Bringing together health, cities and design

Sometimes, great thinking really does begin with a moment of Damascene clarity. Paediatrician Richard Jackson – today one of the leading proponents of healthy urban design – was driving home along a Californian freeway one particularly hot day, when he passed a woman walking by the side of the road, struggling with heavy bags. His initial reaction was to slow down, thinking to offer her a lift – but caution won out, and he drove on. It was later – worrying that she could have become seriously ill – that he realised that, had she died, the death certificate would have read ‘heatstroke’ when in fact it should have read: ‘terrible urban design’'.

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Unleashing health by design: creating a culture of wellness in our cities was a panel discussion* across health, urban issues and design – sectors that could do so much by working together, but which often fail to join up their research, thinking and action. Lord Mawson noted that the real opportunity for the post-Brexit economy isn’t within sectoral silos – it is in the connections between the silos. (He should know: he established the Bromley by Bow Centre, itself a paradigm for bringing sectors together to benefit health.) This is about more than just bottom-up thinking – it is about turning things inside out.

However, in this space the NHS is notably hard to do business with: its interest is in curing disease, rather than in the promotion of good health within local communities. We need to do a much better job of linking health with environmental and financial sustainability, and there is a long way to go before existing good practice (such as at Bromley by Bow) is ‘industrialised’ and becomes mainstream.

‘Risk’ was highlighted as a barrier to action, particularly the threat to vested interests of different ways of working. We are a very risk-averse society – whether the perceived risk of building ‘green’ homes without being sure that they would sell (they would!) or the risk of creating play spaces for children (the benefit from being physically inactive and uninquisitive far outweighs the disbenefit of a minor bump).

There was frustration that ‘public health’ seems to be regarded as being only about smoking and obesity, when in fact the social determinants of health go far wider, encompassing housing and education. How can we bring health more comprehensively into discussions about these other aspects of public spending? Part of the problem is a failure to align incentives; the return on investment on better housing or improved air quality will be seen in fewer admissions to hospital, rather than in the housing or transport sectors.

I asked how we can encourage the whole of society to adopt the ‘prevention’ agenda. Without strong support (not just from health professionals, but also from the media and the voting public), politicians will never afford prevention the priority it deserves, and it will remain the poor relation of spending on health care. In 2015, public health budgets were cut by 7.4 per cent (£200 million) – in contrast to the ringfenced (although arguably still insufficient) spending on the NHS. Here, as Sunand Prasad noted, cities can be part of the answer: although national politics can feel distant, it is through local neighbourhoods that people can really make their voices heard.

Finally, there was a call for papers for the Healthy City Design Congress in October, for which today was the launch. This will be a partnership between SALUS Global Knowledge Exchange and the Royal College of Art’s Helen Hamlyn Centre for Design.

As at all good events, the networking was every bit as informative as the formal discussion. I had a particularly interesting conversation with Lorna Hughes, community programme manager at a new development of 15,000 homes in Ebbsfleet, one of 10 Healthy New Towns sites. I have been intrigued about the programme since meeting last year with Ravi Baghirathan, the NHS lead on Healthy New Towns, so it was good to get an update and hear Lorna’s first-hand enthusiasm.

*Speakers were Professor Rachel Cooper, Professor Dame Anne Johnson, Lord Andrew Mawson, Dr David Pencheon and Sunand Prasad (who related the Richard Jackson anecdote). It was chaired by Professor Jeremy Myerson and Marc Sansom (SALUS Global Knowledge Exchange).