In 2018 in the UK people are much more likely to suffer from preventable, lifestyle related illnesses such as diabetes and heart disease, than they are to suffer from communicable diseases such as measles or tuberculosis. This situation is set to worsen. The number of people with diabetes is projected to rise by one million by 2035, largely driven by more cases of type 2 diabetes and increasing rates of obesity. This could lead to a 29% rise in heart attacks and strokes, putting enormous strain on our public services. Obesity and diabetes put so much pressure on the NHS that as a nation we now spend more each year treating these illnesses, than we spend on the police, fire, and judicial system in total. And that is without counting the cost of the impact of poor health on people’s lives, families, communities and the wider economy.
Many attempts to encourage healthier lifestyles have tended to focus on the individual, motivating people to change or giving them more knowledge about healthy living and encouraging them to ‘behave well’. At its worst, this perspective has sometimes taken the form of ‘fat shaming’; 90% of overweight people say they have been abused because of their size.
But the overwhelming evidence points to unhealthy lifestyles – poor diet, physical inactivity, smoking, drinking, and loneliness – as ‘a normal response to an abnormal environment’. When people live in environments which are saturated with fast-food outlets, and offer minimal green or safe outdoor space, which is more likely in places with lower than average income, it is unsurprising that we tend to eat fast food and stay indoors, especially if we are time or income poor. For example, in our research in a city in the North of England, people described their neighbourhood as “an island with two roads around it and one through the middle!” Similarly in our research in Halstead, Essex, parents explained that it felt like “a vacuum and the teenagers have nowhere to go.” And when we asked young people in North London about community wellbeing, one young man highlighted the inequality of access to sports facilities: “[there has been] no funding in my estate for ages — it’s not nice, but Kensington has just got a new swimming pool”. Time and time again in our conversations with communities, we are reminded of the impact that the places in which people live have on their ability to socialise, exercise and more broadly to live well.
Recognising this, and at a time when many new homes are needed, NHS England (NHSE) is working to ensure that new places are designed and built in a way which enables and promotes healthier living. The NHSE Healthy New Towns programme is working with 10 new housing developments to shape the built environment, health and social care services, and to support community life. To maximize learning from this work, and to bring together what is known more broadly, The Young Foundation has been working in partnership with NHSE and others to develop a guidance publication outlining how to ‘Put Health into Place’.
This is the first publication to explore how we can work with the built environment, health and social care services and communities to create healthy new places. It builds on The Young Foundation’s practical work in Tower Hamlets where we are supporting communities to be health-creators, as well as our Reimagining Rent programme which is reimagining how the private rental sector works.
In this publication we outline 10 key principles for creating places which encourage health:
- Plan ahead collectively: work in partnership with local stakeholders and residents to co-create the new place.
- Plan integrated health services that meet local needs: design and create health and care services for the future.
- Connect, involve and empower people and communities: facilitate community leadership, decision-making and ownership.
- Create compact neighbourhoods: design live-able, walkable new neighbourhoods.
- Maximise active travel: make cycling, walking, and running as the ‘go to’ travel choices.
- Inspire and enable healthy eating: ensure the physical and social environment makes healthy eating easy, affordable and fun.
- Foster health in homes and buildings: design buildings and work with intuitions, such as schools and workplaces, to enable healthy living.
- Enable healthy play and leisure: create a built environment and activities and opportunities which enable healthy play and leisure across the life course.
- Provide health services that help people stay well: take a preventative and proactive approach to healthcare, such as prescribing to social rather than medical support.
- Create integrated health centres: create health hubs which incorporate a range of support, including community organisations.
As always, at The Young Foundation, we believe that the needs and aspirations must be at the heart of designing a new town or development, and that residents must be empowered to help them take shape – because a healthy town is also one which is socially sustainable. Residents in and around the 10 healthy new towns are taking action to make their places socially sustainable in a range of ways, including:
- Friends of Red Hall, Darlington, where a group of local residents have come together to organise a range of community events and have also created the unofficial Tiny Little Library, to ensure people have access to books.
- The Sewing Rooms, Halton, a social enterprise where local residents are trained in sewing and upholstery, to support social connections and employment.
- Edible Ebbsfleet, where residents are taking over unused public spaces and turning them into edible gardens.
To find out more about this work and Putting Health into Place, you can see our recent ‘taster’ publication available online here. The full publication will be launched in March 2019.