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Borrow some medical practice to build healthy homes and places

This past year has seen real progress in demonstrating how our built environment - the homes & places where we live – impacts our individual and collective health.

Several organisations including TRUUD (Tackling the Root Causes Upstream of Unhealthy Urban Development), the Quality of Life Foundation , Impact Urban Health and the Centric Lab are developing strong evidence on the links between our built environment, health and health equity. Focusing on a range of social, environmental and corporate determinants of health, this evidence base will be invaluable in bringing stakeholders together and shaping the design and development of our local communities.

The TCPA has built a strong body of evidence on the impact of poor quality homes on health, and has led a campaign for healthy homes which has underpinned the Healthy Homes Bill, now approved by the House of Lords as an amendment to the Levelling Up Bill and awaiting debate in the House of Commons. The amendment states that the Secretary of State “must promote a comprehensive regulatory framework for planning and the built environment” that secures the "physical, mental and social health and well-being of the people of England”.

The Netflix series on Blue Zones has demonstrated to a global audience how our local environments support our longevity, and shown us the ingredients and attributes manifested in places across the world that contribute to healthy living. A reasonable and actionable takeaway from the series is that we all deserve to live in a Blue Zone.

And earlier this year the Marmot Institute for Health Equity launched its Health Equity Network which now has over 1,000 members across the country interested in engaging and building evidence around social determinants of health, and embedding these into their professional practice.

At a time when health, planning and housing top the agendas of government and governments in waiting, we have an opportunity to apply this evidence to design homes and places that have real impact on the health of local communities.

It’s not an easy process, and one reason is that the majority of people who practice in each of these areas – health and housing & planning, don’t understand, or even talk to each other.

In recent weeks I’ve been to several events that demonstrate this challenge, and reveal the opportunities within. All were focused on themes of health and health equity, organised by think tanks in the health and built environment sectors. The former events attracted mainly health professionals from the NHS and local authorities; the latter mainly planners from design practices and local authorities. Neither attracted many from the private sector in either healthcare, housing or regeneration.

Seizing the opportunity to build homes and places that genuinely improve health and health equity requires the people and processes that shape both planning and health policy to integrate in practice.

As a start I would lead with planning, regarded as a broken system and begging for reform. I’d take five well established and widely practiced approaches to designing and delivering patient care in the medical and healthcare sectors -- and apply these to the design, development and delivery of homes and places in our local communities. This will not only encourage better communication between health providers and planners, but just may improve our collective health and wellbeing.

First, do no harm. This is the principle that defines all who practice medicine, guiding all those have the most direct impact possible on human health. But it is rarely acknowledged or adhered to in a unified or standardised way when it comes to non-medical practice, even when that practice has a significant impact on human health. Designing, creating and maintaining our built environment is one such practice.

Second, promote health literacy. Actively engage local communities about their health, because this will generate dialogue and build trust among stakeholders in communities undergoing new development. There is evidence that health literacy can serve as a catalyst for social cohesion. The preparation of a Health Impact Assessment for development projects can serve as a platform for understanding health needs, promoting dialogue about health and effectively become a vehicle for proactive community engagement.

Third, focus on prevention and longevity. The Blue zones show us how places can help us live healthier and longer lives. Equally, the TCPA’s research on housing shows us how poor quality housing can harm our health, and research shared this week revealed more about housing and its impact on our longevity.

Fourth, base all interventions on evidence. The medical profession relies on strong evidence for both diagnosis of conditions and recommendation of treatment for patients, and planners should do the same. There’s tons of evidence on how our built environment impacts our health - I described some of it above – now let’s use it.

Fifth, offer hope. Doctors offer their patients medical interventions that will make their lives better. No one agrees to a medical intervention if they’re not hopeful it will improve their health and wellbeing. Why should they support an intervention in their neighbourhood if it’s not going to improve their lives?

Language matters. Practice matters. Creating healthy homes and places requires a common approach to language and practice. And as a bonus – developers and local authorities who adopt these approaches into their planning practice might just find that the hated NIMBYs get onside. Because if there’s one thing that everyone agrees on, it’s that good health matters.

Clare Delmar

Listen to Locals

13 October 2023


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