Environment
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).
Air pollution: fine particulate matter
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 from Public Health England, 2019). The annual burden of long-term exposure to air pollution in the UK has been estimated to be an effect equivalent to 29,000 to 43,000 deaths at typical ages (UKHSA Chemical Hazards and Poisons Report, 2022).
Although air pollution can be harmful to everyone, it particularly affects people living in polluted areas, those who are exposed to higher levels of air pollution in their day to day lives, and those who are more susceptible to health problems caused by air pollution, widening health inequalities.
The annual average metric is a summary of typical environmental conditions and the population weighting accounts for human exposure. In addition to this indicator, other air pollutants (such as NO2), as well as indoor air pollutants, are also considered important. However, methodological considerations make it impractical to include these in a health outcomes indicator at present. This indicator aims to support local areas to prioritise action on air quality to help reduce the health burden from air pollution.
This indicator is defined as annual concentration of PM2.5 (fine particulate matter) at an area level (mean), adjusted to account for population exposure. PM2.5 means the mass (in micrograms) per cubic metre of air of individual particles with an aerodynamic diameter generally less than 2.5 micrometers. PM2.5 is also known as fine particulate matter
Air pollution (fine particulate matter or PM2.5 concentration) in Bury was 7.1 µg/m3 compared to England average of 7 µg/m³ placing Bury in the middle quintile in England. An analysis of trend data for Bury shows that the average PM2.5 concentration rose from 8.2 µg/m³ in 2018 to 8.8 µg/m³ in 2019, before dropping sharply to 7.1 µg/m³ in both 2020 and 2021. It then increased slightly to 7.6 µg/m³ in 2022, followed by a return to 7.1 µg/m³ in 2023. Similarly, across England, PM2.5 levels declined from 9.5 µg/m³ in 2018 to 7.5 µg/m³ in 2020, rose modestly to 7.8 µg/m³ in 2022, and then fell again to 7.0 µg/m³ in 2023. These significant reductions in 2020 align with the onset of the COVID-19 pandemic, during which lockdowns and reduced economic activity contributed to lower air pollution levels nationwide (Figure 1).
Figure 1: Mean annual concentration of PM2.5 (fine particulate matter) at an area level µg/m³ (adjusted to account for population exposure) in Bury and England from 2018-2023
Bury has the 8th highest levels of air pollution in its group of 16 similar local authorities, with the highest level in Bexley of 7.8 µg/m³ and lowest in Telford and Wrekin of 5.7 µg/m³. No data on inequities are available for Bury. Data at England level shows higher levels of air pollution in three most deprived deciles and lower in the less deprived deciles.
Estimated fraction of mortality attributable to particulate air pollution
This indicator presents fraction of annual all cause adult mortality attributable to particulate air pollution (measured as fine particulate matter, PM2.5) and is measured as proportion for all individuals aged 30+ years. The proportion in Bury for the year 2023 was 5.3% compared to 5.2% in England. Statistical comparison for this indicator was not available. In Bury, the proportion increased slightly from 6.1% in 2018 to 6.5% in 2019, before dropping significantly to 5.3% in both 2020 and 2021. It then rose modestly to 5.6% in 2022, followed by a slight decline to 5.3% in 2023. Across England, the trend was similar: the proportion remained stable at 7.1% in 2018 and 2019, then fell sharply to 5.6% in 2020 and 5.5% in 2021, before decreasing further to 5.2% in 2023 (Figure 2).
Figure 2: Fraction of annual all cause adult mortality attributable to particulate air pollution (measured as fine particulate matter, PM2.5) in Bury and England from 2011-2023
Bury has the 8th highest fraction of annual all cause adult mortality attributable to particulate air pollution (measured as fine particulate matter, PM2.5) in its group of similar local authorities, with the highest level in Bexley of 5.8% and lowest in Telford and Wrekin of 4.3%. No data on inequities are available for Bury. Data at England level shows that mortality attributable to PM2.5 is higher in more deprived areas, with the proportion gradually decreasing as deprivation levels lessen.
Population exposed to road, rail and air transport noise of 65dB(A) or more, during the daytime
There are a number of direct and indirect links between exposure to noise and health and well-being outcomes. Exposure to noise can cause disturbance and interfere with activities, leading to annoyance and increased stress. Furthermore, there is increasing evidence that long term exposure to high levels of noise can cause direct health effects such as heart attacks and other health issues. The Government's policy on noise is set out in the Noise Policy Statement for England. The policy's long-term vision aims to promote good health and a good quality of life through the effective management of noise in the context of Government policy on sustainable development. Within this context and through the effective management and control of environmental, neighbour and neighbourhood noise, the policy aims to:
- avoid significant adverse impacts on health and quality of life;
- mitigate and minimise adverse impacts on health and quality of life; and
- where possible, contribute to the improvement of health and quality of life
This indicator is defined as noise exposure determined by strategic noise mapping produced in connection with the Environmental Noise (England) Regulations (‘the Regulations’) using national calculation methods and input data supplied from the relevant authorities. The results overlaid on a residential population dataset to determine number of people exposed per authority and is measured as a proportion (%).
The percentage of the population exposed to road, rail and air transport noise of 65dB(A) or more, during the daytime in Bury for the year 2021 was 5% compared to England average of 4.3%, placing it in the 2nd worst quintile. Data points for this indicator are available at five-year intervals, starting from 2006. Figure 3 shows that the percentage of the population in Bury exposed to transport noise levels of 65dB(A) or more has declined over time from 9.5% in 2006 to 5.0% in 2021. This trend suggests a gradual reduction in high noise exposure. In comparison, the England average remained relatively stable, ranging from 5.2% to 5.5%, and was consistently lower than Bury until 2021, when Bury's rate dropped slightly below the national average.
Figure 3: Percentage (%) of the population in Bury exposed to transport noise levels of 65dB(A) or more during day time in Bury and England from 2006-2021
Bury has the 5th highest proportion of the population in Bury exposed to transport noise levels of 65dB(A) or more in its group of similar local authorities, with the highest proportion in Sutton of 6.7% and lowest in Telford and Wrekin of 1.1%. No data on inequities are available for Bury. Data at England level shows that more deprived areas tend to have higher percentages of population exposed to transport noise levels of 65dB(A) or more, while less deprived areas generally show lower percentages. Although there are some fluctuations, the overall pattern indicates a greater exposure or impact in more deprived communities.
Population exposed to road, rail and air transport noise of 65dB(A) or more, during the night-time
The percentage of the population exposed to road, rail and air transport noise of 65dB(A) or more, during the night-time in Bury for the year 2021 was 12.3% compared to England average of 8.4%, placing it in the worst quintile. Data points for this indicator are available at five-year intervals, starting from 2006. Figure 4 shows that the percentage of the population exposed to night-time transport noise levels of 65dB(A) or more dropped significantly from 34.4% in 2006 to 13.4% in 2011, and remained relatively stable thereafter, with a slight decline to 12.3% in 2021.
Across England, the trend also shows a gradual decline over the same period, though the national exposure levels were consistently lower than Bury’s, indicating that Bury had a higher proportion of its population affected by night-time transport noise throughout the years (Figure 4).
Figure 4: Percentage (%) of the population in Bury exposed to transport noise levels of 65dB(A) or more during night-time in Bury and England from 2006-2021
Bury has the highest proportion of the population in Bury exposed to transport noise levels of 65dB(A) or more at night time in its group of similar local authorities, with the lowest proportion in Telford and Wrekin of 2.6%. No data on inequities are available for Bury. The general trend for England shows no consistent linear relationship between deprivation and exposure to night-time transport noise of 65dB(A) or more. While some of the more deprived deciles show higher exposure levels, the values fluctuate across the spectrum, indicating that exposure is not strictly tied to deprivation level in this case.
Rate of complaints about noise
This indicator is defined as the number of complaints per year per local authority about noise per thousand population (according to statistics collected by the Chartered Institute of Environmental Health (CIEH)). It is measured as a crude rate per 1,000 population all ages. The rate of complaints about noise for the year 2023/24 in Bury was 5.3 per 1,000 population, statistically better than England average of 5.3 per 1,000 population. In Bury, the rate of noise complaints remained relatively stable between 2010/11 and 2019/20, fluctuating between 4.1 and 5.0 complaints per 1,000 population. However, there was a sharp spike to 12.1 in 2020/21, likely linked to the COVID-19 lockdowns, before falling back to 5.3 in 2023/24. Across England, there was a gradual decline from 7.8 in 2010/11 to the mid-6s, followed by a similar spike during 2020/21, and then a return to lower levels post-pandemic. This suggests that both Bury and England experienced a temporary surge in noise complaints during the pandemic, likely due to increased time spent at home and heightened sensitivity to local disturbances (Figure 5).
Figure 5: Crude rate of complaints about noise per 1,000 population in Bury and England from 2010/11-2023/24
Bury has the 3rd highest rate in its group of similar local authorities, with the lowest rate in Bolton of 306 and the highest in Sutton of 6.2. No data on inequities are available for Bury and England.
Number of premises licensed to sell alcohol per square kilometre
Local authorities have a demand for better local information on the supply and demand for alcohol in their areas so that this information can be seen alongside alcohol harms. Licensing is one of the few areas where local areas have the power to act to reduce alcohol availability. By including this data in LAPE LAs can compare the number and density of licensed premises in their area with similar areas and with areas experiencing similar harms. Bury has developed an alcohol licensing matrix available here.
The number of premises licences and club premises certificates permitted to sell or supply alcohol per square kilometre in Bury was 5.4 in 2023/24, statistically worse than England average of 1.3. Trend data suggests that the number of premises licences and club premises certificates permitted to sell or supply alcohol per square kilometre in Bury has remained relatively stable, increasing slightly from 5.2 in 2015/16 to 5.5 in 2021/22, before a small dip to 5.4 in 2023/24. Across England, the rate has been consistently lower, holding steady at around 1.2 to 1.3 throughout the same period, with minimal variation. This indicates that Bury has a much higher density of licensed premises compared to the national average (Figure 6).
Figure 6: Number of premises licensed to sell alcohol per square kilometre in Bury and England from 2015/16-2023/24
Bury has the 5th highest rate in its group of similar local authorities, with the lowest rate in Bexley of 10.1 and the highest in Telford and Wrekin of 1.7. No data on inequities are available for Bury. Data for England are available by deprivation and suggests that more deprived areas tend to have a higher density of premises licensed to sell alcohol, with the most deprived decile having the highest rate at 7.9 premises per square kilometre. In contrast, less deprived areas have significantly lower densities, generally below 1.5 premises per square kilometre, indicating a clear association between deprivation and alcohol outlet density.
Fast food outlets per 100,000 population
The environment in which we live and work has positive and negative effects on our health and wellbeing. One component of the built up environment is food outlets and the choices they provide. Meals eaten outside of the home tend to be associated with higher calories, and portion sizes tend to be bigger, which can make it more challenging to eat healthily. The neighbourhood food environment is one important modifiable determinant of dietary behaviour and obesity.
The availability of fast food in our environment is one issue, within a complex system, which is associated with a range of negative health outcomes and contributes to the obesogenic nature of some of our neighbourhoods. Fast food is more abundantly available in the most deprived areas of England where obesity in children and adults and the associated health conditions, such as type 2 diabetes, hypertension, and heart disease are most prevalent.
This indicator is designed to help users understand the number of fast food outlets in an area taking the size of the population into account. It is intended to support national policy making and influence planning activities in local authorities with the aim of reducing the availability of fast food, where this is deemed desirable, in order to improve health outcomes.
It is defined as crude rate per 100,000 population: the number of fast food outlets is divided by the population of the area and multiplied by 100,000. The rate in Bury for the year 2024 was 165.7 per 100,000 population, statistically worse than England average of 115.9 per 100,000. No trend data are available for this indicator for Bury and England. Bury has the 2nd highest rate of fast food outlets per 100,000 population, with the highest rate in Tameside of 170.5 per 100,000 and lowest in Bracknell Forest of 63.1 per 100,000. No data by inequities are available for Bury. Data for England are available by levels of deprivation, with increasing rate of fast food outlets per 100,000 population by increasing levels of deprivation. The highest rate is in the most deprived decile of 147.7 per 100,000 population and lowest is in the least deprived decile of 81.1 per 100,000 population.
Access to Healthy Assets & Hazards Index
The Access to Healthy Assets and Hazards (AHAH) index is designed to allow policy/decision makers to understand which areas have poor environments for health, and to help move away from treating features of the environment in isolation. The index captures multidimensional features of the built environment including accessibility to retail services (e.g., fast food outlets, pubs, gambling stores), health services, green and blue spaces, and overall air quality. These features are potentially harmful to health and the overall index captures unhealth environments. The AHAH index is comprised of four domains: access to retail services (fast food outlets, gambling outlets, pubs/bars/nightclubs, off licences, tobacconists), access to health services (GP surgeries, A&E hospitals, pharmacies, dentists and leisure centres), the physical environment (access to green spaces, and three air pollutants: NO2 level, PM10 level, SO2 level) and air pollution (NO2 level, PM10 level, SO2 level). The AHAH index provides a summary of an area's relative performance on these indicators (the second and third domains conceptualised as health promoting and the first (access to retail) as health demoting). It therefore provides information on how conducive to good health an area is relative to other areas, for the specific indicators. PHE's Spatial Planning for Health document states that an 'ever-increasing body of research indicates that the environment in which we live is inextricably linked to our health across the life course. For example, the design of our neighbourhoods can influence physical activity levels, travel patterns, social connectivity, mental and physical health and wellbeing outcomes.The indicator is intended to support interventions to improve the health promoting qualities of the environment, and is primarily aimed at those working in public health roles in local authorities. The AHAH index is originally produced at LSOA level as an average of values for constituent postcodes, but is required at local authority and higher geographical levels in this profile. Using the percentage of the population living in LSOAs in the worst quintile as the indicator focusses on the people exposed to the most health demoting environments. An alternative measure, to average the AHAH index value of constituent LSOAs for each higher geographical unit, becomes increasingly less useful as the size of the unit increases: an LSOA average can be thought to apply more or less to those living in that LSOA (for the majority of LSOAs), whereas an average across a local authority has a more difficult interpretation. Some of indicators in the AHAH index overlap partially with individual indicators already in the natural and built environment domain (Number of premises licensed to sell alcohol per square km, Density of fast food outlets, and Air pollution: particulate matter). In contrast to the individual indicators that provide detail on specific measures which are considered important to bring attention to, the AHAH index provides an easily accessible summary of these features of the built environment.
This indicator measures the percentage of the population who live in LSOAs which score in the poorest performing 20% on the Access to Healthy Assets & Hazards (AHAH) index. The proportion in Bury for the year 2024 was 6.9%, lower than England average of 20.9% and placing Bury in the best quintile in England. There appear to be issues with trend data and it will not be presented here. Bury has the 6th lowest proportion in its group of 16 similar local authorities, with the highest proportion in Bexley of 24.2% and lowest in Telford and Wrekin of 2.1% No data by inequities are available for Bury. Data for England are available by levels of deprivation. In general, the indicator shows that people living in more deprived areas in England are more likely to reside in locations with poor access to healthy assets and greater exposure to hazards. As deprivation decreases, the percentage of the population living in these poorly performing areas tends to decline, although the trend is not perfectly linear.
Affordability of Home Ownership
Housing affordability affects where people live and work, and factors that influence health including the quality of housing available, poverty, community cohesion, and time spent commuting.[ Housing is an important social determinant of health, and the link between housing and health is widely acknowledged. There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. In a study by Pollack et al. ‘the strongest associations were found between housing unaffordability and cost-related outcomes, supporting the mechanism that unaffordable housing is associated with financial trade-offs and reduced discretionary spending on health-related expenses. It is possible that, over time, these trade-offs may have a deleterious effect on health, for example, by reducing one's ability to successfully manage chronic conditions or decreasing the use of preventive services. Lack of housing affordability may be a sensitive marker for other forms of material deprivation such as food insecurity’.
This indicator, based on median house price and median earnings in a given area, is just one way of looking at affordability of home ownership. Its strengths lie in providing a simple, broad and comparable measure across areas. It is defined as ratio of median house price to median gross annual residence-based earnings (A higher ratio indicates that on average, it is less affordable for a resident to purchase a house in their local authority district)
In 2023, the house price-to-earnings ratio in Bury was 6.8, which is lower than the England average of 8.3 and places Bury in the second-best quintile nationally. Looking at the trend over time, Bury’s ratio increased steadily from 3.2 in 2002 to 5.9 in 2019. It then dipped slightly to 5.5 in 2020, followed by a sharp rise to 6.6 in 2021, before stabilising at 6.8 in both 2022 and 2023. This means that although house prices in Bury have become less affordable over time, rising steadily in relation to local earnings, the area still remains more affordable than much of England, suggesting relatively better housing affordability compared to the national average. The ratio in England increased from 5.1 in 2022 to a peak 9.1 in 2021, before declining to 8.3 in 2023.
Bury has the 9th highest rate in its group of similar local authorities, with the highest rate in Sutton of 11.7 and lowest in Stockton-on-Tees of 5. No data by inequities are available for Bury and England.
Killed and seriously injured casualties on England's roads
Motor vehicle traffic accidents are a major cause of preventable deaths and morbidity, particularly in younger age groups. The vast majority of road traffic collisions are preventable and can be avoided through improved education, awareness, road infrastructure and vehicle safety. The need for safer roads is also linked to public health strategy, and existing government backed initiatives, to increase "active travel" and physical activity.
The Royal Society for the Prevention of Accidents have issued a guide to Road Safety and Public Health (2014), which explores the relationship between road safety and public health aims. The guide recommends that public health and road safety teams identify areas for collaborative working and potential benefits of road safety initiatives on other health issues, and share data and evidence to identify effective actions and evaluate their impact.
This indicator presents crude rate for the number of people reported killed or seriously injured on the roads, all ages, per 1 billion vehicle miles travelled. The rate in Bury for the year 2023 was 47.1, statistically better that England average of 91.9. Between 2017 and 2023, Bury experienced a general downward trend in the rate of people killed or seriously injured on the roads, falling from 67.8 in 2017 to 47.1 in 2023, with a peak of 70.6 in 2021. In comparison, the rate for England remained relatively stable, ranging from 89.9 in 2019 to 94.5 in 2018, and ending at 91.9 in 2023. This indicates that while national figures have stayed consistently high, Bury has seen a more noticeable improvement in road safety over time (Figure 7).
Figure 7: Crude rate for the number of people reported killed or seriously injured on the roads, all ages, per 1 billion vehicle miles travelled in Bury and England from 2017 – 2023
Bury has the lowest proportion in its group of 16 similar local authorities, with the highest in Sutton of 148.9. . No data by inequities are available for Bury and England.
Fuel Poverty
A household is considered to be fuel poor if they are living in a property with a fuel poverty energy efficiency rating of band D or below And when they spend the required amount to heat their home, they are left with a residual income below the official poverty line. There is compelling evidence that the drivers of fuel poverty (low income, poor energy efficiency, and energy prices) are strongly linked to cold homes. 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. The Government is interested in the amount of energy households need to consume to have a warm, well-lit home, with hot water for everyday use, and the running of appliances. Therefore fuel poverty is measured based on required energy bills rather than actual spending. This ensures that those households who have low energy bills simply because they actively limit their use of energy at home, for example, by not heating their home are not overlooked.
This indicator is defined as the percentage of households in an area that experience fuel poverty based on the "low income, low energy efficiency (LILEE)" methodology. The percentage in Bury for the year 2022 was 13.1% similar to England average of 13.1%, placing it in the middle quintile. Trend data for Bury suggests that from 2019 to 2022, the percentage of households experiencing fuel poverty remained relatively stable, fluctuating slightly between 13.1% and 13.4%. Similarly, the rate for England also stayed consistent, ranging from 13.1% to 13.4%. Overall, Bury closely mirrored the national average throughout this period.
Bury has the 7th highest proportion in its group of 16 similar local authorities, with the highest proportion in Calderdale of 18.1% and lowest in Bracknell Forest of 6.1%. No data by inequities are available for Bury. Data for England are available by levels of deprivation, ethnic group, household composition, tenure, rurality, disability and working status. Fuel poverty is more prevalent among households facing higher levels of deprivation, with 19.1% of individuals in the most deprived decile affected, compared to just 8.9% in the least deprived. Ethnic disparities are also evident, as 17.2% of people from ethnic minority groups experience fuel poverty, compared to 12.4% among white ethnic groups. Household composition plays a significant role: the highest rates are seen in lone parent households with dependent children (29.3%), while the lowest are in couples under 60 without dependent children (6.8%). Among older adults, 13.4% of single-person households with someone aged over 60 are affected. Rurality also influences fuel poverty, with 15.1% of households in rural villages, hamlets, and isolated dwellings impacted, compared to 12.9% in urban areas. Additionally, 17.4% of households with a disability experience fuel poverty, in contrast to 10.4% of those without a disability.