THE ESTATE AND SOCIETY
Placemaking to address UK’s ‘health inequality crisis’
Paul Kelly, director for Strategic Advisory at Mace, argues that to ease pressures on the health service, and ensure greater health equality across society, government, healthcare providers, and the private sector across the UK, will need to work more closely together, moving towards a multi-agency approach to ‘placemaking’ and the promotion of wellbeing.
The UK has experienced an increase in health inequality over the last two decades, which risks placing enormous pressure on the nation’s social fabric. While the phrase ‘left behind places’ has been coined in recent years to describe towns, coastal communities, and rural areas that have experienced economic turmoil, the impact of poor health outcomes in these areas is less frequently discussed. However, the link between declining productivity and increases in long-term illnesses is clear. Data from the Office for National Statistics shows that around a third of the UK population lives in the UK’s most deprived 10% of places, where nearly one in four people suffer from a long-term illness. Life expectancy in these areas is on average 16 years less than in the most prosperous parts of the country. The poorest and least healthy communities are often located remarkably close to significantly ‘better off’ areas, making the contrast particularly stark. On the Wirral, for example, life expectancy for residents in Birkenhead on the east side of the peninsula is 10 years shorter than for their neighbours in Hoylake and West Kirby on the western coast. Just six miles separates these two areas.
Complex reasons for divergence The reasons for this divergence in outcomes are complex, and in many cases relate to broad social changes that have taken place across Europe and North America over the last four decades: deindustrialisation, urbanisation, the growth of the knowledge economy, and the loss of community institutions such as churches and local trade unions. However, a factor often underplayed in these discussions is the quality of the built environment, and its importance in producing positive health outcomes. If we are to address health inequalities, we need to think more holistically about how placemaking can address the problems faced by communities in some of the more deprived parts of the UK.
60 Health Estate Journal April 2020
A sense of community or belonging is created by the presence of tangible social infrastructure such as local community groups and facilities, but also, Mace says, ‘by the less obvious social capital produced by groups of volunteers and civic organisations’.
Placemaking and health
Thinking holistically about the interaction between place and health is not necessarily a new concept. The great philanthropists of the Victorian era, for example, understood the importance of ensuring access to high quality housing, parks, and infrastructure. Sir Titus Salt built the village of Saltaire after observing the poor health of many of those who worked in his textile mills in Bradford. Realising that simply building houses wouldn’t be enough, Salt developed an entire community – including a library, school, hospital, concert hall, and a range of shops. Saltaire remains an attractive place to live today because of the long- term vision on which it was founded, and the principles underpinning its creation. Similarly, the likes of Bourneville in Birmingham (founded by the Cadbury family), and Port Sunlight in Merseyside (created by soap manufacturers, the Lever Brothers) are popular, attractive, prosperous places in large part because of their active promotion of healthy lifestyles. More recently, the village of Poundbury in Dorset, conceived by the Prince of Wales as an alternative to the
car-reliant suburbs of the 80s, has attracted praise for its human scale, walkability, and integration of mixed-use developments.
Efforts intensifying for Net Zero 2050 With efforts intensifying for Net Zero 2050, and demand for much better infrastructure and services from a growing population, planners, developers, and politicians over coming years will need to embrace the challenge of harnessing the most effective placemaking principles across a much wider scale. At a political level, Prime Minister, Boris Johnson, has already set out recognition of this challenge by acknowledging that his new Government cannot take for granted the support it recently gained from many former Labour voters and constituencies. To promote good health, provide employment opportunities, and to develop a true sense of pride and connection to a place, it is also crucial that private developers are thinking holistically about what makes a great place.
Research from Mace, included in our recent Insights report on the UK’s
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