Health Impact Assessment

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1. Introduction

Background

1.1 This document contains the Health Impact Assessment for the draft fourth East Sussex Local Transport Plan (LTP4) for public consultation. Once adopted, LTP4 will replace the third plan (LTP3) adopted over a decade ago in 2011. Our third plan was intended to last until 2026, though many of its proposals have either been delivered, are in progress or have been withdrawn. Our new plan covers the period 2024 to 2050 and builds on some of those existing proposals as they remain essential to addressing the challenges that affect East Sussex’s economy, environment, and quality of life. Since adopting LTP3, policy context has changed significantly on a national, sub-regional and local scale, affecting how and when people travel, and why they travel.  

1.2 Public health and environmental concerns such as climate change, have increased in importance, with governmental policies also changing to reflect this. Simultaneously, economic decline and changing user habits have placed greater focus on redeveloping the economy and raising productivity levels, whilst also improving community services and facilities to accommodate post-COVID 19 changes.  

Approach to the Health Impact Assessment

1.3 As part of the development of an equitable and sustainable Local Transport Plan, the preparation of an Integrated Impact Assessment (IIA), which this Health Impact Assessment (HIA) is part of, has been prepared to identify, evaluate, and mitigate sustainability, environmental, health and equalities concerns. Further information on equalities can be found in the Equalities Impact Assessment – a component part of the Integrated Impact assessment. 

1.4 Health is influenced by several complex factors. Health Impact Assessment is a process to identify the likely health effects of proposals, policies, and projects and to implement measures to limit negative impacts and maximise the benefits of positive impacts. The purpose of this HIA is to act as a device to integrate health throughout the LTP planning process.   

1.5 We have prepared this HIA in line with the Government’s current published guidance: Health Impact Assessment in spatial planning - GOV.UK, given the Local Transport Plan is a spatial plan for transport. As part of this, we have drawn upon Public Health Outcomes Framework indicators which are applicable to planning, by screening health and wellbeing metrics with the Local Health Fingertips tool. Appendix A contains a health-specific policy review, which we have conducted to ensure that the key themes of national, regional, and local policy are considered as part of this assessment.  

1.6 We have ensured quality assurance as part of our HIA process, by objectively assessing spatial planning priorities in the context of health, using high-quality baseline evidence. These evidence-based findings will be used to provide recommendations, with the people of East Sussex in mind, to reduce health inequalities and protect community health. The findings from this HIA have been scrutinised and assessed by Public Health officers at the Council, and this document will be subject to feedback through public consultation. 

1.7 This HIA has been undertaken on the draft LTP. The draft LTP will go out for public consultation, to gather feedback on the proposed policies and schemes.  Following public consultation and finalisation of the LTP there may be additional considerations that are relevant to the health determinants which are the subject of this report, and as a result this HIA may need to be updated.  

1.8 The contents of the LTP and its constituent elements (particularly the objectives and intended outcomes) are broad and it is at detailed scheme design and implementation where its full effects need to be considered and mitigated against. It is not possible to guarantee that the effect of the LTP will result in uniform positive impacts because a key consideration will be the way in which the LTP is delivered. This means that the HIA will need to be developed further when the LTP is delivered. 

Vision  

1.9 The LTP envisages:  

“An inclusive transport system that connects people and places, is decarbonised, safer, resilient, and supports our natural environment communities and businesses to be healthy, thrive and prosper.” 

Objectives 

1.10 There are six main objectives underpinning the vision for safer, more sustainable transport in East Sussex: 

• Deliver safer and accessible journeys; 
• Support healthier lifestyles and communities; 
• Decarbonise transport; 
• Conserve and enhance our local environment;
• Support sustainable economic growth; and 
• Strengthen the resilience of our transport networks. 

Outcomes  

1.11 For the purposes of the LTP, a set of outcomes have been identified resulting from each of the objectives. 

Deliver safer and accessible journeys

• Create enhanced and inclusive transport networks for all users. 
• Contribute to reducing the number of casualties and collisions on our transport networks. 
• Contribute to improving personal safety for all journeys. 
• Improve interchange between travel modes. 
• Improve access to key local services by all modes. 

Support healthier lifestyles and communities 

• Increase the proportion of walking, wheeling and cycling journeys. 
• Increase active travel and public transport journeys through education, training, travel behaviour change initiatives and information. 
• Redesign road space to balance the needs of different road users, including encouraging people to walk, wheel, cycle and use the bus. 
• Support reduction of emissions to improve air quality. 
• Mitigate noise pollution through technology and design. 
• Improve access to green spaces, public rights of way and leisure and health facilities. 

Decarbonise transport

• Increase the proportion of people travelling by walking, wheeling, cycling, public and shared transport.
• Facilitate the uptake of ultra-low and zero-emission vehicles for journeys, through the delivery of supporting infrastructure. 
• Work with partners to decarbonise transport and tackle climate change. 
• Support clean technologies and fuels that contributes towards the decarbonisation of transport. 

Conserve and enhance our local environment

• Conserve and enhance our local and natural environment by mitigating negative impacts of transport design and delivery. 
• Enhance and create attractive and connected communities and public spaces. 
• Support habitat connectivity and increase in biodiversity through the delivery of enhanced and new transport infrastructure and public spaces. 

Support sustainable economic growth

• Facilitate the efficient movement of goods and people. 
• Contribute to reducing deprivation and inequality through improved accessibility for all to employment, education and training. 
• Attract and retain businesses and a skilled workforce in the county. 
• Enhance sustainable access to key visitor and cultural destinations. 
• As the local highway authority, engage with our Local Planning Authorities to deliver sustainable and well-connected housing and employment growth identified in their Local Plans. 

Strengthen the resilience of our transport networks

• Improve journey time reliability for people and businesses. 
• Enable transport journeys to be resilient, flexible and adaptable and recover quickly from emergencies and events. 
• Improve the condition of highway and other transport infrastructure and assets.  

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2. Scoping and methodology

2.1 This HIA has been undertaken to identify whether East Sussex County Council’s LTP could have a disproportionate impact on varying health determinants. This assessment considers potential positive and negative impacts, and where feasible, provides a detailed rationale to explain the degree to which each determinant is impacted.

Study area

2.2 The population scope of this HIA includes the residents within the following districts and boroughs  within East Sussex: 

• Eastbourne  
• Hastings 
• Lewes 
• Rother 
• Wealden 

2.3 Expressing how different health outcomes affect different sub-groups will help influence more targeted and meaningful transport interventions (transport, health and wellbeing report). The main vulnerable groups within the population that have been identified are:  

• Rural communities 
• Coastal communities 
• Women, girls and pregnant women 
• Children and young people 
• Older people  
• Disabled people  
• Unemployed or low-income groups 

Health determinants

Overwhelming evidence indicates the wider determinants of health, including socioeconomic factors, our physical environment, access, traffic, and health behaviours, have the most impact on our health. Table 2.1 shows the key determinants of health and wellbeing outcomes, as illustrated in Public Health England’s Health Impact Assessment in spatial planning guide. The wider determinants reflect how transport is a complex contributing factor to several health-related outcomes.  

Table 2.1: Wider determinants of health and wellbeing, including HIA health considerations (source: Public Health England)

Access	Traffic and Transport	Socio-economic	Land Use
Local public key services and facilities Good quality affordable housing Healthy and affordable food Natural environment Green spaces and public realm Leisure, sport, recreation, play and physical activities within the environments	Accessibility Access to public transport Opportunities for active travel (cycling and walking) Links between communities Community severance Connections to jobs Connections to services, facilities and leisure	Employment, including skills development and training opportunities Local business activity Regeneration Tourism and leisure industries Community/social cohesions and access to social networks Community engagement	Sustainable and efficient land use in urban and/or rural settings Quality of Urban and natural environments, such as air and noise pollution Climate change impacts

Transport and movement are likely to exhibit a combination of direct and indirect impacts on different health determinants. In order to undertake a focussed assessment, health has been analysed in the context of the eight key pathways associated with transport as presented in the Government’s Transport and Health Resource. While the wider determinants set out in Table 2.1 are inter-connected, those which are most pertinent to East Sussex are discussed under the pathways: 

• Lifestyle 
• Access, accessibility, and community severance  
• Economic health 
• Safety  
• Crime 
• Congestion and stress 
• Air quality  
• Noise

2.4 Using the public health outcomes framework, key indicators have been identified on both a national and district level and can be mapped to each of the eight health pathways. Appendix B illustrates this data in more detail. Pathways lacking direct links to the public health outcomes, have been further supported by supplementary data in Chapter 3: Baseline Evidence: 

(i). Lifestyle  

• Healthy life expectancy at birth 
• Year 6: Prevalence of overweight (including obesity) 
• Percentage of physically active children and young people 
• Percentage of adults (aged 18+) classified as overweight or obese 
• Estimated diabetes diagnosis rate  
• Percentage of physically active adults 

(ii). Access, accessibility and community severance 

• Children in absolute low income families (under 16s) 

• Children in relative low income families (under 16s) 
• Fuel poverty (low income, low energy efficiency methodology) 
• Infant mortality rate 
• Winter mortality index 
• Winter mortality index (age 85+) 
• Estimated dementia diagnosis rate (age 65 and older) 

(iii). Economic health 

• Gap in the employment rate between those with a physical or mental long term health condition (aged 16-64) and the overall employment rate 
• The percentage of the population with a physical or mental long term health condition in employment (aged 16-64) 
• The percentage of the population who are in receipt of long term support for a learning disability that are in paid employment (aged 18-64) 
• Percentage of people in employment 

(iv). Safety (risk of trips, strain and collision)  

• Percentage of physically inactive adults 

(v). Crime 

• Violent crime – hospital admissions for violence (including sexual violence) 

(vi). Congestion and stress 

• Loneliness: Percentage of adults who feel lonely often or always or some of the time 

(vii). Air quality 

• Fraction of mortality attributable to particulate air pollution (new method) 

(viii). Noise  

• The rate of complaints about noise 

Stakeholder engagement

2.5 In order to develop the desired vision of the future, we have worked with our stakeholder representatives to explore how different political, economic, social, technological and environmental trends might impact the future in 2050. Engagement has been undertaken with the public and workshops with access groups, primary and secondary schools in rural and urban areas, further education institutions, Council members and officers, and local stakeholders such as district and borough councils. Appendix C summarises the stakeholders who have been engaged and the type of engagement conducted.  

2.6 Engagement identified a number of insights related to health, summarised below:  

• The theme ‘safety, health and air quality’ was ranked as the most important in ESCC with 79% of respondents selecting it as an important theme for the forthcoming LTP. 
• The theme ‘accessibility, equity and social inclusion’ was ranked as the second most important in ESCC with 77% of respondents selecting it as an important theme for the forthcoming LTP. 
• 51% of respondents selected the theme ‘sustainable economic development’ as an theme in ESCC for the forthcoming LTP. 
• Respondents pinned issues on a map relating to ‘accessibility, equity and social inclusion’, The majority of pins are clustered in the larger towns in the county – Eastbourne, Hastings, Bexhill. Uckfield, Crowborough and Lewes. 
• During the public consultation, improved active travel infrastructure was a recurring suggestion across all of the themes in the ESCC LTP. 
• During engagement with young people, the majority travel to school via active modes. Many of those who didn’t travel to school by walking, cycling, or wheeling wished that they could.  
• Engagement with key stakeholders through meetings with specific user groups or one-to-one meetings showed that road safety was a key area for intervention. 
• Respondents pinned issues on a map relating to ‘safety, health and air quality’. The majority of these were clustered in the larger towns. In addition, there were clusters of comments along some of the main routes in the county and focus on the towns of Eastbourne, Bexhill, Hastings, Lewes, Peachaven, Newhaven and Seaford. 

Impacts on equality

2.7 This HIA provides an assessment of the LTP’s likely impact on health. Often, there are direct crossovers between health and equality. Further information on the implications of the LTP on equality is provided within the Equality Impact Assessment (EqIA) for the LTP4.

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3. Baseline evidence

Data sources

3.1 For the purpose of this assessment, data and information has been gathered and compared to the determinants of health characteristics for all East Sussex Census Output Areas alongside England and the UK and as a whole. East Sussex County Council’s East Sussex in Figures (ESiF) website provides a basis for the data explored in this section, profiled by borough areas. Further, the most up to date information has been accumulated from the State of the County (2023) report), in combination with the Joint Strategic Needs Assessment.  

Vulnerable population groups

3.2 As set out in Chapter 2: Scoping and Methodology, the following vulnerable groups within the population have been identified:  

• Rural communities 
• Coastal communities 
• Women (with a focus on pregnant women) and girls 
• Children and young people 
• Older people  
• Disabled people  
• Unemployed or low-income groups 

3.3 The following Chapter will take into consideration the needs of these groups and highlight the role of transport can play in facilitating and supporting a more socially equitable and inclusive future in which health inequalities are minimised. 

Demographics

Population size  

3.4 Based on Office for National Statistics (ONS) 2021 Census, the population in East Sussex is approximately 546,000. There has been population increases in every district, with the overall population increasing by 3.6% since 2011 (East Sussex in Figures - population by age and sex 2001-2021- districts). According to Figure 3.4, within East Sussex itself, Wealden is the most populated district with 160,000 residents, while Hastings has the smallest population of 91,000.  

3.5 Population projections to the year 2035 reflect the number of extra dwellings being planned for the future by local authorities. By 2029, population is projected to reach 601,006 and by 2035, this is further expected to increase up to 628,000. This population increase represents 12% against the 2020 figure (and 15% against the 2021 Census). Wealden is expected to see a population increase at 22% with an additional 43,600 people, while Eastbourne is expected to experience the smallest increase at 4% with an additional 4,100 people. Hastings is expected to see a 5.4% increase with 5,000 more residents, Lewes with 11,200 more residents (11% increase) and Rother is expected to have 12,100 more residents (12.5% increase). In terms of gender split, East Sussex has a slightly higher female to male ratio, with 283,700 females (51.9%) and 262,147 males (48.1%).  

3.6 This population growth will drive demand for new housing and additional employment opportunities, educational facilities, and health services. Existing transport is likely to require upgrading to accommodate the additional demand, with appropriate future-proofing options explored to ensure connectivity between new and existing housing, employment, education, and healthcare sites.  

3.7 Only 29% of women nationally say they achieve the recommended levels of at least 30 minutes of moderate activity five times a week, compared with 39% of men nationally ( Department for Transport). In East Sussex 20% of people did less than 30 minutes of physical activity per week (State of the County: Focus on East Sussex (2023)). Physical inactivity has wider implications in terms of costs to the NHS and reducing economic productivity. Transport can have a role in addressing the barriers preventing both men and women from achieving this recommendation.  

Race and Ethnicity 

3.8 People from ethnic minorities are a population-sub-group reported to be particularly at risk of transport poverty (NatCen Social Research for Department for Transport). Transport poverty refers to households and individuals who struggle or are unable to make the journeys that they need. There are several definitions, but they tend to comprise low income, poor availability of public transport and needing a long time to access essential services.  

 3.9 As shown in Figure 3.1, the majority of people in East Sussex (96%) were of white origin according to the 2011 census – 10% more than the figure for England and Wales. A higher percentage of pupils (15%) are from ethnic minority backgrounds, compared to the adult population. Overall, Eastbourne has the highest percentage of students from ethnic minority backgrounds for both primary (31%) and secondary (22%) schools.  

3.10 The LTP should seek to develop a transport network which is both financially and physically accessible to all people, and one which has sufficient connectivity that takes people to where they need and want to go.  

Figure 3.1: Ethnicity by district

Ethnicity by district

Area	White	Black or Black British	Asian or Asian British	Other Ethnic Group	Mixed	All
England and Wales	48,209,395	1,864,890	4,213,531	563,696	1,224,400	56,075,912
East Sussex	505,422	2,912	9,143	1,721	7,473	526,671
Eastbourne	93,508	783	2,795	535	1,791	99,412
Hastings	84,631	1,065	2,126	484	1,948	90,254
Lewes	94,159	416	1,400	252	1,275	97,502
Rother	87,951	305	1,103	198	1,031	90,588
Wealden	145,173	343	1,719	252	1,428	148,915

Figure 3.2: Percentage of Ethnic Minority Students

Age

3.11 Age is an interconnected factor with health determinants. As a result of LTP4, those most vulnerable are likely to be disproportionately impacted. Hence, appropriate analysis of age distribution and demographics in East Sussex is essential to understanding the health impacts on different groups.  

3.12 Individuals over the age of 65 account for approximately 26% of the population of East Sussex, while over 85s account for 3.8%, both disproportionately larger than the average seen in England (18.4% and 2.4% respectively) ( East Sussex in Figures, population and households profile for East Sussex). Figure 3.3 highlights an ageing population as the proportion of 65s has increased since 2001, which is in line with the rest of the South East (+3%) and England (+2.5%) (East Sussex in Figures, population by age and sex 2001-2021 - districts).  Since 2011, there has also been a 5% decrease in those aged between 15 and 44. Eastbourne is the only district with an increase in people aged between 25 and 44, with other districts attributing their decline to an aging population, shifting individuals into older age brackets. 

Figure 3.3: Population change in East Sussex

Population change in East Sussex (source: East Sussex in Figures)

Age	Eastbourne	Hastings	Lewes	Rother	Wealden
Under 15	6%	-9%	-4%	-6%	-2%
15-24	8%	-1%	5%	11%	17%
25-44	4%	-2%	-8%	-8%	-7%
45-64	32%	25%	17%	15%	21%
Over 65	13%	20%	27%	24%	43%

3.13 The over 65s now represent a quarter of the county’s population and are projected to make up nearly a third of all people by 2034. All elderly age groups are expected to increase in size, with the number of very elderly people aged 85 and over expected to increase by 76%, from around 22,200 in 2020 to 39,100 in 2035. This is particularly pronounced in Rother, as older people (aged 65+) are expected to make up 40% of the population in 2034 (up from 32% in 2019) (Joint Strategic Needs Assessment Population Projections in East Sussex). 

3.14 As people age, they become more prone to developing complex health conditions such as dementia and type 2 diabetes. Conditions such as this can have a significant impact on people’s ability to move around and can increase the risk of falls. This in turn can lead to people living more reclusive lifestyles.  

3.15 The LTP4 should also ensure that new development is inclusive and accessible to all users, with careful consideration given to the design of public space. Seating, as well as shade and shelter from the elements should be incorporated into these designs so that older people have places to sit, rest and socialise.  

3.16 Improving access to public transport should also be an important part of LTP4, particularly in rural and coastal areas which may experience disproportionately negative impacts of a limited service, and where aging is occurring at the greatest pace. This will provide older people with better opportunities to access key services and reduce social isolation.  

Population distribution  

3.17 The distribution of people across East Sussex is presented in Figure 3.4 which highlights the rural nature of the region with population densities below 210 people per km2 in the majority of inland areas. Constrastingly, the most densely populated towns are located on the coast: Eastbourne, Hastings, Bexhill-on-Sea, Seaford and Peacehaven. Over 60% of the population concentrated on the coastal fringe in the three main urban areas of Eastbourne/South Wealden, Bexhill and Hastings, alongside Newhaven, Seaford and Peacehaven (LTP4 Evidence Base).  

3.18 These towns are where most people live and work. However, there are also several other more densely populated towns located away from the coast, these include Lewes, Crowborough, Uckfield and Hailsham. These towns also play an important role in serving the more rural areas nearby. East Sussex also has a high proportion of over 65s residing in rural areas (27.3%), compared to both the South East (24.3%) and England and Wales (23.6%).  

Figure 3.4: Population density in East Sussex

Figure 3.4 source: Office for National Statistics

3.19 Larger percentages of older people living in rural areas (such as Burwash or Mayfield) is likely to mean that their access to essential services and health care facilities is limited, as they are often located in urban centres. This is a key issue that will need to be addressed through LTP4.  

Life expectancy  

3.20 Life expectancy refers to the number of years an individual is forecasted to live at birth. Figure 3.5 displays life expectancy across England, the South East region and the districts in East Sussex.  On average, females in East Sussex have a higher life expectancy of 84.1 years, while males have an average life expectancy of 80.1 years. Wealden has the highest female life expectancy of 85 years, higher than all other districts, East Sussex, the South East region and England averages.  

3.21 Hastings has the lowest life expectancy for both males (78 years) and females (81.8 years) comparative to the rest of England, East Sussex and the South East (East Sussex in Figures, life expectancy at birth by sex, 1991-2020 - districts. This is likely linked to deprivation levels, as Hastings is the only district which has the highest number in the most deprived decile of the population.  

3.22 Figure 3.6 shows that most districts in East Sussex have a higher death rate than birth rate. Hastings displays a higher birth rate than death rate in 2011 and 2015. Overall, East Sussex has an infant mortality rate of 2.4 deaths per 1,000 live births (East Sussex in Figures).  

3.23 The State of the County 2023 Report refers to the gap in life expectancy between the most and least deprived areas of East Sussex, with the biggest causes of death associated with these gaps being circulatory diseases, cancers, and respiratory diseases. On average, people from more deprived areas are dying from these causes at a younger age compared to those living in the least deprived areas. The gap in life expectancy amounts to 4.5 years for women and 6.8 years for men.  

3.24 There is an opportunity for transport to work towards reducing this life expectancy gap through the provision of an accessible and inclusive transport network. Extending the active travel network to the more deprived areas may encourage proactivity and benefit health and fitness. Improved public transport provision across the county may encourage modal shift away from private vehicles. This may also help reduce the life expectancy gap by improving air quality over time.   

Figure 3.5: Life expectancy in 2018-2020

Life expectancy in 2018-2020

Area	Female	Male
England	83.1	79.4
South East	84.1	80.6
East Sussex	84.1	80.1
Eastbourne	83.6	78.9
Hastings	81.8	78
Lewes	84.8	80.5
Rother	84.3	80.4
Wealden	85	81.6

Figure 3.6: Natural change, 2011-2020

Natural change, 2011-2020

Year	East Sussex	Eastbourne	Hastings	Lewes	Rother	Wealden
2011	-892	-124	172	-53	-560	-327
2015	-1,427	-224	33	-145	-730	-361
2020	-2,366	-420	-46	-498	-708	-694

Source for above figures and tables: East Sussex in Figures

Health determinant 1: Lifestyle

Obesity

3.25 Figure 3.7 highlights that obesity is most prevalent among reception in Rother (23.5%), higher than the national average. Obesity is most prevalent in year 6 children in Hastings (38.4%), approximately 1% higher than the national average. According to fingertips data for 2022-2023, 68.3% of adults in Eastbourne are classified as overweight or obese compared to 63.8% in England. However, the prevalence of healthy weight for reception children (78.6%) and year 6 children (64.5%) in East Sussex is greater than the average in England (76.5% and 60.8% respectively).  

3.26 Obesity can impact an individuals’ mobility, meaning people are more reliant on private car use or public transport to reach goods and services including reaching GPs or hospitals for medical check-ups. This therefore results in more vehicles on the county’s roads, leading to increased emissions. Providing an accessible alternative to private vehicles will aid gradual modal shift to active travel or sustainable transport modes.  

3.27 The Government’s Transport and Health Resource states that, on average, each journey by public transport requires 6-10 minutes of walking. Whilst the health benefits of journeys solely consisting of active travel are more apparent, the use of public transport can also contribute to achieving recommended levels of physical activity by facilitating small yet routine physical activity.  

Prevalence of obesity in East Sussex, 2022 - 2023

Prevalence of obesity in East Sussex, 2022-2023 (source: Fingertips)

Area	Reception: Prevalence of overweight (including obesity)	Year 6: Prevalence of overweight (including obesity)	Adults (18+) classified as overweight or obese
England	22.3%	37.8%	63.8%
East Sussex	20.3%	34.0%	62.7%
Eastbourne	19.3%	32.0%	68.3%
Hastings	20.6%	38.4%	61.5%
Lewes	17.8%	30.3%	59.0%
Rother	23.5%	33.6%	64.6%
Wealden	18.8%	30.1%	63.7%

Source for above figure and table: Fingertips

Health status  

3.28 Figure 3.8 shows that health status in East Sussex is generally very good (34.4%) or good (42.7%). ‘Good’ health status in East Sussex is highest in Lewes and Wealden (44% respectively) and ‘very good' health status is highest in Eastbourne (36.4%). Of all districts, Rother has the highest proportion of individuals in ‘very bad’ health and Hastings has the highest proportion of individuals in ‘bad’ health. 

3.29 Long-term poor health status may result in social isolation and as a consequence increase loneliness and poor mental health. This highlights the necessity of transport connectivity which gives people freedom to travel and facilitates friends and family visiting those who are less able to travel themselves.  

Health status in East Sussex, 2008-2009

Health status in East Sussex, 2008-2009 (source: East Sussex in Figures)

Health status	East Sussex	Eastbourne	Hastings	Lewes	Rother	Wealden
Very good	34.3	36.4	34.6	33.5	30.7	35.2
Good	42.7	41.8	40.1	44.1	42.8	44.0
Fair	19	17.8	19.4	17.4	23.1	18.3
Bad	3.2	3.2	5.1	4.2	0.6	1.9
Very bad	0.8	0.7	0.8	0.8	0.9	0.7

Physical activity and wellbeing 

3.30 Although the components of mental health are complex, it is a vital part of wellbeing. Mental health can impact physical proactivity, thus a lack of transport connectivity can lead to seclusion and reduced physical activity. The LTP should therefore consider initiatives which encourage people to achieve the recommendation for levels of physical activity. Further, the noise impacts resulting from transport construction and interchange can negatively affect mental health.  

3.31 Compared to the rest of the South East region, East Sussex has a higher proportion of individuals who do not participate in activity as displayed in Figure 3.9. District specific data set out in Figure 3.10, indicates that Hastings has the highest proportion of inactive adults (27.3%), while Lewes has the highest proportion of active adults (71.9%) followed by Wealden. 

Percentage who did not participate in activity

Percentage who did not participate in activity (source: Sport England)

Year	England	South East	East Sussex
Nov 2015-16	6.5%	5.5%	6.0%
Nov 2016-17	5.9%	4.3%	5.8%
Nov 2017-18	5.9%	4.6%	6.4%
Nov 2018-19	5.4%	4.3%	4.1%
Nov 2019-20	7.1%	6.0%	6.4%
Nov 2020-21	8.2%	6.5%	8.2%
Nov 2021-22	8.9%	6.9%	6.4%

Activity levels in East Sussex

Activity levels in East Sussex (source: Sport England)

Area	Inactive	Fairly inactive	Active
East Sussex	22.9%	11.4%	65.7%
Eastbourne	27.3%	12.1%	60.6%
Hastings	19.2%	8.9%	71.9%
Lewes	24.7%	8.8%	66.6%
Rother	18.7%	11.6%	69.7%
Wealden	22.0%	10.6%	67.3%

Sources for above tables and figures: Sports England (no participation in activity) and Sports England (activity levels)

Health determinant 2: Access, accessibility, and community severance

Disability  

3.32 Health impairments can also include disabilities. Disability refers to people who have physical, sensory, intellectual, or mental health impairment(s). Transport can disproportionately impact individual physical health, which may result in some groups in the population finding it difficult to use certain modes of transport or being excluded from using them entirely. The LTP needs to consider the needs of different users and take steps to accommodate these needs as much as possible in order to provide an inclusive transport network.  

3.33 Disability and impairment projections set out in Figure 3.11 show that in 2020, the number of people with disabilities in East Sussex were around 97,000, with rates per 100 people highest in Hastings. According to East Sussex County Council forecasts, by 2035 this is expected to reach 122,427. Of these figures, the highest proportion is in Wealden (28% for 2035), indicating a large percentage of disabled individuals residing inland. Compared to 2020, the county is expected to have an increase in people with a disability of 25,800.  

3.34 The number of Blue Badges issued to disabled people in East Sussex is expected to increase as a result of the county’s aging population and also that hidden disabilities are now eligible. This may require consideration to the increased availability of on-street and off-street parking which is dedicated to Blue Badge holders in the future.  

Figure 3.11: Disability and Impairment Projections

Disability and impairment projections (source: East Sussex in Figures)

Area	2020	2025	2030	2035
East Sussex	19.2	20	20.7	21.5
Eastbourne	20.3	20.9	21.9	22.9
Hastings	21.3	21.9	22.7	23.6
Lewes	18.4	19.2	20	20.7
Rother	20.9	21.7	22.5	23.4
Wealden	17	17.8	18.4	19.1

Access to health  

3.35 Accessibility data in Figure 3.12 shows that the majority of individuals in East Sussex (96.7%) travel by car to access GPs within a 15-minute radius, indicating a lack of appropriate public transport or walking routes. With average cycle times under 20 minutes to GP surgeries there is potential for a higher uptake of cycling here as well. Eastbourne and Hastings have high proportions of individuals cycling to access GPs (96% and 97.3% respectively).  

3.36 Figure 3.13 shows that hospitals within a distance of 30 minutes are largely accessed by car. The highest proportion using public transport/walking to access hospital comes from individuals in Hastings (84.6%). From Wealden, the average journey time to hospitals by public transport is 58 minutes. This may be the only form of transport for some hospital users, especially patients without access to a car or where walking and cycling journeys are too long. The LTP should look to improve accessibility of health care sites so that locations are accessible to all.  

Figure 3.12: Access to GPs within a distance of 15 minutes, 2014-2019

Access to GPs within a distance of 15 minutes, 2014-2019 (source: East Sussex in Figures)

Area	Walk	Public transport/walk	Cycle	Car
East Sussex	51.3	59.4	73.4	44.6
Eastbourne	63.5	66.2	80.0	63.4
Hastings	82	96	97.3	80.8
Lewes	96.7	100	100	94.5
Rother	51.3	59.4	73.4	44.6
Wealden	63.5	66.2	80	63.4

Deprivation

3.37 The Index of Multiple Deprivation (IMD) is a measure of relative deprivation for small areas (Lower Super Output Areas (LSOAs)) and combines several factors including employment, education, crime, income, barriers to housing and services, living environment and health. These factors are combined and weighted to give an overall score and ranking for each LSOA in England. These rankings demonstrate relative deprivation, as opposed to level of affluence.  

3.38 Deprivation across England is dispersed, within 61% of local authority districts containing at least one of the country’s most deprived neighbourhoods22. East Sussex experiences the highest levels of deprivation of all the counties in the South East region. Out of 151 upper tier local authorities, East Sussex ranks as 93 for LSOAs among the most deprived 10% in England. The majority of deprived neighbourhoods in East Sussex are coastal areas in Hastings, Eastbourne and Rother. Hastings has the highest number of all five districts within the most deprived 10% (30.2%).  

3.39 These LSOAs in Hastings, along with 4 LSOAs in Eastbourne and 2 in Rother fall within the most deprived decile nationally. 12 of Eastbourne’s 61 LSOAs are among the most deprived 20% in England, and 18 LSOAs (in Eastbourne rank among the most deprived 30% nationally. Six of Rother’s 58 LSAOs are among the most deprived 20% of LSOAs in England. Lewes reported no residents in the most deprived decile and only 3% in the second with 58% in the top 4 least deprived deciles. Wealden similarly only has 6% of residents in the 4 most deprived deciles and 52% in the top three least deprived. Distribution of deprivation is mapped in Figure 3.14. 

3.40 Limited travel choices can mean that some people are unable or constrained in their ability to access the places they need and want to go. This exclusion can be made worse when met with high transport costs and lower incomes (a compounding effect known as Transport Poverty). In turn, this can lead to poorer health outcomes. It is important, then, that the transport network is progressive in meeting people’s needs by providing accessible and affordable journeys to all people.  

Figure 3.13: Access to hospitals within a distance of 30 minutes, 2014-2019

Access to hospitals within a distance of 30 minutes, 2014-2019 (source: East Sussex in figures)

Area	Walk	Public transport/walk	Cycle	Car
East Sussex	6.7	22.5	13.7	0
Eastbourne	32.1	57.4	84.6	13.4
Hastings	40.3	96	99.1	2.3
Lewes	83.9	100	100	78.4
Rother	6.7	22.5	13.7	0
Wealden	32.1	57.4	84.6	13.4

Figure 3.14: Deprivation across East Sussex in 2019

Health determinant 3: Economic health

Employment and Workforce Breakdown 

3.41 As evident in Figure 3.15, of the 241,614 people in employment in East Sussex, the majority drive a car or van to work (49%) or mainly work at or from home (31%), while 8% travel to work on foot (East Sussex in Figures).  

3.42 Travel to work data highlights there is scope to improve the level of physical activity within East Sussex. Improvements to the public transport network, whether this be expanding connectivity, increasing service frequency or reducing the cost of ticket fares, may encourage workers who currently drive to work in a car or van to use a public transport alternative – and all public transport journeys start and end with a walking or wheeling trip.

Figure 3.15: Method of travel to work for all people in employment in East Sussex in 2021

Method of travel to work for all people in employment in East Sussex in 2021 (source: East Sussex in figures)

Method of travel	Number of people	Percentage
Driving a car of a van	117,929	49
Work mainly at or from home	75,130	31
On foot	19,919	8
Passenger in a car or van	9,125	4
Bus, minibus or coach	5,742	2
Train	5,418	2
Cycle	3,061	1
Other	2,514	1
Taxi	1,450	1
Motorcycle, scooter or moped	1,213	1

Education 

3.43 Education refers to the acquisition and distribution of knowledge. Transport plays a significant role in accessing educational institutions, facilities and opportunities. A well-educated, skilled workforce encourages growth of a local economy. Restrictions in accessing education can directly affect economic prosperity but also indirectly impact health outcomes.   

3.44 Figure 3.16 shows that Hastings has the highest level of individuals with no qualifications (20.2%), while Lewes has the highest level of individuals with a Level 4 qualification and above (34.8%). Compared to the rest of the South East, East Sussex has a higher proportion of individuals with no qualifications (15.4% and 17.3% respectively).

Figure 3.16: Qualification attainment in 2021

Qualification attainment in 2021 (source: East Sussex in figures)

Area	No qualifications	Highest level of qualification Level 4 and above
East Sussex	17.3%	31.3%
Eastbourne	18.4%	29.8%
Hastings	20.15%	28.6%
Lewes	16.1%	34.8%
Rother	18.9%	29.9%
Wealden	14.9%	32.6%

Health determinant 4: Safety

Road collisions and safety 

3.45 Road traffic collisions typically involve vehicles and other road users, often resulting in injury. In the context of health, collisions are an immediate risk to the safety of individuals.  

3.46 Figure 3.17 shows that the number of fatal collisions was lowest in 2019, while the lowest number of slight and serious collisions was in 2020. However, in 2020 the number of fatal collisions increased from 2019.  According to information provided by the East Sussex Road Safety Team, collisions were evenly split between urban and rural areas, with cluster locations being those where a collision involves a car.  

3.47 Focusing on the rate of people killed or seriously injured (KSIs), the average rate in East Sussex has been greater than the average for England (State of the County Report 2023). Based on the latest three year reporting period unaffected by restrictions or lockdown due to COVID-19 (2017-2019), this was 68.1 per 100,000 population for East Sussex compared to 43.2 per 100,000 in England.  

3.48 Improving road safety through implementation of measures such as reduced speed limits where appropriate, provision of new and improved pedestrian and cycle crossing points, and restrictions to through (motor) traffic will be considered . Providing high quality walking and cycling networks protected from motor traffic, where these are deliverable, will also create safe and convenient options for people to move around the county using active travel.

Figure 3.17: Road collisions by severity 2015-2020

Road collisions by severity 2015-2020 (source: Accidents by Severity, East Sussex County Council)

Severity	2015	2016	2017	2018	2019	2020	Total
Fatal	21	23	22	21	14	17	118
Serious	291	313	299	303	351	245	1,802
Slight	1,156	1,038	1,002	936	958	728	5,818
Total	1,468	1,374	1,323	1,260	1,323	990	7,738

Road condition  

3.49 The quality of road surfaces can influence the extent to which accidents occur, but also the extent to which individuals choose to engage in physical activity (Transport and Health Resource). Road maintenance of the Strategic Road Network (SRN) in East Sussex is managed by National Highways and the remainder of the local and major roads in the county are maintained by the County Council as the local highway authority. 

3.50 As shown in Figure 3.18, generally the percentage of roads where maintenance should be considered has decreased, suggesting that road maintenance programmes are working.  However, variation by road type indicates that unclassified roads were  the least maintained as of 2019-20,. The County Council has increased the capital programme budget for road repairs from £15m to £18.1m per annum to maintain the Council’s 10-year road condition targets of 4%, 4% and 14% (for Principal, Non-Principal and Unclassified Roads) in need of repair. 

3.51 As described in Figure 3.10,  22.9% of the East Sussex population are inactive, indicating scope for improvement in the quality and condition of the public realm and urban environment such as footways and cycle paths, to encourage an increase in levels of physical activity.  

Figure 3.18: Road maintenance

Percentage of roads where maintenance should be considered (source: Department for Transport)

Year	Principal roads	Non-principal roads	Unclassified roads
2007	14%	15%	12%
2008	13%	13%	9%
2009	10%	10%	11%
2010	10%	10%	15%
2011	10%	13%	19%
2012	8%	10%	19%
2013	7%	9%	25%
2014	5%	9%	22%
2015	5%	6%	22%
2016	5%	6%	19%
2017	4%	7%	14%
2018	5%	7%	9%
2019	5%	5%	14%

Health determinant 5: Crime

3.52 Barriers to using public transport and engaging in active travel include a fear of crime and the implications for personal safety.  

3.53 Figure 3.19 highlights that the majority of residents in East Sussex feel fairly safe outside in their local area after dark. Lewes has the highest percentage of residents feeling fairly unsafe (17.8%) or very unsafe (10.4%).  Nationally, women feel less safe than men in all settings after dark, according to ONS survey analysis. Compared with data from the previous year, more people had stopped walking in quiet places such as “parks or open spaces” after dark in the last month because of feeling unsafe; an increase in both men (from 18% to 24%) and women (from 32% to 37%).   

3.54 As presented in Figure 3.20, crime is prominent in East Sussex boroughs and may be a contributing factor in threatening individual perception of safety. Public order offences are highest in Hastings (10 per 1000 population), compared to the national average of 7.4.  According to data provided by the Adult Social Care and Health Department in the State of the County 2023 Report, across 2022-2023, there was a 13.2% increase in public place serious violent crimes. Knife crime also increased by 11.5% compared to the previous year (state of the County 2023).  

3.55 This could be improved through measures such as improved street lighting and wayfinding to provide people with attractive and busier routes through urban areas. This is particularly important in areas such as Eastbourne and Hastings, where public order offences are highest, and residents are most concerned. 

Figure 3.19: Safety levels in 2017

Safety levels in 2017 (source: East Sussex in Figures)

Area	Very safe	Fairly safe	Neither safe nor unsafe	Fairly unsafe	Very unsafe
East Sussex	27	44	16.7	8.4	3.9
Eastbourne	20.7	43.8	17.8	11.7	5.9
Hastings	13.5	44.6	21	13.9	7.2
Lewes	11	38.8	21.9	17.8	10.4
Rother	23.3	45.7	14.9	11.3	4.8
Wealden	24.4	45.4	15.8	9.8	4.6

Figure 3.20: Recorded crime by key offences 2020-2021

Recorded crime by key offences 2020-2021 (source: East Sussex in Figures)

Type of crime	England	East Sussex	Eastbourne	Hastings	Lewes	Rother	Wealden
Theft offences	20.3	13.7	18.1	20.8	10.8	13	9.1
Violence against the person	28	23.3	32.3	38.2	19.3	20.9	13.3
Criminal damage and arson	7.4	7.2	8.7	11.5	6.2	7	4.5
Public order offences	7.4	6.5	9.1	10	5.5	5.8	4
Sexual offences	2.3	2.3	3.1	3.4	2.1	2.2	1.3
Miscellaneous crimes against society	1.7	1.4	1.5	2.2	1.6	1.4	0.9
Possession of weapons offences	0.7	0.8	1.1	1.4	0.6	0.6	0.5

Health determinant 6: Congestion and stress

3.57 Since 2011, the population of East Sussex has increased at a rate of 3.6% (East Sussex in Figures, population by age and sex 2001-2021). With this anticipated growth comes an increase in the need for transport in order to meet demand. Expanding transport provision increases the risk of congestion, which can burden both physical and mental health.  

Mental health 

3.58 Mental health condition prevalence varies between 0.8% in Lewes CCG and 1.1% in Hastings, Rother and Eastbourne, CCGs, with the largest number of patients registered in Hastings and Rother CCG31 according to 2013/2014 data.  

3.59 It is estimated there are approximately 55,600 people in East Sussex with a common mental health disorder; 2700 with a personality disorder and 1700 with probable psychosis. Suicide rates across males and females are also higher than the national rate. Increasing congestion levels may induce high stress levels, leading to increased isolation and vulnerability of certain  groups. According to the State of the County 2023 Report, there is a higher percentage of adults in East Sussex with high anxiety (26%) and low life satisfaction (5.4%) compared to the national average (22.3% and 4.4% respectively).   

3.60 Additionally, the percentage of adults who feel lonely often, always or some of the time is higher in certain East Sussex boroughs, compared to the England average (22.26%) as evident in Figure 3.21.  

3.61 There is an opportunity for transport to mitigate detrimental effects on mental health. By improving connectivity, reducing journey times and reducing harmful transport emissions, the stress of travel is also minimised which improves the quality of the transport experience. Provision of affordable transport, such as introducing concessionary travel passes, may reduce social exclusion experienced by older people and those who face mobility difficulties. Moreover, a lack of affordable and inclusive travel options may exacerbate generational divides in social connectivity as transport facilitates social interaction and networking amongst all groups (NatCen for Department for Transport).  

Figure 3.21: Loneliness in 2019/20

Loneliness in 2019/20 (source: Public Health Outcomes Framework)

Area	Percentage of adults who feel lonely often or always or some of the time
England	22.26%
Eastbourne	15.3%
Hastings	22.4%
Lewes	24.0%
Rother	22.8%
Wealden	15.9%

Health determinant 7: Air quality

Air quality and health 

3.62 The movements of most forms of highway-based transport have resultant impacts on air quality, and is based on several factors, including the fuel type, weight and age/condition of the vehicle. A large range of pollutants result from highways-based transport and are produced through both the combustion/burning of fuels, but also the general wear and tear to the vehicle, such as from tyres and braking systems. Pollutants enter the respiratory system and cause widespread health impacts across the majority of the body’s major functions.  

3.63 The impact of poor air quality disproportionately impacts individuals both as they age, from children to older people, and also those with underlying health conditions, or if they are pregnant. 

How air pollution affects people throughout their lifetime

During pregnancy 

• Low birth weight 

Children 

• Asthma 
• Slower development of lung function 
• Development problems 
• More wheezing and coughs 
• Start of atherosclerosis 

Adults 

• Asthma 
• Coronary heart disease 
• Stroke 
• Lung cancer
• Chronic obstructive pulmonary disease (as chronic bronchitis) 
• Diabetes 

Older adults  

• Asthma 
• Accelerated decline of lung function 
• Lung cancer 
• Diabetes 
• Dementia  
• Heart attack, heart failure and strokes

3.64 Generally, air quality in East Sussex is good, however there are town centre locations where the objectives of air quality are not met. In turn, this may adversely impact individuals who are sensitive to poor air quality.  

3.65 There is a growing body of evidence that links maternal exposure to air pollution and adverse pregnancy outcomes. Air pollution particles have been shown to reach the foetal side of the placenta (Nature Communications) and there is consistent evidence that exposure to air pollution such as particulate matter and ozone (O3) during pregnancy increases the risk of low birth weight and preterm birth (JAMA Network and National Library of Medicine).  

3.66 Air Quality Management Areas (AQMAs) are areas where local air quality is unlikely to meet national air quality standards. Consequently, the appropriate district or borough council must monitor local air quality to understand the actions that can be taken to improve its condition. East Sussex has two main AQMAs in Lewes including Lewes Town Centre, and A259 Newhaven Ring Road for nitrogen dioxide pollutants. As of 2017, the Hastings Borough Council AQMA for particulate matter was revoked (Department for Environment, Food & Rural Affairs).  

3.67 The LTP has a role in reducing health inequalities which may disproportionately impact vulnerable communities, such as those in the most deprived 10% nationally, pregnant women or those with pre-existing health conditions. Improving public transport links to health care facilities, employment centres and education facilities across the county so that people can attend medical appointments, workplaces, and education without being reliant on access to a car. This will likely have a positive impact on air quality, with fewer cars on the roads. For further information on how the LTP addresses equality, please refer to the ESCC LTP4 Equality Impact Assessment (EqIA) and the ESCC LTP4 Integrated Impact Assessment (IIA).  

Carbon emissions 

3.68 Figure 3.23 shows that including all sectors, carbon dioxide emissions in Wealden are higher than any other district in East Sussex. While this could be attributed to Wealden having the highest population, the inverse cannot be applied to Hastings which has the smallest population. Over time, carbon emissions have decreased however, as of 2020, East Sussex had carbon emissions of 2,224 kt, 31% of which came from Wealden, 20% from Rother, 19% from Lewes, 16% from Eastbourne and 14% from Hastings.   

3.69 Appropriate transport mitigations, such as decarbonisation, should be in place to counter the worsening effects of climate change in line with the Government’s Decarbonising Transport – A Better, Greener Britain strategy. 

 

Figure 3.23: Carbon dioxide emissions by sector, 2005-2020

Carbon dioxide emissions by area, 2005-2020 (source: East Sussex in Figures)

Area	2015	2016	2017	2018	2019	2020
East Sussex	2,224	2,147	2,033	1,992	1,880	1,672
Eastbourne	360	336	315	309	288	263
Hastings	302	279	265	256	246	225
Lewes	432	416	397	387	369	326
Rother	439	441	418	417	384	341
Wealden	691	675	638	624	594	516

Open spaces 

3.70 East Sussex is home to a vast range of natural environmental assets. These assets provide opportunities to support both mental and physical wellbeing through giving individuals open space for recreational and leisure purposes. Designated areas in East Sussex (East Sussex in Figures - East Sussex Designations) include: 

• 87,981 hectares of High Weald Area of Outstanding Natural Beauty (AONB); 
• 365 Sites of Nature Conservation Importance (SNCI), accumulating 8,680 hectares of land; 
• 1,398 hectares of land designated as Local Nature Reserve; 
• 12,936 hectares designated as Sites of Special Scientific Interest (SSSI); 
• 24, 365 hectares of South Downs National Park, split across Eastbourne, Lewes and Wealden; 
• 315 scheduled ancient monuments; 
• 2 registered battlefields; 
• 33 registered parks and gardens; 
• 6,379 listed buildings; 
• 139 registered conservation areas; and 
• 4 registered marine heritage sites.  

3.71 There is scope for improve transport provision, extending cross-borough to key designated areas in order to maximise use of these spaces. Further, promoting open spaces will benefit disadvantaged community groups who are likely to suffer from seclusion or poor air quality by encouraging active travel as a means to enhance both physical and mental health. 

Health determinant 8: Noise

3.72 Exposure to noise can cause disturbance and annoyance to individuals in close proximity. While auditory impacts are the most common drawback of extreme noise levels, children and older age groups especially may be vulnerable to cognitive dysfunction and/or serious mental health implications.  

3.73 In some urban areas in East Sussex, noise pollution is an issue around major highways. Strategic noise maps produced under the Environmental Noise (England) Regulations 2006, identifies hotspots where the highest 1% of noise levels occurs in residential locations – they are known as Important Areas (Ias). Figure 3.24 shows the extent of Ias compared to major routes such as the M20 between London and Dover. Highways in East Sussex with a particular need to consider the noise from vehicles include the A21, A22, and A27, and A259. 

3.74 Figure 3.25 illustrates a higher than national average (12 per 1,000) for noise complaints in the borough of Hastings (19.6 per 1,000). The long-term impacts of noise can be more widespread and extensive than causing hearing loss. The Government’s Transport and Health Resource outlines emotional functionality, stress, communication, and sleep disturbance as indirectly affected by health. Transport construction, operation and systems in East Sussex must consider the negative implications of poor noise management, as it is estimated that the annual social cost of urban road noise in England is £7 to £10 billion (Department for Environment, Food & Rural Affairs).  

Figure 3.24: 24 hour annual average noise levels (Source: England Noise and Air Quality Viewer, Department for Environment, Food & Rural Affairs)

Figure 3.25: Rate of noise complaints 2021-22

Rate of noise complaints 2021-22 (Source: Public Health Outcomes Framework)

Area	Rate of noise complaints per 1000
England	12
Eastbourne	7.4
Hastings	19.6
Lewes	6.3
Rother	4.7
Wealden	3.7

Evidence base summary

3.75 The evidence base provides a comprehensive overview of the demographics and health determinants of across East Sussex. The key issues identified in the evidence base have been summarised, and an assessment provided as to what the potential implications may be on health, and how they link to transport. Consideration has then been provided to establish what the LTP needs to deliver in order to address these issues and improve health outcomes in East Sussex. 

Demographics

Pathways and demographics

• East Sussex has a higher proportion of over 65s and over 85s than the national average.
• East Sussex also has a high proportion of over 65s residing in rural areas compared to both the South East and England and Wales.
• Eastbourne is the only town in East Sussex which is experiencing growth of under 15s, though Lewes, Rother, Wealden and Eastbourne are all experiencing a growth in the population of people aged 15-24.
• During engagement with young people, the majority travel to school via active modes.

Implications on health and the links to transport

• Increased likelihood of age-related impairments occurring, which may be exacerbated by the transport network which currently favours driving cars, rather than walking, cycling or using public transport in many areas.
• Increased risk of social isolation, particularly in rural or coastal areas (such as Hastings) where public transport connections are poorest, and deprivation is highest.
• Large percentages of older people living in rural areas (such as Burwash or Mayfield) is likely to mean that their access to essential services and health care facilities is limited, as they are often located in urban centres.
• Physical inactivity has implications in terms of costs to the NHS and reducing economic productivity. Transport plays a key role in addressing the barriers preventing both men and women from undertaking more exercise.

What the LTP needs to deliver to address issues

• Improving access to public transport, particularly in rural and coastal areas which may experience disproportionately negative impacts of a limited service.
• Developing active travel networks so that people can walk, cycle and wheel to key services, reducing social isolation and increasing daily exercise. This is particularly important in areas of deprivation, where people are less likely to have access to a car.
• Population growth will drive demand for new housing and additional employment opportunities, educational facilities, and health services. Existing transport is likely to require upgrading to accommodate the additional demand, with appropriate future-proofing options explored to ensure connectivity between new and existing housing, employment, education and healthcare sites.
• Improving access to green and blue spaces, as well as connections to leisure centres and gyms.

Health determinant 1: Lifestyle

Pathways and demographics

• East Sussex fairs relatively well with regard to prevalence of obesity compared to the national average. It needs to be acknowledged, however, that England has higher levels of obesity than many major European countries.
• Health status in East Sussex is generally ‘very good’ or ‘good’, though Rother has the highest proportion of people in ‘very bad’ health, and Hastings the highest with ‘bad’ health.
• Compared to the rest of the South East region, East Sussex has a higher proportion of individuals who do not participate in activity, and this is worst within Hastings.
• During Phase 1 of engagement, the theme ‘safety, health and air quality’ was ranked as the most important in ESCC with 79% of respondents selecting it as an important theme for the forthcoming LTP.
• During the public consultation, improved active travel infrastructure was a recurring suggestion across all of the themes in the ESCC LTP.

Implications on health and the links to transport

• Increased risk of obesity related illness and impairments occurring across the population, particularly in Rother and Hastings, who currently suffer from worse health status’ than other towns within the county.
• Obesity can sometimes affect mobility, meaning people are more reliant on (or inclined to use) private cars to reach goods and services, including reaching GPs or hospitals for medical check-ups. This can consequently result in more vehicles on the county’s roads, leading to increased emissions.
• Long-term poor health status may result in social isolation and as a consequence increase loneliness and poor mental health.

What the LTP needs to deliver to address issues

• Developing active travel networks so that people build in incidental daily exercise into their daily routes, making it attractive and convenient to walk, cycle and wheel. This was a recurring suggestion throughout public engagement and consultation.
• Improving air quality within East Sussex, primarily in urban areas, to reduce the harmful impacts of pollutants on the health of residents

Health determinant 2: Access, accessibility, and community severance

Pathways and demographics

• Disability and impairment projections for East Sussex show that the county is expected to have an increase in people with a disability going forwards.
• The vast majority of people travel to health care facilities by car, which may indicate a lack of convenient and attractive public transport and active travel connections, or health care facilities located in inaccessible locations.
• East Sussex is among the most deprived 10% of authorities within England, and areas of Hastings, Eastbourne and Rother fall within the most deprived decile nationally.
• During the phase 1 engagement, the theme ‘accessibility, equity and social inclusion’ was ranked as the second most important in ESCC with 77% of respondents selecting it as an important theme for the forthcoming LTP.
• During Phase 1 of engagement, respondents pinned issues on a map relating to ‘accessibility, equity and social inclusion’, The majority of pins are clustered in the larger towns in the county – Eastbourne, Hastings, Bexhill, Uckfield, Crowborough and Lewes.

Implications on health and the links to transport

• Higher levels of deprivation are linked to worse health outcomes, therefore failing to address one of the root causes - poor access to education and employment centres - will result in worse health outcomes on a continual basis.
• Increased risk of social isolation, particularly in rural or coastal areas (such as Hastings) where public transport connections are poorest, and deprivation is highest
• Large percentages of older people living in rural areas (such as Burwash or Mayfield) is likely to mean that their access to essential services and health care facilities is limited, as they are often located in urban centres.
• Limited travel choices can mean that some people are unable or constrained in their ability to access the places they need and want to go. This exclusion can be made worse when met with high transport costs and lower incomes (a compounding effect known as Transport Poverty). In turn, this can lead to poorer health outcomes.

What the LTP needs to deliver to address issues

• Improving accessibility across the transport network so that people living with impairments are not excluded from using the system, and therefore not inadvertently disconnected from employment, education, or leisure activities.
• Improving public transport links to health care facilities, employment centres and education facilities across the county so that people can attend medical appointments, workplaces, and education without being reliant on access to a car.
• Providing genuine and attractive alternatives to the private car, particularly through improved walking and cycling networks, which will provide low cost and efficient transport. This will disproportionately benefit the most deprived residents in the county who are not likely to be able to afford a private car, or who are currently spending large percentages of their income on one currently.

Health determinant 3: Economic health

Pathways and demographics

• The majority of people employed within East Sussex drive a car or van to work (49%) or mainly work at or from home (31%), while 8% travel to work on foot.
• During Phase 1 of engagement, 51% of respondents selected the theme ‘sustainable economic development’ as an important theme in ESCC for the forthcoming LTP.

Implications on health and the links to transport

• Higher levels of driving, and lower levels of public transport usage and walking/cycling will have implications for overall public health. Every public transport trip starts and ends with a walk, and active travel requires physical effort – with fewer people using these modes, the benefit of incidental exercise is being missed.
• Restrictions in accessing education can directly affect economic prosperity but also indirectly impact health outcomes by way of learning about benefits and importance of health.

What the LTP needs to deliver to address issues

• Improving public transport links to health care facilities, employment centres and education facilities across the county so that people can attend medical appointments, workplaces, and education without being reliant on access to a car.
• Expanding connectivity through increasing public transport service frequency and/or reducing the cost of ticket fares to encourage workers who currently drive to work in a car or van to use a public transport alternative.
• Developing active travel networks so that people build in incidental daily exercise into their daily routes, making it attractive and convenient to walk, cycle and wheel.

Health determinant 4: Road safety

Pathways and demographics

• The rate of people killed or seriously injured (KSIs) in road collisions is higher than the average for England, suggesting that the county has a road safety issue.
• Collisions are mostly evenly split between urban and rural areas
• Engagement with key stakeholders through meetings with specific user groups or one-to-one meetings showed that road safety was a key area for intervention.

Implications on health and the links to transport

• The actual and perceived danger on the roads is a large deterrent to people choosing to walk and cycle. Dangerous roads, whether perceived or real, will ensure that only a small minority of people feel comfortable or safe to switch from private car/public transport usage to active travel. This can have consequences for overall public health, as walking and cycling are proven to be excellent ways of achieving daily recommended exercise.

What the LTP needs to deliver to address issues

• Improving road safety through implementation of measures such as reduced speed limits where appropriate, provision of new and improved pedestrian crossing points, and restrictions to through (motor) traffic.
• Providing high quality walking and cycling networks, protected from motor traffic, thus creating safe and convenient options for people to move around the county using active travel.

Health determinant 5: Crime

Pathways and demographics

• Most residents in East Sussex feel fairly safe outside in their local area after dark.
• Lewes has the highest percentage of residents feeling fairly unsafe (17.8%) or very unsafe (10.4%).
• Crime is prominent in East Sussex and may be a contributing factor in threatening individual perception of safety.
• Public order offences are highest in Hastings (10 per 1000 population), compared to the national average of 7.4. 

Implications on health and the links to transport

• Fear of crime may be deterring some people from choosing to walk or cycle as they feel like more exposed and dangerous activities than using a car or public transport. This can have a negative impact on health outcomes, as people are being prevented from building exercise into their journeys.
• Fear of crime on public transport may also be deterring some people from using the bus or train, which could force them into using a car. This can have externalities which impact on wider health outcomes, such as increased pollution and stress.

What the LTP needs to deliver to address issues

• Improving the safety of streets and public transport hubs through better spatial planning.
• Retrofitting measures such as improved street lighting and wayfinding to provide people with attractive and busier routes through urban areas. This is particularly important in areas such as Lewes and Hastings, where public order offences are highest, and residents are most concerned.

Health determinant 6: Congestion and stress

Pathways and demographics

• There are approximately 55,600 people in East Sussex with a common mental health disorder; 2,700 with a personality disorder and 1,700 with probable psychosis. Suicide rates across males and females are also higher than the national rate.
• There is a higher percentage of adults in East Sussex with high anxiety and low life satisfaction compared to the national average.
• The percentage of adults who feel lonely ‘often, always, or some of the time’ is higher in Hastings, Lewes and Rother than the national average.

Implications on health and the links to transport

• Increased congestion within the county may lead to worsened health outcomes, with increased stress levels.
• In turn, long-term stress and poor mental health may prevent people from attending work or education, resulting in social isolation and poor education and economic outcomes.

What the LTP needs to deliver to address issues

• Improving public transport links to health care facilities, employment centres and education facilities across the county so that people can attend medical appointments, workplaces, and education. This is particularly important in Hastings, Lewes and Rother where adult loneliness is highest in the county, and above the national average.
• Developing active travel networks so that people build in incidental daily exercise into their daily routes. Exercise has been proven to benefit mental health and stress.
• Ensuring that new development is well planned, and not car dependent. Car dependency is likely to increase congestion, and consequently impact the mental health of residents.  

Health determinant 7: Air quality

Pathways and demographics

• Generally, air quality in East Sussex is good, however there are town centre locations where the objectives of air quality are not met. East Sussex has two Air Quality Management Areas where air quality is at its worst – in Lewes town centre and Newhaven Ring Road.
• Including all sectors, carbon dioxide emissions in Wealden are higher than any other district in East Sussex. Rother, Lewes, Hasting and Eastbourne also have high carbon emissions.
• During Phase 1 of engagement, the theme ‘safety, health and air quality’ was ranked as the most important in ESCC with 79% of respondents selecting it as an important theme for the forthcoming LTP. Respondents also pinned issues on a map relating to ‘safety, health and air quality’. The majority of these were clustered in the larger towns. In addition, there are clusters of comments along some of the main routes in the county and focus on the towns of Eastbourne, Bexhill, Hastings, Lewes, Peacehaven, Newhaven and Seaford.

Implications on health and the links to transport

• A large range of pollutants result from highways-based transport and are produced through both the combustion/burning of fuels, but also the general wear and tear to the vehicle, such as from tyres and braking systems. Pollutants enter the respiratory system and cause widespread health impacts across the majority of the body’s major functions
• The impact of poor air quality disproportionately impacts individuals both as they age, from children to older people, and also those with underlying health conditions, or if they are pregnant.
• Poor air quality is often experienced by the most deprived people in society, despite them being one of the lowest contributors to the pollution.
• Carbon emissions affect several life expectancy outcomes relating to respiration and food production.

What the LTP needs to deliver to address issues

• Improving public transport links to health care facilities, employment centres and education facilities across the county so that people can attend medical appointments, workplaces, and education without being reliant on access to a car. This will likely have a positive impact on air quality, with fewer cars on the roads. This is especially important in Lewes due to the poor air quality that the town experiences.
• Providing high quality walking and cycling networks, protected from motor traffic, thus creating safe and convenient options for people to make shorter journeys without the need for car.
• Ensuring that appropriate transport mitigations, such as decarbonisation, should be in place to counter the worsening effects of climate change in line with the Government's Decarbonising Transport - A Better, Greener Britain strategy.
• Ensuring that new development is well planned, and not car dependent. Car dependency is likely to increase congestion, and consequently decrease air quality.

Health determinant 8: Noise

Pathways and demographics

• There are higher than national average (12 per 1,000) for noise complaints in the borough of Hastings (19.6 per 1,000).
• Areas in East Sussex that suffer from the worst transport related noise pollution are along the A21, A22, and A27, and A259.

Implications on health and the links to transport

• Exposure to noise can cause disturbance and annoyance to individuals in close proximity. While auditory impacts are the most common drawback of extreme noise levels, children and older groups especially may be vulnerable to cognitive dysfunction and/or mental health implications.
• The long-term impacts of noise can be more widespread and extensive than causing hearing loss. The Government’s Transport and Health Resource outlines emotional functionality, stress, communication and sleep disturbance as indirect effects of noise.

What the LTP needs to deliver to address issues

• Ensuring that consideration is given to new highway schemes, and the implications that this may have on noise and public health.

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4. Impact Assessment

Introduction

4.1 The analysis of health impacts has focussed on the health determinants likely to be influenced by mobility and transport and as a result, the LTP. The eight pathways mentioned in Section 2- Scoping and Methodology include:

• Health determinant 1: Lifestyle
• Health determinant 2: Access, accessibility, and community severance
• Health determinant 3: Economic health
• Health determinant 4: Safety
• Health determinant 5: Crime
• Health determinant 6: Congestion and stress
• Health determinant 7: Air quality
• Health determinant 8: Noise

4.2 These have consequentially been applied to the LTP’s objectives which include the following:

• Deliver safer and accessible journeys
• Support healthier lifestyles and communities
• Decarbonise transport
• Conserve and enhance our local environment
• Support sustainable economic growth
• Strengthen the resilience of our transport networks.

4.3 The following pathways have also been applied to the LTP’s themes and related policies:

• Theme A: Tackling climate change and enhancing our local environment
• Theme B: Safer, healthier and more active travel
• Theme C: Make public transport accessible for all
• Theme D: Keeping East Sussex Connected

LTP Objectives

Objective 1: Deliver safer and accessible journeys

Outcomes 

• Outcome 1.1: Create enhanced and inclusive transport networks for all users. 
• Outcome 1.2: Contribute to reducing the number of casualties and collisions on our transport networks. 
• Outcome 1.3: Contribute to improving personal safety for all journeys. 
• Outcome 1.4: Improve interchange between travel modes. 
• Outcome 1.5: Improve access to key local services by all modes. 

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Slight beneficial
Safety	Significant beneficial
Crime	Slight beneficial
Congestion and stress	Uncertain effect
Air quality	Slight beneficial
Noise	Uncertain effect

Rationale

By improving both the safety and accessibility of all transport journeys, this will improve confidence levels of East Sussex’s residents, workers, and visitors in using the transport network.

Increasing the proportion of bus/rail journeys in East Sussex will also increase opportunities to exercise, as in the majority of cases these journeys will involve a walk to access the bus stop/railway station. Increasing public transport usage has the potential to reduce inactivity levels across East Sussex. Increasing opportunities for regular exercise will also benefit those with long-term health conditions and other disabilities, who are shown to disproportionately benefit through light exercise.

In vulnerable and disadvantaged communities this will particularly benefit those on lower/limited incomes if policies and schemes improving the affordability of transport are implemented. This will increase travel choices for these individuals and communities, in turn improving opportunities for accessing social/familial care, with social isolation for these groups remaining a key issue. Finally, it will allow communities to access an increased range of food options available to them.

Increasing options for public transport will also facilitate a shift away from private vehicle usage and the health benefits resulting will enable, such as improved air quality and road safety.

Mitigation measures / recommendations

Increasing public transport journeys by disadvantaged and vulnerable communities not only requires improving the physical accessibility of services, but also the financial accessibility. An opportunity to further improve likely health impacts resulting from this outcome would be to introduce cheaper public transport tickets to disadvantaged/vulnerable individuals.

A number of the other perceived outcomes resulting from this objective are relatively general in nature. It is recognised that individuals with specific characteristics will disproportionately benefit through improved personal safety in comparison to others. To improve the focus of these priorities the language should be more specific in nature

Objective 2: Support healthier lifestyles and communities

Outcomes

• Outcome 2.1: Increase the proportion of walking, wheeling and cycling journeys. 
• Outcome 2.2: Increase active travel and public transport journeys through education, training, travel behaviour change initiatives and information. 
• Outcome 2.3: Redesign road space to balance the needs of different road users, including encouraging people to walk, wheel, cycle and use the bus. 
• Outcome 2.4: Support reduction of emissions to improve air quality. 
• Outcome 2.5: Mitigate noise pollution through technology and design.

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Slight beneficial
Economic health	Uncertain effect
Safety	Uncertain effect
Crime	Uncertain effect
Congestion and stress	Significant beneficial
Air quality	Slight beneficial
Noise	Significant beneficial

Rationale

By increasing the proportion of those walking, wheeling, and cycling this provides excellent opportunities to improve activity levels, particularly reducing the number of those who exercise less than 30-minutes per week.

Increasing the proportion of bus/rail journeys in East Sussex will also increase opportunities to exercise, as in the majority of cases these journeys will involve a walk to access the bus stop/railway station. Increasing public transport usage has the potential to reduce inactivity levels across East Sussex. Increasing opportunities for regular exercise will also benefit those with long-term health conditions and other disabilities, who are shown to disproportionately benefit through light exercise.

Reducing vehicle emissions could include both the switch to alternative fuels and electric vehicles (noting concerns over affordability), but additionally and associated noise pollution presents the opportunity to improve the quality of both the built and natural environment.

Mitigation measures / recommendations

Evidence from disability advocacy groups has presented specific challenges arising from the redesign of road space. A particular example may include the impact of shared spaces on blind and partially sighted individuals. Consequentially, schemes including the redesign of road space, particularly using uncommon approaches, should incorporate additional levels of stakeholder engagement to identify specific constraints and mitigatory solutions.

Furthermore, new pedestrian and cycle infrastructure should be designed in an inclusive manner and facilitate those who use other forms of mobility aids (such as powered/unpowered wheelchairs, mobility scooters, frames & walking sticks) alongside people using pushchairs/ prams

Taking into consideration  different road users, redesigning road space with the people of East Sussex in mind will improve safety and reduce crime levels. Ensuring that implementation of better lighting, surveillance and public realm conditions is considered as part of the LTP will shift the uncertainty on crime and safety towards a positive impact.  Economic health will likely benefit as a multiplier of these considerations.

Objective 3: Decarbonise transport

Outcomes 

• Outcome 3.1: Increase the proportion of people travelling by walking, wheeling, cycling, public and shared transport. 
• Outcome 3.2: Facilitate the uptake of ultra-low and zero-emission vehicles for journeys, through the delivery of supporting infrastructure. 
• Outcome 3.3: Work with partners to decarbonise transport and tackle climate change. 
• Outcome 3.4: Support clean technologies and fuels that contributes towards the decarbonisation of transport. 

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Uncertain effect
Economic health	Uncertain effect
Safety	Uncertain effect
Crime	Uncertain effect
Congestion and stress	Slight beneficial
Air quality	Significant beneficial
Noise	Slight beneficial

Rationale

Reducing the proportion of people travelling by private car, in combination with increasing the proportion of those walking, wheeling, cycling, and using public transport will help increase opportunities to exercise. This will improve activity levels, particularly reducing the number of those who exercise less than 30-minutes per week.

Reducing carbon emissions will include alternative methods of travel including both the shift to electric vehicle usage, as well as use of sustainable fuels. With transport being a major contributor to UK greenhouse gas emissions, decarbonising the network will restore high environmental quality in terms of low pollution levels. Both the built and natural environment are expected to benefit from a reduction in vehicle emissions, as well as an investment in the infrastructure which can help facilitate zero-emission journeys.

Mitigation measures / recommendations

An opportunity to further improve likely health impacts resulting from this outcome would be to introduce cheaper public transport services to those from a disadvantaged background. Additionally, supporting the uptake of electric vehicles (including affordability) and zero-emission journeys through provision of grants to low-income households could encourage more walking, wheeling, cycling and public transport journeys.

A number of the other perceived outcomes resulting from this objective are relatively general in nature. It is recognised that increasing the proportion of active travel users will involve infrastructure changes and will include thorough assessment of vulnerable people to also accommodate for their needs.

Objective 4: Conserve and enhance our local environment

Outcomes

• Outcome 4.1: Conserve and enhance our local and natural environment by mitigating negative impacts of transport design and delivery. 
• Outcome 4.2: Enhance and create attractive connected communities and public spaces. 
• Outcome 4.3: Support habitat connectivity and increase in biodiversity through the delivery of enhanced and new transport infrastructure and public spaces. 

Health determinant impact

Health impact	Health effect
Lifestyle	Uncertain effect
Access, accessibility and community severance	Slight beneficial
Economic health	Uncertain effect
Safety	Uncertain effect
Crime	Uncertain effect
Congestion and stress	Uncertain effect
Air quality	Significant beneficial
Noise	Slight beneficial

Rationale

Reducing vehicle emissions could include the switch to alternative fuel and electric vehicles (noting affordability issues) but could also include a reduction in journey dwell times to minimise exhaust emissions and associated noise pollution. This provides an opportunity to enhance the built and natural environment by saving energy and preserving the quality of the area for future generations. Further, conservation of habitats and vulnerable species will help support human and societal needs, as well as stabilise the ecosystem.

Creating attractive community spaces will include linking local communities together by means of transport. Generally, mental health is likely to improve from increased social support and interaction in a pleasant environment, thereby reducing suicide rates and improving wellbeing

Mitigation measures / recommendations

It is recognised that facilitating habitat connectivity effectively may involve minor structural changes to prioritise habitat trails and paths. Early identification of the locations and routes at risk may help mitigate the associated noise and air pollution.

Creating connected and attractive community spaces will not only include developing an aesthetically pleasing environment, it will also involve tailoring the space to meet the needs of a variety of users. An opportunity to maximise the health benefits of the general public would be to conduct community engagement to better understand how spaces are currently used versus how this can be made more sustainable

Objective 5: Support sustainable economic growth

Outcomes

• Outcome 5.1: Facilitate the efficient movement of goods and people. 
• Outcome 5.2: Contribute to reducing deprivation and inequality through improved accessibility for all to employment, education and training. 
• Outcome 5.3: Attract and retain businesses and a skilled workforce in the county. 
• Outcome 5.4: Enhance sustainable access to key visitor and cultural destinations. 
• Outcome 5.5: As a Local Highway Authority engage with our Local Planning Authorities to deliver sustainable and well-connected housing and employment growth identified in their Local Plans.  

Health determinant impact

Health impact	Health effect
Lifestyle	Uncertain effect
Access, accessibility and community severance	Significant beneficial
Economic health	Significant beneficial
Safety	Slight beneficial
Crime	Slight beneficial
Congestion and stress	Uncertain effect
Air quality	Uncertain effect
Noise	Slight beneficial

Rationale

Improving access will include designated links to reach key employment hubs and educational institutions, in order to reduce the number of people travelling by private car/van and encouraging the shift to more sustainable modes.

Reducing deprivation parallel to supporting housing growth will likely increase the number of employment opportunities available, as well raise income levels. The built environment will be impacted by planned housing schemes, however transport linking new developments is likely to be more technologically advanced, resilient, and deliberate in establishing connections to key focal points.

In turn, this can contribute towards a more skilled workforce with a greater proportion of individuals able to access and afford education and training, thus closing the gap between those in East Sussex who do not have a qualification and the rest of the South East region.

Furthermore, building a robust tourism sector will increase the number of employment opportunities - contributing to multiplier effects such as sustaining the local economy and supporting the quality of the built environment in terms of maintaining amenities and service provision. 

Mitigation measures / recommendations

Improving access to places of work, schools and training facilities not only requires improving the physical accessibility, but also the financial accessibility. In strengthening businesses and raising housing supply, consideration must be given to those from lower income backgrounds, who may be disproportionately affected by a hike in land value. An opportunity to support access to key services, could include a quota for affordable housing, as well as targeted support to transition individuals into better paid employment.

It must be noted that local, regional and national economies are subject to fluctuations as a result of market changes. To mitigate the effects of this, support could be provided in building contingency plans, as well as factoring in uncertainty into business plans.

Additionally, ensuring vulnerable, disadvantaged and older generations are not limited or ‘left behind’ when integrating the latest technology to support future transport journeys is essential. An opportunity to assimilate people to the latest technology could involve targeted awareness sessions as well as on-site assistance to prevent digital exclusion. 

Objective 6: Strengthen the resilience of our transport networks

Outcomes 

• Outcome 6.1: Improve journey time reliability for people and businesses. 
• Outcome 6.2: Enable transport journeys to be resilient, flexible and adaptable and recover quickly from emergencies and events. 
• Outcome 6.3: Improve the condition of highway and other transport infrastructure and assets.  

Health determinant impact

Health impact	Health effect
Lifestyle	Uncertain effect
Access, accessibility and community severance	Slight beneficial
Economic health	Slight beneficial
Safety	Slight beneficial
Crime	Slight beneficial
Congestion and stress	Slight beneficial
Air quality	Uncertain effect
Noise	Uncertain effect

Rationale

Improving journey time reliability will result in improved punctuality of employees and consistent deliveries, increasing productivity within businesses. Such improvements will also enable people to access key services and reach destinations without delay or disruption.

Building a transport network which is adaptable ensures that the built environment has capacity to handle any adverse change without lasting impacts. Recovering from emergency and events quickly, will likely support the efficiency of the transport network, enable rapid interchange and reduce negative impacts of congestion resulting from delays, consequently improving the quality of the environment.

Improving the condition of highway infrastructure will ensure that journeys are as efficient as possible, whilst also minimising the risk of accidents and ensuring safety. This will likely improve public health outcomes, as access to health-supportive resources such as family/social support and care are increased.

Mitigation measures / recommendations

A number of the perceived outcomes resulting from this objective are relatively general in nature. It is recognised that individuals with specific characteristics will disproportionately benefit through improved personal safety in comparison to others. To improve the focus of these priorities the language should be more specific in nature.

An opportunity to improve journey time reliability could involve real-time travel updates. However, ensuring vulnerable, disadvantaged, and older generations are not limited or ‘left behind’ when integrating the latest technology to create an adaptable network is essential. An opportunity to assimilate people to the latest technology could involve on-site assistance to prevent digital exclusion.

LTP Themes

Theme A: Tackling climate change and enhancing our local environment: Supporting decarbonisation of the transport system and the way in which transport can support, protect, and enhance our natural and built environment.

Policy A1: Reducing emissions

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Slight beneficial
Economic health	Uncertain effect
Safety	No effect
Crime	No effect
Congestion and stress	Slight beneficial
Air quality	Significant beneficial
Noise	Slight beneficial

Rationale

Supporting active travel as part of this policy is likely to result in social, physical, and mental health benefits. Modal shift and use of alternative fuels will result in reduced emissions to air, and reduced noise from vehicle traffic.

Mitigation measures / recommendations.

Shifting people towards a decarbonised future will involve monetary challenges which can be mitigated through the provision of grants and loans, which may consequently drive the uncertain impacts on economic health towards a more positive perspective. However, external factors may influence the nature of this impact.

Policy A2: Future zero emission vehicles and infrastructure

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Slight beneficial
Economic health	Uncertain effect
Safety	Uncertain effect
Crime	Uncertain effect
Congestion and stress	Uncertain effect
Air quality	Slight beneficial
Noise	Slight beneficial

Rationale

Similar to Policy A1, supporting micro-mobility modes will result in social and mental health benefits. Zero emissions buses and vehicle infrastructure will reduce Nitrogen dioxide emissions, although particulates from tyre wear will remain. There is also a positive effect from reduced vehicle noise.

Mitigation measures / recommendations

Installation of safety features as part of zero emission vehicles and better enforcement of safety procedures may shift uncertain impacts on crime and safety towards positivity.  However, it is unclear how this will be incorporated as part of clean technologies and infrastructure at present.

Policy A3: Resilience and adaptation

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Uncertain effect
Economic health	Uncertain effect
Safety	Significant beneficial
Crime	No effect
Congestion and stress	Uncertain effect
Air quality	Uncertain effect
Noise	Uncertain effect

Rationale

Measures including risk management, network maintenance and use of technology, means that infrastructure is more resilient to climate events. It also provides people with better access to information on alternative transport modes in an event, including not travelling. This benefits health and well-being by reducing physical risk (e.g. from flooding) and related anxiety.

Mitigation / Recommendations

None identified

Policy A4: Biodiversity and natural capital

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	No effect
Economic health	No effect
Safety	No effect
Crime	No effect
Congestion and stress	Uncertain effect
Air quality	Uncertain effect
Noise	Uncertain effect

Rationale

Access to nature has benefits for well-being and mental health.

Mitigation measures / recommendations

Ensuring that the benefits of natural capital are maximised will involve identifying active travel routes which are readily available and pose minimal harm to the environment in terms of restoration and maintenance.

Theme B: Safer, healthier and more active travel: The capacity for transport investment to increase public health and individual wellbeing. Schemes include active travel, improved connectivity, placemaking, public space enhancements, behaviour change programmes and mobility hubs.

Policy B1: Healthy Lifestyles

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Slight beneficial
Safety	Slight beneficial
Crime	Uncertain effect
Congestion and stress	Uncertain effect
Air quality	Slight beneficial
Noise	Uncertain effect

Rationale

This policy promotes active travel and exercise, reduces air pollution, improves safety and public realm, and provides access to opportunities and healthcare. There are physical and mental health benefits from exercise, but also this policy provides opportunities to connect people to each other and nature. There are economic and health benefits from better access to employment, services and healthcare.

Mitigation measures / recommendations

While the impact on congestion, stress and noise is uncertain, the LTP should focus on improving connectivity to key services for rural communities, which may  reduce long-distance trips and traffic. In turn, this may reduce the abundance of noise resulting from private travel and relieve the residual implications on stress.

Policy B2: Air quality

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Uncertain effect
Safety	Slight beneficial
Crime	Slight beneficial
Congestion and stress	Slight beneficial
Air quality	Significant beneficial
Noise	Slight beneficial

Rationale

This policy looks at traffic management for urban areas, reducing need to travel by car, promoting less polluting forms of transport and reducing air pollution.  This is likely to improve traffic-related air quality and related respiratory conditions, but also improve safety, connectivity and wellbeing in urban areas.

Mitigation measures / recommendations

None identified

Policy B3: Active travel

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Slight beneficial
Safety	Significant beneficial
Crime	Uncertain effect
Congestion and stress	Uncertain effect
Air quality	Significant beneficial
Noise	Uncertain effect

Rationale

The policy encourages modal shift, improves safety and public realm. There are potentially significant benefits in relation to connectivity, reducing air pollution, exercise and social well-being.

Mitigation measures / recommendations

None identified.

Policy B4: Improved access to green and blue infrastructure 

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Slight beneficial
Economic health	Uncertain effect
Safety	No effect
Crime	Slight beneficial
Congestion and stress	Uncertain effect
Air quality	No effect
Noise	No effect

Rationale

The policy seeks to provide enhanced natural environment, consideration of rural crime and access to green/blue spaces.  Uptake of active travel is likely to greater, with benefits to physical and mental health and well-being.

Mitigation measures / recommendations

Trees and other vegetation reduce air pollution and noise and associated health effects, including respiratory disease, asthma, sleep deprivation, anxiety and annoyance.

Policy B5: Placemaking

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Slight beneficial
Economic health	Slight beneficial
Safety	Slight beneficial
Crime	Slight beneficial
Congestion and stress	Uncertain effect
Air quality	Slight beneficial
Noise	Uncertain effect

Rationale

This policy aims to ensure the public realm is clean, safe, easily navigable and accessible for all. Improving the public realm can encourage modal shift through increased safety for active travel, reducing emissions and attracts use of public spaces, including economic uses, discouraging crime and encourages social interaction. 

Mitigation measures / recommendations

Use of green infrastructure to reduce urban heating and related health effects. Placemaking schemes which involve noise impacts should be mitigated on a location-specific basis, to ensure that no single area is disproportionately affected.

Policy B6: Rights of Way

Health determinant impact

Health impact	Health effect
Lifestyle	Significant beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	No effect
Safety	Slight beneficial
Crime	Uncertain effect
Congestion and stress	Uncertain effect
Air quality	Slight beneficial
Noise	No effect

Rationale

The policy aims to develop a safe network, which allows better navigation, is accessible and protects the countryside. In addition to improving physical health through exercise, there are opportunities to improve safety, social interaction and mental health. This also encourages modal shift with minor improvement of air quality.

Mitigation measures / recommendations

Potential to include both safety and accessibility measures (e.g. segregation from vehicles, dropped kerbs, accessible gates or textured paving) on Public Rights of Way.

Theme C: Make public transport accessible for all: Bringing as many people as possible within reasonable distance of a high quality, frequent and reliable public transport provision. We propose a suite of urban, inter-urban and rural bus service enhancements, as well as rail enhancements.

Policy C1: Safety 

Health determinant impact

Health impact	Health effect
Lifestyle	Slight beneficial
Access, accessibility and community severance	Slight beneficial
Economic health	Uncertain effect
Safety	Significant beneficial
Crime	Slight beneficial
Congestion and stress	Slight beneficial
Air quality	No effect
Noise	No effect

Rationale

Support for improved road user behaviour and safety in transport planning. This reduces chance of injury and is more likely to encourage active travel modes.

Mitigation measures / recommendations

None identified.

Policy C2: Accessibility  

Health determinant impact

Health impact	Health effect
Lifestyle	Slight beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Slight beneficial
Safety	Uncertain effect
Crime	Uncertain effect
Congestion and stress	Uncertain effect
Air quality	Uncertain effect
Noise	Uncertain effect

Rationale

The policy supports accessibility improvements and access to key services such as education, health and social care. It also aims to reduce transport poverty by making transport more affordable.

Mitigation measures / recommendations

None identified.

Policy C3: Bus and coach  

Health determinant impact

Health impact	Health effect
Lifestyle	Slight beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Slight beneficial
Safety	No effect
Crime	No effect
Congestion and stress	Slight beneficial
Air quality	Slight beneficial
Noise	No effect

Rationale

Communities are better connected within and to urban areas, improving access to services, well-being and reducing isolation, benefiting mental health. There is potential for improved air quality, reduced congestion and related stress. Onward travel is more likely to be by active travel.

Mitigation measures / recommendations

None identified.

Policy C4: Rail 

Health determinant impact

Health impact	Health effect
Lifestyle	Slight beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Slight beneficial
Safety	No effect
Crime	No effect
Congestion and stress	Slight beneficial
Air quality	Slight beneficial
Noise	No effect

Rationale

Communities are better connected with a focus on growth, tourism along the south coast and connectivity to London. Public transport use can improve well-being through social interaction and encourage onward active travel. There are potential improvements to congestion, related stress and air quality.

Mitigation measures / recommendations

None identified.

Policy C5: Integrating transport  

Health determinant impact

Health impact	Health effect
Lifestyle	Slight beneficial
Access, accessibility and community severance	Slight beneficial
Economic health	Slight beneficial
Safety	No effect
Crime	No effect
Congestion and stress	Uncertain effect
Air quality	Uncertain effect
Noise	No effect

Rationale

The policy has potential to improve affordability and ease of use through smart ticketing and better transport interchanges. This improves connectivity, access to services and employment and potential for interchange with active travel.

Mitigation measures / recommendations

Incorporate cycle parking and storage at transport interchanges.

Consider personal security as part of design at interchanges.

Policy C6: Taxi and private hire Demand Responsive Travel 

Health determinant impact

Health impact	Health effect
Lifestyle	Uncertain effect
Access, accessibility and community severance	Slight beneficial
Economic health	Slight beneficial
Safety	Slight beneficial
Crime	Slight beneficial
Congestion and stress	Uncertain effect
Air quality	Uncertain effect
Noise	Uncertain effect

Rationale

Provision outside normal working hours supports access to a wider range of job opportunities and better connectivity. The policy supports better safety and security.

Mitigation measures / recommendations

None identified.

Theme D: Keeping East Sussex Connected: Supporting people and businesses in getting where they need to go, quickly and reliably. Specifically, longer distance highway, railway and bus schemes are of importance as well as freight.

Policy D1: Strategic connectivity 

Health determinant impact

Health impact	Health effect
Lifestyle	Uncertain effect
Access, accessibility and community severance	Significant beneficial
Economic health	Significant beneficial
Safety	Slight beneficial
Crime	No effect
Congestion and stress	Slight beneficial
Air quality	Slight beneficial
Noise	Slight negative

Rationale

The policy supports improvements on regional and national corridors, linking settlements with areas of growth. Improvements to rail corridors are likely to result in modal shift from private car, and related air quality improvements, highways improvements may also ease congestion and improve air quality, although noise is likely to increase from road and rail sources. There are mixed effects on health.

Mitigation measures / recommendations

Assessment of air and noise effects and incorporation of mitigation measures for major transport schemes. These air and noise impacts should be mitigated on a location-specific basis, to ensure that no single area is disproportionately affected.

Policy D2: Freight and international gateways  

Health determinant impact

Health impact	Health effect
Lifestyle	No effect
Access, accessibility and community severance	Significant beneficial
Economic health	Slight beneficial
Safety	No effect
Crime	No effect
Congestion and stress	Uncertain effect
Air quality	Uncertain effect
Noise	Uncertain effect

Rationale

Movement of freight is likely to have benefits to communities in reducing movement of freight by road. There are also likely to be economic benefits from better movements of goods. Other health benefits are likely to be limited.

Mitigation measures / recommendations

None identified.

Policy D3: The needs of business and the visitor economy 

Health determinant impact

Health impact	Health effect
Lifestyle	Slight beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Significant beneficial
Safety	No effect
Crime	No effect
Congestion and stress	Slight beneficial
Air quality	Slight beneficial
Noise	Slight negative

Rationale

Improving connectivity can provide better access to trade, travel and support tourism, with better economic health.  Improvements to rail corridors are likely to result in modal shift from private car, and related air quality improvements, highways improvements may also ease congestion and improve air quality, although noise is likely to increase from road and rail sources. There are mixed effects on health.

Mitigation measures / recommendations

Assessment of air and noise effects and incorporation of mitigation measures for major transport schemes. These air and noise impacts should be mitigated on a location-specific basis, to ensure that no single area is disproportionately affected.

Policy D4: Supporting sustainable development and development control 

Health determinant impact

Health impact	Health effect
Lifestyle	Slight beneficial
Access, accessibility and community severance	Significant beneficial
Economic health	Slight beneficial
Safety	Slight beneficial
Crime	Uncertain effect
Congestion and stress	Slight beneficial
Air quality	Slight beneficial and slight negative
Noise	No effect

Rationale

The effects of the policy on health will depend on the nature of transport infrastructure to be delivered alongside new development. Integration of active travel and public transport, in addition to reducing car use through e.g. car-free areas, minimal parking can encourage active travel, exercise and greater social interaction within communities. There would be positive effects through better connecting

Mitigation measures / recommendations

Integration of active travel, and improvements to public realm should include elements of better lighting and surveillance to improve public perception and reduce fear of personal safety.

Policy D5: Parking 

Health determinant impact

Health impact	Health effect
Lifestyle	Uncertain effect
Access, accessibility and community severance	Significant negative and significant beneficial
Economic health	Uncertain effect
Safety	Slight beneficial
Crime	Slight beneficial
Congestion and stress	Slight negative
Air quality	Significant beneficial and significant beneficial
Noise	Slight negative and slight beneficial

Rationale

The effects of the policy will depend on the nature of parking provision. Reduced parking will help manage demand and support modal shift with potential benefits for air quality and noise. However, better parking provision, including safe and secure parking, may also encourage use of vehicles with increased emissions to air and noise. Parking provision is essential for some people with reduced mobility so increases accessibility.

Mitigation measures / recommendations

Retain or provide additional Blue Badge  parking spaces and parent & child parking, considering this on a site specific basis.

Policy D6: Highways maintenance and asset management 

Health determinant impact

Health impact	Health effect
Lifestyle	No effect
Access, accessibility and community severance	Uncertain effect
Economic health	Uncertain effect
Safety	Slight beneficial
Crime	No effect
Congestion and stress	Uncertain effect
Air quality	Uncertain effect
Noise	Uncertain effect

Rationale

Potential health benefits relate to possible improved safety, no further effects are identified.

Mitigation measures / recommendations

None identified.

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5. Conclusion

5.1 This HIA has methodologically worked through consideration of health and wellbeing impacts, it has identified where there are potential issues, but also opportunities, and it will help shape the further development and revision of the LTP and HIA to maximise benefits to health and wellbeing across diverse local populations and geographic areas. The nature of the positive impacts described is as follows:

• Improving public transport services and giving people the ability to use public transport services with confidence will have a variety of health benefits: Improving connections to services/opportunities will enable people to participate in activities with both physical and mental wellbeing benefits and will reduce emissions and improve air quality as people are encouraged out of their private cars directly improving air quality with positive impacts on respiratory health. The walk to / from the bus stop or train station will also help build in incidental activity into everyday life, and this type of light exercise can be of particular benefit for people with long-term health conditions and other impairments. While these benefits will be felt across the county, they are likely to be especially pronounced in urban areas such as Hastings and Eastbourne, where trips are more likely to be shorter, and where air quality is poorer.
• Increased access to services and opportunities also help to keep people independent for longer, maintain social and support networks, combating isolation and loneliness, and can improve access to better food choices and the direct health benefits of this, especially for growing children. Improving the accessibility of public transport is particularly important for disabled people, especially as part of any interchange. These interventions will be especially important in the rural areas of Rother.
• New and improved infrastructure and initiatives to support active travel will help to make walking, wheeling, and cycling natural choices for short, local journeys. This will have direct positive impacts on people’s health from the increased physical activity involved (including both physical health - especially cardiovascular and musculoskeletal - and mental health and wellbeing) as well as having an impact on reducing congestion and associated alleviation of noise and stress. This is especially needed in areas such as Hastings and Rother, where the current health status of residents is particularly poor.
• Supporting the take up and use of electric vehicles, as well as increasing the use of sustainable fuels will reduce emissions/improve air quality and therefore have a positive impact on respiratory health especially. Increased use of electric vehicles will reduce noise and therefore have a beneficial impact on stress created by noise. This may help with alleviating some of the air pollution issues in the county, particularly in towns with dedicated Air Quality Management Areas, such as Lewes. It is noted that currently, electric vehicles, are typically more expensive than many diesel and petrol models, and therefore, less affordable.
• The focus on ensuring sustainable economic growth and on ensuring access to education and employment opportunities by means other than the private car, also means positive impacts on opportunities and reducing deprivation. Restrictions in accessing education can directly affect economic prosperity but also indirectly impact health outcomes by way of learning about benefits and importance of health.

It is also important to recognise that in order to maximise the potential of LTP4 to ensure good health and ensure that the benefit of better health is available to all, there is also a need to:

• Ensure that improved access to public transport is accompanied by ways to ensure financial accessibility (e.g. as cheaper public transport tickets for disadvantaged/ vulnerable individuals) so that people can afford to use these services and benefit from the improved connections (to services, to social networks) that they offer.
• Ensure that streets/public spaces are designed carefully with additional levels of stakeholder engagement to identify specific constraints and mitigatory solutions, so that interventions designed to improve walking, wheeling and cycling do not adversely affect othersand can be used by everyone (e.g. walking and cycling infrastructure designed to also include people who use powered/unpowered wheelchairs, mobility scooters, frames & walking sticks).
• Ensure that consideration has been given to the affordability of electric vehicles. As part of this, the move to electric vehicles and sustainable fuels to achieve decarbonisation should not wholly replace, efforts to achieve a shift from private car travel to public transport and active travel, so that congestion, noise, and road safety benefits for health can also be realised. Encouraging modal shift in combination with provision of loans and grants will help facilitate the uptake of more sustainable methods of travel such as electric vehicles.
• Undertake a comprehensive assessment of vulnerable people to understand how infrastructure changes will affect individuals. Ensure that vulnerable, disadvantaged, and older people are not ‘left behind’ when integrating technology with transport services – this may mean targeted awareness sessions as well as on-site assistance to prevent digital exclusion.
• Identify paths, locations, and routes ideal for improving habitat connectivity to reduce associated air and noise pollution implications.
• Incorporate green infrastructure, vegetation and trees as part of placemaking schemes to reduce air pollution, noise and associated health effects.
• Include measures to improve Rights of Way and pedestrian routes such as dropped kerbs, accessible gates and segregation from vehicles, subject to the availability of funding.
• Improve cycle parking at transport interchanges to improve public perception of safety and security, as well as to promote active travel as a primary form of transport.
• Mitigate noise impacts from major highway and road schemes through consideration of implications on a location-specific basis.
• Retain and expand the quantum of Blue Badge parking and parent and child parking.
• Introduce better lighting and surveillance as part of placemaking, and safe public transport protocol to ensure personal safety and reduce crime.

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Appendix A: Policy review

National legislation and policy

Legislation and policy	Relevant points for LTP4 and HIA
Public Health England Strategy 2020-25	Notes that health inequalities have not improved over the last 10 years, and there are greater disparities, including levels of childhood obesity and greater risk of being physical inactive, in deprived areas. It identifies ten priorities, those which are relevant to the LTP and HIA include smoke-free society, cleaner air, better mental health, best start in life and enhanced data and surveillance capabilities. The LTP will also have a role in providing active travel opportunities.
Health Impact Assessment in spatial planning guidance	This guide provides insight into how HIA’s can be used in the planning system. A thoroughly conducted HIA recommends measures to maximise positive impacts, minimise negative impacts and reduce health inequalities. HIA’s are considered a vital tool in identifying health impacts of spatial and development plans and providing recommendations to mitigate harm. The HIA will need to consider how negative impacts can be mitigated and how unintended consequences may arise from the LTP.
Transport and Health Resource – Delivering Healthy Local Transport Plans (2011)	The Transport and Health resource is intended to support the development of local transport plans. There are eight key health pathways noted to be associated with transport including: lifestyle; access, accessibility and community severance; economic health; safety (risk of trips, strain and collision); crime; congestion and stress; air quality and noise. The HIA should consider how these pathways will be affected by the LTP.
Public Health Outcomes Framework	The Transport and Health resource is intended to support the development of local transport plans. There are eight key health pathways noted to be associated with transport including: lifestyle; access, accessibility and community severance; economic health; safety (risk of trips, strain and collision); crime; congestion and stress; air quality and noise. The HIA should consider how these pathways will be affected by the LTP.
Environmental Noise (England) Regulations 2006 (as amended)	These Regulations apply to environmental noise, mainly from transport. The regulations require regular noise mapping and action planning for road, rail and aviation noise and noise in large urban areas (agglomerations). They require production of Noise Action Plans and identification of Important Areas (areas exposed to the highest levels of noise) and suggests ways the relevant authorities can reduce these. The HIA should consider how the LTP may impact environmental noise.
Nature Positive 2030 (2021)	Following on from global commitments for nature, including to protect 30% of our land and seas by 2030; five statutory nature conservation bodies set out how the UK can achieve these commitments, ensuring nature recovery play a critical role in achieving net zero. The HIA will need to identify transport related impacts on nature and opportunities to mitigate negative impacts.
Environment Act 1995 (as updated by the Environment Act 2021)	Requires local authorities in the UK to periodically review and assess air quality in their area. If a local authority finds any places where air quality objectives are not likely to be achieved, it must declare an Air Quality Management Area and put together a plan to improve the air quality - a Local Air Quality Action Plan. The HIA identifies AQMAs.
Air Quality Regulations 2010 (as amended)	Sets legally binding limits for concentrations in outdoor air of major air pollutants that impact public health such as particulate matter (PM10 and PM2.5) and nitrogen dioxide (NO2) from transport related sources. The HIA will need to consider whether changes to air pollution may occur due to the LTP.
National Air Quality Strategy for England, Scotland, Wales and Northern Ireland 2011	The Strategy sets out air quality objectives and policy to improve air quality in the UK in order to benefit public health, quality of life and the environment. Objectives and targets are set for each air quality pollutant, for example, to achieve and maintain 40ug.m3 of annual average nitrogen dioxide.  The HIA will need to consider whether changes to air pollution may occur due to the LTP.
Clean Air Strategy 2019	The strategy sets out the action that is required to tackle all sources of air pollution These will support creation of Clean Air Zones and help meet targets to cut emissions by 2030. Chapter 6 sets out action to reduce emissions from transport including ending sale of petrol and diesel cars by 2040 (Road to Zero), consultation of Aviation 2050 – the future of the aviation sector, air quality strategies for ports and clean modes of transport for freight and passengers. The HIA will need to consider impacts on air quality and associated health outcomes.
UK Plan for Tackling Roadside Nitrogen Dioxide Concentrations (‘the NO2 Plan’) 2017	The effort to reduce NO2 needs to be targeted on the sources that make the biggest contribution to the problem: road vehicles contribute about 80% of NO2 pollution at the roadside and growth in the number of diesel cars has exacerbated this problem. In developing their local plans to tackle the causes of air pollution, local authorities should consider a range of options from improved technology to limiting access. The LTP and HIA will need to consider transport options which improve air quality.
Levelling up the United Kingdom, 2022	The White Paper includes missions for public transport and digital connectivity; reducing health disparities and improved well-being. It includes policy drives to deal with ill poor diet and obesity; ensuring natural beauty is accessible, with improved Green Belts around towns and cities, supported by Local Nature Recovery Strategies and woodland creation in plan-making as well as place-making and regeneration of towns and cities. The LTP and HIA will need to consider these policy drivers in their objectives.
Net Zero Strategy: Build Back Greener, 2021	This strategy sets out policies and proposals for decarbonising all sectors of the UK economy to meet a UK net zero target by 2050. For transport this means support and funding for zero emissions vehicles and infrastructure, investment in cycling, walking and buses, investment in rail electrification and city rapid transport systems, as well as measures for the reducing emissions from the maritime and aviation sectors. The LTP and HIA will need to consider transport options which reduce emissions in line with targets.
The Inclusive Transport Strategy: achieving equal access for disabled people, 2020	This Strategy sets out the Government’s plans to make our transport system more inclusive, and to make travel easier for disabled people. While it is focused on the inclusion of disabled people, many of the improvements will also benefit other travellers. The HIA will consider equalities effects of the LTP.

Regional legislation and policy

Legislation and Policy

Relevant points for LTP4 and HIA

Transport Strategy for the South East, 2020

The Strategy covers 16 constituent local transport Authorities, 5 local enterprise partnerships, and 46 district and borough councils. The Strategy sets out a 30 year vision for region and the strategic economic, social and environmental goals and priorities that underpin it. These include net-zero, improved productivity, health and wellbeing, quality of life, accessibility and protection of the south-east unique natural and historic environment. The LTP and HIA for ESCC will sit within this regional framework.

Local legislation and policy

Legislation and Policy	Relevant points for LTP4 and HIA
East Sussex Environment Strategy, 2020	The Strategy was developed by the East Sussex Environment Board, a partnership of private, public and educational sector organisations. The purpose of the Strategy is to set out long-terms aims for transformational change and steps needed to address the urgent environmental challenges and to maximise the available opportunities, including actions for the Board to deliver in the next 1-2 years. Key challenges include climate change, natural capital, air quality, water and resource efficiency. Key opportunities comprise clean growth, improved productivity and resilience, improved health outcomes and reduced health costs. The HIA will need to reflect health challenges and opportunities, aims and actions.
East Sussex whole-system healthy weight plan 2021-2026	The East Sussex healthy weight plan is aimed at increasing the number of people in the county who have a healthier weight and are completing recommended levels of physical activity.  It sets out the approach for tackling unhealthy weight (both overweight and underweight) and physical inactivity over the next five years, with a focus on system-wide prevention and early intervention. The HIA will assess how provision of sustainable transport and improving access to and safety of pedestrian and cycle-ways will impact health.
East Sussex Joint Strategic Needs Assessment	The East Sussex JSNA provides resources containing information to help inform decisions and plans to contribute to reducing health inequalities. Important areas to consider include support for an ageing population, talking about mental health, reducing life expectancy differences, tackling obesity, understanding complex illness patterns and understanding demand for services. The HIA will need to consider how the LTP will reduce health inequalities by addressing these areas.
State of County report – focus on East Sussex (2023)	The State of the County report uses a range of data to understand the context in East Sussex for assessing the impact that certain plans may have on the area. Key focus points relevant to the HIA and LTP include schools, children, health, adults, deprivation, population, road safety and environment. The HIA will need to consider whether changes to any of these factors may occur due to the LTP.
East Sussex Public Health and Planning Memorandum of Understanding (2022)	The East Sussex Public Health and Planning MoU describes how the public health team in East Sussex County Council, and local planning authorities will work together to deliver statutory public health responsibilities. The MoU identifies the links between planning and health and establishes specific processes and actions that these bodies can take.

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Appendix B: Key health indicators

• Appendix B: Key health indicators [161.5 KB] [pdf]

Please note: we know this file may not be accessible for users of assistive technology. We are working to make it accessible.  

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Appendix C: Stakeholder engagement

5.3 In order to develop the desired vision of the future, we worked with our stakeholder representatives to explore how the future in 2050 might be impacted by social, political, economic and environmental trends. Engagement in early phase of developing draft LTP4 was undertaken with varying groups detailed below.

Early phase of developing draft LTP4

Group	Mode of engagement
East Sussex County Council Officers	LTP4 Project Board Internal Officer Liaison Group
East Sussex County Council members	Member Reference Group Two Member Online Session
External Stakeholder	Workshop sessions held with: Local Authority stakeholder group including transport user groups and strategic Partners such as districts and boroughs and National Highways, Network Rail and Transport for the South East 6 schools and further education colleges Disability groups Online engagement platform for use with the public

5.4 Phase 2 of the engagement programme was undertaken follows:

Phase 2 engagement programme

Timescales	Tasks	Engagement
Jan – Feb 2023	Finalising evidence base Completing stage 1 engagement Development of vision and objectives	Scenarios session 1: Ranking future uncertainty
Feb – Mar 2023	Future scenario development	Scenarios session 2: Formation of scenarios Scenarios session 3: Presentation of high-level scenario impacts Identification of preferred scenario
Apr 2023	Option generation	Presentation on modelled results from preferred scenario Option generation workshop
May 2023	Package short listing Initial strategy development	Shortlist packages of interventions The Strategy
Jun 2023	Full strategy development Development of thematic strategies Development of SEA, HRA and HIA	Presentation of the draft version of the LTP
Aug 2023	Final draft of LTP for consultation	Presentation of the final draft of LTP for consultation
Autumn 2023	Public consultation on LTP	Public consultation on LTP
Winter 2023/2024	East Sussex governance and approvals	East Sussex governance and approvals

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