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HSE Public Health, Area A CC: DR EAMONN O’MOORE, DIRECTOR FOR NATIONAL HEALTH PROTECTION CC: MR CATHAL FLYNN, DIRECTOR OF ECONOMIC DEVELOPMENT, PLANNING & CAPITAL PROJECTS 1 HSE Public Health, Area A (Cavan, Louth, Meath, Monaghan & North Dublin) FSS Sláinte Poiblí, Ceantar A (An Cabhán, An Lú, An Mhí, An Muineachán agus Baile Átha Cliath Thuaidh) T: + 353 46 928 2700 | F: + 353 46 928 2744 | For Cavan, Louth, Meath & Monaghan, use: Unit H/I, Kells Business Park, | Cavan Road | Kells | Co Meath A82 W2P3 Aonad H/I Páirc Ghnó Cheanannais | Bóthar an Chabháin | Ceanannas | Co na Mí A82 W2P3 For North Dublin, use: Dr. Steevens’ Hospital |Dublin 8 | D08 W2A8 Ospidéal Dr. Steevens’ | Baile Átha Cliath 8 | D08 W2A8 TO: Ms Claire O’Dwyer Principal Environmental Health Officer FROM: Dr Keith Ian Quintyne Consultant in Public Health Medicine (sí Health Protection) RE: Environmental & Health Impact: ‘EHIS Reference Number: 3171 - Notice of Intention to Review Monaghan CDP 2019-2025 and Prepare Monaghan CDP 2025-2031’ DATE: 6th July 2023 Thank you for the opportunity for HSE Public Health, Area A (covering counties Cavan, Louth, Meath, Monaghan and North Dublin) to provide a submission on the proposed Monaghan CDP 2025 - 2031. The following submission represents the views HSE Public Health, Area A, and does not necessarily reflect the views of the population living in the area. Please refer to APPENDIX A for more information on HSE Public Health, Area A. Dr Keith Ian Quintyne will be the primary contact for this submission, if further input is required from HSE Public Health, Area A. Yours sincerely Dr Keith Ian Quintyne Dr Ciara Carroll MBBS MD MPH PgCertMed E AdDipMedL FRCPI FFPHMI FFPH MB BCh BAO MSc DOWH ProfCert (Statistics) Consultant in Public Health Medicine SpR in Public Health Medicine MCRN: 239386 MCRN: 414987 CC: DR EAMONN O’MOORE, DIRECTOR FOR NATIONAL HEALTH PROTECTION CC: MR CATHAL FLYNN, DIRECTOR OF ECONOMIC DEVELOPMENT, PLANNING & CAPITAL PROJECTS 2 INTRODUCTION Thank you for the opportunity for HSE Public Health, Area A to make a submission on the Review of the Monaghan County Development Plan 2019-2025 and Preparation of the Monaghan County Development Plan 2025-2031 - Strategic Issues & Options Paper. In this submission, we will focus on the following sections of the paper:  Environmental Assessment and Monitoring;  Housing Strategy;  Climate Change, Environment and Heritage;  Infrastructure and Services; and  Community Services / Facilities. ENVIRONMENTAL ASSESSMENT AND MONITORING What objectives and policies are needed within the development plan to protect and enhance the environment? We would recommend incorporating the following objectives within the development plan to protect and enhance the environment while improving public health:  Promote the use of sustainable energy sources for all local-authority related activities and infrastructure (including social housing) to reduce emissions of greenhouse gases, in turn reducing air pollution and decreasing the risk of cardiovascular and respiratory disease.1  Ensure that there are sufficient waste management installations in the county while keeping the health and environmental impact of these to a minimum through regulation and identifying appropriate locations based on economic, environmental and social criteria.2  Develop green space and support biodiversity to mitigate heat, noise and air pollution and promote better physical and mental health in Co Monaghan.3 HOUSING STRATEGY Is there enough social housing and is it in the right places? Development of social housing should keep pace with the increasing population and associated demand in Co Monaghan to reduce the potential for housing insecurity to negatively impact 1 Landrigan PJ. Air pollution and health. The Lancet Public Health 2017;2(1):e4-e5. doi: 10.1016/S2468- 2667(16)30023-8 2 Mohan R, Spiby J, Leonardi GS, et al. Sustainable waste management in the UK: the public health role. Public health 2006;120(10):908-14. doi: https://doi.org/10.1016/j.puhe.2006.05.021 3 Aerts R, Honnay O, Van Nieuwenhuyse A. Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces. Br Med Bull 2018;127(1):5-22. doi: 10.1093/bmb/ldy021 CC: DR EAMONN O’MOORE, DIRECTOR FOR NATIONAL HEALTH PROTECTION CC: MR CATHAL FLYNN, DIRECTOR OF ECONOMIC DEVELOPMENT, PLANNING & CAPITAL PROJECTS 3 human health, particularly mental health.4 Social housing should be provided in mixed tenure communities to promote social integration and community cohesion,5 and to avoid the potential negative health effects associated with segregation including obesity, cancer, poorer pregnancy outcomes and increased mortality.6 Social housing (as well as private housing) should be built to a high standard to ensure that houses are warm and large enough to accommodate residents to promote good physical and mental health, particularly amongst children. 7 What facilities are required to support housing in both rural and urban locations? Housing developments should be accompanied by adequate green space that is suitable for outdoor recreation for people of all ages, particularly children and older adults, to improve mental health and cognitive function, protect against chronic illness and promote healthy ageing.8910 Residential areas should be designed to enhance walkability and should be well connected with facilities such as schools, retail outlets and health facilities by safe and efficient active transport infrastructure to promote physical activity, support mental wellbeing and encourage social engagement.11 CLIMATE CHANGE, ENVIRONMENT AND HERITAGE What should we be doing within the County to address climate change? We would recommend the following measures to address climate change while also promoting better health for the population of Co Monaghan:12  Shift energy production to use more solar and wind power to improve air quality.  Enhance energy efficiency by increasing the use of smart thermostats, better insulation, retrofitting buildings and using LED lighting to improve air quality.  Promote active transport to improve air quality and increase physical activity. 4 Vásquez-Vera C, Carrere J, Borrell C, et al. Neglected housing insecurity and its relationship with renters health: the case of Barcelona, Spain. Gac Sanit 2022;36(3):207-13. doi: 10.1016/j.gaceta.2021.08.005 [published Online First: 20211103] 5 Norris M, Hayden A, McMahon E, et al. Social Housing in Mixed Tenure Communities. In: Agency. RCftICfSHaTH, ed., 2021. 6 Kramer MR. 'Residential Segregation and Health'. In: Kawachi I, Berkman LF, eds. Neighborhoods and Health. New York: Oxford Academic Press. 2018. doi: 10.1093/oso/9780190843496.003.0012 7 Laurence J, Russell H, Smyth E. Housing adequacy and child outcomes in early and middle childhood: ESRI, 2023. 8De Keijzer C, Bauwelinck M, Dadvand P. Long-term exposure to residential greenspace and healthy ageing: A systematic review. Current environmental health reports 2020;7:65-88. 9Jimenez MP, DeVille NV, Elliott EG, et al. Associations between nature exposure and health: a review of the evidence. International Journal of Environmental Research and Public Health 2021;18(9):4790. 10 McCormick R. Does access to green space impact the mental well-being of children: A systematic review. Journal of pediatric nursing 2017;37:3-7. 11 Bird EL, Ige JO, Pilkington P, et al. Built and natural environment planning principles for promoting health: an umbrella review. BMC public health 2018;18(1):930. doi: 12 Mailloux NA, Henegan CP, Lsoto D, et al. Climate Solutions Double as Health Interventions. Int J Environ Res Public Health 2021;18(24) doi: 10.3390/ijerph182413339 [published Online First: 20211218] CC: DR EAMONN O’MOORE, DIRECTOR FOR NATIONAL HEALTH PROTECTION CC: MR CATHAL FLYNN, DIRECTOR OF ECONOMIC DEVELOPMENT, PLANNING & CAPITAL PROJECTS 4  Protect and restore ecosystems such as forests and grasslands to improve water quality, reduce potential for environmental extremes and promote better mental health. INFRASTRUCTURE AND SERVICES How can the use of public transport, cycling and walking be encouraged? Cycling and walking should be encouraged to promote physical activity and health,13 cardiovascular and respiratory health,13 and mental health.14 Cycling has been associated with additional benefits such as reduced air and noise pollution,15 increased social cohesion and interaction,16 decreased road danger for cyclists and motorists,16 and enhanced accessibility to businesses.17 To enable safe and equitable participation in active transport, the following measures are recommended, as outlined by the World Health Organization (WHO) Global Action Plan on Physical Activity 2018-2020:18  Develop a safe, high quality network for walking, cycling and other forms of mobility on wheels (including wheelchairs), incorporating the principles of universal and equitable access for people of all ages and abilities.  Increase the connectedness of walking and cycling networks to promote safe access to services including educational facilities, sports and leisure facilities, green areas, local shops and public transport hubs.  Prioritise actions that reduce risk for the most vulnerable road users, such as the development of pedestrian and cycle infrastructure which is segregated from motor vehicle and appropriate speed restrictions (i.e. 30km/hr in residential areas) and traffic calming interventions. There should be a particular focus on zones close to schools and other educational facilities.  Where possible, future development within Fingal should aim to locate educational settings, workplaces and other services together, to enable efficient access by walking and cycling.  Uptake of active transport should be promoted through social marketing campaigns and the implementation of policies and programmes which encourage walking and cycling, such as travel to school or work initiatives, or the implementation of cycle hire schemes. 13 De Hartog JJ, Boogaard H, Nijland H, Hoek G. Do the Health Benefits of Cycling Outweigh the Risks? Environmental Health Perspectives. 2010; 118(8): 1109-1116. Doi: 10.1289/ehp.0901747 14 Kelly P, Williamson C, Niven A, Hunter R, Mutrie N, & Richards J. Walking on sunshine: scoping review of the evidence for walking and mental health. British Journal of Sports Medicine. 2018; 52 (12): 800 - 806. 15 World Health Organization (WHO), Regional Office for Europe. Implementation Framework for Phase VII (2019 - 2024) of the WHO European Healthy Cities Network: Goals, Requirements and Strategic Approaches. World Health Organisation. 2019. Available at: https://apps.who.int/iris/bitstream/handle/10665/346087/WHO- EURO-2019-3478-43237-60598-eng.pdf?sequence=3&isAllowed=y (Accessed 03 Jul 2023) 16 Marshall WE, Ferenchak NN. Why cities with high bicycling rates are safer for all road users. Journal of Transport & Health. 2019; Vol 13: 100539. 17 Lee A, March A. Recognising the economic role of bikes: sharing parking in Lygon Street, Carlton. Australian Planner. 2010; 47 (2): 85-93. DOI: 10.1080/07293681003767785 18 World Health Organisation (WHO). Global action plan on physical activity 2018–2030: more active people for a healthier world. World Health Organisation. 2018. Available at: https://www.who.int/publications/i/item/9789241514187 (Accessed 03 Jul 2023) CC: DR EAMONN O’MOORE, DIRECTOR FOR NATIONAL HEALTH PROTECTION CC: MR CATHAL FLYNN, DIRECTOR OF ECONOMIC DEVELOPMENT, PLANNING & CAPITAL PROJECTS 5 Public transport is associated with increased physical activity,19 with improved access to public transport suggested as a means to reduce healthcare costs.20 To encourage the use of public transport, the following measures are advised as proposed by the WHO:18  Provide public transport that is accessible to all and integrated with facilities for pedestrians and cyclists in urban, peri-urban and rural communities.  Public transport should be as cost-effective, efficient and accessible as private motor vehicles. Services should have sufficient capacity, coverage and frequency to support this, and should be accessible to people of all ages and abilities. COMMUNITY SERVICES / FACILITIES What community facilities should be provided with new developments at local and neighbourhood level? We would recommend that the following amenities be considered for new developments:  Access to recreational resources including green spaces and active transport infrastructure to increase physical activity and improve cardiovascular health.21  Promote a healthy food environment by ensuring accessibility to supermarkets selling fresh produce and keeping the number of fast-food outlets low.22  Develop meeting spaces for voluntary, social, cultural or spiritual participation to promote social cohesion within communities for improved physical and mental health, and better quality of life for residents.23 What can the new County Development Plan do to promote social inclusion? We would recommend considering the needs of the following groups who may face barriers to social inclusion when developing the County Development Plan:24  Individuals in jobless households;  Lone parents;  People with disabilities;  Homeless people or those impacted by housing exclusion; and  Members of the Travelling Community, Roma, refugees and asylum seekers. HSE Public Health, Area A recommends that Monaghan County Council include active transport, green space initiatives, climate change adaptations, and environmental determinants 19 Patterson R, Webb E, Millett C, Laverty AA Physical activity accrued as part of public transport use in England. Journal of Public Health. 2019; 1;41(2):222-230. doi: 10.1093/pubmed/fdy099. 20 Brown V, Barr A, Scheurer J, Magnus A, Zapata-Diomedi B,Bentley R. Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia. The International Journal of Behavioral Nutrition and Physical Activity. 2019;16(1):89. doi: 10.1186/s12966-019-0853-y. 21 Diez Roux AV. Residential environments and cardiovascular risk. Journal of Urban Health 2003;80(4):569- 89. doi: 10.1093/jurban/jtg065 22 Cummins S, Macintyre S. Food environments and obesity—neighbourhood or nation? International Journal of Epidemiology 2006;35(1):100-04. doi: 10.1093/ije/dyi276 23 Miller HN, Thornton CP, Rodney T, et al. Social Cohesion in Health: A Concept Analysis. ANS Adv Nurs Sci 2020;43(4):375-90. doi: 10.1097/ans.0000000000000327 24 McGuinness S, Bergin A, Delaney J, et al. Profiling barriers to social inclusion in Ireland: the relative roles of individual characteristics and location: ESRI, 2018. CC: DR EAMONN O’MOORE, DIRECTOR FOR NATIONAL HEALTH PROTECTION CC: MR CATHAL FLYNN, DIRECTOR OF ECONOMIC DEVELOPMENT, PLANNING & CAPITAL PROJECTS 6 of health that will improve awareness of social determinants of health in the community, within regional programmes, and amongst health and community service providers. HSE Public Health, Area A appreciates the opportunity to make this submission. Please do not hesitate to contact us should you need additional information or have any queries in relation to this submission. ACKNOWLEDGEMENT Mr Ian Watkins (Grade V), HSE Public Health, Area A, for assistance with completion of this submission. CC: DR EAMONN O’MOORE, DIRECTOR FOR NATIONAL HEALTH PROTECTION CC: MR CATHAL FLYNN, DIRECTOR OF ECONOMIC DEVELOPMENT, PLANNING & CAPITAL PROJECTS 7 APPENDIX A Context: Ireland faces a number of public health challenges through changing demographics, increasing incidence of lifestyle-related health conditions such as obesity and type 2 diabetes, infrastructure requirements, the balancing of transport needs, and the reconciliation of urban design and urban intensification issues. HSE Public Health, Area A has a statutory obligation to improve, promote and protect the health of people and communities in the East and North-East region of Ireland. Consultants and Specialists in Public Health Medicine (CPHMs and SPHMs) are all designated as Medical Officers of Health (MOH). They are appointed in the HSE Public Health, Area A to provide public health services for Cavan, Louth, Meath, Monaghan, and North Dublin. The current mandate and statutory responsibility for comprehensive health protection related to the environment comes through MOH legislation. The Health (Duties of Officers) Order, 1949 (S.I. No. 128 of 1949)25 states that Medical Officer of Health (MOH) shall carry out the following roles: Section (1): Advise the county council – generally in relation to the health of the people and the provision of health services, sanitary services and housing accommodation, on any questions relating to health matters or sanitary matters in the making and subsequent operation of such bye-laws. Section 1 is the advisory mandate. While the law expects the MOH to advise the county council (as would have been appropriate at the time of enactment) in practice, because of the changes in operational responsibilities, CPHMs advise the relevant authorities, including the county council. Section (2): Inform himself as respects all influences affecting or threatening to affect injuriously the public health in the county and as respects the causes, origin and distribution of diseases in the county. Section 2 provides a mandate for public health investigations and risk assessment and for descriptive and analytical epidemiology of the effect of the environment on health, including for climate change influences on health. In addition, where there is an environmental source of an infectious disease, Infectious Diseases Regulations, 1981 (S.I. No. 390 of 1981) also applies. This mandates the MOH to investigate and take all necessary steps to prevent the spread of infection. The most common area where the MOH investigates and takes control measures is for drinking water contamination, but other areas include contamination of bathing water, air quality incidents, chemical contamination incidents, and the MOH also has an important emergency planning, preparedness and response role. HSE Public Health, Area A’s primary role is to improve population health. It therefore actively seeks to influence any initiatives or proposals that may affect population health in the East and North-East regions of Ireland to maximise their positive impact and minimise possible negative effects. 25 Health (Duties of Officers) Order, 1949 Available URL: http://www.irishstatutebook.ie/eli/1949/si/128/made/en/print (Date accessed: 5th July 2023).