The built and natural environment is a key determinant of health and wellbeing. It includes the characteristics (both observable and perceptions) of a physical environment in which people live, work and play, including: schools, workplaces, homes, communities, parks/recreation areas, green (ie visible grass, trees and other vegetation) and blue spaces (ie visible water).
Neighbourhoods are places where people live, work, and play and have a sense of belonging. The design of a neighbourhood can contribute to the health and well-being of the people living there. Several aspects of neighbourhood design (walkability and mixed land use) can also maximise opportunities for social engagement and active travel.
Evidence based principles for building healthy neighbourhoods:
- Enhance neighbourhood walkability
- Build complete and compact neighbourhoods with diverse land use mixes, local amenities and greater residential densities
- Enhance connectivity with safe and efficient infrastructure for walking and cycling and access to public transport
Housing is an important social determinant of health, and the link between housing and health is widely acknowledged. Housing affordability affects where people live and work, and factors that influence health including the quality of housing available, poverty, community cohesion, and time spent commuting. There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship.
Homelessness is associated with severe poverty and is a social determinant of mental health. To be deemed statutorily homeless a household must have become unintentionally homeless and must be considered to be in priority need. As such, statutorily homeless households contain some of the most vulnerable and needy members of our communities. There are a number of risk factors associated with the likelihood of someone becoming homeless, ranging from drug and alcohol issues, bereavement, or experience of the criminal justice system, to the wider determinants of health such as inequality, unemployment, and housing supply and affordability. The majority of the people that are found to be homeless but not in priority need are single homeless people, who as a group have very high prevalence of mental and physical health issues.
Evidence based principles for healthy housing:
- Improve quality of housing so it is warm, energy efficient and safe
- Increase provision of affordable and diverse housing
- Increase provision of affordable housing for vulnerable groups with specific needs, such as adults with intellectual disability, adult substance users, and those who are currently homeless
Access to healthier food
The food environment plays an important role in promoting a healthy diet, but this is a complex system influenced and determined by a series of factors, including a person’s proximity to food retail outlets and the type of food available. Vulnerable groups, including those on a low income, children, young people, those who are overweight or obese, and those of certain ethnicities, are less likely to achieve a healthy and balanced diet. To date, there is relatively limited good quality review level evidence on the influence of the food environment on health and wellbeing outcomes. However, existing evidence indicates that making healthier foods more accessible and increasing provision of low cost healthier food could be effective interventions, but these are likely to be more effective as part of a whole system approach to diet and obesity.
Evidence based principles for healthier food environments
- Healthy, affordable food for the general population
- Enhance community food infrastructure – there is some initial evidence that urban agriculture (the practice of cultivating, processing and distributing food in or around urban areas) and growing food in gardens and allotments may improve attitudes towards healthier food, increased opportunities for physical activity and social connectivity, and increased fruit and vegetable consumption
Natural and sustainable environment
There is a very significant and strong body of evidence linking contact and exposure to the natural environment with improved health and wellbeing. Protecting the natural environment is essential to sustaining human civilization.
Evidence based principles for natural and sustainable environments:
- Reduce exposure to environmental hazards – including air pollution, excessive noise, flooding.
- Access to and engagement with the natural environment - access to, and engagement with, the natural environment is associated with numerous positive health outcomes, including improved physical and mental health, and reduced risk of cardiovascular disease, risk of mortality and other chronic conditions
- Adaptation to climate crisis
Transportation plays an important role in supporting daily activities. Active travel (cycling, walking and use of public transport) can increase physical activity levels and improve physical and mental wellbeing. Prioritisation of active travel can also reduce over reliance on motorised transport, contributing to improved air quality and a reduction in road injuries
Evidence based principles for healthy transport
- Provision of active travel infrastructure - there is a wealth of high quality evidence to show that investing in infrastructure to support walking can increase physical activity levels and improve mobility among children, adults and older adults. There is moderate to high quality evidence that indicates that prioritising active travel, through investment in cycling infrastructure, can lead to numerous health gains
- Provision of public transport
- Prioritise active travel and road safety
- Enable mobility for all ages and activities
Further useful links
- The Bolton picture
- Public Health England (2017) - Spatial planning for health evidence review
- Long term flood risk map
- Flood map for planning
- NICE guidance – physical activity and the environment
- NICE guidance - Excess winter deaths and illness and the health risks associated with cold homes
- NICE guidance – indoor air quality and health