University Hospital North Staffordshire

Cathy Russell, associate at Ryder, discusses recent research into the links between placemaking and wellbeing.

An increasing body of research indicates that some of our most pressing health challenges such as physical inactivity, mental health issues, and the needs of an ageing population, can be influenced by the places we inhabit. As designers, we have an impact by creating environments which influence behaviour through connectivity, mixed uses, access to green space, sustainable transport, and opportunities for physical activity and social interaction. Healthy places can add environmental, economic and social value, as outlined in the Healthy people healthy places evidence tool by Public Health England.

How the environment affects health

How do places influence health and wellbeing outcomes?  Research in this field has grown considerably in the last few years.  Firstly, there are several alarming statistics on the issues faced - physical inactivity is responsible for 1 in 6 deaths in the UK, claims that air pollution is a factor in up to 40,000 deaths per year in the UK and that urban residents have been found to have an increased risk of mental health issues, for example, mood disorders increase by 39% compared with rural environments.  These adverse effects on health and wellbeing affect all ages across all sectors of society, but particularly affect vulnerable groups. The financial costs of physical inactivity alone are estimated to be £7.4bn per year.

Regular physical activity helps to prevent obesity and reduces the risk of many chronic conditions, including coronary heart disease, stroke, type 2 diabetes, cancer, mental health problems and musculoskeletal conditions. Activity that can be incorporated into everyday life, such as walking and cycling, has been found to be as effective for weight loss as supervised exercise programmes. Similarly, regular exercise can be as effective as anti-depressants for treating mild to moderate depression.  Access to green space and nature is also crucial in improving both physical and mental health as it promotes exercise, provides a setting for social interaction, and reduces stress. This positive impact on wellbeing can be attributed to a combination of biophilia theory (humans have a biological need to be in contact with other species) 

Many of the health and wellbeing themes discussed here are intertwined.  For example, the ambition to increase people’s activity levels, perhaps by increasing cycling and walking is linked to the need to also reduce exposure to air pollution, through discouraging private car use, improving public transport and increasing areas of vegetation and trees.  On another level, the perceived safety of environments influences how likely we are to choose to walk or cycle, rather than drive.  In addition to fear of crime, this choice can be influenced by subtler emotional responses to place, such as whether a lively street with active frontage inspires us and increases the likelihood of social interaction, or whether a long, featureless street frontage makes us prone to negative thoughts and reduces our interest in engaging with others.  More walking and cycling also has the potential to achieve other benefits such as supporting local businesses and promoting vibrant town centres, providing an attractive public realm, and reducing congestion (and air pollution), road danger, and noise which can have a detrimental effect on mental health, including through its impact on sleep.

How can we design healthy places?

We have the capacity to influence health outcomes at different scales, from individual buildings (for example, the Well Building standard for workplaces, and hospitals where views to green space improves recovery outcomes) to whole neighbourhoods, including interventions in existing places as well as the design of new ones. 

At the University Hospital of North Staffordshire, one of the design drivers was creating access to or views of gardens and green space to aid rehabilitation, referencing Roger Ulrich’s research findings. The structure of streets, squares and gardens within Cambridge Biomedical Campus promotes pedestrian activity and develops a distinctive, memorable sense of place. Ryder’s competition winning North Shore masterplan creates a sustainable, mixed use development which exploits its south facing riverside location and provides pedestrian and cycle connections through the site, linking it with Stockton’s existing town centre. Lodge Road in London provides clusters of apartments which can be readily converted to support dementia, allowing residents to remain in familiar surroundings as their needs change.  Shared facilities include café, flexible activity space and roof gardens.

Measures we can achieve through placemaking

These include promoting active travel so that travelling on foot or by bike is a more attractive option than driving.  Measures include introducing safe cycling and walking routes, bicycle parking, high quality public spaces, reduced vehicle speeds, mixed uses so that amenities are easily accessible, good public transport, and a permeable street network with convenient connections between different areas. 

Compact, walkable places with a mix of uses also provide increased opportunities for social interaction which helps to mitigate feelings of loneliness and builds our self esteem and resilience.  Cultural opportunities and interventions in public space such as seating, games, pop up uses, and multi use events spaces can also be beneficial in this respect.

Well maintained green space should be integrated into all designs, with a focus on ensuring people have consistent, regular exposure to urban nature in their daily routines.  This could include incorporating street trees and planting into commutes, green walls, views of nature from office windows and gardens for lunch, and networks of parks and public spaces for recreation.  Urban food growing has also been found to be associated with improved attitudes towards healthy eating, increased opportunities for social connectivity and physical activity.

Living in high quality, well managed and affordable housing with good public and active transport links is associated with numerous positive health outcomes.  These include improved social engagement among older adults, reduced injury among older adults and children, and improved general wellbeing.  It can also help to reduce the impact of economic disparities on the mental health of residents in poorer areas.

Feelings of safety and security is a key consideration, both in terms of encouraging physical activity, and guarding against mental health problems.  This can be facilitated through the clear demarcation of public and private space, natural surveillance (‘eyes on the street’), and maintenance (linked with ‘broken windows theory’ where the perception of a neglected environment leads to further neglect).  This can also be extended to traffic safety (including the safe design of shared spaces for all users) and navigational safety in which landmarks in the urban environment can assist wayfinding, particularly for people with dementia.

Guidance and initiatives

A wealth of best practice and guidance exists, such as Active by Design, , World Health Organisation’s Collaborating Centre for Healthy Urban Environments, Healthy People, Healthy Places) and Sport England’s Active Design.  Detailed guidance that can help to ensure pedestrians and cyclists are considered before other user groups in the design process is available in Manual for Streets.

NHS England’s current Healthy New Towns programme is using cross sector partnerships with local public health teams to achieve better health outcomes in housing delivery projects.