Other Factors Affecting Health
Health and well-being is closely linked to the ‘conditions in which people are born, grow, live, work, and age’ (The Marmot Review, 2010 - external link). Inequalities in health often reflect the differences in circumstances such as income, housing conditions, education levels and the overall deprivation of the area people live in. Similarly, improvement in these often interlinked factors can have a significant impact on health and well-being adding not only years to life but life to years. This is a summary of the key social and environmental factors associated with health, health inequalities and life expectancy:
Key issues and challenges
- Addressing the gap in educational attainment between the poorest and affluent primary school pupils
- Minimising the impact of welfare reforms on household incomes, especially those with children
- Increasing the number of residents in sustained employment in the east
- Transportation and urban planning - reducing emissions and road traffic accidents and improving access to jobs, services and parks and green spaces and increasing opportunities for physical activity
- Housing shortage and increasing prices are factors which exacerbate overcrowding and poor housing conditions. Haringey has one of the highest number of residents in the country in temporary accommodation.
Haringey is the sixth most deprived area in London which is mostly related to low incomes, barriers to housing and high crime . In 2014, 36% of children lived in poverty and 1 in 4 lived in a household where no adult works . There are large inequalities in the levels of deprivation and good health within Haringey, and the more deprived the area the shorter the life expectancy, especially for men.
Unemployment and worklessness in Haringey is higher compared to London with stark variation between areas in the east and west: 1 in 20 Crouch End residents claim out of work benefits compared to nearly 1 in 4 for Northumberland Park . Ethnic minorities, lone parents, disabled people, people living in social housing and people with low or no qualifications are more likely to claim out-of-work benefits. This reflects the demography in the east of the borough. Recently, there have been an increasing number of young people joining these groups.
Educational attainment indirectly influences future health of children through job prospects, income, social standing as well as through practical, social and emotional knowledge and skills acquired to achieve healthy life styles. Attainment across all prime areas of learning at early years foundation stage is slightly lower in Haringey, at 76.1%, compared to England at 76.3%. At the end of primary education and GCSEs 53.6% of Haringey children are achieving 5 A*-C grades. This is above the England average of 52.8% . However, children in deprived areas, looked after children, children eligible for school meals and children with special educational needs have worse educational outcomes, potentially laying foundations for poorer health later on in life and widening the gap in life expectancy.
Environmental factors including reduced CO2 emissions, good transport links, reduction in fuel poverty and access to green and open spaces all have a great potential to improve the health and well-being of Haringey residents. Air quality is important for many vulnerable people, including children, older people and those with existing heart and lung conditions. In 2013, an estimated 6.8% of deaths in Haringey were due to long term exposure of PM2.5 (particulate matter) emissions, which is higher compared to, for example, deaths due to road accidents . The biggest source of PM2.5 emissions is generated by road transport and concentrated on high roads and large junctions. Carbon emissions are higher in more affluent areas – higher income is linked to higher gas and electricity consumption. Overall, domestic sector accounts for over half of total carbon dioxide emissions in Haringey.
Poor quality housing and overcrowding is associated with poorer health and well-being. Respiratory illness, hypothermia, heart attacks and strokes, with damp exacerbating symptoms of arthritis among older people are just some of the consequences. Poor housing also increases the risk of stress, anxiety and depression. Cold or overcrowded households can have significant negative effects on educational development. Haringey has 3,000 homeless households living in temporary accommodation, among the highest in the country . The 2015 Index of Multiple Deprivation revealed that for barriers to housing Haringey was the 10th worst local authority in the country . Whilst we have relatively high levels of affordable accommodation and a large number of responsible landlords, many homes do not meet the required standards, or are situated in run-down areas. Similar to the rest of London, housing in Haringey is becoming increasingly unaffordable with the majority being outpriced from home ownership. With the decrease in affordable homes (the estimated demand for additional housing units now over 4,000 a year) there is a growing problem of some landlords exploiting the relatively cheaper housing market, especially in Tottenham, to maximise returns by converting properties into very small units.
Crime, like health, is linked to factors such as poverty, poor educational attainment and unemployment. The same social and environmental factors that predict geographic variation in crime rates may also be relevant to explaining community variations in health and well-being. However, Haringey has in recent years seen a decrease in overall crime levels. The Index of Multiple Deprivation 2015 indicated that, from 2010, Haringey has improved from the 4th to 8th worst local authority in London for crime . Reported offences for personal violence and assault, which can have direct mental and physical consequences for health, are also down but public fears about crime can erode individual well being and community cohesion. Those who get involved in crime are likely to keep re-offending – especially young people.
Domestic violence constitutes over 1 in 3 of all violent crime in Haringey . Women are more likely to be victims of domestic violence, in particular 16-24 year-olds are at greatest risk including sexual violence. Children are also affected by domestic violence through exposure to violence perpetrated against their mothers. Domestic violence is more likely to begin or escalate during pregnancy and may become worse during postpartum. Domestic violence can also impact on health by increasing the risk of alcohol and drug misuse and homelessness.
- Social and environmental problems are interlinked. The accumulation of disadvantage over the course of life increases the risk of ill health and premature death. These risk factors are more dominant, although not exclusively, in the more deprived parts of Haringey in the east. Similarly health is poorer in areas with higher unemployment, lower educational attainment, high crime, poor housing conditions, high homelessness and unemployment.
- The disparity in educational outcomes and the prevalence of social issues such as youth offending in the east is potentially paving a way for adverse health outcomes later in life. Addressing the gap in educational attainment between the poorest and richest primary school pupils can help decrease the gap in health outcomes.
- Ongoing welfare reform poses a challenge for Haringey in: minimising the impact on household incomes and children; increasing the number of residents in sustained employment; whilst ensuring those entitled to claim welfare benefits can do so.
- Housing shortage and increasing prices are factors which exacerbate overcrowding and poor housing conditions. The challenge is for regeneration schemes not to contribute to the increase in prices and the regulation of landlords to ensure private housing meets the required standards.
- Successful transportation and urban planning has a potential for significant improvements in health and wellbeing - by reducing emissions and road traffic accidents and improving access to jobs, services and parks and green spaces as well as increasing facilities for physical activity.
- By improving the wider social and environmental circumstances Haringey residents can achieve good health and well-being regardless of where in the borough they live
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