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Peter Brett Associates Health Impact Assessment (HIA) Scoping Paper

Trumpington Meadows Sustainable Urban Extension Health

Impact Assessment (HIA) Scoping Paper

The aim of this paper is to do a rapid scoping of the health and wellbeing issues
relating to the proposed mixed use development by the Trumpington Meadows Land
Company (TMLC) at Trumpington.

Our general HIA ethos and approach

The international Gothenburg consensus definition of health impact assessment (HIA)
is: “A combination of procedures, methods and tools by which a policy, program or project may
be judged as to its potential effects on the health of a population, and the distribution of those
effects within the population.”1

We see HIA as the key systematic approach to identifying the differential health and
wellbeing impacts, both positive and negative, of plans and projects. In this case the
proposed urban extension at Trumpington Meadows.

HIA uses a range of structured and evaluated sources of qualitative and quantitative
evidence that includes public and other stakeholders' perceptions and experiences as
well as public health, epidemiological, toxicological and medical knowledge. Our
approach is particularly concerned with the distribution of effects within a population, as
different groups are likely to be affected in different ways, and therefore we look at how
health and social inequalities might be reduced or widened by a proposed plan or

Our aim is to inform and influence clients and decision-makers by providing a rigorous
analysis of the potential impacts as well as recommending options, where appropriate,
for enhancing the positive impacts, mitigating the negative ones and reducing health

We use both a biomedical and social definition of health, recognising that though
illness and disease (mortality and morbidity) are useful ways of understanding and
measuring health they need to be fitted within a broader understanding of health and
wellbeing to be properly useful (See Fig 1).

WHO European Centre for Health Policy; Health impact assessment: main concepts and suggested
approach; Gothenburg consensus paper; WHO Regional Office for Europe; 1999.

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Peter Brett Associates Health Impact Assessment (HIA) Scoping Paper

Fig 1: The determinants of health and wellbeing2

We therefore use the following World Health Organization psycho-social definition of

health in our work: Health is “the extent to which an individual or group is able to
realise aspirations and satisfy needs, and to change or cope with the environment.
Health is therefore a resource for everyday life, not the objective of living; it is a
positive concept, emphasizing social and personal resources, as well as physical

This definition builds on and is complementary to the longer established World Health
Organization definition that “Health is a state of complete physical, social and mental
wellbeing and not simply the absence of disease or infirmity”4.

We follow standard accepted HIA methodology as set out by the Department of Health,
and the Health Development Agency (now the subsumed into the National Institute of
Clinical Excellence) and the Devolved Regions5 6 7 8.


Peter Brett Associates; Adapted from Dahlgren G and Whitehead, Policies and strategies to
promote social equity in health; Institute of Future Studies; Stockholm; 1991.
World Health Organization; Health Promotion: A Discussion Document on the Concepts and
Principles; WHO Regional Office for Europe; Copenhagen; 1984.
World Health Organization; Preamble to the Constitution of the World Health Organization as
adopted by the International Health Conference, New York, 19-22 June 1946, and entered into
force on 7 April 1948
Health Development Agency, Introducing health impact assessment (HIA)
informing the decision-making process, England; 2002.
NHS Executive; Resources for HIA: Volumes 1 & 2; England; 2000.
Welsh Assembly Government and Health Challenge Wales; Improving Health and Reducing
Inequalities: a practical guide to health impact assessment; 2004.
Public Health Institute of Scotland; HIA: a guide for local authorities; Scottish HIA
network; 2001.

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Peter Brett Associates Health Impact Assessment (HIA) Scoping Paper

Overall the indicators of health and wellbeing for people living in Cambridge
City and South Cambridgeshire show that they are two of the healthiest
places to live in England.

• Cambridge has one of the lowest deprivation measures in the country.
• It has high levels of decent local authority housing,
• There is high life expectancy and a lower than average number of
deaths from smoking, heart disease, stroke, and cancers. And a
higher than average proportion of the population are estimated to be
eating healthily.
• However, the difference in the life expectancy between the healthiest
and least healthy parts of the city is 7 years. This is high, with many
less healthy places having less inequality.
• The level of recorded violent crime is significantly higher than the
national average (although the total number of recorded crimes has
fallen over the past 3 years).
• In relation to children and young people there are high levels of GCSE
achievement and low levels of teenage pregnancy
• The proportion of older people helped to live at home in the county of
Cambridgeshire is much lower than the national average.
• The road trauma rate for people using roads in the area is high,
although, importantly, this may differ from the road trauma rates of
local residents.
• There are significantly higher numbers of hospital admissions related
to alcohol, even after taking into account the numbers of young
• The Community Strategy for Cambridge has identified some key
issues for the local population: traffic congestion and the need to
promote alternatives to car travel; crime and the fear of crime;
enough affordable housing; and the many needs of older people.

South Cambridgeshire10
• Cambridge has one of the lowest deprivation measures in the country.

Department of Health; Health Profile for Cambridge City;
www.communityhealthprofiles.info; 2006.
Department of Health; Health Profile for South Cambridgeshire;
www.communityhealthprofiles.info; 2006.

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Peter Brett Associates Health Impact Assessment (HIA) Scoping Paper

• Life expectancy for both men and women is well above average, even
when compared with similar areas.
• However, the difference in the life expectancy between the healthiest
and least healthy parts of the district is 6 years.
• The proportion of the population who smoke is low as is the
proportion who are estimated to binge drink.
• In relation to children and young people GCSE achievement is high
and teenage pregnancy is low.
• and the number of violent offences is relatively low.
• The number of older people who are supported at home in the county
of Cambridgeshire is significantly low.
• The population has grown by over a fifth during the past 20 years and
is likely to grow by a similar amount over the next twenty, with
important consequences for infrastructure and services.
• Local reports have recently emphasised a focus on: children and
young people; the importance of promoting healthier lifestyles
through increased physical activity, healthier eating and smoking
reduction; addressing inequalities; and improving and developing
services to enable older people to continue living independently at

Proposed development11

The proposed development includes the following uses, to be developed over

the period up to 2015:

• approximately 1,200 dwellings on 30 ha, including affordable housing, with one

parking space per dwelling plus an allowance for visitors’ parking

• two new access points onto Hauxton Road and an emergency access off
Grantchester Road

• land for a primary school

• land for other local community uses within the local centre, including live/work
or flexible ground floor space

• approximately 60 ha of riverside community park

• formal and informal open space, and children’s play space

Information sourced from the design and access statement and environmental
impact assessment and sustainability assessment.

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Peter Brett Associates Health Impact Assessment (HIA) Scoping Paper

• 0.5 ha of allotments

• a network of footpaths and cycleways

• a gateway feature into Cambridge city and the site.

Rationale for the proposed development12

The principle of sustainable urban extensions on the edge of Cambridge city

and of revisions to the green belt to accommodate this growth is well
established and was incorporated within the 2000 Regional Planning Guidance
for East Anglia. The Cambridgeshire Sub-Regional Study (2001) was
commissioned to identify where the green belt could be rolled back to
accommodate the substantial growth for Cambridge and its sub-region. Land
south of Cambridge was identified, which subsequently became known as the
Cambridge Southern Fringe.

The Cambridgeshire and Peterborough Structure Plan (2003) subsequently

incorporated policies for the delivery of the Southern Fringe. Policy P9/2C
requires a strategic master plan for the whole of the Southern Fringe to be
prepared, including land to the east and south of Trumpington. This requirement
has subsequently been satisfied through the Southern Fringe Area
Development Framework prepared by the city council to expand upon Policy
9/5 of the city local plan, and approved in January 2006.

Trumpington Meadows is identified for sustainable residential development as

part of the wider Cambridge Southern Fringe in both the emerging City Local
Plan and South Cambridgeshire Local Development Framework. Both provide
details of the Councils’ vision for the site, and guidance on the form and nature
of development anticipated, including the desired land use mix, accessibility,
and landscape and open space principles.

The historicity of the Southern Fringe urban expansion largely accounts for the
degree of consensus surrounding the local plan allocations that seek to
implement this.

Our approach to this HIA

Information sourced from the design and access statement and environmental
impact assessment and sustainability assessment.

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Peter Brett Associates Health Impact Assessment (HIA) Scoping Paper

Our approach is based on established good practice guidance on HIA developed by the
Department of Health and the Health Development Agency (now the subsumed into the
National Institute of Clinical Excellence) and the Devolved Regions. Given the nature of
the proposed development and its general fit with regional and local spatial plans we
consider a rapid health impact assessment (HIA) to be the most suitable type of HIA to
carry out.

The aim of our proposed rapid HIA will be to assess the potential positive and negative
health impacts on the existing communities around the proposed development and the
communities that are likely to live and work in the new development.

It will focus on seven key themes:

1. Consider how the development fits with the health, social care and wellbeing
(-related) policies and strategies of the local authority, PCT and region.

2. Analyse the potential positive and negative health and wellbeing effects of the
proposed development on existing and new communities.

3. Analyse health inequalities and social exclusion and the potential for this
proposed development to narrow or widen them.

4. Analyse the potential impacts on vulnerable groups in the community e.g. older
people, children, families, people with disabilities, people on low
incomes/unemployed, etc.

5. Analyse the potential indirect, cumulative and synergistic health impacts.

6. Analyse the potential impacts on health and social care services.

7. Develop mitigation and enhancement measures (alongside and complementary

to ones that have been described in the other assessment work carried out to

Scope of proposed HIA

The geographical scope of this HIA will be the development site and the wards
surrounding it. These are Trumpington, Haslingfield and The Eversdens, The Shelfords
and Stapleford, Harston & Hauxton and Barton in relation to Cambridge City and South
Cambridgeshire as a whole.

The population considered by this HIA are the resident population in the geographical
areas described above and the new people likely to move into the development. As

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Peter Brett Associates Health Impact Assessment (HIA) Scoping Paper

described above key vulnerable groups will be considered to assess any potential
health inequalities that might be widened or reduced by the proposed development.

The direct and wider determinants of health that we will consider are: infectious and
non-infectious diseases; accidents and physical injuries; mental health; employment
and enterprise; housing and accommodation; transport and connectivity; education and
learning opportunities; crime and safety; health and social care; retail shops and
amenities; social capital and cohesion; culture and leisure; lifestyle and daily routines;
land and spatial. One specific issue identified by a rapid review of the proposed
development is the level connectivity of the proposed greenspace to enable both new
residents of the development and the existing residents in the surrounding area to fully
use the planned greenspace within the proposed development.

The assessment will be largely qualitative except where data is available to enable
quantification or where quantification of health impacts has already been undertaken in
previous assessments e.g. technical studies for the environmental impact assessment

We will consider a range of information sources. These will include ONS census and
neighbourhood data; DoH health profiles; Audit Commission area profiles;
Cambridgeshire Observatory data; Eastern Health Observatory data; information from
Cambridgeshire PCT, Cambridge City Council and South Cambridgeshire Council; as
well as previous relevant HIA reports, databases and review of health impact evidence.
In relation to assessing the potential health and social care implications of the
proposed development we will use any local guidance that is available as well as good
practice guidance from elsewhere e.g. the London NHS Healthy Urban Development

We do not propose any HIA related wider stakeholder or community consultation as

given the nature of the development, the current outline level of design detail and the
previous consultations that have already taken place we do not consider that it would
provide additional data to this assessment.

We will use a matrix table to analyse the potential positive and negative health and
wellbeing impacts and classify impacts in the levels defined in Table 1 below. We will
compare the potential impacts to a ‘Do Nothing’ option for the construction, short term
operation and long term operational phases of the proposed development.

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Peter Brett Associates Health Impact Assessment (HIA) Scoping Paper

Table 1: Definition of the levels of potential impact

Significance Level Criteria

Severe ---- Only adverse effects are assigned this level of importance as
they represent key factors in the decision-making process, and
(negative only)
may threaten the viability of the project. These effects are
generally, but not exclusively, associated with sites and features
of international, national or regional importance. A change at a
regional or district scale site or feature may also enter this
category. Typically, mitigation measures are unlikely to remove
severe adverse effects.
Major +++/--- These effects are likely to be important considerations at a local
or district scale. If adverse, potential concerns to the project may
(positive or negative)
become key factors in the decision-making process. Mitigation
measures and detailed design work are unlikely to remove all of
the adverse effects upon the affected communities or interests.
Moderate ++/-- These effects, if adverse, while important at a local scale, are
unlikely to be key decision-making issues. Nevertheless, the
(positive or negative)
cumulative effect of such issues may lead to an increase in the
overall effects on a particular area or on a particular resource.
They represent issues where effects will be experienced but
mitigation measures and detailed design work may ameliorate
or enhance some of the consequences upon affected
communities or interests. Some residual effects will still arise.
Minor/Mild +/- These effects may be raised as local issues but are unlikely to
be of importance in the decision-making process. Nevertheless
(positive or negative)
they are of relevance in enhancing the subsequent design of the
project and the consideration of mitigation and/or compensation
Neutral/No Effect ~ No effect or effects which are beneath the level of perception or
within normal bounds of variation.

We will produce a health impact report detailing our findings. The broad structure of the
report will be:
• Executive Summary
• Introduction
• Brief summary of proposed development and context of proposed development
• Methodology
• Health and wellbeing policy context
• Baseline Assessment/ Community profile
• Summary of major pathways of health impact
• Analysis of proposed development against a Do Nothing Option
• Mitigation and enhancement measures
• Monitoring and evaluation measures
• Conclusion

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