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Designing neighbourhoods for health, well-being and social inclusion

11 November 2015

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.

SHINE represented 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 discussions.

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.

Urban 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 attendance.

Bristol Health Partners’ involvement aimed at raising awareness of the SHINE Health Integration Team (HIT), through a presentation, literature and debate.

A health 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

After 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.

The next 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.

As an 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 private partners.”

In 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 population health.

References

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

Designing neighbourhoods for health, well-being and social inclusion
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