Three key figures from the world of public health welcomed a new position paper ‘Public Health and Landscape – Creating healthy places’
Ann Marie Connolly, director of health equity and impact at Public Health England, said, ‘We have to look at how we design around simple parts of daily life – how we go to work, to the shops, to see friends and family.’ She spoke about the growing problem of obesity and that only 56 per cent of the population is physically active. Only 15% of the population, she said, uses outdoor space for exercise. ‘We would like it to be much more,’ she said, adding ‘If physical activity becomes part of everyday life, it is as important as supervised exercise.’
Shahed Ahmad, director of public health at the London Borough of Enfield, which is one of the most deprived boroughs in London, spoke about the fact that public health initiatives had helped to reduce the death rate by 34% in three years. It is vital, he said, to avoid creating or maintaining obesogenic environments, and he also stressed the importance of environments that promote wellbeing.
His first acts he said, had been to deal with the ‘low hanging fruit’, for example making sure that existing parks were more appealing and better used. But there are parts of the borough where space is at a premium, they are clogged with parked cars and he could not see any room in which to plant trees. He could not see how to improve them, ‘but perhaps you professionals can’.
Ahmad also emphasised the importance of having measurable outcomes, as health professionals appraise work in terms of the cost per QALY (quality adjusted life year) gained.
Sheila Beck, principal public health adviser with NHS Scotland, talked about the importance of reducing inequalities in health. In Glasgow, for example, the average male life expectancy varies by 28 years depending on where people live. ‘There are lots of different factors affecting this,’ she said. ‘I would argue that landscape is an important part of the story, and that living near healthy green spaces can mitigate some of the inequalities.’ Chronic stress is known to contribute to early heart attacks and cancer, she said, so that environments that help reduce stress can be very important.
Sue Illman, president of the Landscape Institute, welcomed the guests at the launch, saying, ‘Too often public discussions of health centre around symptoms and their treatment rather than how to contribute to wellbeing.’
She introduced a film about the Dalston Eastern Curve Garden in north London, designed by J & L Gibbons, which is one of the case studies in the position statement. It is a rare area of green in a built-up area, offering calm, a place for children to play and an environment in which all the community, including those with mental health problems, can meet and interact.
Val Kirby, who chairs the LI’s Public Health Working Group which produced the position statement, said, ‘We believe that the way that landscapes are planted and managed should be guided as much by their importance for health as for other functions.’
She stressed that the publication of the position statement is just a first step in the landscape profession’s intention to work with public health professionals and with policy makers to create a larger number of healthy landscapes.
The position statement makes the point that with rising health costs (the NHS’s share of GDP has risen in the past 50 years from 3.4 per cent to 8.2 per cent), investing in landscape in ways that can influence public health is cost effective. It quotes a 2012 study by the Canadian Public Health Association which shows that it is 27 times more expensive to achieve a given reduction in cardiovascular mortality through clinical interventions than through public health measures.
The statement sets out the five principles of healthy places. They are:
1. Healthy places improve air, water and soil quality, incorporating measures that help us adapt to, and where possible mitigate, climate change.
2. Healthy places help overcome health inequalities and can promote a healthy lifestyle.
3. Healthy places make people feel comfortable and at ease, increasing social interaction and reducing anti-social behaviour, isolation and stress.
4. Healthy places optimise opportunities for working, learning and development.
5. Healthy places are restorative, uplifting and healing for both physical and mental health conditions.
The document spells out in detail what each of those principles means and how to address them, and then uses a number of case studies to illustrate each principle in turn.
To download the publication and watch the video, visit the health section of the LI website.