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Relationship between health, sustainability Document Transcript
SUSTAINABLE LOCAL ECONOMIES FOR HEALTH
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)
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
• 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
• 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.
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.
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
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
An understanding of these interrelationships will help policy-makers,
planners and regeneration practitioners maximise their health and
sustainability impacts on their communities.
• 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.
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,
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.
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
“Real progress cannot be measured by money alone. We must ensure
that economic growth contributes to our quality of life, rather than
Rt Hon Tony Blair MP, Foreword to A Better Quality of Life, the UK’s first
Sustainable Development Strategy, 1999.
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
• 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”
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
The matrix can be downloaded from the London Health Commission’s website
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
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
o A proposition to improve a local supply chain might lead you to
procurement which is captured under Economic Climate & Local
• 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
• 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?
• 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
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
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
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.
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
• 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
• Based on SLEHP, a Sustainable Development Index has been developed
which allows the Trust and Skanska to measure progress against specific,
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.
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
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
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.