Health is influenced by a wide range of social, economic and environmental factors. We as individuals cannot always control them and they influence and often constrain the ‘choices’ we make and the lifestyle we lead. They are the social, economic and environmental conditions that influence the health of individuals and populations.

Lack of income, inappropriate housing, unsafe workplaces and poor access to healthcare are some of the factors that affect the health of individuals and communities. Similarly, good education, inspired public planning and support for healthy living can all contribute to healthier communities.  The majority of local government services impact upon or can influence the conditions in which people live and work and, to a certain extent, the life chances of individuals.

Housing

Poor housing quality is a major issue. Hazards in the home are implicated in up to 50,000 deaths a year and 0.5 million injuries and illnesses requiring medical attention. National studies show that poor housing conditions also contribute to increased risk of Cardiovascular Disease (CVD), respiratory diseases, depression, anxiety, trips and falls in the elderly and young children.Social housing in Knowsley is provided by a number of housing associations, also known as Registered Providers, following the completion of the transfer of Knowsley Council housing stock to these bodies in the early 2000s. Knowsley is a member of the Sub Regional Choice Based Lettings Scheme, Property Pool Plus, which replaced the former “waiting list” system held by individual Registered Providers.

A snapshot of the data held within Property Pool Plus as at March 2015 is detailed in Table 3. There are over 2,000 households on the current waiting list. This shows the majority of Knowsley’s existing registrations are for homes for single persons, couples and small families; with much less demand from households with 3 or more children. Average house prices in Knowsley are low in comparison to nearby areas, and substantially lower than the regional and national averages. Despite this, comparatively low earnings and hence household incomes mean that affordability is a major barrier to home ownership for many Knowsley households. CLG provides consistent data on affordability ratios for Local Authorities

The 2015 Private Sector Housing Condition Survey found an estimated 7,072 Category 1 hazards in Knowsley’s private sector stock, of which over 1,100 are within the privately rented sector. Category 1 hazards include major issues such a lack of adequate heating, fire alarms which aren’t working, a leaking roof, a broken rail on a steep stairway, and a lack of physical security e.g. doors and windows not locking. This means that private rented sector properties are disproportionately affected by these major hazards in comparison to other tenures of properties in Knowsley. The total cost of mitigating these hazards in Knowsley’s private housing stock is estimated as £15.2 million (£2.6 million in the private rented sector). It is estimated that they will be responsible for over 434 harmful events requiring medical treatment every year. The estimated cost to the NHS of treating accidents and ill-health caused by these hazards is £1.3 million/year and £3.2 million/year to wider society, and around 130 quality-adjusted life-years (QALYs).

Crime

There are complex and often indirect links between crime, the fear of crime, the environment, and health and well-being at both individual and population levels. However, overall crime and fear of crime appear to be linked to health and well-being mainly as aspects of socioeconomic disadvantage. The impact of crime on health and wellbeing has been increasingly recognised in recent years, from the making of the NHS as a responsible authority for crime and disorder partnerships in 2003 to the Marmot Review of Health Inequalities in England in 2010. Evidence suggests that areas of high crime usually have significant levels of neighbourhood stress, fear of crime and mental ill-health, whilst lower crime and reduced fear of crime is associated with better mental health and other health outcomes including levels of alcohol related harm and higher physical activity.

Between April 2013 and March 2014, there were 5,303 victims of crime in Knowsley. The majority of total crime victims for both sexes (3,512 / 66.3%) are aged between 26 and 59 years – with females age 26-40 comprising the majority and males 41-59 comprising the majority.

The Safer Knowsley Partnership undertakes monitoring of hate incidents and crimes reported directly to the Local Authority and to other partners, in particular Merseyside Police. The number of cases reported has risen year on year since 2006. Latest available data shows that in 2013/14 there were 271 recorded incidents compared to 262 in 2012/13 (increase of 3%) with a repeat incident rate of 25%. About 92% are reported by the police with the remaining 8% from Speak Up Services, the Knowsley alternative reporting option. Feedback from residents has indicated favouring a local option, so being able to speak to somebody who knows their area .Most recent evidence suggests calls to the dedicated ASB unit have seen an annual increase of approximately 22%. Analysis shows calls relate to a variety of issues including neighbour disputes, football on highways, criminal offences (assaults, drug dealing, threats, harassments etc) to general ASB relating to groups congregating.

Strategic Threat Assessment 2017-18

Transport

Transport has a vital role in contributing to the health and wellbeing of the Knowsley communities and is important contributory factor to health inequalities if transport needs are not met. The rise in personal car use has meant liberation for people who are young and more affluent. More deprived, elderly and disabled people can become trapped in „residential islands‟ surrounded by dense traffic, or without the means to access more distant facilities and services in out-of-town developments.


Access to a personal vehicle is one of the main enablers to a greater freedom to work and enjoy leisure facilities.Data from the 2011 Census (ONS) shows that 37% of Knowsley residents do not have access to a car or van for travel; this is 12% higher than the national figure of 25%. The majority of the more deprived areas such as Stockbridge, Longview and Cherryfield all have lower levels of car ownership than the rest of the borough. The highest age bracket for Knowsley residents who out commute into Merseyside is the 16-24 year olds where almost 70% work outside of Knowsley. Almost 25% of 25- 34 year olds work outside of the Merseyside region. Only the 50-64 age bracket has over 30% of people who both live and work in Knowsley.

Local Transport Plan

Environmental

The environment and health are inextricably linked. Living in an environment you are happy in is proven to improve a person’s quality of life and health. Access to green spaces, climate change and environmental health factors such as air quality, contaminated land, public nuisance (noise, pest control,dust etc.) environmental crime and dog control all affect the environments in which people live. All of this affects people’s quality of life and overall health and wellbeing. Natural green spaces can have a positive impact on health by providing venues for physical activities to help to reduce the risk of a range of health conditions associated with an inactive lifestyle. Health activities in green spaces can also help with rehabilitation, for example low level walking activities for people who are recuperating from cardiac problems. Green spaces can also promote improved mental health and wellbeing. Undertaking positive activities in green spaces has been proven to improve wellbeing, for example gardening on allotment sites, volunteering activities and taking part in team building activities.

Healthy environments are essential to the achievement of long-term improvements in the health of the population, in creating and maintaining sustainable communities. Conversely, environmental degradation and global changes in climate, habitat, energy supplies and other key stressors can all have significant health consequences. Poor air quality is a significant public health issue and can be a result of vehicle emissions, industrial process emissions and bonfires. Air pollution is associated with a myriad of health problems including respiratory diseases such as emphysema and bronchitis, asthma, impaired lung development in children, premature births and low birth weight, lung cancer and heart disease.

It has been estimated that particulate air pollution in the UK is a contributor in nearly 29,000 deaths in 2008 and is associated with 340,000 life years lost.