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Building in Health Rob Ballantyne

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Building in Health Rob Ballantyne Building In Health Rob Ballantyne Milton Keynes South Midlands Health and Social Care Group exists to develop proposals with partners towards evolving an appropriate local health and social care infrastructure in support of the Government’s sub regional strategy to help deliver unprecedented population growth in six key areas – Northampton and West Northamptonshire, North Northamptonshire, Milton Keynes, Aylesbury, Bedford, Luton and Dunstable. Membership comprises representatives from Social Care and Health, Local Government and Voluntary Sector organisations. The group’s work has included commissioning research into models of care and receipt of research outputs, pre-consultation and consultation with key stakeholders and their publics, producing recommendations and feeding these back before developing an agreed planning framework for the future provision of health and social care in the Milton Keynes South Midlands sub-region. Rob Ballantyne is an independent health and social care consultant. Rob has considerable experience of working both in Health and in Social Care at senior and Director level. He is also a qualified town planner. He has worked with a number of organisations in the East Midlands, on topics ranging from strategy development in a PCT to carrying out a service review for a Local Authority Improvement and Scrutiny Committee. He is also working in the field of Health Impact Assessment. This guide was produced while he was working for the Public Health Group, East Midlands. [email protected] Published in 2006 by: Milton Keynes South Midlands Health and Social Care Group, Nene House, Isebrook Hospital, Irthlingborough Road, Wellingborough, NN8 1LP A checklist and workbook based on this document is available at: www.mksm.nhs.uk This report draws heavily on: Healthy sustainable communities: What works? - Ben Cave, Peter Molyneux and Adam Coutts - Milton Keynes & South Midlands Health and Social Care Group, 2004. Healthy sustainable communities: A spatial planning checklist - Ben Cave and Peter Molyneux - Milton Keynes & South Midlands Health and Social Care Group, 2004. 1 Building In Health “We shape our buildings and afterwards our buildings shape us.” W.S. Churchill 1943 Population health is affected not only by age, sex and genetic make-up, but also by general socio-cultural conditions, living and working conditions, social and community influences and individual lifestyle factors. “The environment we live in, our social networks, our sense of security, socio-economic circumstance, facilities and resources in our local neighbourhood can affect our experience of health.” 1 “Sustainable communities meet the diverse needs of existing and future residents, their children and other users, contribute to a high quality of life and provide opportunity and choice. They achieve this in ways that make effective use of natural resources, enhance the environment, promote social cohesion and inclusion and strengthen economic prosperity.” 2 In 2004 the government commissioned the Egan Review to identify the skills needed to deliver sustainable communities Components to sustainability: GOVERNANCE Effective and inclusive participation, representation and leadership SOCIAL AND CULTURAL Vibrant, harmonious and inclusive communities ENVIRONMENTAL Providing places for people to live in an environmentally friendly way HOUSING AND THE BUILT ENVIRONMENT A quality built and natural environment TRANSPORT AND CONNECTIVITY Good transport services and communication linking people to jobs, schools, health and other services ECONOMY A flourishing and diverse local economy SERVICES A full range of appropriate, accessible public, private, community and voluntary services These headings have been used in this report This paper is a brief guide and checklist for planners, developers, and health professionals into what provides the setting for healthy sustainable communities. 3 2 1. Governance 4 The Wanless Review ‘Securing our Future Health’ showed that where public engagement in relation to their health is high there is dramatically improved population health status and relatively less demand on future healthcare resources. 5 1.1 Public involvement Are plans being developed with the active involvement of all of those likely to be affected – both existing residents and potential incomers? This needs to be properly resourced. Participation in itself can be health promoting. People are most likely to take control of their health if they feel they can influence other aspects of their lives. Socially isolated individuals in less cohesive communities are more likely to experience poor health than those from more cohesive neighbourhoods. Community involvement fosters the development of community feeling and social capital, which itself can be beneficial for health. 6 1.2 Inclusiveness Does this participation involve hard to reach groups? Regeneration may displace marginal groups, and may not benefit existing residents. Those on the margins of society, and lower socio-economic groups have significantly worse health status than those better off and more involved. 7 1.3 Considering the health impact Has consideration of the impact of proposed developments on human health been part of the evidence put forward when strategies are being developed or schemes considered? 8 Have strategies and projects had a Health Impact Assessment (HIA) screening, and has HIA been carried out on schemes where the initial screening shows that significant health impact may result? Considering human health is a requirement of ‘Strategic Environmental Assessment’ (SEA). SEA applies to strategic level policies, for example, Regional Spatial Strategies, Local Transport Plans etc. 9 The World Health Organisation defines HIA as “a combination of procedures or methods by which a policy, programme or project may be judged as to the effects it may have on the health of a population” These effects can be direct, such as the health impact of air pollution. They can also be indirect, working through the determinants of health such as housing, social cohesion, employment and access to services. 3 HIA is not a statutory requirement, but may be considered as good practice where a significant health impact, positive or negative, may result. HIA can be carried out as a separate exercise or as part of Environmental Impact Assessment (EIA). 10 2. Social and Cultural 11 A sense of community identity and belonging is important for health and wellbeing. Planning policies and new developments cannot by themselves create ‘communities’ but they can encourage or discourage the formation of social cohesion and social capital. 2.1 Integration Are large developments of 2000 or more dwellings planned as balanced communities with a range of housing types and tenures? Developments should not have the effect of segregating areas or excluding certain groups. 12 Places that exclude or segregate certain groups will tend to increase health inequalities. Life expectancy in the poorest and most deprived areas can be up to 10 years less than in more favoured areas 2.2 Social infrastructure Are well-designed places available where people and voluntary groups can gather and use, for example shared places of worship, community centres, sports facilities, community spaces? Is there community involvement in the design and management of such places? 13 Social support is an important determinant of longevity and quality of life. People living in high trust communities have a lower probability of reporting poor health. Social infrastructure as above can assist in the development of such trust. 2.3 The Arts The arts can help to create social capital, and should be integrated into large developments. Is there a 'Percentage for Arts' in the scheme or policy? 14 Culture provides employment, encourages learning and inspires people to creative, active and healthy lifestyles. 15 2.4 Crime and fear of crime Are developments designed to minimise opportunities for crime, and maximise opportunities for community control and defence of the local area? Is community involvement an integral part of this approach? 4 Crime related injury is a significant public health problem in itself. Fear of crime reduces social solidarity, and has an adverse psychological impact. Fear of leaving home exposes older people in particular to isolation and vulnerability. 16 3. Environmental 17 Egan considers the environment in the context of: “ Living in a way that minimises the negative environmental impact and enhances the positive impact, (e.g. recycling, walking, cycling)”. 3.1 Land Contaminated Land Exposure Assessment (CLEA) should be carried out to assess any health risks from Brownfield sites. 18 Does waste management encourage reduction, recycling and reuse? Are landfill sites more than 2km from residential areas? Integrated Pollution Prevention Control (IPPC) is a regulatory system to ensure that industry adopts an integrated approach to pollution control. 19 Have the Primary Care Trust (PCT) and Health Protection Agency been consulted? Heavy metals, oil, asbestos, landfill gases are injurious to health. Waste disposal is major generator of road transport. Proximity to landfill sites has been associated with certain adverse birth outcomes. PCTs are statutory consultees for health on IPPC, with the Health Protection Agency providing advice and information. 3.2 Water Do developments minimise extensive hard surfaces, which cause rapid water and contaminant run-off? Are flood risk minimised? 20 21 ‘Non point source’ water pollution
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