Written evidence submitted by Dr Mark A Green, Reader in Health Geography, University of Liverpool (PHS0059)



Title: Building healthier places for preventing ill health


What is the issue and why should the committee consider it?

Our health is influenced not only by who we are, but also the places that we live, work and socialise in. We do not live in a social vacuum, we interact with the world around us. The air that we breathe, whether it is easy or not to walk to our GP, if the shops around us sell fresh fruit and vegetables – they all matter to our health and wellbeing. These ‘wider determinants of health’ have been evidenced in scientific studies to be more important than genetics. Tackling these issues and designing healthier places can therefore significantly help to prevent diseases, ill health and disability.


These are issues that we are leading on here at the University of Liverpool. Our ‘Access to Healthy Assets and Hazard’s’ project generates small area data for Great Britain on the locations of environmental features that influence health (e.g., access to health services, green spaces, fast food outlets, air quality; see https://mapmaker.cdrc.ac.uk/#/access-healthy-assets-hazards to map these features freely). Studies we have led on have showed that areas with more pubs and off-license stores have more alcohol-related harms. During the COVID-19 pandemic, we showed how the features of places influenced infections and how we could use geography to better target out interventions (e.g., using ‘vaccine buses’ to remove barriers of access). Our recent £7million UKRI funded ‘Groundswell’ project will evaluate what works in designing urban green and blue spaces to reduce non-communicable diseases and improve wellbeing.


Why this matters now?

Our places are over-saturated with environmental ‘bads’ (features of places that cause ill health and disability) and lack local assets that can prevent ill health. Many parts of the UK continue to fail air quality monitoring targets, especially in cities and urban areas. Our urban centres and high streets are increasingly being populated by stores that are not healthy. For example, data we have generated show that on average, individuals in Great Britain are roughly 1 and half minutes (driving time) – or 1.41km – from a fast food outlet or 1.35km from a gambling outlet and roughly 1 minute 10 seconds – 1.14km from a pub.


Many of these environmental ‘bads’ are concentrated in poorer and deprived areas meaning that any action will narrow health inequalities. For example, we have showed that people who live in the least deprived 10% of neighbourhoods are just over two and a half times further away from a fast food outlet than people who live in the most deprived 10% of areas.”


Why the government needs to take action?

Modifying the environment and characteristics of places is easier and cheaper for the UK Government than tackling individual or household associated issues (e.g., low income). Local Authorities, Combined Authorities and UK Government have existing powers in place to improve places and their environments. We can build more parks, we can improve air quality, we can limit through planning rules the locations of fast food outlets. There are a lot of ‘easy wins’. Ensuring that we have enough access to natural environments will have co-benefits for tackling climate change.


Through modifying parts of the environments, the benefits are also wider since places imprint on many people at once, rather than focusing solely on individuals or households which have limited reach. A large literature has shown how tackling the upstream factors (including environments) of ill health are more effective both overall and for reducing inequalities than downstream (i.e., individual) level strategies.


We are constantly modifying parts of our environments and places – both intentionally to improve health (e.g., by Local Authorities), and unintentionally through natural evolutions of places (e.g., fast food chains expanding). In the UK, we do a bad job at evaluating all of this change and identifying what works – the UK Government can help here in scrutinising how we can improve environments to benefit health and make recommendations to encourage the design of healthier places.


February 2023