Improving health by creating supportive environments.
Dear Editor
McKinnon and colleagues quite rightly remind us of the potential to influence health and wellbeing by changes to the environment.(1) There is an increasing body of research in this area(2-5) and the World Health Organisation estimates that 23% of global deaths and 26% of deaths among children under five are due to modifiable environmental factors.(2) In the past there has been considerable public health success by making changes to the physical, economic and social environments, but much more could be achieved.
The burden of environmental risks is not evenly shared both in this country and around the world. For example, in regions such as sub-Saharan Africa an estimated 35% of death and disease is linked to environmental hazards.(6) It is also staggering that unsafe water, poor sanitation and hygiene still kill an estimated 1.7 million people annually and that indoor smoke from solid fuels kills an estimated 1.6 million people annually due to respiratory diseases. In order to try to tackle such issues the World Health Organisation and the United Nations Environment Programme have established the Health and Environment Linkages Initiative.(7)
In England, Marmot has recently reported on inequalities, and the environment was cited as a key determinant of health and wellbeing.(8) The report stated that the evidence of the relationships between health and the environment has grown and that the role the environment plays in influencing health is now better understood. Important areas that were covered included: air quality, transport, and housing.
The links between housing and health have been established for some time. Poor housing can result in infection, physiological, psychological and accident hazards.(9) Chadwick’s seminal work is a classic example of what can be achieved by making changes to the environment.(4) His work has had an impact in the UK, USA and further afield. In high income countries, although we’ve largely eradicated the diseases associated with the slums of the Victorian era there still remains a significant number of health and safety hazards in the home.(9,10)
Houses in the UK are still not as safe as they could be.(11) Every year, more than 6,000 people are killed due to unintentional injuries sustained in this environment, and it’s the under-5s and the over-65s, who are most at risk.(12) In order to address this the Royal Society of Prevention of Accidents (RoSPA) has produced an innovative evidence based framework - Safer by design.(12)
The framework was developed in consultation with industry and is supported by Public Health England.(12) It encourages house builders and designers to go beyond current regulatory requirements for accident prevention and outlines low-cost, practical interventions that can be “designed in” to address issues such as falls, poisoning, entrapment, and burns and scalds. The Berkeley Group and Orbit Homes are in the process of building new houses in line with the framework’s recommendations, hopefully other companies will soon follow. With greater publicity, it could also have an influence on the current housing stock.
Creating supportive environments is one of the five action areas of the Ottawa Charter because of the irrefutable links between people’s health and their environment.(13) The Charter led to the development of the settings approach where environments are designed to support healthy behaviours.(14) Globally, there are a variety of settings including health promoting hospitals, health promoting workplaces and health promoting schools.(14)
Creating health promoting settings such as a workplace or hospital is a complex process and requires considerable skilled support. In the UK, public health practitioners have such skills, but there would need to be increases in department budgets to enable them to undertake this work.(15,16) When the new public health strategy is produced in England it should be based on the settings approach to muster the supportive action for different environments.(17)
Although the importance of the environment in human health and wellbeing has been known for centuries it has not always been given the precedence that it deserves.(4) Housing, transport and local communities could all be designed so that there are considerable improvements to health and reduced costs to the NHS. We believe that the influence of the environment on health should be higher on the priorities of public health leaders, healthcare professionals and policymakers.(1,4)
2) World Health Organization. Preventing disease through healthy environments A global assessment of the burden of disease from environmental risks. Geneva: WHO, 2016.
3) Public Health England. Spatial Planning for Health. An evidence resource for planning and designing healthier places. London: PHE,2017.
4) Donaldson L and Rutter P. Donaldsons’ Essential Public Health. Fourth Edition. London: CRC Press, 2018.
5) World Health Organization. WHO Housing and Health Guidelines. Geneva: WHO, 2018.
7) World Health Organization and United Nations Environment Programme. The Health and Environment Linkages Initiative (HELI). WHO,2020. https://www.who.int/heli/aboutus/en/ (Accessed 20/04/20)
8) Marmot M. et al. Health equity in England: The Marmot Review 10 years on. London: Institute of Health Equity, 2020.
9) The Parliamentary Office of Science and Technology. POSTNOTE Number 371. Housing and Health. London: The Parliamentary Office of Science and Technology, 2011.
10) Roys M, Nicol S and Garrett H. The Full Cost of Poor Housing. Bracknell: IHS BRE Press, 2016
11) Royal Society for the Prevention of Accidents. Safe and active at all ages: a national strategy to prevent serious accidental injuries in England. Birmingham: RoSPA, 2018. https://www.rospa.com/national-strategy/
17) Watson M C and Lloyd J. The need for a health strategy that unites the country. British Medical Journal rapid response, 27 July 2019. https://www.bmj.com/content/366/bmj.l4829/rr
Competing interests:
No competing interests
21 April 2020
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK. http://ihpe.org.uk/
Rapid Response:
Improving health by creating supportive environments.
Dear Editor
McKinnon and colleagues quite rightly remind us of the potential to influence health and wellbeing by changes to the environment.(1) There is an increasing body of research in this area(2-5) and the World Health Organisation estimates that 23% of global deaths and 26% of deaths among children under five are due to modifiable environmental factors.(2) In the past there has been considerable public health success by making changes to the physical, economic and social environments, but much more could be achieved.
The burden of environmental risks is not evenly shared both in this country and around the world. For example, in regions such as sub-Saharan Africa an estimated 35% of death and disease is linked to environmental hazards.(6) It is also staggering that unsafe water, poor sanitation and hygiene still kill an estimated 1.7 million people annually and that indoor smoke from solid fuels kills an estimated 1.6 million people annually due to respiratory diseases. In order to try to tackle such issues the World Health Organisation and the United Nations Environment Programme have established the Health and Environment Linkages Initiative.(7)
In England, Marmot has recently reported on inequalities, and the environment was cited as a key determinant of health and wellbeing.(8) The report stated that the evidence of the relationships between health and the environment has grown and that the role the environment plays in influencing health is now better understood. Important areas that were covered included: air quality, transport, and housing.
The links between housing and health have been established for some time. Poor housing can result in infection, physiological, psychological and accident hazards.(9) Chadwick’s seminal work is a classic example of what can be achieved by making changes to the environment.(4) His work has had an impact in the UK, USA and further afield. In high income countries, although we’ve largely eradicated the diseases associated with the slums of the Victorian era there still remains a significant number of health and safety hazards in the home.(9,10)
Houses in the UK are still not as safe as they could be.(11) Every year, more than 6,000 people are killed due to unintentional injuries sustained in this environment, and it’s the under-5s and the over-65s, who are most at risk.(12) In order to address this the Royal Society of Prevention of Accidents (RoSPA) has produced an innovative evidence based framework - Safer by design.(12)
The framework was developed in consultation with industry and is supported by Public Health England.(12) It encourages house builders and designers to go beyond current regulatory requirements for accident prevention and outlines low-cost, practical interventions that can be “designed in” to address issues such as falls, poisoning, entrapment, and burns and scalds. The Berkeley Group and Orbit Homes are in the process of building new houses in line with the framework’s recommendations, hopefully other companies will soon follow. With greater publicity, it could also have an influence on the current housing stock.
Creating supportive environments is one of the five action areas of the Ottawa Charter because of the irrefutable links between people’s health and their environment.(13) The Charter led to the development of the settings approach where environments are designed to support healthy behaviours.(14) Globally, there are a variety of settings including health promoting hospitals, health promoting workplaces and health promoting schools.(14)
Creating health promoting settings such as a workplace or hospital is a complex process and requires considerable skilled support. In the UK, public health practitioners have such skills, but there would need to be increases in department budgets to enable them to undertake this work.(15,16) When the new public health strategy is produced in England it should be based on the settings approach to muster the supportive action for different environments.(17)
Although the importance of the environment in human health and wellbeing has been known for centuries it has not always been given the precedence that it deserves.(4) Housing, transport and local communities could all be designed so that there are considerable improvements to health and reduced costs to the NHS. We believe that the influence of the environment on health should be higher on the priorities of public health leaders, healthcare professionals and policymakers.(1,4)
References
1) McKinnon G et al. Strengthening the links between planning and health in England. BMJ 2020;369:m795.
https://www.bmj.com/content/369/bmj.m795
2) World Health Organization. Preventing disease through healthy environments A global assessment of the burden of disease from environmental risks. Geneva: WHO, 2016.
3) Public Health England. Spatial Planning for Health. An evidence resource for planning and designing healthier places. London: PHE,2017.
4) Donaldson L and Rutter P. Donaldsons’ Essential Public Health. Fourth Edition. London: CRC Press, 2018.
5) World Health Organization. WHO Housing and Health Guidelines. Geneva: WHO, 2018.
6) World Health Organization and United Nations Environment Programme. Priority risks and future trends. WHO,2020. https://www.who.int/heli/risks/ehindevcoun/en/ (Accessed 20/04/20)
7) World Health Organization and United Nations Environment Programme. The Health and Environment Linkages Initiative (HELI). WHO,2020. https://www.who.int/heli/aboutus/en/ (Accessed 20/04/20)
8) Marmot M. et al. Health equity in England: The Marmot Review 10 years on. London: Institute of Health Equity, 2020.
9) The Parliamentary Office of Science and Technology. POSTNOTE Number 371. Housing and Health. London: The Parliamentary Office of Science and Technology, 2011.
10) Roys M, Nicol S and Garrett H. The Full Cost of Poor Housing. Bracknell: IHS BRE Press, 2016
11) Royal Society for the Prevention of Accidents. Safe and active at all ages: a national strategy to prevent serious accidental injuries in England. Birmingham: RoSPA, 2018.
https://www.rospa.com/national-strategy/
12) Royal Society for the Prevention of Accidents. Safer by design. A framework to reduce serious accidental injury in new-build homes. Birmingham: RoSPA, 2019.
https://www.rospa.com/home-safety/Advice/Safer-by-design
13) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.
https://www.who.int/healthpromotion/conferences/previous/ottawa/en/
14) Watson, M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185. https://pdfs.semanticscholar.org/c1b6/3555f6b033effdc0062235adb7bab3de43...
15) Watson M C and Lloyd J, 2016. Need for increased investment in public health BMJ 2016;352:i761.
https://www.bmj.com/content/352/bmj.i761
16) Watson M C and Thompson S, 2018. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279
17) Watson M C and Lloyd J. The need for a health strategy that unites the country. British Medical Journal rapid response, 27 July 2019.
https://www.bmj.com/content/366/bmj.l4829/rr
Competing interests: No competing interests