C O N T E X T 1 1 9 : M A Y 2 0 1 1 17 areas. This may reflect differences in amenities, quality of housing and public realm, incivilities, crime and fear of crime, and opportunities for social interaction. Evidence shows that these all may be worse in deprived neighbourhoods. This can be shown to impact on both mental and physical health. The reputation of the area may also be important. Stigma associated with particular areas may also lead to poor mental and physical health. There is growing evidence showing the relationship between chronic stress associated with living in a stigmatised, poorquality environment, and physiological changes that lead to cardiovascular disease and other conditions. All of these issues suggest a need to ensure that we are designing our towns and cities in ways that promote good health for the people who will live and work there. In some areas, public health professionals, spatial planners and others are working together to assess formally the potential health impacts of proposed new developments.This is supported by the World Health Organisation healthy cities movement, which promotes approaches to healthy urban planning, including the use of health impact assessments. A group of planners and public health professionals in Glasgow used their experience of assessing the health impacts of a spatial framework for Glasgow’s east end to develop the Healthy Sustainable Neighbourhood Model. The model provides a framework of the elements needed to develop a healthy and sustainable environment. They are now testing the model against master plans and other developments, and creating a community version. Health organisations can also ensure that the design of their own buildings promotes health. NHS Lothian has developed a set of Principles for a Healthy Built Environment to inform the design of healthcare facilities. These recognise the impact of NHS facilities on health and wellbeing of patients, staff, visitors and the local community. The evidence that the physical environment affects people’s health is clear.The places we build today will either enhance or damage health for decades to come. So it is essential to take every opportunity to influence these places to ensure we gain the maximum benefit well into the future. Further reading Scottish Health Impact Assessment Network www.healthscotland.com/ resources/networks/shian. aspx Jones, R and Currie, E, Healthy Sustainable Neighbourhood Model, Briefing Paper No 7, Glasgow Centre for Population Health, 2009. www.gcph.co.uk/ assets/0000/0405/ GCPH_BP_7_concepts_ web__2_.pdf Barton, H, Grant, M and Guise, R, Shaping Neighbourhoods for Local Health and Global Sustainability, Routledge, 2010 NHS LOTHIAN PRINCIPLES ON THE BUILT ENVIRONMENT AND HEALTH Overarching aim 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 Overarching principles 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. Planning process The planning process for new buildings and renovations should facilitate active participation and collaboration with patients, carers, staff and wider groups of affected people. Design 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. Facilities Each health service development should seek to provide relevant facilities that maximise 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 minimise the environmental impact of the development and enhance wellbeing of users. The Healthy Sustainable Neighbourhood Model Margaret Douglas is consultant in public health, NHS Lothian, and chair of the Scottish Health Impact Assessment Network. indicator, the experience of people in low-income areas is worse than that in high-income areas. This applies for health-related behaviours, rates of specific conditions, measures of wellbeing and life expectancy. For each of these there is a gradient of increasingly poorer health with increasing deprivation. Clearly health inequalities relate to social and economic differences, but there are also important influences arising from the physical environment in which people live and move around. Research shows that people who live in deprived neighbourhoods have poorer health outcomes than people with similar individual characteristics who live in more affluent
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