We focus on three: the regulation of takeaways and fast foods (a sector that has grown considerably in the past 30 years); the improvement of air quality; and fire safety.
Access to fast foods
- Meals eaten outside the home account for a quarter and a fifth of the calorie intake of men and women respectively. Takeaways account for a quarter of this market, producing foods that are often high in saturated fat and salt and low in fibre, which contributes to poor health (Cabinet Office 2008).
- Many (but not all) research studies have found a direct link between a fast food-rich environment and poorer health and particularly obesity (Public Health England 2013a; GLA 2012).
- Takeaway food services cluster in town and city centres and arterial roads, in areas of high socio-economic deprivation, and where unemployment is highest. In one deprived London borough, for example, a survey of schoolchildren found that more than half purchased food or drinks from fast food or takeaway outlets twice or more a week, with about 10 per cent consuming them daily (Patterson et al 2012).
Air quality improvement
- Improving air quality could have an enormous impact on health. The health impacts of air pollution are greater than the risks of passive smoking and transport accidents added together (Department of Health 2010).
- In 2008, around 29,000 deaths – more than 1 in 20 – were due to long-term exposure to air pollution (Committee on the Medical Effects of Air Pollutants 2010). These deaths were premature, with an average loss of length of life of 11.5 years, and more than 340,000 life years lost.
- Road transport is responsible for up to 70 per cent of air pollutants in urban areas. This leads to geographical inequalities in death rates as a result of air pollution, from around 3 per cent in rural areas to more than 8 per cent in parts of London (Public Health England 2013c).
- Fire crews attended 625,000 fires or false alarms in 2010/11; there were 388 firerelated deaths and 11,000 non-fatal injuries (Department for Communities and Local Government 2012). Cigarettes account for a large proportion of unintended fires.
Local authorities need to maximise existing resources principally through environmental health officers but also their powers to regulate types of traffic and traffic flows to ensure that they are fully contributing to public health strategies and goals.
To reduce the negative impacts of takeaways and fast foods on health, local authorities can (Public Health England 2013a; GLA 2012):
- through information, training, advice, award schemes and, where necessary, inspection and regulation, work with takeaways and the food industry to make food healthier
- work with schools to reduce the amount of fast food students consume during breaks and on journeys to and from school
- regulate the number and concentration of outlets. In particular:
– planning permission for fast food outlets should include consideration of the potential impacts on prevention and reduction of cardiovascular disease
– planning permission could even be restricted in certain areas (eg, within walking distance of schools)
– there could be a review and amendment of classes of use orders to address disease prevention related to the concentration of fast food outlets.
To reduce the negative impact of air pollution on health, local authorities can (Kilbane-Dawe 2012):
- lead by example in their local area by:
– implementing business engagement programmes to reduce air pollution
– encouraging expansion of council-run income-generating car clubs
– promoting zero emission ‘last mile’ delivery of as many goods and services as possible
– organising ‘eco-driving’ training for taxi-drivers to encourage more fuel-efficient driving, and finding ways to reduce idling at taxi ranks
- invest in longer-term changes with potentially greater impacts, such as:
– vertical roof exhausts for buses, and fitting diesel particle filters
– rolling replacement of boilers with the least polluting models
– ensuring that new buildings are air quality neutral
– encouraging people to make more journeys by bike, through integrated and harmonised cycling networks.
Local authorities have considerable powers for regulating the flow and types of traffic to reduce air pollution and its health effects including the development of low emission zones. However, each case needs to be judged on its merits, to ensure that the benefits outweigh the costs (Department for Environment, Food and Rural Affairs 2007; Watkiss et al 2003).
To promote fire safety, local authorities can:
- find ways to incentivise people to use fire alarms in their homes and undertake home safety assessments. Evidence suggests this would reduce accidental dwelling fires (Arch and Thurston, no date)
- support the provision of wider public health interventions by fire crews. Innovative authorities, such as Merseyside Fire and Rescue have expanded their roles to deliver opportunistic health promotion interventions such as sex, drug and alcohol awareness, green gyms and gardening projects. They have a Beacon award for their contribution to reducing health inequalities (Marmot et al 2010, p 153).
In 2002, the average local authority area incurred NHS costs of around £18 million to £20 million due to obesity, and a further £26 million to £30 million in lost productivity and earnings due to premature mortality (National Obesity Observatory 2010). Estimates from around the same time suggest that fires cost £6.9 billion in England and Wales (Weiner 2001; ODPM 2006).
The cost-benefit evidence for investing in air quality is substantial. A review for the London Royal Borough of Kensington and Chelsea showed that each of the options set out in the previous section on reducing air pollution is cost-beneficial, with potential for significant revenue generation, and spillover benefits including noise reduction. The overall benefit-to-cost return was £620 in benefits for every £100 spent (Kilbane-Dawe 2012). Low-emission zones can be a cost-effective way to reduce air pollution but only if well designed and tailored to local needs (Department for Environment, Food and Rural Affairs 2007).
- A Local Councillor’s Guide to Environmental Health provides concise guidance for elected members of local authorities to help them understand the role, function and potential of environmental health officers for improving public health (Chartered Institute of Environmental Health 2011).
- Our Health, Our Wellbeing: Environmental health – securing a healthier future for all, includes case studies from initiatives by 28 councils in England (Chartered Institute of Environmental Health 2012).
- The Department for Business, Innovation & Skills has recently produced a report exploring the links between regulatory activity and health outcomes, with case studies of how small-scale schemes have achieved impressive results, particularly through engaging takeaways in strategies to improve health (Department for Business, Innovation & Skills 2013).
Fast foods and takeaways
- Public Health England’s Obesity Knowledge and Intelligence team (formerly the National Obesity Observatory) has produced various tools to help authorities evaluate and assess the impact of local actions (Public Health England 2013a, b).
- The Greater London Authority (GLA)’s Takeaways Toolkit focuses on finding relevant evidence on health impacts, working with partners to develop the local case for action, and evaluation (Greater London Authority 2012).
- Fast Food Takeaways: A review of the wider evidence base makes recommendations for local authorities on fast food (taking into account its role in youth culture and identity), litter, and healthier catering initiatives, among other areas (Bagwell 2013).
- There are local case studies from The Camden Good Food Partnership (Camden Council et al 2010), Brighton and Hove Food Partnership (Brighton and Hove Food Partnership 2012), Bristol Food Policy Council (Bristol City Council 2013), Wigan Healthy Business Team (Wigan Council 2013) and Bradford district’s food strategy developed by the council and its partners (bWhatYouEat 2013).
- Data on the percentage of premature deaths due to air pollution by local authority can be found in the benchmarking tool and map, part of the Public Health Outcomes Framework data tool (Public Health England 2013c).
- A report prepared for the Royal Borough of Kensington and Chelsea, 14 Cost Effective Actions to Cut Central London Air Pollution, includes case studies of Low Emission Zones in London, Berlin and Oxford (Kilbane-Dawe 2012).
- A study of cost-benefit analysis of Low Emission Zones suggests they are only likely to be cost-effective for large urban authorities and if targeted towards high-pollutant vehicles (Watkiss et al 2003).
- The GLA has produced bespoke Better Environment Better Health guides for each London borough setting out local information on air quality and pollution and actions to take (Greater London Authority 2013a, b).
- The Department for Communities and Local Government has published fire statistics by local authority, which can be downloaded as Excel data to support benchmarking (Department for Communities and Local Government 2012).
- The Economic Costs of Fire gives revised estimates of the total cost of fire and, for the first time, of the average costs of different types of fire, disaggregated by location and cost type (Office of the Deputy Prime Minister 2006; Weiner 2001).
- The Merseyside Fire and Rescue Service has won national awards for its innovative work to reduce health inequalities (Campbell 2009).
For references please see
Next section: Health and spatial planning