The ongoing Coronavirus pandemic has thrown a spotlight on public health and highlighted how this fundamental aspect of urban planning has been neglected for too long. There is a certain irony that public health has become sidelined in recent planning and development. We should remember public health’s fundamental influence in 19th century planning and its responses to contagion and hygiene.
We need an approach to health that goes beyond specialist healthcare buildings, and that applies researched evidence to new homes and communities. Most of all, we need to focus on how the design of places impacts the health of the citizen and for that, I am suggesting a framework or dimensions of citizen health and wellbeing.
In the UK, and many other developed countries, too many developments are being built that literally make people sick. These include:
- Housing developments designed at lower densities but that are reliant on centralised amenities, which reduce the number of short journeys traditionally made on foot and increase reliance on private cars.
- Social isolation of young elderly and carers, leading to the poorer health outcomes associated with increased loneliness.
- Social isolation of elderly in ‘grey ghettos’, away from established support networks of family and friends.
- Poor housing quality lacking good air, light and space, especially external space. Cost to UK of poor housing is estimated at £1.4B per year.
- Poor air quality, especially alongside distributor roads (estimated 40,000 deaths per year from air pollution in the UK).
- Inadequate access to green spaces, contact with nature, sport and active recreation.
- Poor diet with insufficient access to fresh food and over-reliance on fast and heavily-processed food.
- Centralised healthcare accessed via longer journeys.
- Isolation from learning and employment opportunities, resulting in poorer economic outcomes correlating with poorer health outcomes.
Sources: Health Inequality in England: the Marmot Review 10 Years On (2020); Transport for New Homes (2018)
Healthy places mean healthy citizens.
The objective of healthier places is to have healthier people. This means not only helping those with recognised health conditions, but helping currently healthy people stay that way longer and into later life.
The relationship between the healthy citizen, their urban environment, and the supporting care and health services they receive can be distilled into six dimensions of healthy places that are:
- Active in mind, body and spirit, encouraging physical and mental exercise as part of our everyday routines. This includes active travel like walking and cycling, as well as sport and recreational activity such as gardening. Mental stimulus is also important – from learning and skills to jobs (paid and voluntary).
- Sustained through the air, food, water and light healthy bodies demand. Healthy people also need to be economically sustained through rewarding employment.
- Independent to ‘age in place’ and remain connected to our friends and family.
- Supported through health and social care, education and training, multi-cultural spiritual support and financial services.
- Sociable to support mankind’s natural desires for company. Places that offer opportunities for safe social interaction, and reduce feelings of loneliness and alienation. Places for casual meetings, shared spaces and layered interfaces, interstitial spaces and thresholds to create a spectrum of sociability supporting different scales of interaction, from strangers to family members.
- Empowered to make decisions, and participate economically, in the care we receive and the decisions affecting our communities, so that our contribution to society can make a difference. Healthy places also motivate volunteering and mutual support, and combat social exclusion, prejudice and fear.
Decision makers, public sector, private sector, and local communities can all benefit from putting healthy living at the heart of Placemaking.
These insights are applicable across a wide range of projects at varying scales and for varied client groups. They are certainly not limited to projects for the healthcare sector alone – they should inform Placemaking in housing and mixed-use developments at a fundamental level.