C O N T E X T 1 1 9 : M A Y 2 0 1 1 23 Healthy environments Healthy environments Healthy environments environments Healthy Healthy environme environments Healthy environments CRAIG STIRRAT Health inequalities in the built environment Evidence from the best places and the worst shows that the impact of health should be assessed in designing and managing the built and historic environment. A Scottish Government study1 states that health inequalities can be identified by postcode. While overall the health of the country is improving, some inequalities are widening. Health planners conclude that the environment has a major part to play in how healthy someone is. The postcode lottery seems to determine why one child at school has a 90 per cent chance of reaching 75 years old, whereas another has no more than a 50 per cent chance. Places with high rates of premature mortality from cancer and high rates of coronary heart disease also tend to be places of poor built environment. Milngavie in the north west of Glasgow, for example, has some of the most desirable residential areas in Scotland and the highest average life expectancies. Many features and amenities make up Milngavie’s special character and account for its popularity as an ideal town in which to reside.2 A few miles away Calton in inner Glasgow is an area of considerable poverty. A 2006 report 3 stated that ‘a child born in Calton… is three times as likely to suffer heart disease, four times as likely to be hospitalised and ten times as likely to grow up in a workless household than a child in the city’s prosperous western suburbs’. Calton has the lowest male life expectancy in Scotland. The important advances in public health in the 19th century were based on controlling the built and natural environment, in particular improving water supplies and sewerage systems. In the 20th century improvements in housing standards and supply reduced overcrowding and its associated diseases such as tuberculosis. Similarly the clean air acts in the latter part of the century significantly reduced the levels of respiratory disease. Places such as Calton demonstrate that the built environment in which people live, work and play can still influence health both directly (through toxic, allergenic or infectious agents) and indirectly through influencing behaviours (such as the amount of space in which to relax, walk or cycle), and through affecting mental health and wellbeing (which in turn may affect physical health). Wider health inequalities are associated with an ageing UK population. Already 30 per cent of households are headed by someone over 65. By 2026, this number is forecast to have risen by 48 per cent, an additional 2.4 million households. By 2036, 2.3 million people will be aged 85 and over. Forty per cent of people aged 80 and above are living with a long-term illness or disability, and 1.5 million have a condition requiring specially adapted accommodation. However, nearly 90 per cent of older people live in ordinary housing. Given current rates of house building, this is unlikely to change significantly. There has been considerable research into the impact of the historic built environment on health. A 2004 report by the Institute of Field Archaeologists and Atkins Heritage Measuring the Social Contribution of the Historic Environment suggests that connectedness through social networks is important to the quality of life and wellbeing for older people. As people age, their social connections (family, friends, and former work and recreation colleagues) may break down. Connections with a historic place may be the start of creating new social connections. The Built Environment Forum Scotland (BEFS) 4 has called for the politicians in Scotland to ensure that health impact assessments5 are integrated into the design and management of the built and historic environment. The BEFS believes that everyone involved in conservation and development should focus not just on delivering more sustainable ‘lifetime homes’ 6, but also on the wider concepts of the ‘lifetime neighbourhood’ 7 and the ‘age-friendly city’. The lifetime neighbourhood has few unnecessary, thoughtless, environmental barriers, making access better for people of all ages, and good transport, public services, public space and amenities, so that people are encouraged to get out of the house and actively participate in their community. References 1 Inequalities in Health 2003 http://www.scotland.gov.uk/Resource/ Doc/47171/0013513.pdf 2 Image of Milngavie Precinct courtesy of Undiscovered Scotland 2000-2011 3 http://news.scotsman. com/scotland/Anation-still-dividedby.2739234.jp 4 http://www.befs.co.uk/ 5 http://tinyurl. com/5sx8t6w 6 http://tinyurl. com/6l7eox4 7 http://tinyurl. com/6hwrxo2 The former Templeton’s Carpet Factory, designed to resemble the Doge’s Palace in Venice, is a bright point in the deprived area of Calton, Glasgow. (Photo: RobertWalker) Craig Stirrat is director of the Built Environment Forum Scotland.
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