You may well know that over 70 years ago, Nye Bevan set up the NHS. But did you also know that when he did so he was minister of both health and housing?
Since then health and housing have diverged. This was perhaps the last time that a government truly recognised that good quality places to live could promote better health outcomes for people. Prevention is better than cure.
Are the dots still joined up today? From what I have read and heard, I don’t think so. For example, hospitals receive funds based on the level of need in their area. This suggests that the more people they care for, the more resources they receive. Leaving aside the altruism of those who work in the NHS, this is clearly a perverse incentive. This may be oversimplifying, but it doesn’t leap out as a system that tackles the causes for poor health outcomes upstream.
What about pre-primary, primary, and community care? What about the physical places we create?
To the government’s credit an All Party Parliamentary Group has been set up and written a white paper on this subject (Click here to download the White Paper). And anytime soon the Department of Health and Social Care should be publishing a green paper recognising that the solution to better health outcomes also includes the built environment. For the first time too, NHS England have underlined the importance of prevention in their Five Year Forward View (Click here to access their webpage on this), but the system can’t change overnight. The NHS is still a fundamentally reactive healthcare service. There is a long way to go, and it’s not just the NHS that needs to take part. Our health is strongly linked to the built environment too.
The importance of prevention came to my attention when I took part in the 3 year UPSTREAM study funded by Wellcome Trust (https://urban-health-upstream.info/). The study looked into the now very substantial evidence linking the quality of urban environments such as air pollution, noise, lack of green space and physical inactivity, to non-communicable diseases such as respiratory illness, cardiovascular disease, diabetes, mental health illnesses and cancer. And it started to look at the barriers and opportunities for making positive interventions in the development of real estate to promote better health outcomes.
I was delighted to be later invited as a property developer to present to public health and medical officials at the Royal Society of Medicine on the subject. How often does a conversation like that between ‘health’ and ‘development’ happen? I want to see a lot more of those conversations.
So I’m helping to organise an Urban Land Institute roundtable event in July looking at just that. What are the barriers to promoting better health outcomes in the built environment? And how can we start to overcome them? We’ll be mapping it all out, thinking about land, policy & regulation, partnerships, financing, design.
Please come and help us out. You don’t need to be a member of ULI to join it (and we are offering a small number of free places for public sector organisations too). We are looking for opinions and perspectives from across the built environment and health sectors.