Land use planning and health and well-being. (Special Issue: Land use futures.)

摘要

This paper is concerned with the relationship between the planning of settlements and health. It gives a brief introduction to the issues before summarising the evidence in relation to a range of topics, concluding with some more speculative thoughts on likely future findings. Modern planning was invented in response to inhumane living conditions in 19th century cities. But in the last century the connection was lost. Only now, with concerns over climate change and obesity, is there beginning to be the realisation that the physical environment is an important determinant of health. The paper uses a particular model of this relationship based on eco-system and health determinants theories to structure the review of evidence. The review covers: lifestyle choices in relation to physical activity and diet, mental well-being and community, the local economy and income, health inequalities and strategic land use transport planning, pollution and urban form, and finally impacts on global ecology. There is now a growing consensus that while personal factors are critical in determining health, the urban environment exacerbates or mitigates health and well-being outcomes. The level of active travel (walking and cycling) and outdoor recreational activity is strongly affected by accessibility to local facilities. Access to green, natural environments, and to local social networks, are factors in mental well-being. The wider sub-regional pattern of housing, economic development, land use and transport is a determinant of social exclusion and therefore health inequalities. It also affects health-damaging pollution, adaptability in the face of climate change and the level of carbon dioxide emissions. We have literally been building unhealthy conditions into many of our towns and cities. But comparisons with the best cities in Europe indicate that it is possible to reverse the less desirable trends. Success depends, however, on more radical policies of local authority control over land and finance than any political party has yet advocated. It also requires collaboration between the full range of powerful public and private organizations that influence the built environment. Future research is likely to further strengthen these conclusions. It will become much more obvious that planning for health and well-being is not only the NHS, but about creating a health-promoting physical, social and economic environment.