Wheeler B. The Influence of Environmental Exposures Across the Life Course on Patterns of Disease: Environmental Equity and Public Health in England and Wales. Thesis submitted to the University of Bristol on 4 October 2002 in accordance with the requirements of the degree of Doctor of Philosophy in the Faculty of Medicine.. 2002.

This thesis brings together three themes for observational study in England and Wales. Firstly, exposures to environmental hazards commonly experienced within industrialised society have the potential for adverse effects on public health. Secondly, inequalities in health across socio-economic groups of society are readily apparent in the UK. Thirdly, since the 1970s, the environmental justice movement in the USA has highlighted inequities in exposure to environmental hazards across American society. This study set out to measure the extent of environmental inequity in England and Wales, and to assess whether it may play some part in the determination of health inequalities.
Four small-area indicators of potential environmental health risk were constructed to facilitate analyses, and to provide tools for the surveillance of environmental equity and the distribution of risk. Standard small-area indicators of deprivation were found to be strongly related to environmental indices based on the locations of industrial and other facilities. Socio-economic inequity in the distribution of ambient air pollution was not so apparent, and there was some suggestion that areas of higher socio-economic status may actually be subject to higher levels of air pollutants.
The risks represented by the environmental indices were found to have measurable adverse effects on some health outcomes in studies using both ecological and individual data, after adjustment for socio-economic status. Results also suggested that environmental inequity may, to a small extent, explain associations between area deprivation and poor public health. Associations are complex and are subject to methodological limitations common to environmental epidemiological studies and geographic analyses.
The study has implications in terms of social justice and health, environmental and planning policy. Recommendations include integration of environmental indices into multi-dimensional measures of socio-economic deprivation. Additionally, explicit consideration should be given to environmental inequity in UK sustainable development strategies, related policy, and public health practice.