Can places make us healthier?

A 19th century vision of ideal homes for the respectable working classes. Image: Wellcome Images.

All of us feel better when we’re surrounded by beauty and good design. It’s why we put so much effort into DIY, interior design or gardening. And it’s why for our holidays we seek out places that will make us both physically and mentally healthier than we can in our working life.

This might seem blindingly obvious. Yet public policy often points in the opposite direction. Developed societies rightly spend huge sums of money on health – hospitals, primary care, and new and old drugs account for at least 10 per cent of GDP and more in some countries.

But if you look at what we know about health there is an odd paradox. According to the Robert Wood Johnson Foundation, one of the world’s largest funders of health, summarising a huge amount of research, the causes of premature death are roughly as follows: 40 per cent behavioural patterns, 30 per cent genetics, 15 per cent social circumstance and 5 per cent environmental effects. The remaining 10 per cent is attributable to healthcare.

Given that medicine is an evidence-based field you would expect that this widely understood knowledge would be reflected in how funds are allocated. Instead, the opposite is the case. The vast majority of health spending goes to healthcare and within that to particular industries, notably pharmaceuticals.

We now take this for granted. But it wasn’t always like this. In the 19th century when rapid industrialisation and urbanisation left cities like Manchester, Birmingham and London wracked by ill-health, crime and misery, huge efforts went into dealing with the physical causes of ill-health. Vast public spending projects worked to deliver cleaner water and air; comprehensive sewers; better housing; and later such things as safe roads. These were all seen as just as important to a healthier population as better hospitals.

Indeed, there is a long history of using urban design to promote health. This thinking was integral to the great projects of Bournville and Peabody, the garden cities of the early 20th century and the new towns of the 1940s, and more recently it’s shaped the NHS Healthy New Towns initiative.

Yet health design has never had the same prestige or support as more narrowly clinical knowledge, and although much is known, little has been rigorously tested. So we can fairly safely say that hospitals are more likely to promote recovery if they make good use of nature, light and art, and if they offer privacy rather than long soulless wards. Similarly, health centres work better if they give people the scope for interaction rather than long lines of chairs or grim corridors.


But we don’t have strong evidence or detailed work on just how much impact these designs have, and even though much of this may appear fairly obvious, a moment’s reflection confirms that it’s at odds with how far too many hospitals and surgeries were designed.

The same imbalance is evident in the ways that towns and cities are planned. You can deliberately design transport and roads to make it easier to walk, cycle or run rather than always depending on cars. You can shape cities to make them full of nature, or even edible, with plenty of fruit trees for example. Planning can be used to reduce advertising of junk food near schools, to cut noise levels and to promote clean air. Much is known about how the presence of green and blue spaces – which means water, ideally in motion – can be good for mental health. Social norms can be influenced in a healthy direction, for example encouraging people to stop their cars from idling. And we’re beginning to see more systematic attention to what could be called MEEs – Mind Enhancing Environments – which can both calm and stimulate us in healthy ways.

But again there is surprisingly little rigorous evidence and surprisingly little use of systematic experiment so that when new initiatives like the Healthy New Towns one are started they have relatively little to draw on.

This under-development of health design reflects a broader mismatch in where we direct resources. Over the last few years, an ever-larger share of public funding has gone to biomedical research even as the results of that research have continued a remorseless long-term decline in terms of impact on health outcomes.

It’s not that we shouldn’t fund such vital research: it’s just that the imbalance with other fields that focus on behavioural, social and environmental influences on health has become huge, and indefensible.

Most new urban developments ignore what’s known about health design, and the situation is even worse in countries like China where cities are being built that are highly likely to be bad for physical and mental health.

We shape our buildings and our buildings shape us, as Churchill famously put it. For now, too many of them aren’t shaping us well. I hope that a new generation of doctors, architects and planners will put this right.

Geoff Mulgan is chief executive of the innovation charity Nesta.

 
 
 
 

Community-powered policies should be at the top of Westminster’s to do list

A generic election picture. Image: Getty.

Over the past five decades, political and economic power has become increasingly concentrated in the UK’s capital. Communities feel ignored or alienated by a politics that feels distant and unrepresentative of their daily experiences.

Since the EU referendum result it has become something of a cliché to talk about how to respond to the sense of powerlessness felt by too many people. The foundations of our economy have been shifted by Brexit, technology and deindustrialisation – and these have shone a light on a growing divergence in views and values across geographies and generations. They are both a symptom and cause of the breakdown of the ties that traditionally brought people together.

As the country goes through seismic changes in its outlook, politics and economy, it is clear that a new way of doing politics is needed. Empowering people to take control over the things that affect their daily lives cannot be done from the top down.

Last week, the Co-operative Party launched our policy platform for the General Election – the ideas and priorities we hope to see at the top of the next Parliament’s to do list. We have been the voice for co-operative values and principles in the places where decisions are made and laws are made. As co-operators, we believe that the principles that lie behind successful co‑operatives – democratic control by customers and workers, and a fair share of the wealth we create together – ought to extend to the wider economy and our society. As Labour’s sister party, we campaign for a government that puts these shared values into practice.

Our policy platform has community power at its heart, because the co-operative movement, founded on shop floors and factory production lines, knows that power should flow from the bottom up. Today, this principle holds strong – decisions are best made by the people impacted the most by them, and services work best when the service users have a voice. Our policy platform is clear: this means shifting power from Whitehall to local government, but it also means looking beyond the town hall. Co-operative approaches are about placing power directly in the hands of people and communities.


There are many great examples of Co-operative councillors and local communities taking the lead on this. Co-operative councils like Oldham and Plymouth have pioneered new working relationships with residents, underpinned by a genuine commitment to working with communities rather than merely doing things to them.

Building a fairer future is, by definition, a bottom-up endeavour. Oldham, Plymouth and examples like the Elephant Project in Greater Manchester, where people with experience of disadvantage are involved in decision-making, or buses in Witney run by Co-operative councillors and the local community – are the building blocks of creating a better politics and a fairer economy.

This thread runs through our work over the last few years on community wealth building too – keeping wealth circulating in local economies through growing the local co-operative sector. Worker-owned businesses thriving at the expense of global corporate giants and private outsourcers. Assets owned by communities – from pubs to post offices to rooftop solar panels.

And it runs through our work in Westminster too – with Co-operative MPs and peers calling for parents, not private business, to own and run nurseries; for the stewards of our countryside to be farmers rather than big landowners; and for workers to have a stake in their workplaces and a share of the profit.

Far from being ignored, as suggested in last week’s article on community power, our work has never been more relevant and our co-operative voice is louder than ever.

Anna Birley is policy offer at the Co-operative party.