Environmental determinants of health equity

About the research and why it is a public health priority

Residents of more affluent areas live around 10 years longer than those in more disadvantaged areas.  Inequalities in healthy life expectancy at birth are even greater – about 19 years for both males and females. The causes of these inequalities are complex but aspects of the natural and built environments are important. This is increasingly so with climate change. Research by LiLaC members is providing crucial evidence to inform policy and other action to address these environmental determinants of population health and health equality.  Our community and policy and practice partners have highlighted the importance of connecting people with places in ways relevant to their lives and their multiple social identities; and understanding who does not use/benefit from natural environments and why. These collaborations have also revealed the desirability of interventions that address the co-benefits of improved natural and built environment, such as biodiversity, food security, energy conservation and better homes.  

Research Highlights

  • Research in ImaginationLancaster is studying ways to harness digital resources to make cities more sustainable, liveable and healthier and working in the UK and West Africa with public health experts on anti-microbial resistance design and how low cost sensors can be deployed at a population scale to understand long-term health issues including the effects of poor air quality on health  
  • Researchers in the Lancaster Environment Centre are focusing environmental justiceair quality inequalities and fuel poverty including analysis of fuel poverty policy and the relationship between energy use, minimum standards of living and well-being. 
  • Researcher in the NIHR Global Health Group at Liverpool estimated the global burden of disease associated with poor air quality, informing  the development of WHO Indoor Air Quality Guidelines and conducted the first ever RCT of health effects of low-cost, energy-efficient wood stoves in poor communities. 
  • Researchers in Liverpool’s Health Data Sciences Network and Department of Public Health, Policy and Systems have created measures of individual exposures to decent housing over a decade with 138,000 person years of follow up. Using this dataset they identified  a halving of emergency respiratory admissions due to whole home improvements for older people in social housing.
  • LiLaC researchers are also involved in the new Future Places Centre health theme that will study how computer technology can shape places and help live healthier lives
  • To help public health agencies understand the vulnerability of their local communities to COVID-19, LiLaC researchers from the NIHR Applied Research Collaboration North West Coast (NIHR ARC NWC) analysed 6,789 small areas in England and assessed the association between COVID-19 mortality in each area and measures relating to ethnicity, poverty, and prevalence of long-term health conditions, living in care homes and living in overcrowded housing. From this they developed the Small Area Vulnerability Index (SAVI) modelling tool, that forecasts the vulnerability of local populations to the virus.


Selected references

Leach, J. Boyko, C. Cooper, R. Woodeson, A. Eyre, J. Rogers, C. (2015) Do sustainability measures constrain urban design creativity? Urban Design and Planning, 168:1; pp30-41 https://doi.org/10.1680/udap.13.00034 

Walker, G. (2012) Environmental Justice: Concepts, Evidence and Politics, London : Routledge. 256 p. ISBN: 9780415589734. 

Bruce, N., Pope, D., Rehfuess, E., Balakrishnan, K., Adair-Rohani, H., & Dora, C. (2015). WHO indoor air quality guidelines on household fuel combustion: Strategy implications of new evidence on interventions and exposure-risk functions. ATMOSPHERIC ENVIRONMENT, 106, 451-457. doi:10.1016/j.atmosenv.2014.08.0 DOI: 10.1016/j.atmosenv.2014.08.064 

Rodgers, S. E., Bailey, R., Johnson, R., Berridge, D., Poortinga, W., Lannon, S., . . . Lyons, R. A. (2018). Emergency hospital admissions associated with a non-randomised housing intervention meeting national housing quality standards: a longitudinal data linkage study. Journal of Epidemiology and Community Health, 72(10), 896-903. doi:10.1136/jech-2017-210370DOI: 10.1136/jech-2017-210370