NHS crisis – an Urban Design crisis?

Soaring levels of obiesity are pushing the NHS to the brink.

Health and Cities. Is the NHS crisis an Urban Design crisis. Is the cure the redesign of our neighbourhoods from car centric environments to sustainable walkable communities?  This article by Noel Isherwood can be found in the Health Triangle magazine – issue no: 57/2018 /https://www.ukhealthradio.com/magazine/

We have a big health issue in the UK.  Does urban design and city planning have the answer?

When not trying to rewrite legislation for post Brexit, as the Guardian pointed out recently, ‘soaring levels of obesity and type 2 diabetes have strained the (NHS) treatment model to breaking point’. (Guardian jan 2018 Kailash Chand)

Quick fix treatments, appear to be favoured over ‘the promotion of light exercise’ and dealing with the issues of ‘poor town planning, weak infrastructure and poor quality housing. These things ‘fuel health problems that ultimately cost the NHS billions that it does not have’.

So what is it about our cities, towns and villages that is contributing to this health crisis?

Since the second world war, following in the footsteps of America we in the UK have reorganised our landscape whether urban or rural, around the requirement of automobile use. As urbanist Jeff Speck points out, ‘the automobile that was once an instrument of freedom, has become a gas-belching, time-wasting and life-threatening prosthetic device that many of us need just to live our daily lives’.

If we consider the out of town Shopping Mal alone, this has in one giant move from the 1960’s onward, removed shopping from the walkable town centres, easily accessible by public transport to largely remote locations creating dependancy on the automobile. If we consider the emergence of internet shopping the need to leave the house at all has been vastly diminished. It’s easier to stay at home than face congestion in a car or the hazards by going on foot or cycling.

Where previous generations walked for everything and kept fit and healthy in the process, today it is very easy not to walk at all.

Design arguments for changing the status quo whether at the city or neighbourhood level  do not have as much impact as arguments put forward by the economists, health professionals and environmentalists.

In this article I am considering the health arguments which are slightly alarming. If we take America, back in the ‘70s, one in 10 Americans was obese. Now one out of three Americans is obese, and a second third of the population is overweight. We in the Uk clearly have a parallel to this.

‘According to the Center for Disease Control (US), fully one third of all children born after 2000 will get diabetes. We have the first generation of children in America who are predicted to live shorter lives than their parents’. (Jeff Speck)

So putting two and two together, it can be argued that this NHS crisis, is an urban design crisis and with the design of our cities and neighbourhoods lies the cure.

Many of our historic city centres in the UK still retain a magnificent walkability. But this is not the case in many regional towns and growth areas since 1945 where a condition approximating America prevails and where much work needs to be done.

We are not short of TV programs on food and diet. We know that diet impacts weight, and weight of course impacts health. But we’ve only started talking about inactivity. But have we equated how this is inactivity born of our landscape?  Have we realised the fact that many of us now live in a place where there is no longer any such thing as a useful walk?

This is driving up our weight.

Studies have been carried out that demonstrate how weight increase is tied to inactivity and some studies can tie weight to where you live.  Do you live in a more walkable city or do you live in a less walkable city, or where in your city do you live?

One study showed that if you lived in a more walkable neighbourhood, you were 35 percent likely to be overweight. If you lived in a less walkable neighbourhood, you were 60 percent likely to be overweight.

There is even a word for this environmental-induced inactivity which describes such neighbourhoods as ‘obesigeneric’.

Another health issue to mention is Asthma.  Three times more people die in America from asthma since the 1990s and almost all of it comes from exhaust fumes, not factories anymore, even in the former industrial zones such as South Wales.

I don’t have time to mention deaths from car accidents.

Perhaps it is true, ‘the NHS made an error from the start: building services around treatment rather than prevention. We see the ramifications of this today.’ (Guardian jan 2018 Kailash Chand)

The best cities in the world today are one which have put walking and cycling at the heart of their strategy for the future and to create walkable neighbourhoods. Millennials are putting the choice of their preferred city to live in ahead of their choice of University and Work. Cities that do not do the same will soon fall behind in the rankings as health, lifestyle and well-being become a bigger issue than how much money can I earn.

We don’t want to have this argument. Politicians and marketers are afraid of marketing green as a “lifestyle choice”. But what if lifestyle was really about quality of life and about perhaps something that we would all enjoy more, something that would be better than what we have right now?

I will discuss the principle of walkable neighbourhoods in a subsequent article.