EUGLOREH project
THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE

FULL REPORT

PART III - HEALTH CAUSES, FACTORS AND DETERMINANTS

10. HEALTH DETERMINANTS

10.5. LIVING AND WORKING ENVIRONMENT

10.5.1. Houses, schools, transports, recreational areas and other main features

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10.5. LIVING AND WORKING ENVIRONMENT

 

 

10.5.1. Houses, schools, transports, recreational areas and other main features

 

 

 

10.5.1.1. Introduction

 

The history of shelter, recognized as one of the most fundamental human needs (add Istanbul Habitat Conference reference), dates back to the beginning of mankind and may be best illustrated by the stereotype of the cave during the Stone Age. With the increasing ability to change and modify the environment, humans started to actively create and shape their shelter and, during the Neolithic revolution, began to settle down in more stable and functional shelters. Since this time, the development and growth of settlements has played a key role in the development of European peoples and has resulted in a trend that has never stopped and today is known as “urbanization”. Urbanization was initiated by the industrial revolution, which created large-scale migration from rural to urban areas and led to the development of large cities. The resulting urban development is a departure from the traditional human settlement and its impact on health is not entirely understood (Lawrence, 2000). Nevertheless, urbanization is linked with a number of assets from both public health and sustainability perspectives, as large-scale settlements open the door to a variety of technological advances and services that are supportive to health (e.g. better access to water supply and sanitation systems; public transport networks; distant heating technologies; health services; etc.). However, human settlement implies also environmental problems linked to transport (noise and air pollutants), household and industrial emissions and urban pests. Sealed land and contaminants are other implications. Green spaces are positive for health and wellbeing. The urban sprawl has many drawbacks encouraging suburban expansion and increases private local car transport and obesity. Housing can lead to the use of hazardous construction material and unhealthy indoor air quality, also influenced by outdoor pollution determinants, energy saving and energy use in air conditioning. The impact of crowding on sanitation, hygiene and infectious diseases is probably very important, but difficult to quantify. Within the thematic framework of human settlements, a variety of policy tools has been developed.

 

10.5.1.2. Data sources

 

The data in this chapter is mostly taken from scientific publications and reports produced by international Institutions working on settlement issues (e.g. UNHabitat, EU, ROSTAT, WHO, UNECE, etc.). As the issue of human settlements covers a variety of environmental as well as social determinants, the information sources naturally tend to be diverse. Within the text, all relevant sources will be identified.

 

One major challenge when describing the health impacts of human settlements is the availability of comprehensive data. Human settlements are a melting pot of uncounted health risk factors and it is very difficult to integrate them into one general assessment. Therefore, generalized assessments can only summarize the more focused evaluation of individual conditions, such as air quality, traffic, safety, sanitation, etc. This problem becomes even more critical when looking for data on the variations within a city. Various projects have shown that both health as well as environmental and housing conditions can vary extremely within a given city, and these variations can significantly exceed those that are found when comparing average and generalized data from cities or countries. Therefore, separate from the available data, we should bear in mind that in any given human settlement, there is an unknown part of the population living in socially and environmentally deprived conditions which cannot be captured by the available data.

 

10.5.1.3. Data description and analysis

 

As human settlements are meant to provide some kind of privacy and protection from outside events to the dwellers, any kind of human settlement can be looked at from two perspectives: the inside environment and the outside environment. This is especially true for individual homes or dwellings, which are part of more or less attractive neighbourhood environments, but also for settlement areas such as villages or cities, which are located within more or less advantaged natural landscapes. Both dimensions are directly linked to the impact of human settlements, with the first being more focused on the individual settlement (home or dwelling) and the second being more related to the settlement area.

 

In the following section, the human settlement as an overall living setting is discussed first, before more details are given on specific settings of human settlements, such as housing, schools, correctional facilities and recreational facilities.

 

Looking at human settlements, many problems that often are defined as “urban problemscome into consideration. Nevertheless, it needs to be stated that in many cases the environmental determinants of urban and rural settlements may be rather similar in general terms, while the detailed mechanisms of exposure may be different. For example, there are air quality problems and noise exposure in many rural places but tend to be looked at as typical problems for large human settlements.

In all settlements, there is a list of potentially health-relevant conditions that affect the residents (Macintyre et al, 2000). This very much depends on the settlement, its size and environmental conditions and whether these conditions are acceptable from a public health perspective. Also, these conditions may change strongly from one neighbourhood to the next (WHO Commission on Social Determinants of Health, 2007). Below, a list of major environmental determinants of human settlement areas is presented and discussed.

 

10.5.1.3.1. Residential buildings

 

Although residential buildings are supposed to be safe shelters and refuges, there is no built environmental structure for habitation that by itself is free of risks. Within the private home, the problem of pollution is one of the most important determinants for health impacts. There are many sources of pollution within the indoor environment, in some cases even desired (for example, open fireplaces). Indoor physical pollution, associated for instance with particular construction materials and furniture and poor ventilation as well as with other factors such as crowding, indoor pests and moulds, unsafe building conditions and inadequate sanitation/ hygiene equipment, may have important impacts on the health of specific population groups. For example, large air conditioning and water cooling plants not complying with EWGLI guidelines are sources of risk for severe pneumonia in humans (legionellosis) due to the inhalation of droplets of water contaminated with Legionella Pneumophila (see chapter 6).

 

Construction materials and products

 

There are a variety of construction materials and products that may result in potential health effects (Federal Environment Agency, 2007). For radon, asbestos and lead, the health effects have been identified many years ago but are still present in many European dwellings. Today’s concern is more related towards volatile organic compounds (carpets, paints, furniture), particulate matter, PCBs and other chemical elements emitted or contained by construction materials and products. In most cases, these compounds affect the indoor air, from which they are inhaled by the residents (European Commission, 1988; Loftness et al, 2007).

 

Heating sources, thermal comfort, dampness

 

The health impact of hygro-thermal conditions within a building operates basically through two mechanisms.

First, the combustion of fuels used for cooking and heating (such as coal, wood, gas) within the building may lead to the emission of pollutants and gases such as particles, carbon monoxide (CO), and carcinogenic compounds (Desai et al, 2004). With faulty equipment or lack of venting, these pollutants can accumulate within the home and trigger severe health consequences.

Second, the indoor temperatures by themselves can directly affect health if they fall under or exceed specific thresholds (Vandentorren et al, 2007; Wilkinson P. et al, 2007). Such extreme indoor temperatures can occur during heat waves and cold spells and mostly affect poor households and low-quality buildings with inadequate heating systems and poor insulation. Moreover, indoor temperatures can affect the degree of dampness and humidity which may lead to mould growth. However, there is very little data on the average indoor temperatures in European homes (Wright et al, 2005).

 

Indoor pests and moulds

 

Mould is recognized as one of the major allergens in the home environment, and can lead to allergic reactions and respiratory infections. In particular, moulds have been identified as a factor in the origin and exacerbation of asthma attacks (Richardson et al, 2005) and are considered dangerous for children and sensitive / allergic population groups (Seltzer / Fedoruk 2007). Within Europe, the exposure to damp and mould in the home varies strongly between countries, ranging from above 30% (Portugal) to under 5% (Finland), with an average of 16% (2001 data, EUROSTAT WHO 2007).

 

For many domestic pests (such as mites, cockroaches, ants, bugs, lice or fleas), the relatively warm and humid conditions within buildings provide a good habitat. While the health impact of hygiene pests such as ants and cockroaches are mostly related to the intake of contaminated food (Milstead et al, 2006), other pests such as lice and fleas bite through human skin and can cause allergic reactions, inflammations or infections.

 

Residential behaviour

 

The behaviour of the residents is a key factor for most of the common health threats within the home (Federal Office for Radiation Protection et al, 2005). First, the behaviour of residents does actively lead to the initiation of exposures: cooking and showering increases the relative humidity, the use of cleaning detergents brings chemical products into the home, and dust cleaning may actually make settled dust volatile again. In addition, smoking or keeping pets in the home releases a number of pollutants and allergens.

 

Second, the behaviour of residents can enforce, prolong or increase the exposure to indoor pollutants and risk factors. As most of the health-relevant exposures of residential behaviour are related to air pollution, it is especially the air exchange rate that plays a role in controlling indoor conditions. Inadequate ventilation may therefore lead to increasing humidity and pollution as it accumulates indoor emissions (Emenius, 1998).

 

Outdoor pollutants

 

Finally, there is the contribution of outdoor pollutants to be recognized. Many outdoor sources of pollution enter into the building, mostly through open windows but – in the case of noise – also through the building structure. The main outdoor determinants that can affect the indoor conditions are traffic-related (air pollutants, noise), or stem from industrial activities or neighbourhood activities (playing children, bars, lawn-mowing etc.). Using data from the European EXPOLIS study, it is estimated that in homes without special indoor sources (such as smoking, open fire etc.), around 60-70% of indoor particulates may be due to infiltration from outdoor sources (Hänninen, 2005).

 

Next to the health risks posed by environmental pollution, other threats can be related to the structure, size and layout of the building, its built features and its amenities.

 

Unsafe building conditions

 

There are two factors relevant to home accidentshuman behaviour and dwelling design / maintenance. The main dwelling design features that may increase the risk of an accident are for example inadequate design of staircases and doors, low window sills, slippery floor material, sharp furniture edges or inadequate lighting. Such risk factors are of special concern for children (European Child Safety Alliance, 2006).

Unintentional home injuries are a serious public health problem. Each year in the EU there are around 20 million home and leisure injuries requiring medical attention. About 2 million of these lead to hospital admissions, and around 83 000 result in death (KFV, 2007). Within EU countries, it is estimated that roughly half of these home and leisure accidents occurred in or around the home. Data from several countries show that often, the number of home injuries can exceed the number of road traffic injuries (Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, 2008) (see chapter 6 for fatal and non-fatal home and leisure accidents per year in selected EU countries).

 

Floor space and density

 

A crowded household is defined as one where the number of people living in the dwelling exceeds the capacity to provide adequate shelter and services to the household members. However, there is no agreed international definition or standard for “crowding”.

The potential consequences of insufficient living space on residential health must be split into two effect dimensions: the physical effects of high population density (mostly related to infectious diseases) and the psychological effects of crowding. Multi-occupation dwellings and flats, particularly high rise flats, are the housing risk factors most strongly associated to poor mental health (Evans, 2003).

Within the EU, high density levels that may lead to crowding are identified for below 10 percent (The Netherlands) to above 25% (Portugal, Greece) of the national populations (Eurostat, various years). However, the burden of this housing problem is mostly carried by large families and poor households and is not visible in the national averages, which mainly range between 2 and 3 residents per dwelling (National Board of Housing, Building and Planning of Sweden, 2004).

 

Sanitation / hygiene equipment

 

The supply of clean water and the provision of hygiene and sanitation amenities are key elements for a dwelling. Still, even highly developed countries know the challenge of contaminated drinking water and water-related disease outbreaks triggered by biological contamination and bacteria as well as by chemicals and heavy metals.

 

Within Europe, the connection of dwellings to public water supply is above 90% for many countries. However, some countries fall short of this figure and may provide public water only for 80% or less of their population (2002 data, EUROSTAT). In addition, it needs to be kept in mind that connection to water supply is mostly a problem in rural areas, where the percentage of connected households can be much lower than in urban areas.

 

It is estimated that as many as 50 million Europeans receive water from small or very small supplies (Michaud et al, 2001). There is a lack of information on the quality of water from these sources, as supplies that serve less than 50 people or produce less than 10m3/day are not covered by the EC Drinking-water Directive, unless the water is supplied as part of a public or commercial activity (European Commission, 1998). Most countries have very limited information on the number of small supplies and the number of people served by these supplies. Microbiological contamination of small water supplies is a problem and can pose a significant health risk that is generally underestimated. For example, in Finland, food and waterborne outbreaks have been recorded annually since 1980 by a voluntary reporting system. In 1997, a new monitoring system for waterborne outbreaks was launched and municipal health protection authorities are now obliged to report all outbreaks of suspected waterborne diseases to the National Public Health Institute; even the smallest outbreaks, such as outbreaks related to the use of private well water, are reported. The new system improved detection rates. While during the voluntary reporting only zero to four outbreaks were reported annually, with the single exception of seven outbreaks in one year, from 1998 to 2005 between four and ten waterborne outbreaks were observed each year. A total of 52 outbreaks (which resulted in over 16 700 cases of illness) were recorded over this period. The majority of the outbreaks occurred in communities with fewer than 500 inhabitants (FFSA, 2006). In the UK, about 1% of the population obtains water from a private water supply, and despite being subject to the same regulatory standards as public water supplies, outbreaks of disease are common. Between 1970 and 2000 there were 25 reported outbreaks of infection associated with private water supplies in England and Wales. The main pathogen, Campylobacter, was implicated in 52% of outbreaks (Said et al, 2003).

In many countries there is no national legislation and in general private well owners are responsible for assessing the quality of the water. An example of the potential size of the problem is provided by the Czech Republic, where analyses of water samples from 1700 public and 3300 private wells carried out by the Public Health Services found that water in 70% of the wells was unsafe to drink (Hulssman, 2005).

 

Moreover, connection to sewage and sanitation systems is less common than access to water (WHO / UNICEF Joint Monitoring programme, 2006).

 

Homelessness

 

The prevalence of homelessness varies across countries. However, it appears to have increased in Europe since the 1980s, particularly among young people and women. There is clear evidence of the significantly poorer health status of homeless people when compared to the general population, including some communicable diseases. Homeless people tend to have problems obtaining adequate health care and may experience barriers to access care, due to discrimination, appointment procedures, and financial constrains. Conditions requiring uninterrupted treatment such as TB and HIV are often inadequately controlled and difficult to manage without a stable residence. Nomadic and semi-nomadic populations such as the Roma (also known as Gypsies) form another vulnerable and at-risk community for communicable diseases. The estimated population across the EU is 8-12 million, mainly concentrated in Central and Eastern Europe. Despite the small number of studies, it is estimated that the life expectancy of Roma is shorter on average by ten years than that of the rest of the population and that the child death rate is up to four timer higher and also that their exposure to certain CDs is higher.

 

Conclusion

 

In brief, the indoor dimension of human settlements can be affected and influenced by the residents to a quite large extent. However, there are determinants of the outside environment that do impact on the internal experience of living and that cannot be mitigated or removed by the individuals. The relevance of the indoor quality and conditions of human settlements in total, as well as in relation to outdoor and urban conditions, cannot be assessed in general terms, as it depends to a large extent on very local circumstances. However, the problems described above can be considered as some major challenges faced by at least several, and sometimes most or all EU countries.

 

10.5.1.3.2. Schools

 

For children, the school environment is the most important indoor environment, besides home.

 

School studies, mainly from North Europe, have shown that children are affected by poor ventilation, chemical exposures such as formaldehyde, moulds and bacteria from damp buildings, and furry pet allergens in settled dust (Daisey et al, 2003; Tranter et al,, 2005). The environmental effects include asthma and allergic symptoms, sick building syndrome symptoms, increased airway infections and impaired learning ability (Daisey et al, 2003; Mendell and Heath, 2005).

 

There are very few international comparative studies on the school environment in different parts of the world. One small comparative EU-funded study in west-Europe found low ventilation rate in most schools, with typically 2000-3000 ppm carbon dioxide (CO2) levels in classrooms. Moreover, this study could demonstrate associations between elevated CO2 levels and elevated levels of particles (PM10) in the classrooms and respiratory health in pupils (Simoni et al, 2006). Classroom levels of PM10 in school may exceed the recommended 24-h limit value of 50 microgram/m3.

 

Swedish intervention studies have shown that the increase of asthmatic symptoms in pupils was reduced after improving the ventilation in the classrooms through the installation of new and more efficient ventilation systems (Smedje and Norbäck, 2000). This point seems to be widely verified also in non-European contexts: school studies from China and South Korea have demonstrated that schools in Asia often have inadequate ventilation flow with levels of CO2 ranging from 1000-4000 ppm (Kim et al, 2007; Zhao et al, 2006), microbial contamination from fungi and bacteria (Zhao et al,, 2008a) and furry pet allergen contamination from cat and dogs (Kim et al, 2007; Zhao et al, 2006). Some indications of a protective effect of bacterial components with respect to respiratory symptoms have been demonstrated (Zhao et al, 2008a).

 

Besides the indoor sources of air pollution, schools in larger cities are affected by outdoor air pollution from traffic and industrial air pollution (Mi et al, 2006; Zhao et al, 2008b). Recently, there has been a focus on impaired learning in relation to classroom conditions. Experimental studies have shown that a reduction of classroom temperature from 25 to 20°C increased speed at different tests in 10-12 y old pupils (Wargocki and Wyon 2007a). Moreover, test performance was increased when the ventilation flow was increased (Wargocki and Wyon, 2007b). Although the school is the work environment for teachers and other school personnel, there are less studies on associations between the school environment and teachers health (Norbäck, 1997). Violence and accidents in schools as well as burn out reactions among teachers are all a part of the school environment (Norbäck, 1997).

 

Moreover, classroom noise can cause physiological and psychological stress reactions in pupils (Wålinder et al, 2007).

 

Therefore, there is a clear need to improve the indoor environment in schools. Classrooms should have frequent cleaning and this should include floors, textiles, open shelves and other areas above the floor level. The classroom should be designed to facilitate cleaning. Low emitting building material should be used when redecorating schools in order to avoid unnecessary chemical exposure.

 

Building dampness and indoor mould growth should be avoided, and the concept of mechanical ventilation in schools should be introduced. City planning aimied at situating new schools away from roads with heavy traffic should be considered.

 

10.5.1.5. Recreational areas and green spaces

 

Within human settlements, the provision of places for leisure, recreation and social activities is as important as the provision of shops and services. The major benefits of such places have been identified as (a) social bonding between residents, producing an own identity and building up social capital and trust, and (b) increased levels of physical activity within the local population, producing a healthier and less overweight population (Frumkin 2003; Takano et al, 2002).

The availability of such places in close enough distance for daily use is a key feature for healthy housing areas and enriches neighbourhood life. Still, contemporary human settlements often lack public gathering places and green areas for social and recreational activities. There is evidence that the use of recreational facilities has a positive effect on health. The effect seems to be twofold, with regular users showing higher survival rates and better mental health (Konlan et al, 2000; Bohnert and Garber, 2007; Rogers and Zaragoza, 2003). In addition, green and open spaces can help to reduce noise and air exposure and also have a compensating effect on the urban heat island in summer time (Elmqvist et al, 2004). Data from the Urban Audit of EU cities shows that in average, only half (52.4%) of the participating cities provide urban green areas within walking distance of up to 15 minutes (data based on 66 cities with data on this indicator).

 

10.5.1.6. Transport

 

The need for transportation is probably the most typical characteristic of larger human settlements and it increases with the size of the settlement area. In public health terms, transport is associated to three major health determinants: noise, air pollution and modal split as the decisive factor for physical activity.

 

Noise is one of the most commonly considered health determinant in settlement areas. Main sources of noise include road, rail and air traffic; industries; construction and public works; but also neighbourhood noise from playgrounds and gardens (WHO 2000). Within Europe, a large part of the population is exposed to traffic noise levels of 55 dBA, and in most countries 10% or more suffer from exposure to noise levels of 65 dBA. The European Commission stated that in the EU, there are an estimated 80 millions of citizens living with unacceptable noise exposure conditions, while for another 170 millions, the noise conditions are defined as critical (European Commission, 1996). City data from the Urban Audit project show that noise exposure is a key problem especially (but not exclusively) for bigger cities, where the exposure to increased noise levels often affects more than 20% of the population.

 

Figure 10.5.1.1. Proportion of residents exposed to day-time noise above 55dB(A)

 

In addition to having cardiovascular effects, excessive noise is known to affect sleep, mental health, concentration and stress levels (Stansfeld et al, 2000; Muzet, 2007).

 

The problem of transport-related air pollution is one of the most recognized effects of human settlements in public health literature (WHO, 2005; EEA, 2006b).

 

Figure 10.5.1.2. Concentrations of elemental carbon and organic compounds, PM10 and PM2.5 in relation to settlement and location

 

Engines and fuel combustion produce a number of air pollutants such as hydrocarbons, nitrogen oxides, and carbon monoxide and – depending on the fuel typeparticles. Especially the production of particulate matter has recently been considered as a major threat to health, as the monitoring of particulate matter in some European cities showed that as much as 89% of the population is exposed to levels exceeding the WHO guidelines (WHO, 2007).

The modal split represents the breakdown of transport means that are being used for mobility needs. It usually considers individual transport by motorized vehicles (cars and motor bikes), public transport (bus and train) and individual transport without motorized vehicles (walking, cycling). The modal split indicates to what extent trips in a given human settlement lead to emissions. However, another indication provided by the modal split is the number of residents engaging in physical activity in relation to mobility and transportation (WHO, 2006).

With rising rates of obesity and decreasing levels of physical activity, physically active transport modes are one of the main strategies to get people active (Shetland Islands Council, 2006). Still, the success of these strategies is restricted when settlements do not provide adequate opportunities for cycling and walking and instead favour car transportation. As forecasts predict a rise in motorized transport, it will be a key challenge for many cities to provide adequate infrastructures for walking and cycling in order to mitigate this trend. However, especially in bigger and densely populated cities, it is possible to reach high levels of active transport behaviour: in Berlin, roughly one third of all trips is made using non-motorized traffic (Senatsverwaltung für Stadtentwicklung, 2004).

 

10.5.1.6. Other issues

 

Household and industrial emissions and waste

 

In addition to air pollution by transport, human settlements suffer from exposure to industrial activities and fuel combustion in households. These emissions can affect large parts of the settlement areas as they are spread by wind and maydepending on weather conditionspollute the streets and open spaces. Reducing particulate air pollution from solid fuel use - for example - reduces the number of respiratory and cardiovascular deaths, as the example of the ban on coal burning in Dublin shows: after the 1990 ban on coal sales and coal burning, black smoke concentrations declined by 70%. In just one year after the ban, deaths from respiratory causes decreased by 15.5% and deaths from cardiovascular causes decreased by 10.3% (Clancy et al, 2002).

An additional problem is the immense amount of waste in large settlements, which may cause health-relevant problems when not collected regularly. Also, local incineration plants may add to the urban air pollution (DEFRA, 2004).

 

Outdoor urban pests

 

As within the building, the human settlement areas provide ideal opportunities for a range of species that live in the city but need to be prevented (Brenner et al, 2003). Main concerns regard pigeons, which leave their droppings on public places and buildings, and rodents such as rats and mice that live in public parks and in the sewage system. In both cases, hygiene concerns are predominant while direct health effects are rare. On the other side, cockroaches can trigger severe allergies and are found in a variety of housing stocks all over the world (Miller / Meek 2004).

Future scenarios of urban sprawl as well as climate changes may add to this concern, as new pests may invade the city or the city may spread to former rural and forested areas, thus increase the number of tick infections (encephalitis etc.) and lyme disease.

 

Sealed-off land and contamination

 

As settlement areas are spreading, also the overall surface of sealed-off areas is increasing. However, in most cities, the expansion of the built-up areas increases in a stronger mannner than the actual resident number of the cities (European Environment Agency, 2006a).

 

Streets, buildings, parking lots and other public infrastructure seal off the ground and reduce the uptake of surface water and rain, which needs to be channelled through waste water channels. Various cities have already seen the limitation of these systems in extreme climate situations, which can quickly lead to flooding as the water flow cannot be managed anymore (Eisenreich et al, 2005).

The industrial heritage of many European cities gives rise to another health threat that is to be considered in conversion projects which turn industrial or military sites into urban quarters or service areas: many of these areas are affected by contaminated soil (brownfields) in which a number of chemicals or heavy metals may be found (Bagaeen, 2006).

 

10.5.1.7. Control tools and policies

 

It is evident that human settlements still have a long way to go to provide their residents with adequate and healthy living conditions, but human settlements also offer unique and unprecedented chances as public transport, efficient energy solutions, and reduced space consumption / urban sprawl. Still, noise, air quality and adequate housing conditions remain a challenge for almost all human settlements. However, human settlements will always be a diverse mix of local neighbourhoods with specific features. This means that city-level data is merely an indicator to monitor the general trends of change within the city, but cannot be representative for the assessment of the human settlement quality and the related health impacts as these are related to specific individual circumstances. The following data from EUROSTAT illustrates this problem for national data and shows what variation in the quality of living conditions can occur for different socio-economic groups.

 

Figure 10.5.1.3. Housing problems by household income group in EU15

 

However, taking the example of crowding, the following chart continues the argument above by showing not only the impact of the income category, but especially the impact of specific social circumstances. The example suggests that the problem of crowding is much more affected by the household situation than by income, and thereby shows that even if we analyse data by income or social group we do not get an adequate insight. Therefore, given the complexity of relevant factors, it must be kept in mind that the average data for countries or cities provided by this chapter is a very weak indication of the actual condition of human settlements, with a large amount of citizens being much more or much less affected than the indicated average.

 

Figure 10.5.1.4. Crowding by income and household situation, EU 15, 1996 and 2001

 

In brief, it can be stated that within human settlements there is a variety of health-relevant conditions which depend mostly on local conditions and relate only little to the overall quality of the human settlement as such.

 

Within the thematic framework of human settlements, a variety of policy tools has been developed by a number of actors and agencies. The by far largest number of these addressesurban health issues”, focusing on larger human settlements. There is a striking lack of policy tools in relation to smaller and rural human settlements.

Most policy tools have been developed for (a) benchmarking and comparison of urban conditions and (b) for the improvement of urban conditions, focusing on specific topics (transport, etc.). A list of policy tools is given here below:

 

Urban Audit

 

The Urban Audit collects information on the living conditions in 258 large and medium-sized cities within the European Union and the candidate countries with the main goal to allow mayors and other locally elected officials to compare their city directly to other cities in Europe. The data covers a variety of topics such as Demography, Social Aspects, Economic Aspects, Civic Involvement, Training and Education, Environment, Travel and Transport, Information Society and Culture and Recreation.

http://www.urbanaudit.org/

 

THE PEP - Transport, Health and Environment Pan European Programme

 

The Transport, Health and Environment Pan European Programme (THE PEP) was set up to address key challenges to achieve more sustainable transport patterns and a closer integration of environmental and health concerns into transport policies. The priority areas are the integration of environmental and health aspects into urban transport and demand side management. The PEP coordinates action in these key areas and provides good practice examples.

http://www.thepep.org/en/welcome.htm

 

WHO - Health city program

 

The WHO Healthy Cities Network is based on the scientific awareness that good urban spatial planning can shape people’s health and that the policy decisions can have a positive or a negative impact on the physical and mental health and well-being of citizens. To achieve this goal it is necessary to put health considerations at the heart of all urban planning and generate political commitment and resources.

With reference to their key advocacy and leadership role, the WHO commits to the following objectives and priority actions:

1.      Raising local awareness and creating a common understanding of the concept of healthy urban planning and all that is implied as a key for changing practices;

2.      Gaining local practical experience from the application of healthy urban planning principles and approaches in the following five priority areas: Transport and mobility, Healthy Ageing and accessibility, Urban design and physical activity, Neighbourhood planning and Long term strategic and master plans;

3.      Mainstreaming healthy urban planning through appropriate and feasible institutional and technical solutions.

Various city case studies, evidence reports and working tools can be found on the who website.

http://www.euro.who.int/Document/Hcp/bursa_statement_E.pdf

 

LHHAP - Local Housing and Health Action Plans

 

Together with the Ministry of Health of Portugal, the WHO housing and health programme has produced a tool box for the development of Local Housing and Health Action Plans for use and implementation by local authorities. In terms of public health, the realization of LHHAP will provide the participating municipalities with elements for developing a preventative strategy against housing-related health effects and injuries, and mitigate social and health inequities within the local population.

http://www.euro.who.int/Housing/activities/20071218_4

 

Urban matrix, knowledge networks

 

Urban matrix, knowledge networks etc. are providers of valid knowledge and good practice examples to support guiding leaders in business, academia and government. They compile and edit scientific awareness and turn the results into simple, specific recommendations, which allow providers and end-users with an accelerated processing of the required information.

http://www.eukn.org/urbanmatrix/

http://www.knowledgenetworks.com/index3.html

 

Urban health indicators

 

Based on the awareness that the health needs of urban dwellers and the ability to monitor urban health will become a high priority, the EU Public Health Programme work plan 2005 identified the development of an urban health indicator system as an essential part of a comprehensive and integrated EU health information and knowledge system. Based on previous works such as ECHI, ISARE, ECHIM and other projects, an international group has started work on the development of a system of urban health indicators.

 http://www.urhis.eu/

 

UN-HABITAT

 

The United Nations Human Settlements Programme, UN-HABITAT, is the United Nations agency for human settlements. It is mandated by the UN General Assembly to promote socially and environmentally sustainable towns and cities in order to provide adequate shelter for all. It carries programs and provides tools in the areas of human settlements and urban issues. Although many projects are focused at the developing world, a number of projects and campaigns are also relevant to European countries.

http://www.unhabitat.org/categories.asp?catid=1

 

Thematic Strategy on the Urban Environment

 

The Communication outlined the problems and challenges faced by Europe's urban areas, focusing on 4 priority themes. These themes, selected in conjunction with stakeholders, are urban environmental management, urban transport, sustainable construction and urban design. The strategy contains recommendations and priorities to be addressed by urban actors and policy-makers.

http://www.unhabitat.org/categories.asp?catid=33

 

EC Directives

 

The European Commission has published a variety of directives in relation to urban environment and settlements. These directives contain relevant information about health and other important issues of environmental conditions, infrastructure or services. The directives relate to information, strategies, recommendations and instructions about construction products, energy performance, noise, air, waste, food, water, regulations and many other issues.

http://ec.europa.eu/environment/abc.htm

 

10.5.1.8. References

Bagaeen SG (2006): Redeveloping former military sites: Competitiveness, urban sustainability and public participation. In: Cities. Vol. 23. Issue 5. P. 339352.

Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (2008): Gesundheitsmonitor Bayern. Ausgabe 1/2008: Unfälle. Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen.

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10.5.1.9. Acronyms

 

CO

Carbon Monoxide

dB(A)

Decibels

DEFRA

Department for Environment, Food and Rural Affairs

ECHI

European Community Health Indicators

ECHIM

European Community Health Indicators Monitoring

EEA

European Environment Agency

EU

European Union

EUROSTAT

The Statistical Office of the European Communities

IDB

Injury Database

ISARE

Indicateurs de Santé pour les Régions de l'Europe

LHHAP

Local Housing and Health Action Plans

PCB

Polychlorinated Biphenyls

PM

Particulate Matter

THE PEP

Transport, Health and Environment Pan European Programme

UN

United Nations

UNECE

United Nations Economic Commission for Europe

UN-HABITAT

The United Nations Human Settlements Programme

UNICEF

United Nations Children's Fund

WHO

World Health Organization