How does the built environment affect health?
The design and build quality of housing, workspaces and public spaces all affect health. For example, people living in warmer, more energy efficient homes are less at risk from cold and have better health outcomes, particularly related to cardio-respiratory disease. Every winter in Scotland there are over 2,000 deaths that are attributable, in part, to cold weather and related conditions . There are known health risks associated with indoor air pollution from tobacco, radon, cooking pollutants, volatile organic compounds and asbestos. High levels of humidity and mould can also cause poor health, notably exacerbating symptoms for people with asthma [8, 9]. Overcrowding may contribute to poor mental health and the spread of communicable disease such as helicobacter pylori (associated with stomach ulcers and other gastric ailments). High levels of noise can cause annoyance, loss of sleep and depression. Natural light can also contribute to mental wellbeing.
The built environment can also encourage or discourage active travel . Increasing walking and cycling in preference to car travel could increase physical activity and reduce air and noise pollution, road crashes, CO2 emissions and community severance . Areas of green space that are attractive, accessible, well connected and designed to encourage use by people in different age groups can also encourage physical activity. There is also evidence that access to and use of green space improves mental health . Neighbourhood design can encourage social interaction and community networks, which is important for mental health, as well as providing informal support networks for some people. The provision of neighbourhoods with easy access to amenities, services and employment can give residents economic and other  opportunities that are conducive to better health. For this reason mixed use neighbourhoods are usually preferred to locating residential areas distant to service, retail and employment .
NHS Lothian initiatives
Some issues identified in the Health impact assessment of the masterplan for Pennywell that could influence health
- Housing standards and energy efficiency
- Tenure mix
- Walkability, transport and parking
- Green space
- Local facilities: economy and social infrastructure
- Maintenance of public realm
- Construction hazards
In Lothian, the Public Health & Health Policy Directorate has worked with partners in local councils for several years on health impact assessments of specific large developments, such as the proposed new towns at Blindwells in East Lothian, Winchburgh in West Lothian and the master plan for Pennywell in North Edinburgh. These assessments aim to identify the potential ways these developments might affect the health of their residents and make recommendations to maximise health gains and minimise health harms (see Box 1).
Planners in Glasgow have developed the Healthy Sustainable Neighbourhood model, which represents the elements needed for balanced, healthy and sustainable communities (see Figure 1). They worked with public health colleagues in the Scottish Health Impact Assessment Network to develop a set of questions for each of these elements that can be used to judge whether plans for a neighbourhood are likely to support health. The model is now being tested in one of the Scottish Government’s Equally Well test sites. Equally Well projects focus on actions and activities that reduce health inequalities. The test site in Glasgow is exploring how to integrate health into spatial planning on the basis that applying health improvement principles at design and planning will have the best chance of improving population health.
Healthy sustainable neighbourhoods model
© Etive Currie, BA(Hons) MRTPI. Development and Regeneration Services, Glasgow City Council, 2007.
Key areas of impact from healthcare facilities
- Location, access and design can impact on physical activity levels.
- Views and use of green space can also encourage physical activity and also improve mental health.
- Food provision can support healthy eating.
- Design can encourage or discourage social interaction.
- Noise, light and legibility of design impact on mental wellbeing of users.
- Healthcare facilities can contribute to the local economy and instil a sense of ‘civic pride’ in local communities.
NHS Lothian has a significant capital building programme. Healthy built environment principles have been agreed and tested to ensure that new hospitals and healthcare facilities are health promoting (see Box 2). These principles form the basis of the Design Quality Framework that describes the approach to capital planning in Lothian. The principles have been tested against recent newly planned facilities and the capital planning process has been reviewed to ensure they are being addressed consistently (see Box 3).
- The built environment is one of the key determinants of health and health inequalities.
- The built environment can have impacts on physical and mental health.
- New approaches that integrate health improvement into planning and design processes may help reduce some of the place-based inequalities that are evident in Lothian.
- Reducing place-based inequalities will be a key contribution to our efforts to tackle social and health inequalities. We are learning more about this topic every day but must continue to research the impacts of the built environment and use this knowledge to make improvements that maximise the benefits of new developments. The development and redevelopment of the built environment should be designed with an eye to the future, to support needs that may evolve over time.
NHS Lothian principles on the built environment and health
NHS Lothian is committed to improving the quality of life of people who use our premises as patients, staff, visitors and the local communities by enhancing and creating buildings and spaces that are healthy for present and future generations and environmentally sustainable.
Location and access
Each facility should be located and designed to secure maximum benefit from transport access, related health and community services, social and environmental amenities.
The planning process for new buildings and renovations should facilitate active participation and collaboration with patients, carers, staff and wider groups of affected people.
The design of each facility and its environment should promote best working practice, be welcoming and accessible to people of all walks of life, and all abilities, and generate a sense of wellbeing, belonging and place to all who use it.
Integration with the community
The design, vision and ethos of each facility should capitalise on its potential benefit to the local community and be physically integrated with the neighbourhood it is located in.
Each health service development should seek to provide relevant facilities that maximize its support for active lifestyles, learning and liveability for patients, visitors and staff.
Building quality and materials
The building quality and materials should optimise whole life value and seek to minimize the environmental impact of the development and enhance the wellbeing of users.
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