What are Non-Communicable Diseases and why are they an urban problem?
Tackling the Root causes Upstream of Unhealthy Urban Development (TRUUD) is a UK research programme that aims to prevent non-communicable diseases (NCDs) and health inequalities linked to poor urban environments, in the future. This blog explores what NCDs are and some examples of why they are an urban problem.
What are Non Communicable diseases (NCDs)?
We are all affected by NCDs. It could be a friend, a member of our family or even ourselves who contract one or more NCDs in our lifetime. NCDs include diseases like cancers, type 2 diabetes, infections of the heart, kidney, and lungs, and the growing mental health crisis. These non-infectious diseases are responsible for nearly nine in ten of all deaths (89%) in the UK1 NCDs can also increase the risk of contracting communicable diseases, such as pneumonia or COVID-19.
Why are NCDs an urban problem?
Low quality urban and built environments increase the risk of chronic ill health, poor mental health and death, causing a huge burden to society. With four in five people in the UK living in towns or cities2, there are many ways urban living can affect our lifestyles and increase the risk of NCDs. The following list illustrates some examples where there is clear data about the relationship between urban environmental quality and NCDs, such as:
- poor access to healthy food, good quality green spaces and amenities;
- poor indoor environments, lacking access to natural light, space, ventilation and insulation;
- climate change risks, such as flooding and overheating;
- increased exposure to noise and air pollution.
People living in more deprived urban areas are especially vulnerable to NCDs through exposure to poorly designed and more polluted urban environments. Such health inequalities3 have increased in England since 20104. The average life expectancy for women in the most deprived areas in England is 8.7 years less than women living in the least deprived areas (79.7 and 86.4 years respectively). The average life expectancy for men in the most deprived areas is 9.4 years less than men in less deprived areas (74.1 and 83.5 years respectively)5. People from Pakistani, Bangladeshi, and Black African backgrounds are more likely to live in an urban location6, and different ethnic groups experience different levels of NCDs. For example older black and minority ethnic people report poorer health outcomes than older white people, even after controlling for social and economic disadvantages7,8.
Access to exercise, healthy diet and nature
Indoor environment and health
Climate change and increased health vulnerabilities
Mental health and noise pollution
Poor health and air pollution
Why look ‘upstream’?
The shocking thing is that NCDs are often avoidable – our diets, the way we travel and levels of activity, and the quality of the environment around us can significantly affect our risk of contracting NCDs. There are numerous factors, we can’t control directly, which can make it harder for us to live healthier lives, and more vulnerable to NCDs. These relate to the decisions that the government, local authorities, and companies take every day, which affect the quality of places we live in. The question is, what is preventing policy makers and corporate leaders from helping to create more healthy urban environments?
Tackling the Root causes Upstream of Unhealthy Urban Development (TRUUD) is a UK research programme that aims to map out the different urban systems, to look at these complex and interconnected drivers that are ‘upstream’ of urban health outcomes. We aim to identify how best to prevent NCDs and health inequalities in an urban context, and promote better health outcomes in the future. In our ‘Why TRUUD and why now?’ blog we start to unpack these underlying factors and outline how TRUUD plans to address them.
How can you help?
TRUUD involves a consortium of five universities (Bath, Bristol, Manchester, Reading, and UWE) working together to develop prototype solutions that will promote healthier urban development. We are working in partnership with stakeholders in Bristol City Council, Greater Manchester Combined Authority and other organisations in Greater Manchester and Bristol to design solutions that will work in practice.
If you would like to get involved and support this vital work, please contact us here.
1 NHS England (2018) Putting Health into Place. (england.nhs.uk), p2
3 Defined by the NHS as “unfair and avoidable differences in health across the population and between difference groups in society” https://www.england.nhs.uk/ltphimenu/definitions-for-health-inequalities
7 PHE (2018) Understanding and reducing ethnic inequalities in health Local action on health inequalities (publishing.service.gov.uk)
8 Evandrou M, Falkingham J, Feng Z, et al. (2016) Ethnic inequalities in limiting health and
self-reported health in later life revisited. Journal of Epidemiology Community Health 2016;70:653–662 https://jech.bmj.com/content/jech/70/7/653.full.pdf
9 WHO (2016) Urban green spaces and health, A review of evidence. p6 A4 Colour cover, vernacular (who.int),
13 Natural England (2009) http://publications.naturalengland.org.uk/publication/35009
14 Houses of Parliament (2016) Green space and health (parliament.uk) Parliamentary Office of Science and Technology
16 PHE (2018) Local action on health inequalities: Understanding and reducing ethnic inequalities in health Local action on health inequalities (publishing.service.gov.uk)
17 National Housing Federation (2020) Poor housing causing health problems for nearly a third of brits during lockdown
19 British Lung Foundation (2021) What are the effects of indoor pollution? | British Lung Foundation (blf.org.uk)
20 Glasgow Centre for Population Health (2013) The built environment and health: an evidence review https://www.gcph.co.uk/assets/0000/4174/BP_11_-_Built_environment_and_health_-_updated.pdf
21 Scottish Executive (2006) A Literature Review of the Social, Economic and Environmental Impact of Architecture and Design
22 Upstream (2018) Upstream_Brochure_WEB_single.pdf (urban-health-upstream.info)
23 MHCLG (2013/2014) English housing survey Relationship between health and home quality | The Health Foundation
24 3EG (2019, website viewed Sept 2021) 17,000 people in the UK died last winter due to cold housing
25 UK Parliament (2021) Overcrowded Housing (England. House of Commons Library Research Briefing SN01013.pdf (parliament.uk)
26 Aviva (2021) building-future-communities-report.pdf (aviva.co.uk)
27 Aviva (2021) op cit
28 The UK Climate Change Committee (2018) Climate change: the future of UK cities (theccc.org.uk)
30 Public Health England (2018) Health matters: reducing health inequalities in mental illness – GOV.UK (www.gov.uk)
31 Orban, et al (2016) Residential Road Traffic Noise and High Depressive Symptoms after Five Years of Follow-up: Results from the Heinz Nixdorf Recall Study | Environmental Health Perspectives | Vol. 124, No. 5 (nih.gov)
33 Centre for Cities (2020) Holding our breath — How poor air quality blights cities | Centre for Cities
34 Asthma Association (2018) auk-health-inequalities-final.pdf (asthma.org.uk)
36 Environment Agency (2021) State of the environment: health, people and the environment – GOV.UK (www.gov.uk)
37 DEFRA (2021) Emissions of air pollutants in the UK – Particulate matter (PM10 and PM2.5) https://www.gov.uk/government/statistics/emissions-of-air-pollutants/emissions-of-air-pollutants-in-the-uk-particulate-matter-pm10-and-pm25#major-emission-sources-for-pm10-and-pm25-in-the-uk
38 Royal College of Physicians (2016) https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution