Fact sheet
December 2007
Environmental health practitioners: Key players in public health
This fact sheet has been compiled by the Chartered Institute of Environmental Health (CIEH)
with support from the Regional Public Health Group based in the Government Office of the
South East. It aims to summarise the work undertaken by environmental health practitioners
(EHPs) working in local authorities and to highlight the important role that they play in
addressing public health issues.
Employees in environmental health in local authorities play a key role in shaping the quality
of local environments. They undertake public health work in a range of areas covering
housing, occupational health and safety, food safety and environmental protection. They are
a hidden resource and often not seen as working in public health. By working together with
those employed in the public health sector and with other partners, targets can be achieved
with better outcomes for all.
1. History of public health and local authorities
In 1840, a government committee was established to assess the health of growing cities,
following concerns about inadequate and often non-existent sanitation.
The committee published its research in 1842. In the same year Edwin Chadwick published
research which for the first time linked poor living conditions with ill health and mortality
rates.
The combined effect of the two reports led to the Public Health Act in 1848, establishing
local boards to improve drainage, paving, cleansing, water supplies and subsequently the
health of the population.
Towards the end of the 19th Century local boards gave rise to the local authority system we
have today, charged with the responsibility to maintain and improve housing standards,
suitable working conditions, controls for the maintenance of the environment, the production
of food that is safe to eat and to this day the health of the population they serve.
There is a historical link between public health and environmental health. Problems with
drainage, refuse disposal and water supplies throughout the 19th and 20th Centuries led to
government intervention which laid the foundation for environmental legislation. Those
employed by local governments were the forerunners of the environmental health officer.
1
2. Who are EHPs and what do they do?
EHPs have a wealth of skills and knowledge of public health and a broad perspective on how
the activities of the local authority and other professions and agencies can improve health
and wellbeing. Their actions directly influence health determinants and maintain healthy
environments for the benefits of both the individual and wider communities, while also
extending to the protection of the environment for future generations.
3. The scope of environmental health
The environmental health contribution to public health includes:
•
•
•
•
•
•
•
•
•
•
Housing and planning
Availability of wholesome drinking water supplies
Quality and availability of safe and nutritious food supplies and support for local food
production
Prevention of accidents and injuries
Health protection and communicable disease control
Noise control
The control of pollution, including nuisances
Remediation of contaminated land
Occupational health and safety
The improvement of air quality
Diagram 1 1
“Environmental health comprises those aspects of human health, including quality of life,
that are determined by physical, chemical, biological, social and psychosocial factors in the
environment. It also refers to the theory and practice of assessing, correcting and preventing
those factors in the environment that can potentially affect adversely the health of present
and future generations.” (MacArthur and Bonnefoy 1998).
1
Environmental health 2012, Chartered Institute of Environmental Health and Health Development Agency 2002
2
Environmental health practitioners, working with and alongside other public health
professionals, are key partners in local and national efforts to protect, improve the health
and quality of life, and reduce health inequalities of the individuals and communities they
serve.
Public health is important as its purpose is to improve the health and wellbeing of the
population and prevent disease and minimise its consequences.
According to the Faculty of Public Health, the ten key areas for public health practice are:
•
•
•
•
•
•
•
•
•
•
4.
Surveillance and assessment of the population’s health and wellbeing
Promoting and protecting the population’s health and wellbeing
Developing quality and risk management within an evaluative culture
Collaborative working for health
Developing health programmes and services and reducing inequalities
Policy and strategy development and implementation
Working with and for communities
Strategic leadership for health
Research and development
Ethically managing self, people and resources
What is public health and how does environmental health fit in?
The World Health Organization defines health as:
“Health is a state of complete physical, mental and social wellbeing not merely the absence
of disease or infirmity”.
Environmental health is concerned with all aspects of our living environment and
environmental health practice works by assessing, correcting and preventing the impact of
environmental stressors on health. These stressors might be biological, chemical, physical,
social, psycho-social or any combination of these (as illustrated in diagram 1). Only by
having a good understanding of the living environment and how the stressors act upon it can
intervention strategies be determined. EHPs may be involved in smoking control, anti-social
behaviour, the night time agenda, controlling noise nuisances and licensing as part of their
day to day work.
5.
Areas of environmental health
The following information (5.1-5.6) summarise some of the issues around the areas of
environmental health and the connection with benefits to public health. The work of EHPs
ranges across these areas.
5.1
Housing
Aspects of the home
Structure and design:
Temperature
Damp
Impact upon health
Excess winter and summer deaths – related to
insulation, heating and ventilation
Excess respiratory and cardiovascular diseases
related to temperature and dampness
3
Noise
Ventilation
Overcrowding
Safety from intruders
Injury prevention
Child safety
Fire safety
Falls prevention
Noise levels affect sleep and mental wellbeing
Ventilation affects temperature, dampness,
infectious diseases and radon
Over crowding increases infectious diseases and
increases stress levels
Increased security reduces fear of crime, potential
injury and reduces the need for rehousing (from
burglary or violent ex-partners)
Lighting, grab rails, child friendly windows and
reducing trip hazards can reduce the risk of falls
Winter warmth
•
Partnership working to address fuel poverty and improve winter warmth
Injury prevention
•
Develop multi-agency approaches to address fire safety, child safety and falls prevention
Home Improvement Agencies and handyperson repair schemes
•
Direct provision with assistance in small repairs, minor adaptations, etc
Influence housing process
•
Engagement with local authority housing partners and housing strategies to ensure
health needs are taken into account
5.2
Food
Aspects of food
The production, manufacture and
preparation of safe and nutritious food
The ease with which consumers are able
to purchase/obtain foods needed for a
healthy diet
Provision of consumer information about
healthy eating and nutrition and the
skills and behaviours necessary for good
nutrition
Impact upon health
Improve the health of the population through the
provision of safe and nutritious food
Improve nutrition at all stages of life for all
members of society, reducing health inequalities
Promote better nutrition to help people to choose
a better diet
Encourage workplaces to promote healthy eating
•
Develop multi-agency approach to develop healthy eating policy for all workplaces and
ensure catering contracts incorporate healthy eating clauses
•
Develop exemplars with public service organisations
•
Develop information and support for employees to enable them to incorporate healthy
eating advice into their diets at home
•
Ensure that employers are aware of the benefits of promoting healthy eating for their
employees
•
Develop skills and knowledge of caterers to provide healthier food
4
Promote healthier menus in catering premises
•
Ensure skills and knowledge of food and health practitioners are appropriate to deliver
healthy eating advice
•
Ensure consistent message on what constitutes a healthy diet
•
Promote healthy eating awards with free publicity to businesses
•
Develop skills and knowledge of caterers to provide healthier food
Ensure that food in the home is safe to eat
•
Enhance general food safety awareness in children and adults
•
Increase householder awareness of correct fridge temperatures
•
Raise awareness of the importance of hand washing
•
Raise awareness of cross contamination risks
Ensure people have access to affordable healthy food
•
Work with government offices, planning departments, Primary Care Trusts (PCTs) to
identify food deserts and encourage local food mapping model to be used
•
Encourage amount of locally produced food used and support local food industry
•
Improve relationships with local producers and develop relationships with local procurers
5.3
Occupational health and safety
Aspect of occupational health and safety
Accidents in the workplace, from key causes
such as:
•
Slips and trips
•
Falls from working at height
•
Workplace transport
•
Machinery
Work related ill-health caused by key factors:
•
Manual handling and repetitive work
•
Stress
•
Noise and vibration
•
Occupational diseases such as asbestosis
Impact on health
Personal suffering, stress, debilitation, and
temporary and permanent disability
Stress through financial loss for individuals
and families, and work absence
Rehabilitation time and effort
(plus financial costs to businesses):
Legal costs and compensation costs
Business losses
Legal action
Job losses
National targets:
•
A reduction in the incidence rate of work-related fatal and major injuries of 3% by
2007/08 against a baseline of 2004/05
•
A reduction in the incidence rate of work related ill-health of 6% by 2007/08 against a
baseline of 2004/05
•
A reduction in the number of days lost due to work related injuries and ill-health of 9%
by 2007/08 against a baseline of 2004/05
Examples of activities of local authority EHPs at reducing the impact on health and
contributing to wellbeing at work:
•
•
•
•
•
Routine workplace visits to advise, educate, support and improve workplace conditions
for approximately half of the workforce
Investigating complaints from workers, and reported accidents
Focusing on the more serious risks dependent on the type of workplace
Active involvement in local business partnerships to support start-up businesses
Working in partnership with the Health and Safety Executive to maximise resources
and expertise
5
•
•
5.4
Involvement in promoting national campaigns such as Better Backs, Bad Hand Day
(dermatitis in hairdressers) etc
Taking regulatory enforcement action where risks are serious and businesses are not
co-operative
Environmental protection
Feature/medium of the
environment
Land (soil)
Water
Air (outdoor)
Noise
Radiation
5.5
Impact upon health
Possibility of physical injury from unguarded mine
shafts etc; physical injury from illicit deposits and
accumulations; direct toxic effects of ingestion,
inhalation and dermal contact; possible fire/explosion
of gaseous emissions from landfills; possible
contamination of drinking water sources e.g. by
landfill leachate. (For radon see below)
Possibility of toxic effects and infectious disease (esp
intestinal) arising from consumption of/exposure to
chemically or microbiologically contaminated drinking
or recreational waters or waste water (sewage)
Potential for genotoxic effects, especially leukaemias
and lymphomas, tumours of lung, skin and bladder;
irritation, inflammation and constriction of airways,
especially in asthmatics and those with chronic lung
disease
NB Auditory effects are not associated with
environmental exposure. Non-auditory effects of
chronic exposure may include sleep disturbance with
secondary effects on next day concentration and
subjective mood
Strong evidence for lung cancer as a consequence of
exposure to radon
Health protection and communicable disease control (CDC)
Aspects of CDC
Prevention of food borne illness and
food poisoning
Surveillance of communicable
diseases, including food borne illness
and food poisoning
Investigating food poisoning
outbreaks
Infection control in premises which
give rise to contamination from
blood and body fluids, e.g. tattooists,
body piercing studios
Infection control in residential care
homes
Port health
Impact upon health
Reduction in food borne illnesses and food poisoning,
e.g. salmonellosis, mycotoxicosis
Early identification of communicable disease
outbreaks
Controlling communicable disease outbreaks and
preventing secondary spread
Prevention of transmission (through cross
contamination) of blood borne viruses
Prevention of transmission of communicable
diseases, including viruses in a particularly vulnerable
population
Detection, reduction or elimination of communicable
diseases arising from sources located in ports or that
6
Pest control
Waste management
5.6
are imported
Reduction in exposure to biohazards and vector
borne diseases; prevention of vector borne diseases,
e.g. leptospirosis.
Sustainable development
Environmental health services in local authorities, along with other partners such as the NHS
and businesses, will develop environmentally sustainable policies and practices at local and
national level. EHPs will promote the adoption of strategies for sustainable living, focusing
on areas such as energy efficiency, waste minimisation and recycling.
6.
Climate change
See fact sheet on climate change “The health impact of climate change: promoting
sustainable communities”, available on this website from January 2008.
For further information visit: http://www.sepho.org.uk/viewResource.aspx?id=10297
7.
National drivers
Environment:
Clean Air Act 1993
Environment Act 1995
Pollution Prevention and Control Act 1999
Air Quality Regulations 2000
Environmental Protection Act 1990
Noise Act 1996
Public Health Act 1936
Environmental Protection Act 1990
Refuse Disposal (Amenity) Act 1978
Control of Pollution (Amendment) Act 1989
Environmental Protection Act 1990
Anti Social Behaviour Act 2003
The Clean Neighbourhoods and Environment Act 2005
Environmental Protection Act 1990
Contaminated Land (England) Regulations 2006
Food Safety Act 1990
Health & Safety at Work Act 1974
Local Government (Miscellaneous Provisions) Act
1976 and 1982
Licensing Act 2003
Housing Act 2004
Public Health Act 1936
Building Act 1984
Public Health (Control of Disease) Act 1984
Air quality, including regulation of
pollution from factories and homes
Nuisances, e.g. noise, their
prevention and control
Solid waste, including litter. Filthy
and verminous premises.
Local environmental quality
Contaminated land
Food safety
Health and safety in non-industrial
workplaces
Licensing
Private sector housing standards
Public health
This list is not conclusive or comprehensive and is provided as a guide only.
7
8.
Local Area Agreements
Environmental health can contribute to Local Area Agreements (LAAs) in a variety of ways.
LAAs are three year contracts drawn up between central and local government and cover a
range of outcomes. Environmental health can contribute to LAAs in a range of areas. These
might include reduction in falls in the home, improving air quality, healthy eating and
nutrition, reducing fly tipping and litter, improvements in cleanliness of the area.
Examples of environmental health work being included into LAAs:
Nutrition
1.
Shropshire Healthy Eating Award
•
Included in Healthier Communities and Older People
•
£90,000 LAA funding over three years
•
To get 170 catering business to achieve an award over three years in the harder to
reach businesses
•
Nutritional training for EHPs (who implement award) and for some caterers
•
As part of tackling obesity
2.
3.
Bracknell Forest Borough Council Healthier Catering Practices
•
Included in Healthier Communities and Older People
•
Target 30 new awards over three years, nine of which will target premises
focusing on inequality related issues
Northamptonshire Heartbeat Award into all schools
•
Included in the Children and Young People
•
All schools, primary and secondary, to be awarded the Heartbeat award as part of
the healthier schools target
Noise
4.
London Borough of Redbridge
•
Included in the Safer and Stronger Communities
•
Funding has been awarded
•
Target is to reduce all complaints of noise from 7,656 to 6,588 over the three
years
•
To reduce night time complaints of noise from 4,779 to 4,156 over the three years
•
To reduce residents responding to survey who think noise is problem from 16
percent to 11 percent
Reducing injuries
5.
Isle of Wight
•
Included in the Safer and Stronger Communities
•
Target is to reduce the number of businesses with almost no or little confidence in
the management health and safety risk rating score from the April 2006 baseline
6.
Kirklees Metropolitan Council
•
Included in the Economy and Enterprise
•
Target to reduce the number of successful new claimants for incapacity benefit
•
Target to reduce the number of working days lost due to work related ill-health
•
Addressing health and safety in the small and medium sized businesses
Housing
7.
Gloucestershire County Council
8
•
•
•
•
The Decent Home Standard has been incorporated into the LAA through all the
district councils
To increase the number of homes with improvements made to heating systems
and thermal comfort resulting in increased affordable warmth
To increase the number of householders advised on energy efficiency
To increase the number of private sector homes occupied by vulnerable people
made decent
9
Local Area Agreement target areas
Healthier Communities and Older People
• Number of test purchased of underage
tobacco sales
• Smoking prevalence
• Percentage of young people drinking alcohol
• Air Quality - local concentrations of specific
air pollutants (where local authorities have
declared air quality management areas
(AQMAs) in respect of nitrogen dioxide
(nitrogen dioxide) and in some cases PM10,
mainly due to road transport)
• Local food procurement: percentage of all
public sector organisations adhering to
healthier nutritional standards
• Number of vulnerable households in fuel
poverty
• Successful referrals to the Warm Front
scheme (this could be acceptable as a standalone indicator but would be expected to be
an intrinsic part of either of the two indicators
above)
• Number of older people living in decent
homes, whether social housing or privately
owned
• Incident rate of fatal and major injuries at
work
• Number of working days lost from workrelated injuries and ill health
Children and Young People
• Percentage of schools achieving the National
Healthy Schools standard
• Percentage of young people drinking alcohol
• Accessibility of safe play areas and
opportunities
• Number of vulnerable people living in social
housing and the private rented sector in
homes in a decent condition (“vulnerable
people” includes children)
• Number of low income families in fuel poverty
Safer and Stronger Communities
• Reduction in violent crime, including alcohol
related violence, domestic violence, sexual
offences, hate crime and the use of weapons
• Measurements of other types of ASB environment or other criminal activity which are
recorded as a crime type (usually by the police)
– e.g. criminal damage, incidents of graffiti,
abandoned cars and fly-tipping
• A reduction in the number of incidents of flytipping using data as recorded on the Flycapture
database
• Reducing levels of noise nuisance in residential
neighbourhoods
• Improvements
in
air
quality
local
concentrations of specific air pollutants: (where
local authorities have declared air quality
management areas (AQMAs) in respect of
nitrogen dioxide (nitrogen dioxide) and in some
cases PM10, mainly due to road transport)
• Quality of surroundings - for example through
increasing number of Green Flag Awards in most
deprived wards
• Number of vulnerable households in fuel poverty
(identified through local area indicators such as
local level data on areas of deprivation or more
sophisticated tools such as the Affordable
Warmth index)
• Successful referrals to the Warm Front Scheme
(NB: this could be acceptable as a stand-alone
indictor but would be expected to be an intrinsic
part of either of the two indicators above)
• An increase in the percentage of abandoned
vehicles removed within 24 hours from the point
where the local authority is legally entitled to
remove the vehicle (BVPI 1218b)
Economic Development and the Environment
• Percentage of new housing within the growth
point that meets level three in the Code of
Sustainable Homes
• Level of local transport congestion
• Proportion of spend on sustainable procurement
• Percentage of food products used being locally
produced and supplied
• Recycling of non-biodegradable non-municipal
commercial waste
• Proportion
of
renewable
electricity
generated/electricity generation from renewable
and non-renewable sources
• Improving
the
energy
efficiency/carbon
performance of operational property and/or
community organisations
10