Do health impacts of development differ between rural and urban settings?

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1 Do health impacts of development differ between rural and urban settings? Margaret Douglas Martin Higgins NHS Lothian Scottish Health and Inequalities Impact Assessment Network (on behalf of Rural Development Steering Group)

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4 It started with a windfarm Population influx Pressure on infrastructure Employment Traffic Heritage Community conflict Mental wellbeing

5 Scottish HIA Network

6 Methods Workshops with scenarios to scope common impacts Policy context and data Critical literature review Significance of the impacts for health Differences between rural and urban impacts Review of HIAs and HIA guidance Using the evidence - Key questions

7 94% of land mass 20% of population 1M people Older population Low pay, high costs Low unemployment, seasonal / second jobs High neighbourhood satisfaction Heterogenous population Urban-rural dynamic

8 Rural communities are often attractive for the very reasons that give rise to their problems. Manthorpe, J., et al., Elderly people's perspectives on health and well-being in rural communities in England: findings from the evaluation of the National Service Framework for Older People. Health & Social Care in the Community, (5): p

9 Social context Many reasons to live there! Low crime Sense of place and community Resilience of people Youth out-migration and ageing Different populations

10 Economic context Economy few major employers, lack of diversity Employment portfolio careers; low wages; few jobs for young people Cost of living fuel and food Housing cheaper than equivalent in cities but less choice so high overall costs

11 Physical context Access to Services need to travel long distances Physical Environment land use, physical terrain, water Infrastructure vulnerable supply and distribution chains

12 So in this context How might a development affect people and health?

13 Psychosocial impacts Solastalgia Good evidence of health impacts Many influences community involvement Social capital Good evidence of health impacts Concerns in many HIAs but limited evidence, could be positive or negative Integration of existing and new communities

14 Employment Clear impacts on health Importance of good work Common lack of required skills Impact on local economy Could be positive or negative Smaller local businesses more likely to use local supply chains

15 Infrastructure Water Transport / Traffic Housing Loss of amenity Pressure on services and/or needs for new and different services

16 Underpinning issues Population movement Magnitude of comparatively small changes in rural and remote areas with sparse populations.

17 Noise Accidents Pollutants Zoonoses Allergens Etc Plus all the more direct impacts Sector specific

18 Conclusions Many issues commonly identified in EIA but health impacts not unpicked Rural context does matter

19 Postscript

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