The built and natural environment and health are inextricably linked. Both the built and natural environment are part of the wider determinants of health and wellbeing across the life course and have an influence on people’s physical and mental health, and on health inequalities. The quality of the built and natural environment can affect connectivity within a neighbourhood and people’s social networks, the location and quality of housing, exposure to air and noise pollution, safe and accessible transport and opportunities for active travel. It also plays a crucial role in promoting access to open space, employment and healthy food options (PHE Healthy Places).

The Public Health England Wider Determinants of Health profile for Bury shows that overall Bury is largely performing better or similar to the England average in most areas.

Bury is significantly better than England for Emergency hospital admissions due to falls in people aged 65 and over for 2021/22. Bury has the fifth lowest rate in this measure when compared to its statistical neighbours (Public Health Profiles). Falls are the largest cause of emergency hospital admissions for older people, and significantly impact on long term outcomes, e.g. being a major precipitant of people moving from their own home to long-term nursing or residential care (Department of Health (2012)).

The physical world around us has a direct impact on our health as well as indirect effects through constraining our options and influencing our behaviours. The availability of fast food in our environment is one such issue which is associated with a range of negative health outcomes. The density of fast food outlets in Bury is significantly higher than the figure for England according to 2014 figures (Public Health Profiles).

The percentage of adults in contact with secondary mental health services who live in stable and appropriate accommodation is significantly worse in Bury (53%) than it is for England (58%) for 2020/21 (Public Health Profiles). Maintaining stable and appropriate accommodation and providing social care in this environment promotes personalisation and quality of life, prevents the need to readmit people into hospital or more costly residential care and ensures a positive experience of social care.

Air pollution today remains the single biggest environmental threat to health in the UK, shortening tens of thousands of lives each year (Gov.UK Environment Agency). Poor air quality is a significant public health issue.  There is strong evidence that air pollution causes the development of coronary heart disease, stroke, respiratory disease, and lung cancer, exacerbates asthma and has a contributory role in mortality (Air Pollution Evidence Review – PHE 2019). Bury continues to have a lower rate of air pollution: fine particulate matter than England, and is similar to the rates seen across Bury’s statistical neighbours (Public Health Profiles). This refers to the annual concentration of fine particulate matter at an area level, adjusted to account for population exposure. Figure 1 below illustrates that rates of air pollution in Bury have decreased for 2020 following a slight increase in 2019, mirroring the trend seen nationally.

Access to green space such as woodland supports wellbeing and allows people to engage in physical activity. Both the presence of a woodland and the number of people who can readily access the space represents a significant asset to that community. Woodlands provide spaces for community activities, social connectedness, volunteering as well as employment. Despite having a higher rate of access to green space than England, the availability of woodland areas has decreased significantly in Bury between 2015 and 2020 (Public Health Profiles), as illustrated in Table 1 below. This refers to the estimated number of people living within 500m metres of an area of woodland two hectares or larger.

Availability of suitable housing is an important social issue as living in overcrowded conditions can have impacts on both physical and mental health. Overcrowding refers to the percentage of households with 1 or more rooms too few for the level of occupancy. Occupancy rating provides a measure of whether a household's accommodation is overcrowded or under occupied. Although Bury is significantly better than England for the proportion of households with overcrowding, there are major inconsistencies within Bury, as illustrated in Figure 2 below. East ward in Bury has a significantly higher proportion of overcrowded households, whereas North Manor has a significantly lower proportion (Public Health Profiles).

There is compelling evidence that the drivers of fuel poverty (low income, poor energy efficiency, and energy prices) are strongly linked to cold homes (UCL Institute of Health Equity (2011). The Health Impacts of Cold Homes and Fuel Poverty). A household is classified as being in fuel poverty if the household’s fuel poverty energy efficiency rating is band D or below and their disposable income (after housing and fuel costs) is below the poverty line. Fuel poverty is distinct from general poverty: not all poor households are fuel poor, and some households would not normally be considered poor but could be pushed into fuel poverty if they have high energy costs. There are 3 important elements in determining whether a household is fuel poor: household income, household energy requirements, and fuel prices. According to estimates from 2020, approximately 11,035 households in Bury are in fuel poverty. Bury has the same proportion of households in fuel poverty for 2020 as England at 13.2%, and is the fourth lowest amongst its statistical neighbours for this measure (Public Health Profiles). However, significant variations exist within Bury. Figure 3 below illustrates the geographical differences in wards in Bury, with regard to the estimated proportion of households in an area that experience fuel poverty based on the "Low Income Low Energy Efficiency" (LILEE) methodology (Public Health Profiles).

Evidence shows that living in cold homes is associated with poor health outcomes and an increased risk of morbidity and mortality for all age groups; furthermore, studies have shown that more than one in five (21.5%) excess winter deaths in England and Wales are attributable to the coldest quarter of housing (Public Health Profiles). There were 90 excess winter deaths in Bury for the period August 2019 – July 2020 which equates to 16.1%, not significantly different to the percentage for England for the same time period of 17.4% (Public Health Profiles).