There are many factors influencing our long-term health, including the environment we live, work and spend our leisure time in. Public Health England’s Aimee Stimpson, national lead for healthy places and Clare Perkins, deputy director of priorities and programmes give insight into how buildings, transport, access to green spaces and our local shops and services can all impact both our physical and mental health.
Our environment can reduce or improve our chance of living a long and healthy life – people in the least deprived areas live around 20 years longer in good health than those in the most deprived.
This inequality has a serious impact on the NHS. Many illnesses, such as cardiovascular disease, type 2 diabetes, poor mental health and some cancers, could be largely prevented if we lived and worked in places that supported our health.
The NHS Long Term Plan has prevention at its core and creating places that support healthy choices is an essential part of this.
Unhealthy places – the cost to the NHS
- Poor housing in England costs the NHS £1.4 billion each year and makes up 8 per cent of the total cost to society.1
- 21.5 per cent of annual excess winter deaths are attributable to cold homes.
- Overheating affects 20 per cent of homes and households – there are 2,000 heat-related deaths each year.
Calculations by Transport for London show that if everyone in the capital walked or cycled for 20 minutes a day, we would save the NHS £1.7 billion in treatment costs over the next 25 years, including:
- 85,000 fewer people being treated for hip fractures
- 19,200 fewer people with dementia 18,800 fewer people suffering from depression
- 18,800 fewer people suffering from depression.
Our physical environment can contribute to ill health in many ways. For example, the layout of streets and the location of schools, shops, services, homes and workplaces can promote sedentary lifestyles, loneliness and poor diets.
Conversely, healthy places can support good physical and mental health by encouraging walking and cycling, reducing air pollution, improving access to healthier food and green spaces, and encouraging social connections through well-connected neighbourhoods.
The NHS is no exception – as healthcare leaders and employers, we all have a responsibility to consider how our working environment impacts the health of staff, patients and visitors, and to make changes where we can to encourage healthy lifestyles.
For example, by promoting active travel (such as walking and cycling) within the NHS and achieving a 3 per cent increase in uptake, the Sustainable Development Unit (funded by NHS England and Public Health England) estimates that alongside improved staff health, the NHS would save over £265 million in avoided health treatment costs.To help create healthy places within and around the NHS, some key questions we should all ask are:
- Does our environment make walking or cycling to appointments or work a viable, appealing option for staff and patients?
- Do our hospital canteens and shops offer affordable, fresh and healthy food?
- Do patients have access to green spaces while staying in hospital and are they safe, attractive and well managed?
- What are we doing to encourage staff and patients to access NHS sites in a sustainable way?
- How are we supporting our staff to live healthy lives – for example, do we offer cycle to work schemes?
It’s crucial that everyone – including the NHS, environmental health officers and local government, such as councillors, traffic and spatial planners – works together to create a shared understanding of what shapes a healthy place. This could be part of a whole systems approach, where local partners work together in stages to address all aspects of the environment and improve a health issue, such as obesity.
The benefits of a healthy place
- Investment in modernising and repairing housing would pay for itself in seven years through savings to the NHS and deliver £17.2 billion of wider savings to society per year.1
- Improving features such as electrics, windows and doors, wall insulation and garden paths in the homes of people aged 60 and over is associated with up to 39 per cent fewer hospital admissions.
- The total number of quality-adjusted life years (QALYs) saved by improving England's housing stock is 175,000.
Estimated NHS cost savings and the value of increased economic output due to a reduction in ill health, absence from work and premature death:
- physical exercise (+3 hours of vigorous activity per week): £12–£39
- having a view of green space from your house (versus no view): £135–£452
- local broadleaved/mixed woodland land cover (+1 per cent within 1 km of the home): £8–£27.
There are a number of useful resources. Public Health England’s (PHE) spatial planning and health evidence resource, for example, is a key tool examining the links between health and the built and natural environment, to help inform policy and support local action.
Understanding and implementing a ‘healthy places’ approach means reducing health inequalities through the way places are planned, designed and operated – for people now and for future generations. Across the country, we all deserve an environment that supports a long and healthy life.
The PHE Healthy Places team
PHE’s Healthy Places team sits within the newly formed Priorities and Programmes division of the Health Improvement directorate. Our focus is to translate evidence into both policy and practice by working across the national and local systems and engaging with the development industry and the NHS.
Aimee Stimpson is national lead for healthy places and Clare Perkins is deputy director of priorities and programmes, at Public Health England. Follow them on Twitter @clare_perkins and @aimeestimpson