycling and walking can be easily incorporated into daily routines to meet physical activity needs. In London, approximately 
4.3 million trips currently made by car or public transport have been identified as easily cyclable21. Creating opportunities which enable Londoners to walk and cycle has other potential health benefits including access to safe, green spaces. This could lead to reductions in congestion which, in turn, may reduce overheating and improve air quality. The negative impacts of transport in London are concentrated in the London's most heavily trafficked streets, where high concentrations of vehicles contribute to air and noise pollution and increased injury risk22. This can create the impression of a hostile environment for walking and cycling and can exacerbate health inequalities. Motor vehicles are responsible for 41-60 per cent of air pollutants in the UK, which have an impact on cardiovascular and respiratory diseases. People who live on or use heavily trafficked streets are the most adversely affected. 

## The Harrow Picture

 On average 442,000 trips per day are made by people originating in Harrow.23  Low numbers of people participate in active travel, with the percentage of people cycling to work 
below the Greater London average. 
 Use of motor vehicles is 16 per cent above the Greater London average.24  There was an average of 534 casualties and 2 fatalities per year on Harrow's roads between 2005 
and 2009: this increased by 21% in 2009-2011. 
 The most heavily used road (excluding motorways) is the A404 with an average daily flow of 
42,000 motor vehicles.25 
 The Borough has no cycle superhighways proposed in the Mayor's 'Vision for Cycling'.26 
 

## Source: London Travel Demand Survey Potential Actions: - Designing Street Environments To Encourage Walking And Cycling. - Designing And Engineering Roads To Reduce Motor Vehicle Speed And Implement 20Mph Zones

where appropriate. 
- Promoting a network of roads and paths that are safe and convenient for cycling and walking. - Supporting walking and cycling by ensuring that, where possible, the needs of cyclists and 
pedestrians are considered before other road users. 
- Promoting cycling through information, maps and cycle hire schemes. 
- Improving safety of heavily trafficked streets where most traffic related health risk is concentrated. 

See also section on air quality. 

Case Study: Cycling across Hackney Hackney has the highest levels of cycling in London. There are more cyclists than motorists in many parts of the borough. This is evidenced by the fact that 6 per cent of journey's originating from Hackney are on bike, higher than any other borough in London23. Since 2001 the Council has sought to increase the areas that are cycle friendly by improving the design and increasing the accessibility of the road network for cyclists.27    
- Road safety has been improved by reducing motor traffic speeds and volumes. The aim is to 

enforce 20 mph speed limits across the borough on all residential roads.27 
- Systematic improvements have been made to the public realm for pedestrians, cyclists and public 
transport users and a number of designated cycle routes such as the Hackney Park cycle route have 
been created.27 
- Hackney has invested in a range of cycle parking bays including lockers in estates, hangars (on 
street bike/storage lockers), on residential streets and large bike ports at transport hubs such as railway stations and town centres. 
- A comprehensive free cycling training programme has targeted a range of audiences.27 
Contact: Ben Kennedy, Hackney Council, ben.kennedy@hackney.gov.uk 
Example of a cycling improvement scheme Wordsworth Road/Palatine Road, Hackney 

## Links To Public Health Outcomes Framework Suggested Further Reading

- Healthy Transport Healthy Lives, British 
Medical Association (BMA) 
- NICE Walking and Cycling, Local 
Government Briefing 
- Mayors Vision for Cycling, 2013 GLA - London Borough of Hackney Sample of 

## Primary 2.13 Proportion Of Physically Active And Inactive Adults Additional (For Example) 1.16 Utilisation Of Outdoor Space For Exercise/Health Reasons 2.7 Hospital Admissions Caused By Unintentional And

Schemes for cycling & public realm (2013) 
deliberate injuries in under 18s 3.1 Fraction of mortality attributable to particulate air pollution 
- What are the health benefits of active 
travel: A systematic review of trials and cohort studies, PloSOne, 8 

## Surface Water Flood Risk

Surface water flooding describes flooding on the land surface from sewers, drains, groundwater and runoff from land after a heavy rainfall event28. Surface water flooding events are difficult to predict but can cause significant disruptions to local populations and to health and other services. London is vulnerable to surface water flooding because some areas have poor drainage systems and large areas of impervious surfaces29. Approximately 480,000 London properties and ten hospitals are at risk of surface water flooding in London30. Surface water flooding is already a considerable risk and one that, without action, will increase in London due to population growth, urban expansion and ageing of drainage systems. In addition, changing climate patterns are likely to increase the number and intensity of large magnitude precipitation events leading to a likelihood of more frequent and larger magnitude surface water flooding events.  Local Flood Authorities are responsible for mapping, assessing and managing local flood risks, identifying whom and what is at risk and the vulnerability of services such as hospitals and schools to surface water flooding. The Mayor's Regional Flood Risk Appraisal identifies surface water flood risk as the most likely cause of flooding in London. The GLA, Thames Water, the Environment Agency and London Councils have been developing and delivering a programme to manage this risk, known as Drain London. There are multiple ways in which flooding can create health risks: 
- Fast flowing water has multiple potential hazards such as moving debris which can cause physical 

injury and even death. Contaminated flood water containing pollutants such as chemicals and sewage can cause disease. 
- Flooding of health facilities results in disruption to access to healthcare facilities, with increased 
difficulty providing routine medical care and increased patient admissions in neighbouring facilities.  
- Exhaust emissions from machinery operating in the clean-up process and recovery from a flood can 
cause carbon monoxide poisoning31.  
- Disruptions in flood recovery, fear of repeat events and added effects of stress due to insurance 
claims and refurbishing properties can cause mental health problems. Up to 25 per cent of people who experienced flooding in their homes in the major UK floods in 2007 experienced mental health 
issues after the event32.  
  
Who might experience the greatest impact? 

Some areas in London are at risk of surface water flooding particularly where there is inadequate sewer/drainage capacity, and some groups are at greater risk4. These include people with limited mobility or/and those who are dependent on medication and/or regular healthcare at home or at a health/social care facility. Those with less flood awareness due to weak social networks and limited or no access to public warning systems and/or information are also at risk. The Harrow Picture The Environment Agency will be releasing a national surface water flood risk map for each London borough in December 2013. Whilst this will show the areas at risk it should also be noted that any low lying area could also potentially be affected but may not be visible on the maps because of the difficulty in assessing surface water flood risk. The maps will provide borough-specific assessments. 

 
Potential actions:  
- Developing emergency plans to reduce effects of surface water flood risk. - Including integrated emergency planning for priority groups/services. Developing land 

management strategies such as green roofs to reduce likelihood of surface water flooding. 
- Incorporating Sustainable Urban Drainage Systems (SuDS) as an alternative to traditional 
approaches to managing runoff. 
- Identifying vulnerable and isolated people and implementing early warning systems and evacuation 
plans. 
- Planning for disruption of infrastructure and increase in patient volumes at health and social care 
facilities. See also section on green spaces and healthy food 

## Case Studies: Purley (Lb Croydon) Community Flood Plan 6

- Purley is vulnerable to flooding and experienced a large flood event in 2007. In response the 
community developed a Community Flood Plan. 
- The flood plan is owned by the community, and aims to reduce the impact of flooding. - It advises the community on how to prevent flooding and what to do if it happens. - It is a low cost but effective way of reducing a wide range of impacts of flooding. - The community has created a number of flood wardens who play a central role in advising local 
citizens and businesses on the flood risk and actions they can take to reduce the impact and nature of flood events. 

## Surface Water Flooding Event, London, July 2007 7

- In July 2007, 121mm of rainfall fell in London, mostly on July 20th, causing some significant 
surface water flooding. 
- Approximately 400 properties were flooded, 158 schools affected and two hospitals were closed as 
a result. 
- The closure of St George's Hospital caused major disruption.8 
 

## Suggested Further Reading Links To Public Health Outcomes Framework

- GLA Regional Flood Risk Appraisal, 2013 - Drain Londonhttp://www.london.gov.uk/priorities/environment/loo king-after-londons-water/drain-london  Programme London Climate Change Adaptation Strategy 
- Multi-Agency Flood Plan, LB Havering, 2012 
- Floods in the European Union, Health effects and their 
prevention (2013), World Health Organisation (WHO) 

## Primary: 3.7 Comprehensive, Agreed Interagency Plans For Responding To Public Health Incidents And Emergencies Additional (For Example) 3.6 Public Sector Organisations With A Board-Approved Sustainable Development Management Plan Air Quality

Good air quality has long been recognised a basic requirement for good health.  The UK Air Quality Standards Regulations 2000, updated in 2010, set standards for a variety of pollutants that are considered harmful to human health and the environment. These are based on EU limit values and are for a range of air pollutants: sulphur dioxide, nitrogen dioxide, oxides of nitrogen, particulate matter 
(PM10 and PM2.5), lead, benzene, carbon monoxide, benzo(a)pyrene and ozone. 

Much of the focus of air quality action is on nitrogen dioxide (NO2) and particulate matter (PM). 

Particulate matter (PM10 and PM2.5) refers to a complex mixture of non-gaseous particles of varied physical and chemical composition. It is categorised by the size of the particulate. In London, road traffic is a significant source of PM mainly from exhaust emissions and wear, tyre and brake wear and dust from road surfaces. In addition, older furnaces and boilers may have an impact on the overall air quality environment within a house. Poor air quality could potentially compromise health and well-being. It should be noted that exceedences apply across the whole of London, particularly near built up areas and major roads. 

What is the impact on health?  What is the evidence? 

Long-term exposure to poor air quality can contribute to the development of chronic diseases and can increase the risk of respiratory illness. In Greater London it is estimated that the equivalent of 4,267 
deaths in London in 2008 were attributable to long-term exposure to PM2.5. It should be noted that this does not relate to real individuals, but is a statistical construct whereby all health impact associated with air pollution are amalgamated. Since everyone breathes the air where they are, a more realistic interpretation is that the risks are distributed across the whole population, with a total mortality impact of the concentrations equivalent to that number of deaths.  At high concentrations NO2 can result in inflammation of a person's airways; long-term exposure can affect lung function and respiratory symptoms and can increase asthma symptoms. PM aggravates respiratory and cardiovascular conditions.  The smaller the particle, the deeper it will deposit within the respiratory tract. The impact of PM2.5 on health is especially significant.  
 
Who may experience the greatest impact? 

- 
People who live or work close to areas with poor air quality 
- 
People with respiratory problems 
- 
People with heart problems 
 

The Harrow Picture 
- On some of Harrow's main arterial roads there are high concentrations of NO2 (see map) which are 
above the recommended limits. 
- Statistical tools are used by public health specialists to try to understand the comparative impact of 
different factors on mortality. Using these techniques, Harrow is the 3rd least affected area by poor air quality in London. 33 
- In 2011 the GLA identified five Air Quality Focus Areas within Harrow. 

## Potential Actions: - Promoting A Modal Shift To Encourage Higher Proportions Of Walking, Cycling And Use Of Public

transport and less use of cars.  This could include a wide range of measures from systemic action within the planning and transport system to one-off events such as car free days. Such measures could lead to significant improvements in air quality. 
- Promoting energy efficiency in homes, public and commercial offices. For more information see the 
Energy Company Obligation34. 
- Individual steps could be taken to:  
a) reduce personal contribution to air pollution such as engine idling; and,  
b) reduce risk of exposure where it is potentially hazardous to health (particularly for people with 
underlying vulnerabilities) through systems such as airText. 
  See also section on active travel and transport. 

## Case Studies: Reducing Exposure - City Air Mitigating Impact - Croydon Air Text

'CityAir' was launched in May 2011 in the City of London to encourage businesses to help to improve local air quality. Best practice guidance and case studies were produced to provide advice to City businesses on reducing emissions from buildings, encouraging staff to walk and cycle in the City, using purchase contracts to require low polluting vehicles and building air quality targets into environmental reporting. Information is available at www.cityoflondon.gov.uk/cityair. To date over 50 businesses have been engaged, representing over 40,000 employees. CityAir employee walking campaigns have been very popular. Contact: Ruth Calderwood ruth.calderwood@cityoflondon.gov.uk In 2005 the London Borough of Croydon developed with the European Space Agency and Cambridge Environment Research Consultants an air quality forecasting service called 'airTEXT'.  AirTEXT provides information on pollution levels in the borough using 'low', 'moderate' and 'high' bandings. Whenever moderate or high pollution levels are expected, subscribers to airTEXT receive a text message, call or voicemail. This enables recipients to respond, if necessary, for example by taking a different route/mode of transport to work, keeping their medication with them or not exercising outside on certain days. In 2012 a new airTEXT app was developed which provides information on four health-relevant alerts: UV, pollen, air quality and temperature.  Currently around 10,000 people use the airTEXT service through text, Twitter or the website. 

## Suggested Further Reading Links To Public Health Outcomes Framework

- GLA Local Authority Air Quality Guides - www.londonair.org.uk - www.comeap.org.uk - NICE Guidance PH41 Walking and 
cycling: local measures to promote walking forms of travel or recreation 
- Kilbane-Dawe (2012) 14 Cost Effective 
Primary 
3.1 Fraction of mortality attributable to particulate air pollution Additional (for example) 
2.13 Proportion of physically active and inactive adults 1.14 The percentage of the population affected by noise Actions to Cut Central London Air Pollution 

## Healthy Food

Access to healthy food is an important wider environmental determinant of health. Improving the food environment means enhancing the availability of affordable and nutritious food and recognising the relationship between the geography of food retailing and dietary patterns35. It also means considering of sustainable production, processing and delivery.  Policy attention has focused on the role of local planning measures and the impact of large supermarkets, provision of food growing places, the physical environment and education on a healthy diet.  Many factors influence the availability of healthy food. The predominance of unhealthy food and low income may interact with environmental factors to limit access. Access to healthy food can be measured through the following indicators: cost, quality, geography, mode of transportation, physical proximity and socio-economic variables. What is the impact on health? What is the evidence? 

Reduced access to healthy food and the ready and cheap availability of unhealthy foods (such as fastfood and takeaway outlets) increases the risk of a diet based on high consumption of sugar, saturated fat and salt and low in vegetables and fruit36. This could lead to obesity, cardiovascular disease, type 2 
diabetes and some cancers associated with obesity. The National Obesity Observatory estimated the cost to the UK economy of overweight and obesity to be £15.8 billion per year (2007). This has an impact on children as well as adults.  Studies have also found that an increased density of fast food restaurants is directly related to increased Body Mass Index (mass index showing body fat based on height and weight) and that having a fast food outlet within 160m of a school is associated with a 5 
per cent increase in obesity37. The Harrow Picture  

 Harrow's adult obesity rate is 19 per cent. This is lower than the London average (21 per cent), and 
the national average (24 per cent).38 
 Harrow's obesity rate among primary school children (year 6) is 20 per cent. This is similar to the 
national and London rates (19 and 23 per cent respectively).39 
 In 12 out of 30 Middle Super Output Areas (two darkest blue areas on map), 31-37 per cent of the 
total population consume five portions of fruits and vegetables a day.40 
 16 per cent of Southwark's population participate five times per week in physical activity for at 
least 30 minutes and nearly 53 per cent participate once a week.41 

Potential actions 
- Developing schemes to promote local and easily accessible healthy food from retailers (for example 
www.cieh.org/healthier-catering-commitment.html). 
- Using planning controls to manage proliferation of fast-food outlets on high streets and near 
schools. 
- Promoting the GLA Healthy Schools London Awards Initiative (www.healthyschoolslondon.org.uk). 
Healthy food choice in schools is recognised as a way to tackle obesity and chronic diseases caused by poor nutrition. This includes diet, education, and healthy meals provided at schools and accessible from nearby areas. 
- Capital Growth (www.capitalgrowth.org) initiatives have the potential to promote community food 
growing. These activities reconnect people to the food system, engages them in issues such as where their food comes from, seasonality, healthy eating, and food security. 
- Procuring from local food suppliers and retailers, signed up to the Healthier Catering Commitment 
Plan. 
See also section on green spaces and surface flood risk. 
Case Study: Fast-food Fix - LB Waltham Forest - Tackling the Takeaways: Making an Impact 
- 
Community engagement on 'takeaways' in the borough identified dissatisfaction with the number and location of 241 local hot food takeaways (HFT).  This included schools, concerned that the proximity of HFTs to schools had a negative impact on healthy eating programmes. 
- 
A  HFT corporate steering group was established to: 
- 
Ensure existing HFT businesses operated as responsibly as possible; 
- 
Develop strategies to tackle the wider social, environmental and economic issues associated with the proliferation of HFTs in the borough. 
Achievements: 
- Supplementary planning documents were developed restricting the opening of new HFT shops. So 
far, 20 applications have been refused planning permission and only 4 HFTs have been given planning permission. 

## - Hfts In The Borough Have Been Reduced From 241 To 194 Contact: Gordon Glenday, Head Of Planning Policy And Regeneration Gordon.Glenday@Walthamforest.Gov.Uk Links To Public Health Outcomes Framework

Suggested further reading 
 
 NICE guidance: www.nice.org.uk  Takeaways Toolkit (2012): see www.london.gov.uk  
 District Action on Public Health: 
http://districtcouncils.info/; 

 CIEH Food Policy, (2013): www.cieh.org  Healthy People, Healthy Lives, (2011);  Good planning for Good Food: see 
Primary: 
2.11 Diet Additional (for example): 
2.6 Excess weight in 4-5 and 10-11 year olds 2.12 Excess weight in adults 2.17 Recorded diabetes 

www.sustainweb.org/publications/?id=192 

## Fuel Poverty

There are three factors that can result in fuel poverty, often in combination: low income, poor energy efficiency in homes and increasing energy prices. A household is now defined as 'fuel-poor' if its total income is below the poverty line (taking into account housing energy costs) and its energy costs are higher than typical for its household type.42 Data on fuel poverty is collected from the English Housing Survey Domestic Fuel Inquiry and published annually by the Department of Energy and Climate Change (DECC).  More than 560,000 households in London are estimated to be spending more than ten per cent of their basic income on energy (the previous official definition of fuel poverty).43. Fuel poverty has the potential to have an adverse impact on children already in poverty as well as to increase the numbers of children living in poverty. Fuel poverty is also known to have an impact on well-being as indicated in self-reported well-being surveys.44  
 
What is the impact on health?  What is the evidence? 

Fuel poverty can have a negative impact on health, especially on people with pre-existing medical conditions. Fuel poverty results in cold homes, exacerbating cardiovascular and respiratory conditions, rheumatoid arthritis and influenza, and negatively affects mental health.42 The effects of fuel poverty may be compounded by social isolation, poor emotional well-being, reduced mobility and poor diet. Cold homes are also known to affect cognitive performance.  However, actual deaths are only one part of the problem. Age UK estimates the cost to the NHS of cold homes as £1.36 billion per year (not including additional costs to social services for subsequent care).45 The recent DECC fuel poverty framework attempts to monetise the health impacts of fuel poverty. It refers to a model estimating changes in people's health from the installation of energy efficiency measures (resulting from changes in the indoor temperature and pollutant exposure).46    
 
Who might experience the greatest impact? 

Fuel poverty affects vulnerable groups such as older people, the group most likely to suffer excess winter deaths. Children, people with disabilities and/or those living in deprivation are also at greater risk of suffering from the effects of fuel poverty as they often need to spend longer time indoors and require heating for longer periods of time. Additionally, private sector tenants are at significantly greater risk of encountering the worst housing quality and are also least likely to access support or feel empowered to do anything about the issue. 


The Harrow Picture 
- The older population of Harrow is projected to rise from 34,800 (2012) to 43,700 (2025) and 
50,000 (2040). 47  
- A Fuel Poverty Risk score has been developed. There are some disparities between wards with 
Pinner South achieving the second 9th lowest risk score of all London wards but Wealdstone being 
423rd out of 625 wards and at significantly greater risk.  
- Twelve Harrow wards are at low risk of fuel poverty and none showing particular risk, according to 
the fuel poverty risk indicator. No wards show a marked improvement or decline in their scores 
between 2006-2010.48 

 
The Fuel Poverty Risk Index was developed by the London Assembly Health and Public Services Committee in their investigation into fuel poverty in London. It is calculated on the basis of twelve indicators across four sections: Housing Dwellings without central heating Uninsulated cavity walls Lofts with less than 150mm insulation Health Health Deprivation & Disability domain (ID2010) Standardised Mortality Ratio Incapacity benefit claimant rate Older people People aged 60 and over Older people claiming pension credit Worklessness Unemployment Poverty Income support claimant rate Child poverty rates Households classified 'fuel poor' 

 Source: GLA (2013) Fuel Poverty Risk Indicators Tool, available on London Datastore 

## Potential Actions: The First Key Step To Any Intervention Is To Identify Vulnerable Areas/Individuals And Map The Extent Of The Problem. Vulnerable Individuals And Households Can Be Identified And Supported Through: - Close Collaboration With Third-Sector Organisations Which Are Working With Vulnerable

groups/isolated populations/people to refer or inform them of available support. 
- Home energy improvements as a vital sustainable solution to fuel poverty. There are opportunities 
through initiatives such as the Green Deal and Energy Company Obligation49. The Mayor's RE:NEW Programme support team50 can offer advice on funding, procurement  and best practice to partner 
with energy efficiency providers. In addition, the issue of overheating should be taken into account when implementing any energy efficiency works especially wall and loft insulation.  Whilst take up of the Green Deal to date has not been significant, it remains an important delivery mechanism to reduce fuel poverty in London. (See section on overheating). 
- Promoting collaboration between local authorities and private landlords in line with upcoming 
energy efficiency legislation (2018 energy efficiency requirements51). 
- Raising awareness of benefits entitlement and support through public health campaigns, working 
with third sector organisations and the local community. 

## Suggested Further Reading

See also section on overheating and air quality. 

Case Study: Barts Health in Tower Hamlets - Reducing Fuel Poverty Barts Health has recently established a partnership project with British Gas and Global Action Plan that aims to reduce fuel poverty in Tower Hamlets. Hospital staff, GPs and community groups refer patients from vulnerable groups or those people living in hard-to-treat homes to the Energy Companies Obligation, supporting the installation of energy efficiency measures in low-income households.  The project will train and support 40 health professionals (GPs, outpatient care staff and community nurses) plus community groups.  The partnership initially aims to target 200 homes.  The initiative is not just a referral mechanism but will raise awareness among vulnerable groups, medical practitioners and the wider community on what steps could be taken to address fuel poverty. Such an initiative could be linked with other seasonal health initiatives such as winter flu jab promotion. Contact: Fiona Daly, Barts Health NHS Trust, fiona.daly@bartshealth.nhs.uk Links to Public Health Outcomes Framework 

- Marmot Review Team, 2011 - The Health Impacts of Cold Homes 
and Fuel Poverty 

Primary 
1.17 Fuel poverty 
Additional (for example) 
1.1 Children in poverty 
2.23 Self-reported well-being 4.15 Excess winter deaths 

- Age UK, 2012 - The Cost of Cold - Hills, 2012, Getting the measure of fuel poverty - DECC, 2013, Helping-households-to-cut-their-energy-bills - DECC, 2013, Fuel Poverty, A Framework for future action. - London Assembly, 2012, In from the cold? Tackling fuel poverty 
in London, GLA 

## Overheating

What do we mean by overheating?  How do we measure it? 

Extreme weather events are more likely to be a factor affecting people's health in future years52. 

Heatwaves, such as the one in the summer of 2003 which caused the death of 2000 people, could become more frequent (London had an excess mortality of 42%, compared to England of 17%). The Urban Heat Island (UHI) effect means that urban areas tend to be hotter than rural areas. This is due to increased absorption of the sun on concrete compared with green or brown spaces, reduced cooling from breezes due to buildings and increased heat production from houses, industry, businesses and vehicles. This is especially relevant for London with its densely built-up central boroughs and high concentration of traffic and people.  The UHI effect is not universally experienced across the city as it relates to availability of green space/water bodies, building density, amount of traffic and energy consumption. However there are particularly vulnerable spots in each borough, as well as vulnerable people across areas. (See maps below). When considering London as a whole, the costs associated with overheating mortality are expected to be around £7-78 million in the 2030s (473-712 heatattributable deaths); by the 2050s, this could rise to £13-149 million (1200-1838 heat-attributable deaths).53  
 
What is the impact on health?   
Overheating54 can cause heat strokes, exacerbates existing cardiovascular and respiratory conditions and affects people with respiratory conditions due to a combination of overheating and poor air quality. A heatwave can also affect mental health with peak suicide and homicide rates reported during previous heatwaves in the UK. Research has shown a direct link between a temperature rise to more than 24˚C and risk of death.55 Additionally, people may suffer from heat-related illnesses, such as heat cramps, heat rash and heat syncope (fainting as a result of overheating). Overheating may lead to dehydration, especially in older people, and there is a strong link between high temperatures, dehydration and blood stream infections, also particularly in older people.56 
  
Who will experience the greatest impact? 

Certain housing conditions (older and small top floor, purpose built flats because of the low solar protection offered by the top floor of poorly insulated flats; and newly constructed houses not suitably designed for extreme heat events and the quality of the built environment could potentially contribute to the overheating of an environment. Certain groups such as children have less efficient body cooling mechanisms and are therefore at greater risk. Similarly, the body's thermoregulatory mechanisms could be impaired in older people and those with chronic health conditions. Those considered vulnerable to overheating may not always perceive themselves to be at risk. Simple measures to reduce the negative impacts of overheating are not always implemented which could place these groups at even greater risk.  
The Harrow Picture The map below shows temperature differences across the borough and also shows the effects of existing infrastructure and green space on overheating risk. Combined with data on vulnerable populations, this will provide a more precise picture of the biggest risk areas. 



Model simulations of London's temperatures were provided by Dr. Sylvia I. Bohnenstengel (University of Reading) using the Met Office Unified Model and MORUSES (MetOffice Reading Urban Surface Exchange Scheme) (Bohnenstengel et al., 2010).  
 
 
London Average Screen Temperatures in degrees Celsius for the period 26 May-19 July 2006 Equal count mapping method: each interval; contains 7% of the total number of grid points 
 
Potential actions:  
The NHS Heatwave Plan for England 2013 suggests actions to mitigate and/ or ameliorate some of the effects of future heatwaves and hot weather.57 Short term actions include: 

 Modifying surface properties and integrating green infrastructure, for example, 'cool roofs', 'green 
roofs' and 'cool pavements' (paving materials that tend to reflect, provide cooler surfaces and increase water evaporation ratio). 
 Planting trees and vegetation and creating green spaces to enhance evaporation and shading, 
(temperatures in and around green spaces can be several degrees lower than their surroundings). The development of 'green spaces' can not only help to alleviate the impact of the UIH effect but has been shown to have other positive health benefits such as improving mental health and wellbeing. Increasing green infrastructure also improves air quality.  
 Insulating homes. This protects against hot weather as well as reducing heating needs in the 
winter. 
 Introducing an active transport plan or car-sharing schemes. These will reduce numbers of vehicles 
used leading to improvements in air quality, whist promoting healthy living. 
 Using reflective paint on south-facing walls and roofs. 
- Taking fuel poverty into account when implementing any energy efficiency works. 
- Considering using the planning process to influence planning decisions on housing and commercial 
properties' heat thresholds. 
- Retrofitting public buildings with energy-saving technology - including low-energy lighting and 
high-efficiency boilers. This presents one of a number of opportunities to improve on infrastructure, growth and support local job creation.  
 The Plan makes the case for a medium term (10–30 years) and long term approach (30+ years). See also section on fuel poverty and air quality. 

Case Study: London Borough of Islington and the CRISP Project CRISP is a joint project between Islington Council and North London Cares that took place in the beginning of 2013. Research among residents aged 65+ concluded that the majority of elderly people did not take hot weather issues as seriously as cold weather issues. Although levels of information were generally found to be good, there were some everyday actions being taken that might exacerbate the risk of overheating. The project identified the need for a widespread information campaign on proper use of windows, curtains and fans. The research identified challenges of communicating information about overheating. The findings and recommendations will inform Islington's Council Seasonal Resilience Plan and the work of the Seasonal Health Interventions Network (SHINE). Contact: John Kolm-Murray, Islington Council john.kolm-murray@islington.gov.uk Links to Public Health Outcomes Framework 

## Suggested Further Reading

 NHS Heatwave Plan for England  
 RE:FIT is the Mayor of London's innovative scheme to reduce 
carbon emissions in Greater London, www.refit.org.uk 
 GLA (2011) London Climate Change Adaptation Strategy  London Climate Change Partnership (2012) Heat Thresholds 
Project: Final Report 
 Built Infrastructure for Older People in Conditions of Climate 
Change (BIOPICCC) 
 Design and Delivery of Robust Hospital Environments in a 
Changing Climate (De2RHECC)  
Primary: 
3.7 Comprehensive, agreed inter-agency plans for responding to public health incidents and emergencies Additional (for example) 
3.6 Public sector organisations with a board-approved sustainable development management plan 

## References

                                                 
1Centre for Disease Control and Prevention (CDC), 2013,from CDC (USA); 
www.cdc.gov/about/history/tengpha.htm 
2 Evidence demonstrating links between access to green spaces and health: 
Coombes, E., Jones, A P, & Hillsdon, M. (2010). The relationship of physical activity and overweight to objectively measured green space accessibility and use. *Social science & medicine*, 70(6), 816-822; Maas, J., Verheij, R. A.,et al (2006). Green space, urbanity, and health: how strong is the relation? Journal of epidemiology and community health, 60(7), 587-592;  
Nielsen, T. S., & Hansen, K. B. (2007). Do green areas affect health? Results from a Danish survey on the use of green areas and health indicators. *Health & place*, 13(4), 839-850; Schipperijn, J., Bentsen, P et al (2013). Associations between physical activity and characteristics of urban green space. *Urban Forestry & Urban Greening*, 12(1), 109-116. Mitchell, R., & Popham, F. (2008). Effect of exposure to natural environment on health inequalities: an observational population study. The Lancet, 372(9650), 1655-1660. 

3MENE Survey evidencing  frequency, mode and motivation in access to Green Space, (2012-2013), from Natural England  www.naturalengland.org.uk/ourwork/research/mene.aspx 
4Local access to public open spaces, taken from  Access to Public Open Space, (2012),  London Data Store http://data.london.gov.uk/datastore/package/access-public-open-space-and-nature-ward ; 
5Survey showing number of people participating in sport in local communities, taken from Active People Survey (2013), Sport England  www.sportengland.org/research/active_people_survey.aspx 
6 Use of small public urban green spaces and health benefits, Peschardt, K. K., Schipperijn, J., & Stigsdotter, U. K. (2012) Use of small public urban green spaces (SPUGS). *Urban Forestry & Urban Greening*, 11 (3), 235-244 
7 Physical Activity and the Environment, taken from "Marmot Review (2010) Fair Society, Healthy Lives"; 
NICE (2008). Physical activity and the  environment., PH Guidance 8 
8 Toolkit showing levels of adult obesity, taken from Adult Obesity (2005) National Obesity Observatory , NHS UK, Public Health England; http://www.sepho.nhs.uk/NOO/e-Atlas/adult/atlas.html 
9 Access to Public Open Space, (2012), taken from  London Data Store, http://data.london.gov.uk/datastore/package/access-publicopen-space-and-nature-ward  
10Toolkit showing levels of adult obesity , taken from Adult Obesity (2011-2012) National Obesity Observatory , NHS UK, Public Health England; http://www.sepho.nhs.uk/NOO/e-Atlas/adult/atlas.html 
11 Toolkit showing levels of adult obesity , taken from Adult Obesity (2006-2008) National Obesity Observatory, NHS UK, Public Health England; http://www.sepho.nhs.uk/NOO/e-Atlas/adult/atlas.html 
12GLA All London Green Grid Supplementary Planning Guidance ,(2012) taken from, www.london.gov.uk/priorities/planning/publications/all-london-green-grid-spg; Datasets to support this guidance, taken fromwww.gigl.org.uk/Ourdatasets/Openspace/tabid/117/Default.aspx; 
13 Green flag award system for green spaces, taken from Keep Britain Tidy, http://greenflag.keepbritaintidy.org/ 
14 Southwark Council outdoor gym, taken from www.southwark.gov.uk/info/200435/free_outdoor_activities/2611/outdoor_gyms/1 
15 Burgess Park regeneration project July 2012, taken from www.southwark.gov.uk/news/article/792/burgess_park_to_reopen_after_8_million_transformation) 
16 London Travel Demand Survey (LTDS),2011,taken from Transport for London, Travel in London, Supplementary Report: ,www.tfl.gov.uk 
17 Evidence demonstrating link between transport and health, March 2013, Keeping well in hard times: 
Protecting and improving health & well-being in an income shortfall: taken from, London Health Inequalities Network. 

18 Link between heavily trafficked streets and health impacts, 2005, taken from Health Development Agency Making the case: Improving health through transport. 

19 Data showing physical activity rates in London, 2010, taken from Public Health England: Physical Activity in London: Key Facts. www.lho.org.uk/LHO_Topics/Health_Topics/Lifestyle_and_Behaviour/PhysicalActivity.aspx 
20 Link between active travel and health, 2012, taken from British Medical Association,  Healthy Transport= 
Healthy Lives, BMA,www.bma.org.uk  
                                                                                                                                                                  
21 Analysis of cycling potential, 2010, taken from Transport for London, December  Analysis of Cycling Potential, Travel in London, www.tfl.org.uk 
22 Report showing negative impacts of transport in London, 2011, taken from Mackett, R.L. & Brown, R. ; 
Transport, Physical Activity and Health. Present knowledge and the way around. Centre for Transport Studies, University College London, www.cege.ucl.ac.uk 
23 Number of travel trip by each modal share, 2011, taken from London Travel Demand Survey. Transport for London, www.tfl.org.uk 
24 Reported road casualties in Great Britain, annual report 2011, taken from www.gov.uk 
25 Most heavily vehicular used roads, 2000-2012, taken from Traffic Statistics, Department of Transport 
26 The Mayor's proposed cycle superhighways for London, 2013, taken from Mayor's Vision for Cycling, GLA, www.tfl.gov.uk 
27 Hackney's case study showing cycling promoting measures, 2013, taken from London Borough of Hackney Sample of Schemes for cycling & public realm. www.hackney.gov.uk ( 
28 Surface Water Management Plan (SWMP), 2010, taken from, Technical Guidance. DEFRA 
www.defra.gov.uk 
29 London Regional Flood Risk Appraisal, October 2009, taken from GLA, ; , www.london.gov.uk 
30 Overall strategic plan for London, the London Plan, 2011, taken from GLA, www.london.gov.uk 
31 Secondary impact of floods on health, 2013, World Health Organisation ; Floods in the WHO European Union, Health effects and their prevention. Edited by Bettina Menne and Virginia Murray, taken from Public Health England's website, www.gov.uk/government/organisations/public-health-england 
32 Effects of floods on mental health, 2011, taken from Murray, V, Caldin et al (2011); The Effects of Floods on Mental Health, Health Protection Agency,www.hpa.org.uk 
33 www.phoutcomes.info 
34 https://www.gov.uk/green-deal-energy-saving-measures/how-the-green-deal-works 35Access to healthy food, taken from, White (2007), Food Access and Obesity, *Obesity reviews*, 8 (s1), 99-
107. ; Chartered Institute for Environment and Health, 2013, taken from Chartered Institute for Environment and Health Food Policy: http://cieh.org/. 

36 Takeaways Toolkit, 2012, taken from, London Food Board and Chartered Institute of Environmental Health  
http://www.london.gov.uk/priorities/environment/promoting-healthy-sustainable-food/londonboroughs/takeaways-toolkit; 
37 Effect of fast food restaurants on obesity and weight gain, taken from, Currie, J., Vigna, SD et al (2010), The effect of fast food restaurants on obesity and weight gain. American Economic Journal: Economic Policy, 32-63. 

42 New Fuel Poverty Definition 2013, taken from Department of Energy and Climate Change (DECC), taken from  Fuel Poverty, A Framework for future action. www.decc.gov.uk 
43Tackling fuel poverty in London 2012, taken from GLA - London Assembly In from the cold? 

www.london.gov.uk  
44 Fuel poverty impact on wellbeing, 2011, taken from, Marmot Review Team, The Health Impacts of Cold Homes and Fuel Poverty, www.gov.uk/government/organisations/public-health-england 
45 Cost of fuel poverty to the NHS, 2012, taken from AgeUK, The Cost of Cold www.ageuk.org.uk/latestnews/archive/cold-homes-cost-nhs-1-point-36-billion 
52 Heatwave Plan 2013, taken from Public Health England, Making the case: the impact of heat on health - 
now and in the future  www.gov.uk/government/organisations/public-health-england  
53 Potential costs of overheating including data, 2013, taken from Department for Environment, Food and Rural Affairs, The Economics of Climate Resilience: Health and Well-being Theme CA0401 www.defra.gov.uk 
54 Overheating and health, 2011, taken from Health Protection Agency, Overheating and health: a review into the physiological response to heat and identification of indoor heat thresholds www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317133912939 
55Association of mortality with high temperatures in a temperate climate: England and Wales, Armstrong et al. (2010) Association of mortality with high temperatures in a temperate climate: England and Wales, Journal of Epidemiology and Health, vol.65:4, 340-345 
 
56 Heatwave Plan 2013, taken from Public Health England, Making the case: the impact of heat on health - 
now and in the future  www.gov.uk/government/organisations/public-health-england  
57 Heatwave Plan 2013, taken from Public Health England, Making the case: the impact of heat on health - 
now and in the future  www.gov.uk/government/organisations/public-health-england 

## Further Reading

 Local Authorities' strategies (e.g. Planning, Transport) are monitored on an annual basis and 
PHOF indicators may be relevant additions to these strategies and a way of spreading a public health approach across the Council:  www.phoutcomes.info  provides useful borough summaries for this approach. 
 The Index of Multiple Deprivation (IMD)  highlights the impact of wider environmental 
determinants most adversely on those in more deprived areas: www.gov.uk/government/organisations/department-for-communities-and-localgovernment/series/english-indices-of-deprivation 
 Public Health has an important role in reminding other departments about health inequalities 
and intra borough inequalities.  Basic summaries can be found at: www.apho.org.uk/?QN=P_HEALTH_PROFILES 
 The local authority planning process offers the opportunity to mainstream some of these 
issues through planning guidance.  The Town & Country Planning Association offers a useful guide:  www.tcpa.org.uk/data/files/TCPA_FINAL_Reuniting-health-planning.pdf 
 The NHS London Healthy Urban Development Unit www.healthyurbandevelopment.nhs.uk 
and their Watch Out for Health Checklist and the Health Impact Assessment Gateway http://www.apho.org.uk/default.aspx?QN=P_HIA offers useful insight across many fields including regeneration, social infrastructure planning, housing, policy development, planning advocacy and negotiations, planning obligations, development management, master planning, environmental and health impact assessment. 
 Some themes in this Guide, for example, (food, fuel poverty, active travel) are addressed in 
Keeping Well in Hard Times hwww.lho.org.uk/Download/Public/17975/1/Keeping per cent20well per cent20in per cent20hard per cent20times.pdf  
 There is a useful guide for developers on maximising environmental benefits at: 
www.environment-agency.gov.uk/research/planning/147852.aspx 
 Effect of exposure to natural environment on health inequalities: an observational population 
study http://eprints.gla.ac.uk/4767/1/4767.pdf 
 Great Outdoors: How Our Natural Health Service Uses Green Space To Improve Wellbeing 
            www.fph.org.uk/uploads/bs_great_outdoors.pdf 

## Public Health Outcomes Framework Mapping Environmental Determinants To The 2013-2016 Public Health Outcomes Framework

| Primary     | Improvements or worsening will have a direct impact on the indicator    |     |
|-------------|-------------------------------------------------------------------------|-----|
| Secondary   | Improvements or worsening may have an impact on this indicator          |     |

|                       | AQ - Air Quality        | AT - Active Travel and Transport     | GS - Access to Green Space         |
|-----------------------|-------------------------|--------------------------------------|------------------------------------|
| FR - Surface Flooding |                         | OH - Overheating                     | FP - Fuel Poverty                  |
| HF - Healthy Food     |                         |                                      |                                    |

| AQ AT                                                  | GS    | FR    | OH HF    | FP    | Domain 1     |
|--------------------------------------------------------|-------|-------|----------|-------|--------------|
| Improving the wider determinants of health             |       |       |          |       |              |
|                                                        |       |       |          |       |              |
| 1.1 Children in poverty                                |       |       |          |       |              |
| 1.2 School readiness                                   |       |       |          |       |              |
| 1.3 Pupil absence                                      |       |       |          |       |              |
| 1.4 First time entrants to the youth justice system    |       |       |          |       |              |
|                                                        |       |       |          |       |              |
| training                                               |       |       |          |       |              |
|                                                        |       |       |          |       |              |
| secondary mental health services who live in stable    |       |       |          |       |              |
| and appropriate accommodation                          |       |       |          |       |              |
|                                                        |       |       |          |       |              |
| significant mental illness                             |       |       |          |       |              |
|                                                        |       |       |          |       |              |
| conditions including adults with a learning disability |       |       |          |       |              |
| or who are in contact with secondary mental health     |       |       |          |       |              |
| services                                               |       |       |          |       |              |
| 1.9 Sickness absence rate                              |       |       |          |       |              |
|                                                        |       |       |          |       |              |
| England's roads                                        |       |       |          |       |              |
| 1.11 Domestic abuse                                    |       |       |          |       |              |
| 1.12 Violent crime (including sexual violence)         |       |       |          |       |              |
| 1.13 Re-offending levels                               |       |       |          |       |              |
|                                                        |       |       |          |       |              |
| noise                                                  |       |       |          |       |              |
| 1.15 Statutory homelessness                            |       |       |          |       |              |
|                                                        |       |       |          |       |              |
| reasons                                                |       |       |          |       |              |
| 1.17 Fuel poverty                                      |       |       |          |       |              |
| 1.18 Social isolation                                  |       |       |          |       |              |
| 1.19 Older people's perception of community safety     |       |       |          |       |              |
| Primary     | Improvements or worsening will have a direct impact on the indicator    |     |
|-------------|-------------------------------------------------------------------------|-----|
| Secondary   | Improvements or worsening may have an impact on this indicator          |     |

|                                                       | AQ - Air Quality        | AT - Active Travel and Transport    | GS - Access to Green Space         |
|-------------------------------------------------------|-------------------------|-------------------------------------|------------------------------------|
| FR - Surface Flooding                                 |                         | OH - Overheating                    | FP - Fuel Poverty                  |
| HF - Healthy Food                                     |                         |                                     |                                    |
|                                                       |                         |                                     |                                    |
| Domain 2                                              |                         |                                     |                                    |
| Health Improvement                                    |                         |                                     |                                    |
|                                                       |                         |                                     |                                    |
|                                                       |                         |                                     |                                    |
| 2.1 Low birth weight of term babies                   |                         |                                     |                                    |
| 2.2 Breastfeeding                                     |                         |                                     |                                    |
| 2.3 Smoking status at time of delivery                |                         |                                     |                                    |
| 2.4 Under 18 conceptions                              |                         |                                     |                                    |
| 2.5 Child development at 2-21/2 years                 |                         |                                     |                                    |
| 2.6 Excess weight in 4-5 and 10-11 year olds          |                         |                                     |                                    |
| 2.7 Hospital admissions caused by unintentional and   |                         |                                     |                                    |
| deliberate injuries in under 18s                      |                         |                                     |                                    |
| 2.8 Emotional well-being of looked after children     |                         |                                     |                                    |
| 2.9 Smoking prevalence - 15 year olds                 |                         |                                     |                                    |
| 2.10 Self-harm                                        |                         |                                     |                                    |
| 2.11 Diet                                             |                         |                                     |                                    |
| 2.12 Excess weight in adults                          |                         |                                     |                                    |
| 2.13 Proportion of physically active and inactive     |                         |                                     |                                    |
| adults                                                |                         |                                     |                                    |
| 2.14 Smoking prevalence - adults (over 18s)           |                         |                                     |                                    |
| 2.15 Successful completion of drug treatment          |                         |                                     |                                    |
| 2.16 People entering prison with substance            |                         |                                     |                                    |
| dependence issues who are previously not known to     |                         |                                     |                                    |
| community treatment                                   |                         |                                     |                                    |
| 2.17 Recorded diabetes                                |                         |                                     |                                    |
| 2.18 Alcohol-related admissions to hospital           |                         |                                     |                                    |
| 2.19 Cancer diagnosed at stage 1 and 2                |                         |                                     |                                    |
| 2.20 Cancer screening coverage                        |                         |                                     |                                    |
| 2.21 Access to non-cancer screening programmes        |                         |                                     |                                    |
| 2.22 Take up of the NHS Health Check programme -      |                         |                                     |                                    |
| by those eligible                                     |                         |                                     |                                    |
| 2.23 Self-reported well-being                         |                         |                                     |                                    |
| 2.24 Injuries due to falls in people aged 65 and over |                         |                                     |                                    |
|                                                       |                         |                                     |                                    |
|    |    | AQ AT    | GS    | FR    | OH HF    | FP    |
|----|----|----------|-------|-------|----------|-------|
|    |    |          |       |       |          |       |
|    |    |          |       |       |          |       |
|    |    |          |       |       |          |       |
|    |    |          |       |       |          |       |
| Primary     | Improvements or worsening will have a direct impact on the indicator    |     |
|-------------|-------------------------------------------------------------------------|-----|
| Secondary   | Improvements or worsening may have an impact on this indicator          |     |

| AQ - Air Quality                                          | AT - Active Travel and Transport    | GS - Access to Green Space         |
|-----------------------------------------------------------|-------------------------------------|------------------------------------|
| OH - Overheating                                          | FP - Fuel Poverty                   | FR - Surface                       |
| Flooding                                                  |                                     |                                    |
| HF - Healthy Food                                         |                                     |                                    |
|                                                           |                                     |                                    |
| Domain 3                                                  |                                     |                                    |
| Health Protection                                         |                                     |                                    |
|                                                           |                                     |                                    |
| 3.1 Fraction of mortality attributable to particulate air |                                     |                                    |
| pollution                                                 |                                     |                                    |
| 3.2 Chlamydia diagnoses (15-24 year olds)                 |                                     |                                    |
| 3.3 Population vaccination coverage                       |                                     |                                    |
| 3.4 People presenting with HIV at a late stage of         |                                     |                                    |
| infection                                                 |                                     |                                    |
| 3.5 Treatment completion for Tuberculosis (TB)            |                                     |                                    |
| 3.6 Public sector organisations with a board approved     |                                     |                                    |
| sustainable development management plan                   |                                     |                                    |
| 3.7 Comprehensive, agreed inter-agency plans for          |                                     |                                    |
| responding to public health incidents and emergencies     |                                     |                                    |
|                                                           |                                     |                                    |
| Domain 4                                                  |                                     |                                    |
| Healthcare public health and preventing                   |                                     |                                    |
| premature mortality                                       |                                     |                                    |
|                                                           |                                     |                                    |
| 4.1 Infant mortality                                      |                                     |                                    |
| 4.2 Tooth decay in children aged 5                        |                                     |                                    |
| 4.3 Mortality rate from causes considered preventable     |                                     |                                    |
| 4.4 Under 75 mortality rate from all cardiovascular       |                                     |                                    |
| diseases (including heart disease and stroke)             |                                     |                                    |
| 4.5 Under 75 mortality rate from cancer                   |                                     |                                    |
| 4.6 Under 75 mortality rate from liver disease            |                                     |                                    |
| 4.7 Under 75 mortality rate from respiratory diseases     |                                     |                                    |
| 4.8 Mortality rate from infectious and parasitic          |                                     |                                    |
| diseases                                                  |                                     |                                    |
| 4.9 Excess under 75 mortality rate in adults with         |                                     |                                    |
| serious mental illness                                    |                                     |                                    |
| 4.10 Suicide rate                                         |                                     |                                    |
| 4.11 Emergency readmissions within 30 days of             |                                     |                                    |
| discharge from hospital                                   |                                     |                                    |
| 4.12 Preventable sight loss                               |                                     |                                    |
| 4.13 Health-related quality of life for older people      |                                     |                                    |
| 4.14 Hip fractures in people aged 65 and over             |                                     |                                    |
| 4.15 Excess winter deaths                                 |                                     |                                    |
| 4.16 Estimated diagnosis rate for people with             |                                     |                                    |
| dementia                                                  |                                     |                                    |
|                                                           |                                     |                                    |
| AQ    | AT    | GS    | FR    | OH    | HF    | FP    |
|-------|-------|-------|-------|-------|-------|-------|
|       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |
| AQ    | Tr    | GS    | FR    | OH    | HF    | FP    |
|       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |
Participation in Physical 
Green Space Access Deficiency (% value 
Activity % per week  - Adult 
Obesity Prevalence  
Adult Obesity  
per Ward) 
Obesity -  
Borough Green Space Surface 
Total Ward N. 
Ward with Access Deficiency 
% Households 
1 time a week  
5 times per week 
LA 
London 
England 
 
Barking & Dagenham 
33.6 
17.0 
4.0 
over 50% 
45.1 
15.4 
28.7 
Barnet 
41.3 
21.0 
4.0 
over 40% 
54.9 
17.6 
17.9 
Bexley 
31.7 
21.0 
4.0 
over 40% 
60.8 
20.0 
26.4 
Brent 
21.9 
21.0 
4.0 
over 40% 
49.4 
16.3 
21.2 
Bromley 
57.8 
22.0 
2.0 
over 50% 
62.4 
21.1 
21.8 
Camden 
24.8 
18.0 
5.0 
over 50% 
65.1 
26.0 
15.5 
City of London 
4.8 
0.0 
0.0 
1.0 
52.8 
28.7 
  
City of Westminster 
21.5 
20.0 
4.0 
over 50% 
59.3 
25.4 
15.0 
20.7 
24.2 
Croydon 
37.1 
24.0 
7.0 
over 50% 
58.9 
19.8 
24.3 
Ealing 
30.9 
23.0 
6.0 
over 50% 
48.2 
14.6 
18.1 
Enfield 
45.6 
21.0 
8.0 
over 50% 
50.7 
18.6 
23.2 
Greenwich 
34.4 
17.0 
1.0 
over 40% 
55.4 
19.5 
22.6 
Hackney 
23.2 
19.0 
5.0 
over 40% 
58.9 
24.0 
22.6 
Hammersmith & Fulham 
19.1 
16.0 
5.0 
over 50% 
66.4 
27.6 
15.6 
Haringey 
25.5 
19.0 
6.0 
over 40% 
54.9 
17.7 
20.1 
Harrow 
34.6 
21.0 
8.0 
over 50% 
51.7 
17.1 
19.2 
Havering 
59.3 
18.0 
7.0 
over 50% 
52.5 
16.4 
27.3 
Participation in Physical 
Green Space Access Deficiency (% value 
Activity % per week  - Adult 
Obesity Prevalence  
Adult Obesity  
per Ward) 
Obesity -  
Borough Green Space Surface 
Total Ward N. 
Ward with Access Deficiency 
% Households 
1 time a week  
5 times per week 
LA 
London 
England 
 
Hillingdon 
49.2 
22.0 
2.0 
over 50% 
48.9 
14.1 
23.2 
Hounslow 
39.6 
20.0 
5.0 
over 40% 
52.4 
17.8 
20.5 
Islington 
12.4 
16.0 
4.0 
over 50% 
61.3 
22.4 
18.0 
Kensington & Chelsea 
15.1 
18.0 
1.0 
over 50% 
63.5 
21.5 
13.9 
Kingston upon Thames 
36.4 
16.0 
5.0 
over 50% 
61.2 
23.1 
16.7 
Lambeth 
17.3 
21.0 
7.0 
over 50% 
62.0 
30.2 
20.7 
20.7 
24.2 
Lewisham 
22.5 
18.0 
3.0 
over 40% 
56.4 
21.3 
23.7 
20.7 
24.2 
Merton 
34.6 
20.0 
3.0 
over 40% 
55.0 
17.5 
19.1 
20.7 
24.2 
Newham 
23.9 
20.0 
9.0 
over 50% 
45.7 
17.3 
25.3 
20.7 
24.2 
Redbridge 
40.6 
21.0 
5.0 
over 40% 
54.5 
19.4 
22.3 
20.7 
24.2 
Richmond upon Thames 
50.8 
18.0 
1.0 
over 50% 
69.3 
27.4 
14.9 
20.7 
24.2 
Southwark 
24.9 
20.0 
7.0 
over 50% 
59.5 
19.5 
22.5 
20.7 
24.2 
Sutton & Merton 
32.0 
18.0 
4.0 
over 50% 
64.2 
19.7 
21.6 
20.7 
24.2 
Tower Hamlets 
15.2 
17.0 
5.0 
over 50% 
55.9 
19.7 
19.4 
20.7 
24.2 
Waltham Forest 
31.4 
20.0 
8.0 
over 40% 
56.2 
20.3 
23.4 
20.7 
24.2 
Wandsworth 
26.9 
20.0 
2.0 
over 50% 
66.4 
26.9 
15.0 
20.7 
24.2 

## Active Travel And Transport Data

|                      | Number of                                       | Annual Casualties on    |
|----------------------|-------------------------------------------------|-------------------------|
|                      | 'Travels per                                    | the Road, 2005-         |
| day' (000's)         | 2009 average                                    |                         |
| Barking & Dagenham   |                                                 |                         |
| 280                  | 604                                             | 1                       |
| Barnet               |                                                 |                         |
| 769                  | 1,344                                           | 3                       |
| Bexley               |                                                 |                         |
| 357                  | 644                                             | -12                     |
| Brent                |                                                 |                         |
| 592                  | 918                                             | -2                      |
| Bromley              |                                                 |                         |
| 691                  | 929                                             | -6                      |
| Camden               |                                                 |                         |
| 744                  | 902                                             | 3                       |
| City of London       |                                                 |                         |
| 262                  | 369                                             | 11                      |
| Croydon              |                                                 |                         |
| 720                  | 1,208                                           | 2                       |
| Ealing               |                                                 |                         |
| 633                  | 1,155                                           | -15                     |
| Enfield              |                                                 |                         |
| 594                  | 1,033                                           | 7                       |
| Greenwich            |                                                 |                         |
| 428                  | 919                                             | 1                       |
| Hackney              |                                                 |                         |
| 404                  | 948                                             | -8                      |
| Hammersmith & Fulham | 494                                             | 745                     |
| Haringey             |                                                 |                         |
| 483                  | 830                                             | 10                      |
| Harrow               |                                                 |                         |
| 422                  | 534                                             | -21                     |
| Havering             |                                                 |                         |
| 477                  | 903                                             | -10                     |
| Hillingdon           |                                                 |                         |
| 563                  | 1,028                                           | -8                      |
| Hounslow             |                                                 |                         |
| 488                  | 959                                             | 4                       |
| Islington            |                                                 |                         |
| 486                  | 742                                             | 33                      |
| Kensington & Chelsea |                                                 |                         |
| 472                  | 818                                             | -2                      |
| Kingston upon Thames |                                                 |                         |
| 378                  | 430                                             | 3                       |
| Lambeth              |                                                 |                         |
| 614                  | 1,234                                           | 6                       |
| Lewisham             |                                                 |                         |
| 476                  | 968                                             | 10                      |
| Merton               |                                                 |                         |
| 431                  | 522                                             | -2                      |
| Newham               |                                                 |                         |
| 590                  | 1,014                                           | -10                     |
| Redbridge            |                                                 |                         |
| 524                  | 866                                             | 9                       |
| Richmond upon Thames |                                                 |                         |
| 447                  | 486                                             | 7                       |
| Southwark            |                                                 |                         |
| 582                  | 1,137                                           | 0                       |
| Sutton               |                                                 |                         |
| 393                  | 576                                             | -7                      |
| Tower Hamlets        |                                                 |                         |
| 561                  | 977                                             | -3                      |
| Waltham Forest       |                                                 |                         |
| 387                  | 865                                             | -6                      |
| Wandsworth           |                                                 |                         |
| 621                  | 925                                             | 14                      |
| Westminster          |                                                 |                         |
| 1168                 | 1,695                                           | -3                      |
| Average              |                                                 |                         |
| 531                  | 886                                             |                         |
| Source               |                                                 |                         |
| London Travel        |                                                 |                         |
| Demand Survey        | Reported Road Casualties, Great Britain, gov.uk |                         |
% Change  
2005-2009 to 
Average Fatalities 
Number of 
2011 
2005-2009 
Vehicles 
6 
95634 
 

## Air Quality Data

 
Fraction (%) of mortality attributable to long term exposure to PM2.5 
Rank 
Barking & Dagenham 
7.1 
14 
27% 
3 
Barnet 
6.8 
10 
21% 
15 
Bexley 
6.6 
7 
18% 
1 
Brent 
7.2 
17 
29% 
6 
Bromley 
6.3 
1 
13% 
1 
Camden 
7.7 
24 
38% 
5 
City of London 
9 
33 
61% 
2 
Croydon 
6.5 
5 
16% 
5 
Ealing 
7.2 
17 
29% 
5 
Enfield 
6.6 
7 
18% 
10 
Greenwich 
7.2 
17 
29% 
7 
Hackney 
7.8 
26 
39% 
8 
Hammersmith and Fulham 
7.9 
27 
41% 
5 
Haringey 
7.1 
14 
27% 
9 
Harrow 
6.4 
3 
14% 
5 
Havering 
6.3 
1 
13% 
3 
Hillingdon 
6.5 
5 
16% 
8 
Hounslow 
7.1 
14 
27% 
10 
Islington 
7.9 
27 
41% 
3 
Kensington and Chelsea 
8.3 
31 
48% 
3 
Kingston upon Thames 
6.7 
9 
20% 
2 
Lambeth 
7.7 
24 
38% 
9 
Lewisham 
7.2 
17 
29% 
9 
Merton 
6.9 
12 
23% 
4 
Newham 
7.6 
23 
36% 
6 
Redbridge 
7 
13 
25% 
4 
Richmond upon Thames 
6.8 
10 
21% 
4 
Southwark 
7.9 
27 
41% 
7 
Sutton 
6.4 
3 
14% 
3 
Tower Hamlets 
8.1 
30 
45% 
6 
Waltham Forest 
7.3 
21 
30% 
7 
Wandsworth 
7.3 
21 
30% 
4 
Westminster 
8.3 
31 
48% 
8 
Source: 


% different from UK average 
Number of Air Quality Focus Areas 

## Table 4 Healthy Food Data

Childhood 
Adult 
Participation in Physical 
Obesity 
% Consumption of 5 portions of fruits and 
Obesity 
Activity % per week  
Prevalence (6yrs 
vegetables a day  
Prevalence 
old) 
LA 
Once a week  
5 times per week 
LA 
Total MSOA N. 
Areas (MSOA) with highest % of consumption 
% Intervals 
Barking & Dagenham 
28.7 
45.1 
15.4 
  
22 
8 
(25.40 - 31.20) 
Barnet 
17.9 
54.9 
17.6 
  
41 
16 
(43.90 - 56-10) 
Bexley 
26.4 
60.8 
20 
  
28 
10 
(31.20 - 37.20) 
Brent 
21.2 
49.4 
16.3 
  
34 
13 
(38.20 - 45.30) 
Bromley 
21.8 
62.4 
21.1 
  
39 
15 
(27.20 - 45.30) 
Camden 
15.5 
65.1 
26 
  
28 
10 
(44.60 - 55.10) 
City of London 
  
52.8 
28.7 
  
  
48 
 
City of Westminster 
15 
59.3 
25.4 
  
24 
10 
(48.60 - 52.10) 
Croydon 
24.3 
58.9 
19.8 
  
44 
17 
(35.50 - 48.8) 
Ealing 
18.1 
48.2 
14.6 
  
39 
15 
(41.10 - 55.40) 
Enfield 
23.2 
50.7 
18.6 
  
36 
14 
(33.90 - 41.90) 
Greenwich 
22.6 
55.4 
19.5 
  
32 
12 
(32.70 - 42.20) 
Hackney 
22.6 
58.9 
24 
  
27 
10 
(34.90 - 41.60) 
Hammersmith & Fulham 
15.6 
66.4 
27.6 
  
25 
10 
(41.70 - 48.20) 
Haringey 
20.1 
54.9 
17.7 
  
36 
14 
(39.20 - 48.00) 
Harrow 
19.2 
51.7 
17.1 
  
31 
12 
(39.70 - 47.60) 
Havering 
27.3 
52.5 
16.4 
  
30 
12 
(30.80 - 37.30) 
Hillingdon 
23.2 
48.9 
14.1 
  
32 
12 
(34.20 - 45.40) 
Hounslow 
20.5 
52.4 
17.8 
  
28 
10 
(36.90 - 47.20) 
Islington 
18 
61.3 
22.4 
  
23 
7 
(27.60 - 40.80) 
Kensington & Chelsea 
13.9 
63.5 
21.5 
  
21 
8 
(50.70 - 54.30) 
Kingston upon Thames 
16.7 
61.2 
23.1 
  
20 
8 
(41.90 - 49.40) 
Lambeth 
20.7 
62 
30.2 
  
35 
13 
(36.00 - 42.90) 
Lewisham 
23.7 
56.4 
21.3 
  
36 
14 
(36.00 - 42.90) 
Merton 
19.1 
55 
17.5 
  
25 
10 
(41.40 - 55.40) 
Newham 
25.3 
45.7 
17.3 
  
37 
13 
(32.60 - 36.60) 
Redbridge 
22.3 
54.5 
19.4 
  
33 
12 
(35.50 - 43.30) 
Richmond upon Thames 
14.9 
69.3 
27.4 
  
23 
8 
(44.70 - 48.30) 
Southwark 
22.5 
59.5 
19.5 
  
33 
11 
(37.50% - 43.30)  
Sutton 
21.6 
64.2 
19.7 
  
24 
9 
(35.20 - 44.30) 
Tower Hamlets 
19.4 
55.9 
19.7 
  
31 
12 
( 29.70 - 42.90) 
Waltham Forest 
23.4 
56.2 
20.3 
  
28 
10 
(33.70 - 37.40) 
Wandsworth 
15 
66.4 
26.9 
  
37 
15 
(42.30 - 46.80) 
Average 
20.6 
57.0 
20.7 
30.7 
11.6 
48.0 
 
London 
20.7 
22.53 


England 
24.2 
19.2 


Source 
Health Needs Assessment Toolkit 
National Obesity Observatory (2010-2011) 
Health Needs Assessment Toolkit 

## Table 5 Fuel Poverty Data

Excess winter deaths 2010/11 
Population Aged 65 
Households in privatelyrented 2011 
Percentage in privately-rented 2011 
2012 
2025 
2040 Barking and Dagenham 
60 
19,700 
24,700 
35,900 
17,000 
22.9 
Barnet 
90 
49,400 
65,600 
88,100 
28,000 
20.5 
Bexley 
90 
38,500 
45,100 
56,300 
10,000 
10.9 
Brent 
40 
33,800 
46,300 
61,100 
26,000 
29.2 
Bromley 
190 
54,200 
64,200 
79,500 
17,000 
12.6 
Camden 
70 
24,800 
30,200 
39,300 
29,000 
26.8 
City of London 
10 
1,100 
1,700 
2,800 
1,000 
8.6 
Croydon 
70 
46,200 
61,200 
84,100 
19,000 
13.9 
Ealing 
90 
37,500 
49,000 
65,300 
29,000 
24.3 
Enfield 
150 
40,000 
49,900 
64,300 
27,000 
22.7 
Greenwich 
70 
27,300 
38,200 
54,100 
18,000 
19.7 
Hackney 
30 
17,900 
23,900 
34,500 
21,000 
22.8 
Hammersmith and Fulham 
40 
16,900 
20,200 
26,100 
21,000 
26.4 
Haringey 
60 
23,000 
29,000 
38,600 
20,000 
23.3 
Harrow 
60 
34,800 
43,700 
50,000 
18,000 
22.2 
Havering 
130 
44,000 
53,800 
64,600 
10,000 
9.4 
Hillingdon 
120 
36,400 
44,300 
56,100 
21,000 
19.8 
Hounslow 
110 
27,800 
35,500 
45,900 
25,000 
27.9 
Islington 
30 
18,400 
22,500 
31,000 
22,000 
24.2 
Kensington and Chelsea 
50 
20,100 
26,600 
33,500 
18,000 
23.0 
Kingston upon Thames 
70 
21,100 
26,600 
34,100 
16,000 
22.6 
Lambeth 
60 
23,700 
31,200 
45,600 
29,000 
23.2 
Lewisham 
90 
26,600 
32,100 
44,800 
25,000 
21.7 
Merton 
60 
23,800 
29,800 
39,800 
19,000 
24.4 
Newham 
70 
21,300 
30,900 
44,300 
29,000 
35.4 
Redbridge 
80 
34,300 
41,200 
51,400 
25,000 
25.8 
Richmond upon Thames 
40 
26,500 
33,100 
42,000 
17,000 
21.5 
Southwark 
90 
22,900 
30,200 
43,500 
29,000 
22.4 
Sutton 
60 
28,600 
34,500 
44,100 
14,000 
16.9 
Tower Hamlets 
40 
15,800 
20,600 
31,200 
32,000 
33.9 
Waltham Forest 
110 
26,500 
34,600 
48,100 
24,000 
26.6 
Wandsworth 
150 
27,700 
33,000 
43,600 
41,000 
34.6 
Westminster 
20 
25,200 
30,400 
39,400 
44,000 
35.9 
75.8 
28357.6 
35872.7 47363.6 
22454.5 
22.9 Source: 

 

## Acknowledgements

Project Team-Responsible for project management, project delivery and writing the guides: 
Annette Figueiredo- Principal Policy & Programme Officer, Resilience and Quality of Life Team-GLA; Jason Strelitz, Public Health Specialist, GLA Alena Ivanova; Elena Guidorzi; Joe Parsons- MA/MSc postgraduate students-University of London, Kings College, GLA work placements Dr Angie Bone-Consultant in Public Health Medicine, Extreme Events and Health Protection, Public Health England The Project Team would like to thank everyone who has been involved in the project and contributed to the production of the guides. Particular thanks go to:  
GLA Staff  
Helen Walters, Head of Health Alex Nickson, Policy & Programmes Manager, Resilience and Quality of Life Team Peter Massini, Principal Policy & Programme Officer, Resilience and Quality of Life Team Lucy Saunders, Public Health Specialist, Health Team Jonathan Pauling, Principal Policy Officer, Food, Economic & Business Policy Team Mark Ainsbury, Senior Policy Officer, Food, Economic & Business Policy Team Elliot Treharne, Principal Policy & Programme Officer, Resilience and Quality of Life Team Liz Prosser, Senior Project Officer, Healthy Schools London, Health Team Kat McKinlay, Policy Officer, Transport Team Gareth Baker, GIS Officer, GIS and Infrastructure Team Michael Jeffreys. GIS Officer, GIS and Infrastructure Team Alison Murray, Programme Officer, Regeneration Team Emma Williamson, Principal Strategic Planner, Planning Team Susan Pape, Internal Communications Officer, HR & Organisational Development, Communications Team Una Buckley, Employee Engagement Manager, HR & Organisational Development Charlotte Hall, Health Inequalities Programme Leader, Health Team Larissa Bulla, Principal Policy & Programme Officer, Energy & Waste Team Kevin Reid, Principal Policy & Programme Officer, Resilience and Quality of Life Team Rebecca Roper, Childhood Obesity and Health Team Support Officer, Health Team GLA Design Team Other Colleagues Alex Trouton, Policy and Information Officer, Lambeth and Southwark Public Health Department Jonathan Hiderbrand, Director of Public Health, London Borough of Kingston Caroline Hancock, Senior Public Health Analyst - Public Health England Thomas Abeling, PhD Researcher, UNITED NATIONS UNIVERSITY, Institute for Environment and Human Security (UNU,EHS) Paul James, Director of the United Nations Global Compact, Cities Programme John Kolm-Murray, Seasonal Health Officer, Islington Council Fiona Daly - Environmental Manager, Barts Health NHS Trust Gordon Deuchars, Policy and Campaigns Manager, Age UK London Dr Anna Mavrogianni, Lecturer in Environmental Design and Engineering, UCL Jonathon Taylor, Research Associate, UCL Professor Virginia Murray, Head of Extreme Events and Health Protection, PHE Professor Sue Grimmond - Department of Meteorology, University of Reading Other formats and languages For a large print, Braille, disc, sign language video or audio-tape version of this document, please contact us at the address below: 
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