Marcus Grant, Director of the Supporting Healthy Inclusive Neighbourhood Environments (SHINE) Health Integration Team gives a round up of the National Urban Design Group annual conference, which took place in Bristol in October.
Bristol Health Partners at the National
Urban Design Group annual conference on 8-10 October in Bristol.
The conference was focused on ‘development, design and profit in
the 21st century’. Despite this unpromising sub-title, health emerged again and
again, threaded through several conference presentations and woven into corridor
At a dedicated ‘design for health, well-being
and social inclusion’ session, there was emerging agreement that
implementation would require engagement of the larger players in the sector,
institutional investors and city-regions.
designers are an unregulated and largely self-defining group of built
environment professionals. Urban Design Group members tend to be passionate about
quality of life in our cities, towns and villages and believe that raising
standards of urban design is central to its improvement. Over 160 developers,
town planners, landscape architects, architects, land surveyors and house
builders gathered at the SS Great Britain conference centre for a programme of
walks and talks over three days. Participants were drawn from both the private
and public sectors, with some not-for-profits such as Sustrans also in
Health Partners’ involvement aimed at raising awareness of the SHINE Health Integration Team
(HIT), through a presentation, literature and debate.
session, chaired by Debbie Sorkin, Director of Systems Leadership at the LGA linked Leadership
Centre, was of particular interest. Debbie, set the scene with a tour-de-force
of the relationship between places people live and their health, outlining the subsequent
impact on health services. Of course at systems perspective, nothing makes
sense; why do we still build housing developments with little or no regard to
supporting healthier lifestyles - and then expect the NHS to ‘pick-up-the-tab’?
But until budgets are integrated, at the local level, and with a long term
perspective - the ‘system failure’ (Chapman, 2004; Wanless, 2002) will
continue. The economic reality is that the NHS is increasingly expected to fund
treatment for preventable ill-health associated with poor place-making. Debbie
cited the Chief Medical Officer’s Tips for Health (DoH 1999) revised by
Professor David Gordon (undated) at University of Bristol, who make the links
with place explicit, such as:
- Don’t live
in a deprived area. If you do, move
- Don’t live
in damp, low-quality housing or be homeless
looking at some of the place-based determinants of health inequality, she
outlined innovation in preventative prescribing such as the ‘gentoo’ programme
of prescribing boilers for diseases associated with cold or damp living
conditions, and a South Yorkshire Housing Association scheme for reducing
hospital admissions through the prescription of services for loneliness,
housing and debt counselling and advice.
speaker was Laurence Carmichael
of the WHO Collaborating Centre for Healthy Urban Environments (a
SHINE partner). Moving the session into a greater depth of understanding,
Laurence outlined a number of thorny issues yet to be solved, concerning the
evidence base, delivery mechanism and political values, these will all need
careful attention if we are to move toward the creating healthier
neighbourhoods. Winning a large measure of acknowledgement from the audience,
Laurence stressed that ‘the mediator between health and place is human
behaviour’ and that if the delivery of healthier environments is through the
private sector; then we need to question how this affects competitive returns.
What is the cost for the volume house builders in adding quality into the quantity
formula that dominates their established cost model approach? Through building
healthier places, the immediate costs increase for them, however they don’t
reap much of the added value; since communities and service providers reap these
main future benefits.
Alex Notay, Policy Director of Urban Land Institute UK,
introduced participants to the Urban Land Institute; this is a US based
independent global non-profit think tank that is supported by members
representing the entire spectrum of real estate development and land use
disciplines. They aim to provide leadership in the responsible use of
land and in creating and sustaining thriving communities worldwide. They
provide a number of resources and tools through a Building Healthy Places
Initiative, such as a Building Healthy Places Toolkit providing
strategies for enhancing health in the built environment.
Finally, Daniel Black, a director of db+a spoke.
Daniel is already starting to collaborate with Bristol Health Partners. Daniel
reflected on the profound impact of visiting the town of Freiburg, southwest
Grermany. This is a cause celebre, an even a pilgrimage for those involved in healthy
sustainable neighbourhoods. Daniel then described his research, including the Wellcome
Trust's 'Factoring long-term health impacts into urban
development’ project under the auspices of their 'Our
planet, our health award'. This research analyse contrasting live development
projects to determine the hidden costs to society of poor-quality urban
development. Partners in the research include the private sector developers.
The importance of their engagement was a theme running through this
session. It is only through their robust engagement, using validated and
evidenced financial models, that we will see the emergence and hopefully mainstreaming
of a new model for residential development - the healthy neighbourhood.
audience member, Stuart Black, director of Clipper Estates, explained: “The
sector must shift from trading in homes to investing in communities, from
short-term to long-term, from the key players being the volume house
builders to city-regions as the public sector, and pension funds as the
conclusion; at the end of the session an audience member from the volume house
building sector confirmed their stance: ”community ill-health is not our problem”,
whilst another participant confirmed the response I often receive when talking
about healthy neighbourhood work to senior health professionals – ”Healthier
urban design, it’s not our problem”. I invite those of us interested in
population health to reflect those comments as an exposure of ‘systems failure’
and as an indictment of the silos we have allowed to grow at the expense of
Chapman, J. (2004). System failure: Why governments must learn to
think differently. Demos.
DoH (1999). The Chief Medical Officer’s
Ten Tips for Better Health
Saving Lives: Our Healthier Nation. London: The Stationery Office.
Gordon, D. (undated). Alternative Tips, available online http://www.bristol.ac.uk/poverty/healthinequalitie... [accessed 10.10.15], Townsend Centre for
International Poverty Research, University of Bristol.
Wanless, D. (2002). Securing our
future health: taking a long-term view. London: HM Treasury, 16.
Conference twitter conversations
can be found at #UD2015 between 8-10 October 2015