Royal Commission on Environmental Pollution

Following the letter from Mr David Lewis dated 21 July 1999, the Royal College of General Practitioners welcomes the opportunity to respond to the Commission. The College has taken the opportunity to consult widely on this issue - and this includes specific groups within the College such as our Rural Practice Group, our Forum on Poverty and Health and our Inequalities in Health Task Group.

Health impact assessment should be considered along side environmental impact assessment in order to determine the effects of policies on sustainable development and the environment on the human society. Unfortunately, there are countless examples of planning decisions which have been taken with little if any regard for health issues. While health and social issues are important in planning decisions in any setting, there often seems to be a particular disregard of such issues in rural areas. Planning regulations often seem to favour developers rather than issues related to the health and social needs of the indigent community. "Demand" issues often outweigh "needs" issues which can cause imbalance in relationships in rural communities - and in term effect the sustainability of a community and so the environment. There is often conflict between national environmental strategies and local interests. It seems important that the health and social needs of rural communities should form part of the discussion for sustainable developments. Rural inequalities and social exclusion do exist although rural communities and problems are often isolated and scattered.

The National Health Service itself has a substantial "environmental footprint". Environmental assessment should be more strongly integrated into health service planning, for example, when constructing new hospitals and other health facilities.

There is only fragmentary knowledge about the impact of sustainable development policies and environmental change, including climate change on human health. Primary care data can make a useful contribution to better understanding of the complex links between environment and health. Primary care could have a useful role in helping to target the implementation of some policies designed both to alleviate the adverse affects of poverty on health and promote sustainable development. An example is the government's initiative on fuel poverty which seeks to target home improvements to elderly people who are particularly vulnerable. Primary care teams could play a useful role in determining who is likely to be vulnerable, as the current system (or lack of it) appears to be ad hoc and may well miss substantial numbers of people who might benefit.

Again with respect to rural communities, transport policy are/is of considerable importance. While it clearly makes sense to pursue "green" policies aiming to discourage use of hydrocarbons, there needs to be encouragement to develop imaginative solutions with respect to public service transport and the more efficient use of privately owned transport (car sharing, etc.). The development of roads and transport network has an impact on the environment and may cause deterioration of rural amenities. There may be benefit in looking at highly co-ordinated transport policies so that cars, buses and trains can be used in combination for a truly efficient service.

With the advent of Primary Care Groups and Trusts, health and social needs form part of the strategy for health improvement of populations. The Department of Health's recently published White Paper "Saving Lives - A Healthier Nation" looks at a public health approach to the population's health and is important when one considers the planning issues and the environment. Health and poverty are inextricably linked with education, employment, housing, transport and the environment. Through their growing links with local authorities and involvement with local public health strategies, primary care groups may play an important mediating role between the health sector and those concerned with environmental issues in local government.

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