Designing for health: part 2.


Building better health outcomes.

This insight was first published on the 21/09/22 for IEMA

Read part 1 here.

Opportunities for healthy lifestyle choices

Access to safe and well-maintained green spaces boosts physical activity, mental wellbeing, social interactions and community cohesion. It provides relief from stress, and reduces blood pressure and cholesterol levels. In built environments, when located close to people’s homes or workplaces, green space has a positive influence on activity levels, providing the best opportunity for walking or cycling.

‘Active travel’ refers to journeys taken on foot or by bicycle that are necessary for practical purposes, such as travelling to school or work. It is associated with numerous health benefits, as it involves physical activity and provides greater opportunities for social interactions. However, walking journeys have declined with the growth of habitual car use, and more sedentary lifestyles are associated with weight gain and increased health risks in the general population.

Distance is the strongest predictor of active travel. Compact neighbourhoods with higher density and connectivity, and a diverse range of land uses, are generally more conducive to active travel. Perceived safety risk is another barrier to active travel, and provision of cycle paths and street lighting increases the number of walking and cycling trips undertaken.

Poor diet is another factor associated with weight gain with associated health risks, although weight gain is largely a factor of a sedentary lifestyle. For example, access to shops locally can encourage exercise via active travel, and opportunities for food production locally, such as growing fruit and vegetables, can encourage exercise outdoors and improved attitudes towards diet.

Significant self-production of food is dependent on the availability of open space, which is often limited in built up areas. High-density housing and housing with small gardens are not conducive to self-production of food.

Allotments, community gardens or orchards and local collectives provide opportunities for local food production, as well as community interaction, social networking and better mental wellbeing.

The condition of the natural environment

Climate change is the greatest threat to global health, impacting disease patterns, food security, water pollution, sanitation and extreme weather – all of which will pose challenges if we are to maintain a healthy built environment. Furthermore, multiple climate and non-climate hazards sometimes coincide, exacerbating impacts; for example, heatwaves in cities exacerbate air pollution levels.

The Intergovernmental Panel on Climate Change has said that improving the resilience and healthiness of built environments should involve mitigating the causes of climate change. For example, an optimised urban form with higher density, pedestrian connectivity and a diverse range of land uses encourages active travel, cuts vehicle-related greenhouse gas emissions and reduces associated air quality impacts. However, the feasibility and effectiveness of climate change mitigation and adaptation in the built environment also requires co-ordination between physical, social and natural infrastructure.

Natural infrastructure or ecosystem services are the range of ecological resources, processes and sinks required to provide the balanced and stable conditions necessary for life on earth. These include provisioning services, such as food and water; regulating services, such as flood and disease control; cultural services, such as spiritual, recreational and cultural benefits; and supporting or provisioning services, such as nutrient cycling.

The use of ecosystem services must contribute to human health without destabilising the ecosystems upon which we rely. These services can be safeguarded in new development though the creation and management of green and blue infrastructure.

Green infrastructure refers to both multifunctional green spaces and green spaces that allow ecological species to leapfrog between habitats, creating a network. For example, rows of street trees provide habitat and connectivity to other habitats, but also can add aesthetic value to an urban area and thus encourage active travel, remove air pollutants from the atmosphere, and reduce wind microclimate and urban heat island effects. Other examples of green infrastructure include wildlife reserves, urban woodland and orchards, river corridors and flood plains, public parks and gardens, green roofs and green walls.

Blue infrastructure refers to multifunctional spaces with an emphasis on water quality, navigation or flood management. Blue infrastructure can also be useful in response to climate change resilience and adaptation responses, and in the management or urban heat island effects. At the project scale, sensitive management of water principally concerns avoiding ‘end-of-pipe’ design solutions for water management, including sustainable urban drainage systems such as soakaways, swales, permeable surfaces, planting systems, vegetation cover and wetland habitats.

In-combination effects

Human health relies on a high-quality built environment, opportunities for community networks to develop and exist, individuals making healthy lifestyle choices, and the overriding condition of the natural environment. In isolation, individual design decisions on new developments have only a limited capacity to influence health. However, when considered collectively and in combination, such design measures are key to shaping better health outcomes at the population scale.

Further reading

The evidence base used to inform this article has been summarised from a review of the following principal information sources: City of Well-being: A radical guide to planning (Barton, 2017), Spatial Planning for Health: An evidence resource for planning and designing healthier places (PHE, 2017), The Marmot Review (Marmot, 2010, 2020) and Climate Change 2022: Impacts, Adaptation and Vulnerability (IPCC, 2022).