2. Scoping and methodology
Introduction
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
The population scope of this HIA includes the residents within the following districts and boroughs within East Sussex:
- Eastbourne
- Hastings
- Lewes
- Rother
- Wealden
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.
Wider determinants of health and wellbeing, including HIA health considerations (source: Public Health England)
- Access
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- 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
- Traffic and transport
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- 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
- Socioeconomic
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- 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
- Land use
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- 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
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
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.
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
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.