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  • 1. SUSTAINABLE LOCAL ECONOMIES FOR HEALTH PROJECT EVIDENCE BASE AND STRATEGIC PLANNING TOOL INTRODUCTION AND GUIDANCE FOR USERS “The environment we live in, our social networks, our sense of security, socio- economic circumstances, facilities and resources in our local neighbourhood can affect individual health.” Choosing Health (Department of Health, 2004) 1
  • 2. Sustainable Local Economies for Health Project Copyright © London Health Commission 2006 The London Health Commission is an independent, high level, strategic partnership which seeks to improve the well-being of all Londoners and reduce inequalities in health. A key priority is regeneration and health, and includes the London Works for Better Health programme which is concerned with employment and health. The Sustainable Local Economies for Health Project (SLEHP) is part of this initiative, focusing on the role that organisations and policy-makers can play in contributing to sustainable communities that are also health-promoting. SLEHP was developed by the London Health Commission in collaboration with sustainability consultants Brook Lyndhurst. This document provides information on the scope and purpose of SLEHP and guidance on how to use the SLEHP strategic planning tool within your organisation or with stakeholders. For further information, contact Catherine Max on 020 7983 4651 or Contents 1. Introduction 2. What the Sustainable Local Economies for Health Project can do for you 3. Why health and sustainability? 4. Employment as a determinant of health 5. Sustainable local economies 6. Introducing the SLEHP matrix 7. Using the SLEHP matrix 8. SLEHP in practice: some examples 2
  • 3. Introduction Policy increasingly acknowledges that there are links between health and sustainability. In practice, however, these links can be hard to pin down, and practical steps to promote health and sustainability are often difficult to devise – particularly in relation to economic development. With this in mind, the Sustainable Local Economies for Health Project (SLEHP) has explored what a healthy, sustainable local economy could look like by identifying • the aspects of employment that shape health • the factors that make a place more sustainable • and the connections between them. This evidence underpins a matrix-based tool to guide users through the links between health, sustainability and employment, and a strategic framework for joint planning and implementation. SLEHP will be particularly useful to you if you work in • Regeneration • Economic Development • Sustainable Development • Public Health. SLEHP uses a collaborative and flexible approach, which enables you to • integrate health and sustainability considerations into a single, comprehensive, strategic planning framework. • assimilate joint stakeholder perspectives into health and sustainability planning in the local community. • find mutually reinforcing, and economically advantageous (“win-win”) solutions to seemingly different problems regarding health and sustainability in the local economy. 3
  • 4. What the Sustainable Local Economies for Health Project can do for you At the heart of SLEHP is an evidence-based matrix that encapsulates the characteristics of individual, employment-related health and the factors that determine the sustainability of a place – and their interconnections. The matrix is designed as a tool to guide users through these interconnections. It also provides a strategic framework within which different professional disciplines and “languages” can come together and develop shared understandings, common approaches and genuine synergies – as a firm foundation for genuinely joined up policy and implementation. For example: Who? Local Authorities and Local Strategic Partnerships What? Local Area Agreements and Local Enterprise Growth Initiatives How? Identifies shared goals for community health and wellbeing, and integrated approaches to achieving them. Who? RDAs, GOs and regeneration partnerships What? Delivering “sustainable communities” How? Facilitates a partnership-based approach to planning and delivery of sustainable social and economic infrastructure. Who? NHS Primary Care and Hospital Trusts What? LIFT programmes and PFI developments How? Enables public and private agencies to jointly maximise the health dividend from new developments for all stakeholders. “SLEHP helped Barts and the London NHS Trust to formulate its ideas around sustainable development and its contribution to the local economy. In particular it provided a structure for its Sustainable Development Index of targets and indicators associated with its new development.” Andrew Attfield, Regeneration Manager, Barts & the London NHS Trust 4
  • 5. Why health and sustainability? An individual’s health and the sustainability of a community are connected and share similar characteristics. The determinants of an individual’s health include good housing, access to services, meaningful employment and a high quality environment. Similarly, a sustainable place – whether a neighbourhood, a town or a region – would be characterised by good housing, provision of a wide and appropriate range of services, access to or provision of employment opportunities and a high quality environment. An understanding of these interrelationships will help policy-makers, planners and regeneration practitioners maximise their health and sustainability impacts on their communities. For example • Promoting employment opportunities can mean encouraging businesses in sectors that better meet local needs, both in terms of economic viability and the well-being of residents. • The introduction of flexible working arrangements can alleviate employee health pressures and reduce unsustainable traffic congestion at peak hours. • An appropriate range of services – or ‘”social infrastructure” –designed in advance and in an integrated way can take account of the wider health and well-being of residents, not just its “sickness service” needs. • The development and promotion of green space can boost physical and psychological well-being, as well as improve the overall viability and, indeed, commercial attractiveness, of a neighbourhood. 5
  • 6. Employment as a determinant of health Employment is one of the most strongly evidenced determinants of health. People’s employment status and the nature of their work have a direct bearing on their physical and mental health and even their life expectancy. This is related to income, a sense of making a valuable contribution and increased social networks gained through work. • “Health is powerfully affected by social position and by the scale of social and economic differences among the population.” (Wilkinson, Unhealthy Societies. Routledge 1996). • Unemployment has a major negative health impact; when unemployed, men are more likely to experience serious mental health or substance abuse problems and women have higher rates of diagnosed disorders (Unemployment & Health: Evidence Review, HDA 2003). • Conversely, not all employment is good employment; the HSE estimates that over 2 million people in the UK suffer from illness caused or made worse by their work (National Statistics, Occupational Health Statistics Bulletin, 2002/03). The ability to find work, be provided with healthy work and stay healthy is significantly shaped by socio-economic status. • Despite the increase in overall health of the UK population in the past fifty years, health inequalities are increasing; an average man in the highest social class has a life expectancy 5.2 years longer than a man in the lowest, and his children are nearly twice as likely to survive birth (Harding & Taylor, Social Determinants of Health & Illness, Pharmaceutical Journal 269, 2002). • Age, gender, ethnicity and disability will all impact upon the ability to find work - young people, men and ethnic minorities are more likely to be unemployed and nearly half of people with disabilities are jobless (Unemployment & Health: Evidence Review, HDA 2003). • Work stress is more prevalent among lower socio-economic status groups (Siegrist, Reducing Inequalities in Health: Work-related Strategies, Scandinavian Journal of Public Health #30, 2002). Social inequalities will shape and be shaped by an individual’s “working experience”. Policy makers & strategic decision-makers need to influence employers accordingly … and reflect on their own employment practices. 6
  • 7. Sustainable local economies Sustainable development can be defined as “a better quality of life, now and for generations to come” to be achieved, as proposed by the UK Government’s 2005 Sustainable Development Strategy, by • living within environmental limits • ensuring a strong, just and healthy society • achieving a sustainable economy • promoting good governance • using sound science responsibly. A sustainable local community is one that • is prosperous; has decent homes for sale or rent at affordable prices; has green and open spaces; enjoys a well-designed, accessible & pleasant living & working environment; is effectively governed with strong sense of community (ODPM, 2002). A sustainable local economy focuses on how these outcomes can be achieved specifically through employment, where • local economic development policy seeks “win-win” outcomes between environmental, economic and social interests, rather than assuming competition between them. • decision-makers appreciate that sustainable policies must vary from place to place – in London, for example, high priority is placed on providing affordable homes for key-workers so they may live in the city in which they work. • the notion of “local” is understood to be different for different occupations – for some this is likely to be the neighbourhood level, whilst for others it could mean national. “Real progress cannot be measured by money alone. We must ensure that economic growth contributes to our quality of life, rather than degrading it.” Rt Hon Tony Blair MP, Foreword to A Better Quality of Life, the UK’s first Sustainable Development Strategy, 1999. 7
  • 8. Introducing the SLEHP matrix The SLEHP matrix integrates the evidence base for health and sustainability factors affecting individuals, organisations and communities: • All aspects of employment that shape health, including health and safety, psychosocial work environment, work practices and company attributes. • Factors that make a place more sustainable, such as skills & training, green transport plans, business survival rates and crime. The matrix shows “in principle” connections between health and sustainability in relation to employment and the local economy. For example: • An important determinant of an individual’s well-being in the workplace and, by extension, their health more generally, is their ability to build and sustain strong social networks at work (“psychosocial” factors). • A sustainable local economy should positively address issues of diversity, equal opportunities, learning and skills, education and income (“social” factors). SLEHP’s proposition is that a healthy sustainable local economy is one that incorporates factors on both these dimensions. For example: • Employment policies aimed at addressing bullying help to improve both psycho-social/health issues for individuals in the workplace, as well as the wider social sustainability of the local community. • Green travel plans are a means to individual health, by encouraging cycling and walking to work, and also contribute to a sustainable local environment. SLEHP also reflects the fact that equalities are key to both health and sustainable development and principles of equality and equity underpin the project. The matrix can be downloaded from the London Health Commission’s website 8
  • 9. Using the SLEHP matrix Finding your way round the matrix At the heart of SLEHP is a matrix diagram, labelled “model” on the spreadsheet accompanying this introduction and guidance. • The rows of the matrix refer to health-related features of employment. • The columns refer to sustainability-related features of local economies. • The intersection points, where rows and columns meet, highlight the fact that there is a relationship between the two. Thus, for example, the column Transport intersects with the row Company Attributes, and draws attention to the ways in which different economic sectors have different transport needs and preferences for different locations. Similarly, the column Neighbourhood intersects with the row Individual Attributes and draws attention to the connections between housing and skills. The rows and columns are themselves subdivided into more specific categories. For each point of intersection or cell, evidence has been gathered that illustrates the nature of the relationship between the issues, and some analysis of this is also offered (double click the relevant cell to reveal). At its simplest, therefore, the matrix can be used as a handy reference resource by providing organised access to the evidence. Using the matrix as a strategic planning tool SLEHP’s most powerful application is as a strategic tool for testing and developing ideas for both policies and projects. By filtering the project or policy idea through the matrix, potential wider linkages and, more importantly, possible health and sustainability “win-wins” can be identified in a systematic fashion. What follows is based on experience of trialling SLEHP in a variety of settings. Among other things, this has shown that the earlier the SLEHP approach is applied, the more likely the given policy or plan is to lead to outcomes which are both healthy and sustainable. However, SLEHP can also be used as part of an impact assessment process. In London, health, sustainability and equalities are statutory cross-cutting themes for the work of the Greater London Authority – SLEHP is being increasingly adopted as a means to ensuring these benefits are optimised. 9
  • 10. The SLEHP matrix step by step A facilitated or workshop type environment produces the best results, and should involve as wide a range of colleagues or stakeholders as possible: you will probably find that SLEHP reveals and facilitates linkages and potential for joint working which may not have been identified previously. • Begin with a policy or project idea that is in draft form or is being reviewed. • Then find the column or row where, at first sight, the project or programme most naturally sits. For example: o A proposition to develop a green travel plan might lead you initially to the Transport column. o A proposition to encourage increased female participation in the labour force might lead you to the Working Practices row. o A proposition to redevelop green space to foster a more sustainable community might lead you to the Neighbourhood column. o A proposition to improve a local supply chain might lead you to procurement which is captured under Economic Climate & Local Sustainability. • The next step is to navigate along the selected row or column, looking for linkages to other issues. In some cases, there will be no apparent link; in some cases, linkages may be apparent, but will already have been considered by those responsible for the idea; in some cases, entirely new linkages may present themselves. • Discussion and debate prompted by the process of navigating along the rows/columns helps both to test and embellish the idea. Not all information relevant to the discussion will be immediately to hand, and additional research may be required. There will not necessarily be consensus that there is - or indeed is not - a meaningful link between the project/policy idea and the row/column. • However, seen as part of a process of testing and attempting to refine ideas, the matrix provides a structured basis for moving forward, underpinned by evidence. It does not in itself provide “answers” as such; rather, it helps to be clear about the questions and suggests avenues to explore. • Depending on the time and resources available, a more comprehensive approach to using the matrix can involve all 36 cells. In each case, the question is the same: o What links, if any, can we identify between our project/policy and the row/column issue raised? 10
  • 11. • If no links are identified in a given cell, simply move on to the next one. If there is discussion to be had, then the discussion can be had there and then or subsequently. Again, depending on the available time and resources, background research can simply be acknowledged as needed, or planned for and executed. Users can vary the number of times the matrix is used, and in how much depth. • The breadth of health, sustainable development and, indeed, equalities issues captured by the matrix is such that, when projects or policies are processed through the entire 36 cells, they stand a very high chance of emerging as richer schemes. • Returning to the earlier examples, the using SLEHP achieved the following: o A green travel plan, developed in isolation as part of a planning requirement, took fuller account of diversity issues (Individual Attributes). Background research, prompted by the matrix approach, revealed that local residents, at whom a local recruitment strategy was targeted, had different travel patterns from other travellers. Furthermore, the linkage to Work Practices prompted a new dialogue between teams responsible for planning new flexible working arrangements, which had consequences for travel-to-work timings. o The matrix approach also led to a more in-depth consideration of Environmental issues, linking not just air quality considerations to a green travel plan (a linkage that certainly had already been made) but also to Psychosocial factors, including management relations. Evidence within the SLEHP matrix supports the notion that a workforce that feels “cared for”, and which feels that management is attending to environmental factors, is both more productive (Economic) and has lower turnover (Work Practices). In both cases, the evidence underpinned the case to funders and managers. o In the case of female participation in the labour market, the matrix pointed not only to childcare issues (which had already been considered by users) but also links to Transport (differential travel times for women with caring responsibilities and/or part-time work), Company Attributes (different kinds of business have different propensities to employ women, and may require different methods of encouragement) and Economic (companies are concerned with profitability and may be more actively encouraged to adopt more flexible working practices, of the kind that might attract women into the labour force, on the basis of the kind of evidence - rather than merely assertion - made available in the SLEHP model). Once 11
  • 12. again, the matrix provided a mix of new insight and access to evidence in support of a case. o Developing green space may be a good thing in and of itself, but the matrix approach helped those developing a project to consider: what different users of green space might be looking for; the potential health benefits to different types of individual within the community; the idea that different types of business are attracted by access to green space (and may be more willing to pay higher rents, and thus pay for the green space); and the idea that there may even be links back to a green travel plan if the green space is developed in such a way as to facilitate walking and cycling rather than merely recreation. o In the final example, a local procurement plan (initially processed under Economic Climate) uncovered linkages through to skills and training (Individual Attributes), working conditions (Health and Safety) and employment/unemployment (Economic Climate & Planning). What began as a relatively blunt notion – increase local procurement – turned into a more sophisticated approach acknowledging that certain kinds of local procurement would make more sense in terms of positive knock-on effects, given the particular local circumstances. Whilst not all the issues raised could be addressed by the immediate user group, they nonetheless pointed towards other agencies with whom relations could be forged - to the wider benefit of the project. 12
  • 13. SLEHP in practice: some examples Barts & The London Redevelopment Project SLEHP has been comprehensively tested in conjunction with Barts & The London NHS Trust (BLT) and Skanska (their PFI partner) who, together, face many challenges: • As the largest PFI project in the country and a procurer of goods valuing £120 million in 2003/04, they face specific workforce needs and a potentially large environmental impact. • This is compounded by being situated in one of the UK’s most deprived areas (Whitechapel in East London) where the local community has a low health and employment status and high minority ethnic profile. SLEHP formed the basis of their Sustainable Regeneration Strategy helping them to appreciate the connections between health and sustainability and identify “win-win” situations in their roles as employer, developer, procurer and local institution: • Using SLEHP they were able to link the building roles of Skanska with the Trust’s goals to increase local procurement, local employment and develop social enterprise. • Based on SLEHP, a Sustainable Development Index has been developed which allows the Trust and Skanska to measure progress against specific, measurable targets. This work is now informing the new national NHS Good Corporate Citizenship self-assessment model. The model is being developed as part of the UK Sustainable Development Commission’s Healthy Futures programme and will, in turn, underpin the Healthcare Commission’s Development Standard for Good Corporate Citizenship. The Barts & The London draft Sustainable Regeneration strategy can be downloaded from the London Health Commission website. 13
  • 14. London Thames Gateway Social Infrastructure Framework SLEHP is integral to the London Thames Gateway Social Infrastructure Framework, for which it provides the basis for addressing workforce and local economic development issues. The Framework will bring together planning for the full range of human services, and explore opportunities for innovative and integrated delivery where appropriate. Development of the Framework is funded by the Department for Communities and Local Government and project managed by the London NHS Healthy Urban Development Unit. London Borough of Croydon Local Enterprise Growth Initiative SLEHP is at the heart of Croydon’s successful Round 1 LEGI bid, an award of £20.3m for its first three years, the second highest in the country. "The real meaning of a 'healthy economy' is one which reaps the rewards of a diverse workforce and engenders a spirit of enterprise across the entire community. Croydon's LEGI will revolutionise entrepreneurial activity in the borough - by connecting potential to opportunity and making well-being central to business success." Angelina Purcell MBE, Chief Executive, Croydon Business London Development Agency Developing combined impact assessment The London Health Commission is working closely with the LDA as a partner organization to help embed health and sustainability into Agency operations including combined health impact assessment approaches based on SLEHP. 14