The link between the quality of the built environment and urban health inequalities is well evidenced. Covid has shone a spotlight on this. For example, the most crowded areas in the country reporting 70% more cases of the virus than the least crowded. There’s huge potential for the built environment sector to contribute to tackling the health crisis. The challenge is how we build partnerships and create useful processes to collaborate effectively with the health sector.
The opening webinar of FoL’s Healthy neighbourhoods: working together programme sought to highlight the most pressing issues between the built environment and health sectors and promote more efficient collaboration, creative thinking and sharing of resources to have a bigger impact on health inequalities. Contributors were:
Patrick Devlin, Pollard Thomas Edwards Architects
Serena Horgan, Catalyst Housing
Michael Parsons, Impact on Urban Health
Bhavini Shah, Montagu Evans
Nicola Wheeler, Catalyst Housing
Watch the event
Health inequalities in context
Michael opened the event by outlining how Impact on Urban Health is successfully using data from Lambeth and Southwark (some of England’s most deprived areas) to address inequalities by prioritising interventions. They have created an urban health index for each neighbourhood in their catchment – revealing the micro differences between places and suggested tailored interventions.
In Lambeth, for example, 37% of black Caribbean residents are living with two or more long-term health conditions compared to 21% of the white British population. The research revealed a mistrust by ethnic minority groups of health services. This suggests a need to prioritise interventions for BAME populations, to build trust and share power –allowing people to feel that the health service is accessible and welcoming.
Addressing health inequalities goes beyond effective use of data. Further challenges raised by the panel and audience were:
- Siloed working – for example, Local Health Trusts and Local Authorities create local strategies at different times and covering different time periods.
- Organisational structure – work needs to be done to demystify the structure of the NHS so that built environment professionals understand who needs to be contacted when.
- Broadening the case – we need to make health everyone’s business.
- Financial pressures – there is a sense that we are tasked with doing and achieving more, without an associated increase in budget.
After Michael, our panellists offered other potential approaches to inequalities from their work. One of these is the co-location of facilities into hubs that can increase efficiencies, helping address financial constraints. Hubs can also make health services more friendly and accessible for those who lack trust in the health system.
Bhavini outlined a collaboration between Kent County Council, Ashford Borough Council and Kent Community Health Trust. The One You scheme made use of an empty retail unit to provide lifestyle advice – going to where people are, rather than expecting them to come to the health service. And it could be replicated in other areas, given the context of increasing empty retail space.
Patrick talked us through the design process for a community hub in Redbridge, housing a library, workspace, café, children’s services and a GP practice. The online consultation process reached around 7,000 people, using interactive whiteboards to explore how people might use the building. This engaging way of getting people to think about their use of a building has resulted in design decisions such as council staff being distributed throughout the building in public-facing spaces to make them more approachable.
Havelock estate – a health-based approach to neighbourhood regeneration
Nicola and Serena provided an example estate regeneration where collaboration for health has been prioritised. Key to the success of the redevelopment of the Havelock estate and the impact on local people’s health has been the investment in community engagement and the strength of local partnerships:
- Catalyst Housing have paid for a community investment worker to understand residents’ priorities and appropriate projects and interventions to address them.
- They identified that people needed hyper local opportunities for activities that are good for their health. Catalyst worked with Canal & River Trust to improve the canal alongside the estate, distribute pedometers and create a healthy walk with signage.
- The community link worker found that information in GPs was very generic. GPs and receptionists didn’t know what was going on just outside the surgery. So they carried out a mapping exercise with other local partners. They identified a local canoe club and affordable exercise classes and created a map for distribution in GPs.
Ideas for working together
There are positive signs and examples we can draw on to tackle the barriers raised:
- Incoming Integrated Care Systems will bring together health providers and commissioners alongside other local partners. They will promote strategic thinking for a locality and help different partners to understand each other’s ways of working.
- As the Havelock example shows, mapping community and healthcare assets can help to understand opportunities, make the best of resources, increase access to funding and avoid doubling-up of efforts.
- Housing associations and local authorities can make the case to social prescribers to broaden what’s offered to patients, including exercise, social activities, fuel top-up vouchers, benefits advice or employment support.
- Broadening the case for health and working with services such as community link workers in housing associations can help access a wider pool of resources and funding streams.
- Built environment professionals can work together with NHS Trusts to think about their estates more holistically. For example, considering how patients can access their sites via active modes of travel. Bhavini highlighted the example of North East London NHS Foundation Trust who have introduced a signposted loop walk around their site to encourage patients to make use of the space as part of their recuperation. This is easier on large health estates, but at the small scale such as within GP practices, Catalyst Housing have demonstrated another way to have an impact (as above).
The examples of effective collaboration provided by our panel show that there are ways of working effectively between sectors to help tackle the health crisis together.
As with many of our big urban challenges, we can lose sight of health goals in the context of short-term budgetary constraints. There needs to be wider recognition that to overcome these health challenges through our built environment projects we need to think long-term.
Find out more
The remainder of Healthy Neighbourhoods programme will seek to provide more examples of how we as a sector can overcome the barriers raised. Find out more here.