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Healthy Planet. Healthy People.

Public health / Healthy Cities

Designers urged to understand people and place to improve health for all

By Andrew Sansom 19 Mar 2020 0

Against the backdrop of the recent publication of ‘The Marmot Review: ten years on’, which found that for the first time in more than 100 years, life expectancy has failed to increase across the UK – and for the poorest 10 per cent of women has actually declined – architectural design practice Ryder has published a new report on the UK context of spatial inequalities in health and wellbeing.

Authored by Cathy Russell, an associate at Ryder, the report says there is now an overwhelming amount of evidence and dialogue around how place affects health and wellbeing. Evidence from the NHS’ Healthy New Towns report shows the
severity of health inequality in the UK, with people in the least deprived areas of the country enjoying around 20 more healthy life years (HLY) than those in the most deprived areas – and this gap is widening. Indeed, it’s estimated that each year in the UK, additional healthcare costs of £5.5 billion are attributed to health inequalities.

‘The Marmot Review: ten years on’ confirms an increase in the north-south health gap, where the largest falls were seen in the most deprived 10 per cent of neighbourhoods in London. Ryder’s new report asks what the built environment industry can do to ensure that we’re creating places that meet the needs of the communities who will use them, and improve their health and wellbeing rather than worsen it.

There are complex, and sometimes contradictory interactions at play impacting on health outcomes, the report finds. For instance, poorer neighbourhoods, which generally have lower levels of car ownership, might be expected to report better health but this is not usually the case. This could be down to other factors, such as: whether healthy food is available within easy walking distance; the quality and accessibility of green space; how safe and attractive walking and cycling routes, and public spaces are; and whether neighbourhoods are alienated by impenetrable highways infrastructure. 

High streets are often an indicator of health inequalities, says the report; for instance, does the high street have a healthy retail offer, and is it inclusive, safe, clean, walkable and cycle-friendly? 

In many instances, tackling health inequality will also help tackle climate change. The report notes that while there have been huge advances in public health since the Victorian era, modernisation has led to some negative consequences, including: low-density sprawl along with high-rise housing set in large areas of poor-quality open space; car-orientated streets that discourage walking, cycling and play; a lack of availability of healthy food; and a reliance on security features. 

Architects, says the report, can play a part in improving the situation by positioning opportunities for enhancing health and wellbeing at the forefront when designing all places, particularly in areas that suffer from health inequality. 

“As an industry, our starting point must be understanding people and place, including what health and wellbeing needs exist within the community,” explains the report. “Armed with this and the wealth of evidence and best practice available, we can create places that improve health and wellbeing for all.” 

The second part of the report is devoted to a series of guiding principles that Ryder suggests should be followed when designing places informed by the growing evidence base on health and wellbeing. 

Engage with people and place to understand health and wellbeing 

Research suggests that increased community control and democratic engagement have a positive impact on social capital and, consequently, on health and wellbeing.

Options include collaborative workshops, ‘place checks’ and using community engagement technology. Urban data collection, such as using sensors to measure air quality or identify patterns of movement, can be used alongside qualitative surveys and engagement. 

Be aware of research, guidance and best practice on health and wellbeing

Potential impact on health and wellbeing should be considered early in the design process. Once the challenges are understood, guidance and best practice can help address these and identify opportunities – for example, through neighbourhood design, housing, food, natural and sustainable environments, and transport. A solid evidence base can also demonstrate not only the predicted health benefits of a design but also interlinked economic, environmental and social benefits.

Consider health and wellbeing factors in site location and uses 

Development should take place in sustainable locations, with good public transport and
active travel provision, increasing accessibility and encouraging physical activity. A good mix of local amenities should be within easy walking distance to reduce car dependence and isolation found in mono-functional developments. 

Provide high-quality, well-managed and affordable housing 

High-quality, well managed and truly affordable housing with good access to green space, public transport, safe and attractive walking and cycling routes is associated with numerous positive health outcomes. These include increased physical activity, reduced injury and improved social engagement and general wellbeing. It can also help reduce the impact of economic disparities on the mental health of residents in poorer areas. 

Design for active travel and physical activity 

Proposals should ensure that travelling on foot or by bike is a more attractive option than driving; this can also help reduce air pollution. Measures include introducing safe cycling and walking routes, bicycle parking, high-quality public spaces, reduced vehicle speeds, mixed uses so that amenities are easily accessible, good public transport, and a permeable street network. Feelings of safety and security can encourage physical activity and improve mental health.

The report concludes with several further design guiding principles: include opportunities for social interaction; provide access to green space and nature; ensure there is access to healthy food; embed health and wellbeing in the design process; use existing toolkits, such as Healthy Streets and Place Standard; cross-discipline working and joined-up services; and influence policy and guidance.

The full report from Ryder, ‘Spatial inequalities in health and wellbeing’ is available at

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