How we sustain Suffolk

Page last updated: 2019 - due to be refreshed in 2021.

 

1 Five key points

  1. Health and wellbeing, social care and sustainability are all linked.  It is only through the consideration of economic, social and environmental impacts in decision-making that delivery of health and social care can be sustainable. (2 Why is sustainability important in Suffolk)
     
  2. Wider determinants of health (also known as social determinants of health) play a big role in overall levels of health and wellbeing. These include many aspects of everyday life such as the natural environment, built environment, local economy, community life, and our lifestyles. (2 Why is sustainability important in Suffolk
     
  3. Suffolk has over 900 county wildlife sites, covering 5% of the County, as well as the Suffolk Coasts and Heaths and Dedham Vale Areas of Outstanding Natural Beauty, which cover over 10% of the County.  (6 Green and blue space)
     
  4. There is evidence that living in greener areas can reduce health inequalities. However, access and proximity to green space are distributed unequally. People living in the most deprived communities are ten times less likely to live in the greenest areas than people who live in the least deprived communities.(6 Green and blue space)   
     
  5. Provision of quality education, appropriate training and skill development, and meaningful employment are vital elements in planning for Suffolk’s sustainable future. Education is consistently identified as the key mechanism for breaking the cycle of disadvantage and poverty across generations. (10 Education, skills and employment)  

2 Why is sustainability important in Suffolk?

Health and wellbeing, care and sustainability are all linked. 22.7% of global deaths are due to modifiable environmental factors, and the links between health and the environment are long established.[1] It is only through the consideration of economic, social and environmental impacts in decision-making that delivery of health and social care is sustainable, with outcomes benefiting the population of Suffolk now and in the future.[2]

Wider determinants of health (also known as social determinants of health) play a big role in overall levels of health and wellbeing.[3], [4] The wider determinants of health include aspects such as:

  • access to greenspace and the natural environment
  • the homes people live in and how these are planned when being built
  • access to meaningful employment
  • access to key services

The interplay between some of these wider determinants of health is highlighted in the health map (Figure 1).

Figure 1: The health map[5]

Figure 1: The health map

 

Source: Public Health England. Spatial planning for health: evidence review. 68 (2017)

"A decent home, a job and friends are more important to good health than the NHS"[5]
 Duncan Selbie, Chief Executive, Public Health England

Sustainability is not a single issue. Sustainable communities need easy access to appropriate services, healthy food, employment, recreational opportunities and green spaces.[6]  

This chapter of the State of Suffolk report is structured slightly differently to the other chapters. It is designed to give an overview of some key aspects of sustainability. All the chapters of this State of Suffolk report (2019) consider aspects of sustainability, even if the expression is not used. This chapter pulls together some of the threads, so for the complete picture please read the other sections of the State of Suffolk.

Summary statistics for areas covered in this chapter are published in: Fingertips Wider Determinants of Health Profile.

2.1 Communities - Social capital and networks

Every area has a different set of geographical, social, economic and demographic circumstances, meaning a local approach is needed to support communities to thrive, be more sustainable, resilient and healthy in changing times and climates.[7]

All of the elements mentioned in this chapter, from the physical environment, to access to meaningful employment, reliable transport and healthy and nutritious food, contribute to building stronger, more resilient communities. Personal and social factors will also shape a large part of an individual’s health and wellbeing. 

The Landscape Institute describe 5 principles that are essential in creating healthy places:[8]

  1. Healthy places improve air, water and soil quality, incorporating measures that help us adapt to, and where possible mitigate, climate change
  2. Healthy places help overcome health inequalities and can promote healthy lifestyles
  3. Healthy places make people feel comfortable and at ease, increasing social interaction and reducing anti-social behaviour, isolation and stress
  4. Healthy places optimise opportunities for working, learning and development
  5. Healthy places are restorative, uplifting and healing for both physical and mental health conditions

Helping to sustain Suffolk as a ‘healthy place’ for all Suffolk residents, will have a positive influence in Suffolk communities.

2.2 Health in all policies

Health in all policies (HIAP) is an approach for local authorities and their partners to help make the most of all they do for local places and people to enhance health. This approach harnesses the powers and impacts of a range of sectors for better health. It can focus on specific public health issues, like obesity or mental wellbeing for instance, and identify policies with major impact on the issue. However, it can also focus on a key policy area with significant health impacts - for instance transport or housing - and work with relevant departments and sectors.[9]

HIAP can help to make tangible the benefits of effective joint working. Working collaboratively across Suffolk in this way means targeted health improvement should be more effective, and it should also benefit the services delivered.  The reduction of health inequalities, and the improvement of people’s mental and physical wellbeing are not things that can be done in isolation by one person, team or organisation.

3 Planning and the built environment

The built environment (including schools, workplaces, homes and communities) is a key determinant of health and wellbeing. Neighbourhood design can affect wellbeing, physical activity levels, travel patterns, social connectivity, mental and physical health. Neighbourhood design affects our daily decisions, so can shape our health behaviour. For example, areas that are more “walkable” and have mixed land use can maximise opportunities for social engagement and active travel.[5]

Spatial planning contributes to all the determinants of health and wellbeing including:[5]

  • protecting diversity through restricting development
  • reducing and mitigating the impacts of climate change through preventing inappropriate development in flood risk areas
  • supporting the natural environment through green infrastructure strategies
  • working with communities to develop and deliver neighbourhood plans and local planning policy to create buildings and places that encourage the local economy, community development, healthy activities and travel

Planning policies for buildings, public transport, parks and recreational facilities can facilitate physical activity, which can help prevent chronic disease. There is a linear relationship between levels of physical activity and the amount of activity-friendly characteristics in a neighbourhood: so any improvements to the built environment would be expected to increase physical activity, regardless of the baseline.[5]

Health Impact Assessments can be used in the planning process to ensure that new developments address potential opportunities and risks to health and wellbeing. Guidance for building design can help reduce health risks, increase energy efficiency, improve heat wave resilience, and reduce excess winter deaths.[2],[6]

Please see State of Suffolk: Where we live for detailed information on housing in Suffolk.

4 Transport

Having well-designed streets and public spaces can increase the attractiveness and safety of the environment, as well as making wayfinding easier and more efficient. A system that makes it easier and safer for people to walk to the shops, schools and other amenities can help improve people’s health by increasing active travel and reducing social isolation. Public transport that is accessible (as well as efficient, affordable, and appropriate), can aid in reducing inequalities by improving access to jobs and health care, and build social connectivity.[10]

Active travel means making everyday journeys by walking or cycling as an alternative to motorised transport (such as cars or motorbikes).[11] The health benefits of active travel include improved mental health, reduced risk of premature death, and prevention of chronic diseases such as coronary heart disease, stroke, type 2 diabetes, osteoporosis, depression, dementia and cancer.[12]–[15] Improved road safety, and roads in a good state of repair can encourage more active travel. Road management can reduce congestion and pollution in populated areas.

The economic benefits of active travel include:[16]

  • increased pedestrian traffic through high streets increasing sales
  • increased local shopping, supporting local small businesses
  • reduction in traffic congestion
  • a more pleasant local environment, encouraging tourism
  • a healthier and more productive workforce
  • reduced financial burden on the NHS
  • improved educational attainment

Increased car ownership has social and economic benefits. It can provide improved access to services, especially for people living in Suffolk’s rural areas, and enable care and health services to be delivered in people’s homes. However, car use reduces physical activity increasing the risk of cardiovascular disease, obesity, metabolic disorders and some cancers.[17] Traffic can also increase pollution (noise and air) and be detrimental to the natural environment.

The impact of traffic to wildlife can include effects such as traffic killing wildlife and habitat destruction. Improving access to areas can also increase the human impact on the natural environment. It can increase noise and habitat disturbance, increased air pollution and litter and increase demands for more development including housing and associated waste.[18]  This impact may be felt particularly in areas that were originally more rural in nature.

Transport networks may also introduce non-local species, damaging ecosystems.[19] There is a particular risk from ship ballast water, which is believed to have led to the introduction of invasive species, for example the Chinese mitten crab (now found in the Stour estuary).[20] Signal crayfish threaten native white-clawed crayfish. If sea temperatures increase, non-native species already in Suffolk waters may increase in number, and other species may colonise our waters.[21]

5 Air quality

Air pollution can have harmful effects on health, the environment, and the economy, and is the largest environmental risk to the public’s health.[22] The relative contribution to air pollution within a region varies geographically.

The major pollutants are particulate matter (e.g. PM2.5) and nitrogen oxides (e.g. NO2). Sources include natural and man-made processes, including construction, industry, power generation, agriculture, home heating, as well as motorised transport by road, rail, sea, and air. Shipping emissions also make a significant contribution to air pollution.[23]

Agriculture is responsible for 10% of UK greenhouse gas end-user emissions (55% of this from methane, and 30% from nitrous oxide). Carbon dioxide (CO2) emissions from agriculture have been reducing at a slower rate than industry (down 19% since 1990, compared to around 50% in industry).[24]

The negative effects of air pollution impact everyone in society, but the effects are disproportionately felt by those at extremes of age (young and old), as well as the socioeconomically disadvantaged. Prenatal exposure is associated with a number of adverse outcomes in pregnancy, and noise pollution can harm the cardiovascular system and people’s mental health.[17], [25]–[31]

Suffolk is predominantly rural, with most non-residential areas used for agriculture. Industrial activity outside of the large towns is mostly light in nature with few large industrial sites. As such, local industry has relatively little impact on air quality. The major air pollutant of concern across much of Suffolk has been nitrogen dioxide (NO2), the primary source of which is emissions from road transport.

As Suffolk has many rural areas that are not on mains gas, it might be expected that solid fuels would be more widely used for heating, leading to relatively high PM10 emissions. However, the highest PM10 emissions are found along roads and in more built up areas.

You can view data on the National Atmospheric Emissions Inventory (NAEI)[32] website, where interactive local authority level emissions maps are published. In addition, the Air Quality England website provides live monitoring data for sites in England. 

6 Green and blue space

Green space (areas such as parks and nature reserves) and blue space (areas with water features such as lakes) include a variety of natural and man-made environments. Suffolk has over 900 county wildlife sites, covering 19,200 hectares or 5%, as well as two Areas of Outstanding Natural Beauty: Dedham Vale (35 square miles of Essex and Suffolk lowland), and Suffolk Coasts and Heaths, covering 155 square miles (equivalent to 10% of the County).

There is evidence that living in greener areas can reduce health inequalities. For example, deaths appear to be reduced in deprived areas that have more green space.[33] However, access and proximity to green space are distributed unequally. The most affluent 20% of wards in England have five times the amount of green space than the most deprived 10% of wards. People living in most deprived communities are ten times less likely to live in the greenest areas than people who live in the least deprived communities.[34]

7 Extreme weather

Extreme weather can disrupt communities, individuals, utilities, businesses, and the environment.[35] Climate risks will affect people differently depending on their social, economic and cultural environment.

Groups that are at greater risk from climate change often also have lower capacity and resources to adapt. More susceptible groups include:[6]

  • low-income households, as climate change disproportionally affects their resources 
  • older people (in particular, females aged 75 and over who are frail, live alone and are isolated)
  • people with chronic or severe illness (physical or mental)
  • infants
  • the homeless
  • people with drug or alcohol dependencies
  • people who cannot adapt their behaviour (perhaps because they have a disability, dementia, or are very young)

When the temperature drops to below 8oC, some people are at increased risk of conditions such as heart attack, stroke, flu, pneumonia, falls and injuries, and hypothermia. Cold weather can also affect people with mental health conditions, such as depression and dementia. Cold weather (ice and snow) may mean older or more vulnerable people are unable to leave their homes. People may not have sufficient food or medication, or be unable to keep warm.[36]

During a heatwave, the main causes of illness and death are respiratory and heart diseases. Part of this may be related to the impact of increased air pollution on existing respiratory conditions. Deaths from renal disease increase, as do suicide rates.[37] There were 2,000 excess deaths during the 10 day heatwave in England in 2003.[35] There may also be reduced air quality, increased allergens (leading to more, and more serious, cases of asthma and hay fever), as well as an increase in skin cancer.[6]

Warmer, drier summers may also bring benefits such increased active travel, which improves health and wellbeing and reduces car use (and resulting pollution).[6] Warmer weather may also increase the number of visitors holidaying in Suffolk, which benefits the economy and provides employment.  However, prolonged sunshine and associated heat can also detrimentally affect the natural and built environment.  For example, there may be increases in algae growth, including toxic algae, and restricted water supplies.[38]

The 2017 UK Climate Change Risk Assessment assessed the top six areas of inter-related climate change risk to be:[6]

  1. Flooding and coastal change
  2. Health and wellbeing from high temperatures
  3. Water shortages
  4. Natural capital
  5. Food production and trade
  6. Pests and diseases and invasive non-native species

These are all relevant to Suffolk with its long coastline, older population (with demographic change increasing the proportion of elderly residents), low rainfall, areas of outstanding natural beauty and other protected landscape, agricultural trade, and ports.

Suffolk has been subject to a wide variety of severe weather events:

  • heavy snowfall in 2003, 2009 and 2010 which caused widespread disruption
  • heatwaves in 2003 and 2006
  • damaging high winds in 1987 and 1990
  • surface water, pluvial, fluvial flooding assessed as a medium risk
  • tidal flooding 2007 and 2013 (and the catastrophic 1953 East Coast Floods), risk assessed as very high nationally, but considered medium risk locally (based on impact of 2007 and 2013 floods)[39]

Suffolk will continue to be susceptible to severe weather conditions, which are likely to evolve as the effects of climate change present new challenges or effects of greater consequence.

8 Food systems

Everyone needs to eat. The World Health Organisation has called for a global approach “to sustainably provide all people with a safe, healthy, and diversified diet.”[40] This affects agriculture, trade, education, social protection as well as public health and the NHS.

The food system comprises the production, processing, transport and consumption of food, including the impact on the natural environment, waste, and the impact of food on health and well-being (including food safety).[41] In 2017, the UK produced roughly half (52% value) the food we consumed, and imported most of the rest from the European Union.[42] In Suffolk there are over 6,500 registered/approved food establishments, ranging from manufacturers to retailers and growers.[43]

The Department for Environment Food & Rural Affairs (DEFRA) stated issues for a sustainable food system in the UK are:[44]

  • encouraging and enabling people to eat a healthy, sustainable diet
  • having a resilient and economically sustainable food system
  • increasing food production sustainably
  • reducing the food system’s greenhouse gas emissions
  • reducing, reusing and reprocessing waste
  • having the appropriate research, skills, knowledge and technology

Unhealthy diets create a greater risk to morbidity and mortality than the combined risks from unsafe sex, alcohol, drug, and tobacco use.[45] Poor quality diet increases the incidence of obesity and diet-related non-communicable diseases, including coronary heart disease, stroke, and diabetes.[45]

A healthy diet is more expensive than a less healthy one.[46],[47] Nutritional quality is often related to price: as price decreases, nutrients are likely to decrease, while added sugar, fat and refined carbohydrate content is likely to increase.[48], [49] Cheaper foods are also often convenient, highly-processed foods and appealing to the taste.[40] There may be a link between low-cost calories and high obesity rates.[48]  People on lower incomes, in less-skilled occupations, or with fewer qualifications are more likely to choose cheaper, less healthy, more energy-dense diets.[46], [48]

A study in Cambridgeshire found people who live farthest from a supermarket are more likely to be obese than those living closest. People who were least-educated and lived farthest away were 3.4 times more likely to be obese compared to those who were most-educated and lived closest.[50]

In Suffolk, higher numbers of fast food outlets are found in more densely populated areas (which tend to be more deprived) than other parts of the County (Figure 2).

Figure 2: Density of fast food outlets per 1,000 population by electoral ward and IMD deprivation, Suffolk[51]

Figure 2: Density of fast food outlets per 1,000 population by Electoral Ward and IMD deprivation, Suffolk

Source: Public Health England. Fast food outlets: density by local authority in England. (2018).

Some food waste occurs during food production (for reasons such as poor harvest planning or an inability to store or process produce). However, in high-income countries like the UK, waste occurs mainly at the consumption end of the system. Consumer waste can be reduced by improving: shopping habits, food storage, food preparation, portion sizes and use of leftovers, as well as understanding of ‘best before’ and ‘use by’ dates.[45]

9 Recycling

Recycling is a core element of becoming more sustainable; this applies in Suffolk, nationally and globally. Many items can be reduced (such as reducing use of single use plastics), reused (for example using re-usable nappies), and recycled (such as glass, paper and plastic recycling, and composting food waste).

By increasing the number of items that we reuse and recycle, we can mitigate some of the negative impacts of waste on the environment, and on society. Recycling can increase sustainability by:[52]

  • Saving money for both individuals and local authorities
  • Reducing rubbish that goes to landfill
  • Conserving resources
  • Saving energy
  • Protecting the environment

In 2016, over half of the waste in Suffolk’s rubbish bins could have been reduced or recycled.[53]  Locally, Suffolk has an aspiration of creating the ‘Greenest County’, though enhancing the natural and historic environment and responding to climate change.[54]

10 Education, skills and employment

Provision of quality education, appropriate training and skill development, and meaningful employment are vital elements in planning for Suffolk’s sustainable future. Education is consistently identified as the key mechanism for breaking the cycle of disadvantage and poverty across generations and has a positive impact on both general health and wider health behaviours.[55]

Similarly, the health and wellbeing of Suffolk’s working age population and the local economy are intrinsically linked. Wellbeing at work is a critical economic issue, and pursuing inclusive economic growth should help to ensure that the benefits of growth are available to all, including those who most need them. Being in work is good for both wealth and health; that is, financial security alongside physical and mental wellbeing. Poor health adversely impacts an individual’s ability to enjoy the financial and social advantages of being in work, and to share in the benefits of local economic growth.

Improving the health and wellbeing of Suffolk’s working-age population can help to increase local economic growth by getting more people into work and increasing business productivity levels. Good employment opportunities, as opposed to low skilled career limiting jobs, are often a key component of high quality of life for individuals. Helping people into better quality jobs therefore helps individuals and can save money for the wider public sector. High quality employment reduces both the long-term demand for healthcare and the cost of welfare payments. Additionally, it can drive increased tax and business rate revenues, which in turn makes investment in key services more affordable.

The combined influence of lower educational attainment, skill levels, wages and job density contribute to both low social mobility and productivity in parts of Suffolk. Raising productivity in Suffolk requires increased provision of higher wage opportunities – which in turn would benefit both wealth and health.

For more detailed information around education, please see the How we develop section of the State of Suffolk.

10.1 Workplace health

Workplace health can be defined as:

“promoting and managing the health and wellbeing of staff, and includes managing sickness absence and ‘presenteeism’ (a person physically at work, but not fully productive)”.[56]

Employment directly and indirectly affects the health of each individual, their families and communities.[57] Good work is good for health and wellbeing, and ill health can be exacerbated by a bad working environment.[56], [57]  

Good work provides: [56], [57]

  • a sense of identity and purpose
  • individuals with some control over their own work
  • reward for effort
  • opportunities for in-work development
  • flexibility for work life balance
  • a decent living wage
  • social interaction
  • a safe working environment

Unemployment is associated with: [57], [58]

  • increased risk of death
  • increased ill health, for example: cardiovascular disease, mental ill health, suicide, health-damaging behaviours
  • lower quality of life
  • lower wellbeing, which increases the longer a person is unemployed

Helping people with health issues get and keep appropriate employment can benefit the local community by contributing to the local economy and to wider community wellbeing. However, jobs must be sustainable and of decent quality.[56]

Appropriate, good quality employment for people with long-term conditions can:[56]

  • support recovery and rehabilitation
  • improve general health
  • increase income
  • develop independence
  • overcome social exclusion
  • reduce the chances of chronic disability or long-term incapacity
  • minimise the physical, mental and social harm caused by long-term sickness absence or worklessness
“NHS, public health and social care organisations play an important role in local communities, as employers, and as core public service providers. They are an integral part of communities and can help support community groups, local agencies and local people to further build a sense of place and identity so people want to live, work and invest there. These elements create the conditions for improved health and wellbeing”.[7]

11 Further information

Read more about health in all policies (HIAP): www.gov.uk/government/publications/local-wellbeing-local-growth-adopting-health-in-all-policies

Find the Joint Strategic Needs Assessment guidance on sustainability: www.sduhealth.org.uk/delivery/measure/health-wellbeing-boards.aspx

The Suffolk Resilience Forum (SRF) is a multi-agency group that provides strategic / tactical and operational guidance and support on the planning for the multi-agency response to a major incident: www.suffolkresilience.com/

This Public Health England report provides the findings from an evidence review examining the links between health, and the built and natural environment to help inform policy and support local action: www.gov.uk/government/publications/spatial-planning-for-health-evidence-review

Find out more about Suffolk’s Greenest County initiative here: www.greensuffolk.org/about/

12 References

[1]         World Health Organization, “An estimated 12.6 million deaths each year are attributable to unhealthy environments,” 2016. [Online]. Available: https://www.who.int/en/news-room/detail/15-03-2016-an-estimated-12-6-million-deaths-each-year-are-attributable-to-unhealthy-environments

[2]         Sustainability and Health Working Group, “Joint Strategic Needs Assessment: A Guide to Integrating Sustainability,” Maidstone, 2013. Available at: https://www.sduhealth.org.uk/delivery/measure/health-wellbeing-boards.aspx

[3]         Public Health England, “Chapter 6: social determinants of health,” London, 2017. Available at: https://www.gov.uk/government/publications/health-profile-for-england/chapter-6-social-determinants-of-health

[4]         World Health Organization, “Social determinants of health,” World Health Organization, 2018. https://www.who.int/social_determinants/en/

[5]         Public Health England, “Spatial planning for health: evidence review,” 2017. [Online]. Available: https://www.gov.uk/government/publications/spatial-planning-for-health-evidence-review

[6]         F. & R. A. Department for Environment, “UK Climate Change Risk Assessment 2017,” 2017. [Online]. Available: https://www.gov.uk/government/publications/uk-climate-change-risk-assessment-2017

[7]         Sustainable Development Unit, “Healthy, sustainable and resilient communities,” 2019. Available at: https://www.sduhealth.org.uk/areas-of-focus/community-resilience.aspx

[8]         Landscape Institute, “Public Health and Landscape Our landscapes have an important role to play in improving public health – so let’s invest in them,” London, 2013. Available at: https://landscapewpstorage01.blob.core.windows.net/www-landscapeinstitute-org/migrated-legacy/PublicHealthandLandscape_CreatingHealthyPlaces_FINAL.pdf

[9]         Public Health England, “Local wellbeing, local growth: Why we need Health in All Policies,” 2016. Available at: https://publichealthmatters.blog.gov.uk/2016/10/25/local-wellbeing-local-growth-why-we-need-health-in-all-policies/.

[10]      The Health Foundation and R. Williams, “Transport and health,” 2018. [Online]. Available: https://www.health.org.uk/infographic/transport-and-health

[11]      Public Health England, “Working Together to Promote Active Travel A briefing for local authorities,” 2016. Available at: https://www.gov.uk/government/publications/active-travel-a-briefing-for-local-authorities

[12]      Parliamentary Office for Science and Technology, “Health benefits of physical activity,” London, 2001.  Available at: http://researchbriefings.files.parliament.uk/documents/POST-PN-162/POST-PN-162.pdf

[13]      Department of Health & Department for Transport, “Active travel strategy,” 2010. Available at: https://webarchive.nationalarchives.gov.uk/20130104171407/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113102

[14]      D. E. Warburton, S. Charlesworth, A. Ivey, L. Nettlefold, and S. S. Bredin, “A systematic review of the evidence for Canada’s Physical Activity Guidelines for Adults,” Int. J. Behav. Nutr. Phys. Act., 2010.

[15]      J. J. De Hartog, H. Boogaard, H. Nijland, and G. Hoek, “Do the health benefits of cycling outweigh the risks?,” Environ. Health Perspect., vol. 118, no. 8, p. 1109, 2010.

[16]      Suffolk County Council, “Active for Life: Suffolk Walking Strategy 2015-2020,” 2015. Available at: https://www.healthysuffolk.org.uk/uploads/Suffolk's_Walking_Strategy.pdf

[17]      Department of Health, “Start active, stay active. A report on physical activity for health from the four home countries’ Chief Medical Officers,” 2011.

[18]      European Commission, “Road infrastructure and biodiversity,” 1990.

[19]      European Environment Agency, “Transport and ecosystems,” 2016. [Online]. Available: https://www.eea.europa.eu/signals/signals-2016/articles/transport-and-ecosystems

[20]      “NBN Atlas.” [Online]. Available: https://spatial.nbnatlas.org/?q=lsid%3ANHMSYS0001593547&lat=51.979584&lon=1.0324574&radius=4.6#

[21]      P. Elliot, “Impacts of Climate Change on Non-Native Species,” in Marine Climate Change Impacts Annual Report Card 2006 , P. J. Buckley, S. R. Dye, and J. . Baxter, Eds. Lowestoft: MCCIP, 2006.

[22]      Department for Environment Food and Rural Affairs, “Air Quality A Briefing for Directors of Public Health,” 2017.

[23]      Defra and Centre for Ecology and Hydrology, “A review of Acidification, Eutrophication, Heavy Metals and Ground-Level Ozone in the UK | Review of Transboundary Air Pollution (RoTAP),” 2012. [Online]. Available: http://www.rotap.ceh.ac.uk/index.html

[24]      T. Benton and Chatham House, “A Better UK Food Policy Requires Better Government,” 2019. [Online]. Available: https://www.chathamhouse.org/expert/comment/better-uk-food-policy-requires-better-government

[25]      G. Hoek et al., “Concentration response functions for ultrafine particles and all-cause mortality and hospital admissions: results of a European expert panel elicitation,” Environ. Sci. Technol., vol. 44, no. 1, pp. 476–482, 2009.

[26]      M. M. Finkelstein, M. Jerrett, and M. R. Sears, “Traffic air pollution and mortality rate advancement periods,” Am. J. Epidemiol., vol. 160, no. 2, pp. 173–177, 2004.

[27]      A. Peters et al., “Exposure to traffic and the onset of myocardial infarction,” N. Engl. J. Med., vol. 351, no. 17, pp. 1721–1730, 2004.

[28]      C. Tonne, S. Melly, M. Mittleman, B. Coull, R. Goldberg, and J. Schwartz, “A case–control analysis of exposure to traffic and acute myocardial infarction,” Environ. Health Perspect., vol. 115, no. 1, pp. 53–57, 2006.

[29]      W. J. Gauderman et al., “Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study,” Lancet, vol. 369, no. 9561, pp. 571–577, 2007.

[30]      Department for Environment Food and Rural Affairs, “Valuing the overall impacts of air pollution,” 2010.

[31]      Committee on the Medical Effects of Air Pollutants, “Long-term exposure to air pollution: effect on mortality,” 2010.

[32]      National Atmospheric Emissions Inventory, “UK Emissions Interactive Map.” [Online]. Available: http://naei.beis.gov.uk/emissionsapp/

[33]      Parliamentary Office of Science and Technology, “Green Space and Health: POSTnote,” POSTnote 538, no. October, pp. 1–5, 2016.

[34]      R. Balfour, J. Allen, C. Petrokofsky, S. Hewitt, M. Depledge, and P. Health England, “Local action on health inequalities: Improving access to green spaces,” no. September, p. 29, 2014.

[35]      Suffolk Resilience Forum, “Severe weather response plan,” Ipswich, 2017.

[36]      NHS, “Keep warm, keep well.” [Online]. Available: https://www.nhs.uk/live-well/healthy-body/keep-warm-keep-well/

[37]      Public Health England and NHS England, “Heatwave plan for England: making the case: the impact of heat on health now and in the future,” London, 2015.

[38]      PHE, “Heatwave plan for England,” Heatwave plan Engl. Wales, p. 4, 2018.

[39]      Suffolk Fire & Rescue Service 2018-21, “Suffolk Strategic assessment of risk,” Ipswich, 2018. [Online]. Available: https://www.suffolk.gov.uk/assets/fire-rescue-and-emergencies/about-suffolk-fire-and-rescue-service/Fire-Strategic-Assessment-of-Risk.pdf

[40]      M. Chan, “Food safety must accompany food and nutrition security,” Lancet, vol. 384, no. 9958, pp. 1910–1911, 2014.

[41]      Oxford Martin Programme on the Future of Food, “What is the Food System? Future of Food.” [Online]. Available: http://www.futureoffood.ox.ac.uk/what-food-system

[42]      P. Border and R. Barnes, “Security of UK Food Supply,” POST - Parliamentary Office of Science and Technology, London, 2017. [Online]. Available: https://researchbriefings.parliament.uk/ResearchBriefing/Summary/POST-PN-0556

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