The environment has a significant effect on health and wellbeing.  High quality environments have a key part in helping people to live healthier and happier lives. Environmental problems such as noise, air pollution, food safety, pest control and contaminated land can have a significant impact on individual and population health.  Climate change continues to pose significant future risks to human health if actions are not taken now both to reduce carbon emissions and reduce energy demands to sustainable levels.

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Last updated: 2013-09-03 14:34:26
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1. What are the key issues?

In the future it is likely that there will be higher summer temperatures with more heat waves, flooding and an increased risk of skin cancer.

Rising fuel prices and poorly insulated homes could result in additional deaths in the winter.

Rising food costs may affect the quality of residents’ diets.

Noise complaints are rising and the latest research quantifies links with coronary heart disease, tinnitus and raised stress levels.

Cardiovascular disease, asthma and cancers are all associated with exposure to high levels of air pollution, all of which are prevalent in Middlesbrough.

Middlesbrough currently has 682 sites identified as potentially contaminated on the historic land use register, with 366 of these identified as high risk due to their past use.

Climate change will bring about a shift in the pattern and ecology of pests. Most emerging diseases are transmitted from animals to humans (zoonotic). In Middlesbrough many low income families are unable to afford pest control treatments – a 20% drop in pest control requests (from 5,000 to 4,000 per year) occurred when subsidies for low income households were removed.

The majority of food businesses in Middlesbrough are compliant with the law and have good hygiene standards. However, there is a very small number annually which are subject to legal action and emergency closure powers are used when conditions present an imminent risk to health. The main areas of non-compliance are in relation to lack of cleaning and pest control.

Local authorities are the principal enforcing authority in retailing, wholesale distribution, warehousing, hotel and catering premises, offices, and the consumer/leisure industries. The local authority focuses on high risk premises in accordance with the review of regulatory functions where inspections have reduced by one-third, and responding to accidents and complaints from the public.

The primary role of the Port Health Authority in relation to Middlesbrough is to inspect the hygiene standards on ships. There is one business in Middlesbrough which directly imports food products into Teesport.


Last updated: 03/09/13

2. What commissioning priorities are recommended?

Reduce the impact of climate change

  • Implementing through partnership working the One Planet Living Action Plan to bring public health benefits, enhance quality of life and reduce burdens on health services;
  • Raising awareness about the importance of greater integration of the climate change, One Planet Living and public health agendas to recognise mutual benefits of greater joint working;
  • Ensuring that health professionals play a greater role in the development and implementation of One Planet Living and sustainable lifestyles; and
  • Ensuring that public services lead by example to encourage more people to adopt more active and sustainable lifestyles through behaviour choices and commitment to the ten principles of One Planet Living.

Tackle noise pollution

  • Completing a noise mapping exercise and implement necessary plans to protect residents from unacceptable noise; and
  • Investigating and remedying public noise nuisance to protect public health.

Ensure good air quality

  • Continuing to monitor air quality in Middlesbrough and investigating when pollution is identified;
  • Informing the public of steps they can take to reduce pollution caused by their activities and the impact that this has upon greenhouse gas emission;
  • Using development control to encourage the use of new technology which reduces pollution for developments in Middlesbrough; and
  • Enforcing pollution legislation to minimise harmful emissions.

Tackle contaminated land

  • Developing the contaminated land database to have a transparent evidence-based prioritisation of potentially contaminated sites; and
  • Investigating contaminated land through the planning process and recommending planning permission when needed.

Ensure environmental pests are controlled

  • Considering the affordability of pest control treatments to control pests of a public health significance when setting prices; and
  • Monitoring the prevalence of pests and their geographic distribution, enabling the introduction of targeted control measures.

Continue to encourage responsible dog ownership
through information, education, and enforcement.

Ensure food safety

  • Regulating food safety and standards, giving priority to higher risk businesses in Middlesbrough;
  • Delivering interventions which improve food safety and focus on local intelligence; and
  • Delivering interventions which improve food standards and focus on local priorities in the nutritional quality of food.

Improve workplace health and safety

  • Regulating local business, focusing on higher risk businesses in Middlesbrough; and
  • Delivering workplace interventions by using local intelligence to reduce workplace accidents.

Control communicable diseases

  • Ensuring continuity of disease outbreak control during the transition of the public health and emergency planning function from the NHS to the local authority;
  • Continuing to investigate cases of both food and environmentally borne infections in relation to the risk of spread; and
  • Implementing targeted education and awareness-raising to the public and business, responding to emerging food safety and environmental risks.

Ensure port health is maintained
by supporting the River Tees Port Health Authority Partnership and conducting annual reviews to establish public health benefits.


Last updated: 03/09/13

3. Who is at risk and why?

Older people are at increased risk of death in winter months compared to other times of year and other age groups.  Fuel poverty and a lack of affordable warmth affects older people more than other age groups and contributes towards excess winter deaths.

The people most at risk from the effects of air pollution are the very young, older people and those who already have a predisposing illness which air pollution can exacerbate.  People with asthma are particularly at risk during episodes of high air pollution levels.  One in eleven children and one in twelve adults in the UK suffer from asthma (Asthma UK, 2010).  In certain situations it is possible that air pollution plays a part in the induction of asthma in some individuals who live near busy roads, particularly roads carrying high numbers of heavy goods vehicles (Committee on the Medical Effects of Air Pollution, 2010).

Socioeconomic status
It is estimated that climate change will have a disproportionate impact on disadvantaged, vulnerable and deprived groups compared to the rest of the population.  The following health impacts of climate change for the UK are identified (Health Effects of Climate Change in the UK, 2008, DH):

  • heat-related health problems and worsening air quality, causing increased pollution-related illness and deaths;
  • increased risk of contaminated drinking water, water-borne infections and exposure to toxic pollutants;
  • increased prevalence of food poisoning and water-borne disease linked to warmer weather;
  • increased rates of sunburn and skin cancer;
  • social disruption, injury, disability and death as a consequence of extreme weather-related events such as hurricanes and river, coastal and flash floods.

Noise can cause annoyance, interfere with communication and sleep, cause fatigue and damage hearing. Physiological effects of exposure to noise include constriction of blood vessels, tightening of muscles, increased heart rate and blood pressure and changes to stomach and abdomen movement. Occupational noise can lead to temporary or permanent hearing loss.  Noise is reported to be responsible for 3% of ischaemic heart disease in the UK, for 3% of tinnitus and causes a rise in stress hormones leading to increased risk of strokes, heart attacks and reduced immune system (WHO, 2011b). The same report says 2% of Europeans suffer severely disturbed sleep and 15% can suffer severe annoyance. People living near busy roads and those with noisy neighbours are most at risk, including the most vulnerable such as housebound, the already sick (who’s condition could be worsened), the young and elderly.  Noise proliferates in areas of deprivation where houses are most densely populated and more likely to be near busy roads.

Reports on the medical effects of air quality suggest that the short-term impact results in the premature death of between 12,000-14,000 vulnerable people in the UK each year and between 14,000-24,000 hospital admissions /readmissions per year. Air quality is one of the government’s 68 indicators in the Sustainable Development Strategy. People in poorer areas tend to live close to pollution sources including busy roads and industrial sites.

Air quality
Air pollution is a major environmental risk to health. By reducing air pollution levels, the burden of disease from respiratory infections, heart disease, and lung cancer can be reduced (WHO, 2011a).

In cities, people inside vehicles are exposed to greater levels of fine particulate matter and carbon monoxide concentrations than cyclists and pedestrians (Kaur et al, 2007).  However, due to increased respiration and longer travel time, pedestrians and especially cyclists may inhale greater concentrations of pollution over the course of their journey – except when they are able to use walk/cycle paths away from motorised traffic (Dirks et al, 2012).

The Lancet series ‘The health benefits of tackling climate change’ (2009) documented the benefits of reducing emissions such as the reduction of motor vehicle use through more walking and cycling.  This will not only diminish transport emissions but reduce obesity, lower the rate of chronic diseases caused by physical inactivity and lessen the health-damaging effects of air pollution.

Contaminated land
Contaminated land poses risks to both human health and the environment depending on the types and volumes of pollutants present at particular sites.

Pest control
Infestations by pests can affect everyone, but tend to affect disadvantaged populations more due to poorer housing conditions, improper storage of food waste and cleanliness.  About 80% of mild or moderate asthmatic children have a positive allergy skin test to cockroach and dust mite allergens.  Rats can spread several diseases (for example, salmonellosis, leptospirosis, and typhus) and carry mites and lice. Rats, mice, cockroaches and bedbugs can be a source of anxiety, affecting mental health and wellbeing (WHO, 2008).

Energy efficiency
Climate change is, in large part, driven by emissions of greenhouse gases such as carbon dioxide. To reduce emissions will require a level of energy efficiency in homes and buildings that is currently uncommon in the UK.  Major policy changes on new buildings, and incentives to modify existing buildings, plus a large shift to strategic and local renewable energy generation and smart power grids is required.

Green space
Access to the natural environment and other open spaces has significant benefits for health and wellbeing, by reducing stress, improving mental well-being and encouraging greater levels of physical activity across all age groups. Safe, green spaces have the potential to increase communal activity in different social groups, increase residents’ satisfaction with their local area and improve air and noise quality. Open space provision also acts to mitigate climate change, reducing the impacts of flooding and heat waves and reducing CO2 emissions.

The frequency of visits to open space declines significantly with increasing distance from the open space, with the exception of young people. There is a statistically significant decrease in the likelihood of achieving physical activity recommendations and an increase in the likelihood of being overweight or obese associated with increasing distance to formal green space (Natural England, 2011).


Last updated: 03/09/13

4. What is the level of need in the population?

Climate change
Current lifestyles in Middlesbrough are unsustainable for the long-term.  The ecological footprint of the average Middlesbrough resident is 5.1 hectares (ha), against a sustainable level of 1.8ha per person.  The only option available is to change lifestyles and use resources more effectively.  In doing so, there is the potential to address public health issues through increased physical activity, better diet, improved mental wellbeing and creating warmer, more energy efficient homes.

Based on national data, noise is responsible for 9 premature deaths per year through ischemic heart disease in Middlesbrough. Anyone exposed to light traffic noise at night (50dB or above) exceeds the threshold for cardiovascular problems. For sleep disturbance the threshold is 42 dB, and 35dB for general annoyance. A noise mapping exercise in Middlesbrough is expected to identify over 800 dwellings at risk. Noise complaints in Middlesbrough have risen 50% in five years. There were 1,663 complaints in 2010.

Air quality
Carbon dioxide emissions in Middlesbrough are close to the UK average.carbon dioxide emissions trend, Tees, 2005-2010

Contaminated land
Work under Part 2A of the Environmental Protection Act 1990 looks at those sites where risks exist which aren’t necessarily going to go through the planning process.  Nevertheless, remediation may still be necessary to protect people and the environment from potential exposure to toxic substances, poisons and explosive gases which may be carcinogenic if exposure is high.  Middlesbrough currently has 682 sites identified as potentially contaminated on the historic land use register, with 366 of these identified as high risk due to their past use and the potential for contamination.

Pest control
There were 4,200 requests for Middlesbrough Council’s pest control service in 2010/11. With approximately 50,000 households, this means about 8% of Middlesbrough households required a pest control service.

Responsible dog ownership
The benefits of owning a dog go hand-in-hand with the responsibilities. In Middlesbrough, 488 stray dogs were handled in 2010, rising to 588 in 2011.  Complaints about dog fouling also increased from 408 in 2010 to 588 in 2011.

Food safety
There are 1,100 businesses in Middlesbrough which sell or prepare food. In 2010/11, Middlesbrough Borough Council made 900 visits to food businesses and 641 food samples were taken. There were 759 service requests.  Approximately 200 cases of food poisoning are notified to the local authority annually.

Workplace safety
There are 2,500 workplaces in Middlesbrough subject to regulation of health and safety law by the Council.  Approximately 500 are inspected each year, based on the risk presented by the business.

Port health
There is currently a low level of need in relation to the number of ships which dock within the Middlesbrough boundary.


Last updated: 03/09/13

5. What services are currently provided?

Climate change
Examples of current programmes, that link sustainable environment programmes and health are:

  • Promotion of cycling in Middlesbrough, including the Middlesbrough Cycle Centre, Bikeability training in schools and community cycling activities.
  • Middlesbrough Urban Farming programme, engaging more people in growing their own produce and eating healthily.
  • Middlesbrough’s Affordable Warmth Group is implementing actions to reduce fuel poverty and excess winter deaths through improving home insulation and access to benefits.

A noise nuisance investigation service is provided by Middlesbrough Council.

Air quality
At present air pollution is monitored at three static monitoring stations in Middlesbrough.  A team of Environmental Health professionals enforce compliance with legislation to control pollution including environmental permitting, nuisance and smoke control.

Contaminated land
Middlesbrough Borough Council acts as a consultee for planning on land contamination issues, including site visits, to ensure sites are remediated to a standard suitable for their end use following thorough investigation. The Council undertakes statutory work and responds to complaints and requests for advice.

Pest control
Middlesbrough Council offers a comprehensive, chargeable pest control service for most types of household pests.

Responsible dog ownership
Middlesbrough Council currently employs one dog warden who deals with stray dogs, dog fouling and responsible dog ownership initiatives.

Food safety
Food businesses are inspected and advice is also made available either during the inspection or through leaflets and websites. Information on the standards in food businesses is made available to the public through the Food Hygiene Rating Scheme.

Workplace safety
Workplaces are inspected and advice is made available either during the inspection or through leaflets and websites. Complaints about workplaces and reportable accidents are investigated, according to the risk presented.

Communicable diseases
An advice service is available to the public, businesses, schools and other organisations about communicable diseases.

Port health
Redcar & Cleveland Borough Council is the lead authority and delivers services in relation to Port Health Controls.


Last updated: 03/09/13

6. What is the projected level of need?

Climate change
The effects of climate change and unsustainable lifestyles will become more acute in future, although it is difficult to assess the extent of the climate change.  Likely effects are:

  • Increased levels of fuel poverty and excess winter deaths linked to rising fuel costs.
  • Increased levels of heat-related deaths.
  • Increased skin cancers from higher levels of UV radiation.
  • Increased incidence of food poverty and poor diets linked to rising fuel prices.
  • Increased risk of flooding, with associated stress leading to mental health problems.
  • Increased incidence in disease linked to increases in pests, flooding and diseases.

Climate change predictions for the 2020s, 2050s and 2080s are available to registered users relative to a baseline period from 1961 to 1990. (DEFRA, 2009). 

Complaints are rising each year. The current cost of providing the noise investigation service is £230,000 per annum. The rise in noise nuisance is expected to continue as resources are in decline. The cost and impact of the noise mapping exercise is unknown at this stage.

Air quality
It is unclear what future air quality will be like.

Pest control
Pests are unlikely ever to be completely eradicated.  In recent years there has been a significant increase in the rat population in the UK. There is now a resurgence of bedbugs.

Workplace safety
The number of inspections required is likely to reduce in future years in line with the Government’s plan to reduce regulatory burden on businesses and, in particular, the self-employed. High-risk businesses will continue to be inspected and accidents which cause major injuries or significant time off work will be investigated.


Last updated: 03/09/13

7. What needs might be unmet?

Climate change
There are several prioritised actions to tackle climate change and encourage the adoption of sustainable behaviours and One Planet lifestyles that are included within the Climate Change Community Action Plan (Middlesbrough Borough Council, 2010) and the One Planet Living Action Plan (Middlesbrough Borough Council, 2010).  There is a risk that Middlesbrough-based organisations do not address climate change.  In addition, there is a risk that residents will be provided with insufficient opportunities to adopt a One Planet lifestyle. The Department of Health recognises that climate change poses unprecedented challenges ranging from global policy challenges to personal and social action (DH, 2008).

Most nuisance noise occurs in the evening and overnight. Recent budget savings have resulted in a reduced out-of-hours service, and the out-of-hours service is likely to cease. As a result, noise nuisance investigations will take longer to conclude and nuisance will go undetected. The Government noise mapping exercise is incomplete and local issues cannot be quantified at this stage.  The level of noise is thought to be above the threshold of ‘light traffic’ (threshold for cardiovascular effects) in some areas and the costs of reducing traffic noise (for example, through the use of special road surfaces) are significant.

Contaminated land
Health issues are uncovered as this work progresses.  The full extent is not known.

Pest control
Currently the Council’s pest control service is chargeable for all pests. Poorer members of the public may struggle to afford such a service and so choose to try to eradicate the problem themselves (often unsuccessfully) or ignore the matter thus putting their health at risk.

Responsible dog ownership
The cost of owning a dog is rising and with the current economic climate the cost of feeding, training, vaccinating and treating a dog can become prohibitive for poorer people. The consequence of this is either that the dog is thrown out, re-homed or is left untrained, unvaccinated and untreated leading to increases in stray dogs, fouling, disease and un-social or dangerous dogs.

Food safety
The current national review of the food law service by the Food Standards Agency may result in a change of delivery. Currently, the reduced staffing resource in Middlesbrough has resulted in an approach which focuses on businesses complying with the law. In relation to advice and support, which encourages higher standards beyond legal compliance, businesses are directed to other information sources, leaflets and websites. Enquiries from the public in relation to food hygiene are also now directed to other information sources and response times have been extended. With a high level of staff turnover in small food businesses, there is continuous need for low cost food hygiene training.

Workplace safety
In Middlesbrough staffing has been reduced and delivery of the health and safety function is now combined with food and safety inspections. Officers have undergone training to ensure their competency. Officers focus on high risk inspections and accident investigation, whilst the delivery of advisory visits, responding to low risk service requests and training, has been reviewed and will be dealt with by other means.


Last updated: 03/09/13

8. What evidence is there for effective intervention?

Reducing particulate matter (PM10) pollution from 70 to 20 micrograms per cubic metre can cut deaths related to air quality by around 15% (WHO, 2005).


Last updated: 03/09/13

9. What do people say?

Climate change
Evidence from the Healthy Town programme suggests that lifestyle interventions have left a sustainable legacy. A recent Voiceover Survey concluded that 51% of participants were now taking more physical exercise as a direct result of the programme and Change4life.

In surveys carried out with noise nuisance clients, and unsolicited comments and complaints received by the service, the Council is commonly asked to expand in out-of-hours provision.

Air quality
Middlesbrough Council’s Neighbourhood Survey in 2003 identified that only 4% of people were “concerned a great deal” about the air quality outside of the home.  The environmental factors that people were most concerned about in the survey were traffic and litter.  As road traffic is one of the main contributors to air pollution in urban areas it is interesting to note that people consider the volume of vehicles to be a concern but do not relate that to the pollution the vehicles produce.

Contaminated land
The Contaminated Land Strategy was reviewed in June 2010 and, as part of the review, a consultation process with partner agencies, departments within the Council, Councillors and the residents of Middlesbrough was undertaken.  There were no objections to the Strategy however it was noted that often people do not understand the concept of contaminated land due to its technical nature and therefore perceived risks are much higher than actual risks.

Pest control
Quarterly customer satisfaction surveys are carried out for Middlesbrough Council’s Pest Control Service. For the survey taken during June 2011, 100% of customers thought that the treatment provided was either excellent or good. Previous comments included that the service should be free or subsidised for people on low incomes.

Responsible dog ownership
Middlesbrough Council’s 2007 Neighbourhood Survey showed dog fouling as one of the top four environmental concerns.  Complaints to the Council about fouling and stray dogs are increasing.

Food safety and workplace safety
The national consumer attitude survey undertaken by the Food Standards Agency identified that 87% of consumers were aware of the food hygiene standards where they eat using the appearance of the premises and staff as their gauge.

Business operators are surveyed locally to assess their satisfaction with the regulatory service offered to them, with 98.1% being satisfied.


Last updated: 03/09/13

10. What additional needs assessment is required?

The Government's noise mapping assessment in Middlesbrough has yet to be carried out but when complete will identify the noise level that the top 1% of households is exposed to. Early indications suggest 800 properties will fall within the assessment and this will be clarified when the assessment is carried out.


Last updated: 03/09/13

Key contact

Name: Paul Robertson

Job title: Environmental Protection Manager

e-mail: paul_robertson@middlesbrough.gov.uk

Phone number: (01642) 728212



Local strategies and plans

Middlesbrough Borough Council (2011) One Planet Living Action Plan

Middlesbrough Borough Council (2010) Climate Change Community Action Plan 2010-2020

Tees Valley Unlimited (2010). Climate Change Strategy 2010 to 2020.

Tees Catchment Flood Management Plan, 2009.

Tees Valley Air Quality Report 2011.

Tees Valley Green Infrastructure Strategy, 2008.


National strategies and plans

Department of Energy and Climate Change (DECC, 2011). Fuel Poverty Strategy

DECC (2010). Warm Homes, Greener Homes.

Environment Agency (2011). National flood and coastal erosion risk management strategy for England.

UK Renewable Energy Strategy, 2009.

Environment Agency (2009). Water resources strategy for England and Wales.


Other references

Chartered Institute of Environmental Health (2008).  The Impact of Climate Change on Pest Populations and Public Health.

Chartered Institute of Environmental Health (2009). The Role of Pest Management in Protecting Public Health.

Climate UK (2012). UK Climate Change Risk Assessment: North East Summary.

Committee on the Medical Effects of Air Pollution

Department of Energy and Climate Change (DECC, 2012). Getting the measure of fuel poverty: final report of the fuel poverty review.

Department for Environment, Food and Rural Affairs (DEFRA, 2009). UK Climate projections.

Department for Environment, Food and Rural Affairs (DEFRA, 2012). UK Climate Change Risk Assessment.

Department of Health (DH, 2008). The Health Impact of Climate Change: Promoting Sustainable Communities.

Environment Agency (2012). Flood Maps.

Faculty of Public Health and Natural England (2010). Great Outdoors: How our Natural Health Service Uses Green Space to Improve Well-being.

Health Protection Agency (2008). Health Effects of Climate Change in the UK.

Natural England (2011). Green Space Access, Green Space Use, Physical Activity and Overweight.

UKCIP (formerly UK Climate Impacts Programme)

West Midlands Public Health Observatory (2010). Excess Winter Deaths (EWD) in England.

World Health Organization (WHO, 2005). Air quality guidelines - global update 2005.

World Health Organization (WHO, 2008). The Public Health Significance of Urban Pests.

World Health Organization (WHO, 2011a). Air quality and health - Fact sheet 313.

World Health Organization (WHO, 2011b). Burden of disease from environmental noise.