Dr Jonathan Stokes; Ms Reese Green; Ms Phoebe Somervail; Dr Jonathan Olsen — Written Evidence (NTC0053)

About the NIHR OPTIMA Project

‘Orienting Policy Towards Inequality Minimising Actions (OPTIMA): A systems science approach to 20-minute neighbourhood policy and evaluation’, is a £1.3M National Institute for Health and Care Research (NIHR) Public Health Research (PHR) Programme-funded project. The project aims to provide evidence to make better decisions possible to reduce health inequalities with place-based interventions, such as the ‘20-minute neighbourhood’ (framed on access to daily service needs within a walkable/wheelable distance). We seek to assess the true impact of 20-minute neighbourhoods, exploring their potential benefits for communities while also examining whether they may contribute to widening health inequalities across Scotland (e.g., via gentrification).

              Funder acknowledgement

This project is funded by the NIHR Public Health Research Programme (NIHR160301). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Authors

This note was prepared by Dr Jonathan Stokes, Ms Reese Green, Ms Phoebe Somervail, and Dr Jonathan Olsen on behalf of the OPTIMA project.

Responses to questions

7. How can new towns use the built environment to support health and encourage healthy lifestyles, including mental health?

1. Many new place-based policies, such as the 20-minute neighbourhoods and new towns, focus on ensuring provision of essential services and amenities (e.g., local healthy food retail, public transport and green space) to local populations, within a short walk/wheelchair/cycle. From reviewing international policy documents, we found multiple proposed (although not well-evidenced in the policy documents) routes to mental and physical health outcomes from local service access, including via assumed increased active travel, increased community connectivity, and increased local economy. [reference: Pollack, R., Olsen, J.R., Heppenstall, A. et al. How could 20-minute neighbourhoods impact health and health inequalities? A policy scoping review. BMC Public Health 24, 3426 (2024). https://doi.org/10.1186/s12889-024-20928-5]
2. However, it is important to note that local access to these services and amenities alone are not sufficient for improving healthy behaviours and health outcomes. For instance:

2.1.                      Our project’s Great Britain-wide analysis of 20-minute neighbourhoods (using 800-metre boundaries around every postcode) shows that, contrary to expectations, postcodes in more deprived areas (with poorer health outcomes) tend to have both access to more service categories overall (Figure 1) and are more likely to have access to every service category we examined than less deprived places (with on average better health outcomes, Figure 2). These findings also align with those found previously in the Scottish context from Olsen et al. (2022). [reference: Olsen, J. R., Thornton, L., Tregonning, G., & Mitchell, R. (2022). Nationwide equity assessment of the 20-min neighbourhood in the scottish context: A socio-spatial proximity analysis of residential locations. Social Science & Medicine, 315, 115502. https://doi.org/10.1016/j.socscimed.2022.115502]

Figure 1. Average Number of Service Categories Present in 20-minute neighbourhoods by Income Quintile

Figure 2. Service Access in Least vs Most Deprived Areas

2.2.                      More broadly, evidence is strongest and most consistent for the health benefits of proximity to green and blue spaces and for related physical-activity infrastructure (e.g., safe walking routes and protected cycling lanes), and equally clear on the risk associated with proximity to major roads, industry, and landfills. However, findings for services such as public transport and supermarkets are mixed. [references: Long, H. A., Wilson, P., Dumville, J., & Shi, C. (2024). Place-based interventions to improve public health and reduce health inequalities: A rapid umbrella review update.; Zhang, Y., Liu, N., Li, Y., Long, Y., Baumgartner, J., Adamkiewicz, G., Bhalla, K., Rodriguez, J., & Gemmell, E. (2023). Neighborhood infrastructure-related risk factors and non-communicable diseases: A systematic meta-review. Environmental Health, 22(1), 2. https://doi.org/10.1186/s12940-022-00955-8]

2.3.                      Shopping, though, is the most frequent travel purpose, yet access to healthy food retailers within active travel distance remains limited. Evidence shows that only 62% of urban and 16% of rural residents in Scotland have access to a healthy food retailer within their 20-minute neighbourhood. This underscores the need to prioritise improving access to healthy food options within communities. [reference: Olsen, J. R., Thornton, L., Tregonning, G., & Mitchell, R. (2022). Nationwide equity assessment of the 20-min neighbourhood in the scottish context: A socio-spatial proximity analysis of residential locations. Social Science & Medicine, 315, 115502. https://doi.org/10.1016/j.socscimed.2022.115502]

2.4.                      Leisure walking accounts for 1 in 10 journeys in Scotland, and spending time in greenspace is linked to numerous physical and mental health benefits. Evidence shows that nearly 90% of Scottish residents live within a 10-minute walk of a local greenspace, with greater proximity associated with more frequent use. However, significant social inequalities persist, as individuals with lower incomes are still less likely to use greenspaces despite having better access. Addressing these deep-rooted social and structural (and potentially quality of service) barriers is essential. [reference: Olsen, Jonathan R., et al. "Trends and inequalities in distance to and use of nearest natural space in the context of the 20-min neighbourhood: A 4-wave national repeat cross-sectional study, 2013 to 2019." Environmental Research 213 (2022): 113610.]

2.5.                      Cycling accounts for an even smaller proportion of journeys than walking, just 2% of all journeys and 3% of commuting journeys in Scotland. Safety concerns are a key reason why people are unwilling to cycle more (https://cycling.scot/media/50ahltp1/cycling-attitudes-and-behaviours-report-wave-4-2022.pdf). (https://www.transport.gov.scot/publication/seqia-screening-report-draft-cycling-framework-and-delivery-plan-for-active-travel/key-issues-and-evidence-summary/). Without a very substantial extension of safe cycling infrastructure, such as connected networks of segregated cycle lanes, it is highly unlikely that cycling will become more frequent, even for short journeys.

2.6.                      Evidence shows that children living in Scotland's most deprived areas are exposed to over twice the number of major and minor roads compared to those in the least deprived areas. High road density increases the risk of pollution exposure and road traffic accidents while also making these areas less conducive to walking, wheeling, and play. Reducing these risks for children should be a key aim. [reference: Olsen, Jonathan R., et al. "Inequalities in neighbourhood features within children's 20-minute neighbourhoods and variation in time spent locally, measured using GPS." Wellbeing, space and society 5 (2023): 100174].

2.7.                      Emerging systems-based research indicates that healthy, vibrant, and liveable places depend not only on proximity but on the diversity, and functional alignment between what residents need and what the environment provides. This underscores the need for policy approaches that recognise places as dynamic systems shaped by the interactions of people, infrastructure, and services—not merely by the presence or absence of individual features. [reference: Zhuo, Y., Hu, H., & Li, G. (2025). The Effects of Land Use Mix on Urban Vitality: A Systemic Conceptualization and Mechanistic Exploration. Systems, 13(7), 542. https://doi.org/10.3390/systems13070542]

3. In terms of area-level health inequalities, the key issue is again dynamics. Even if creating a new town from scratch, the area will evolve and people will move in/out over time.

3.1.                      For example, the recent British Academy (BA) and the Academy of Medical Sciences (AMS) national report exploring the historic and geographic patterns of health inequalities emphasised this issue specifically that, “understanding geographic inequalities in morbidity and mortality requires good data collection and appropriate analysis on population movement… Improved health in an area may result from wealthier individuals with better overall health moving into areas that previously had poorer health outcomes, pricing local populations out. This scenario results in a change in health outcomes for the local area, but not for the people who once resided there. How, then, can we distinguish between ‘levelling up’ and gentrification? – the former indicating real, long-term, positive impact, the latter an artificial outcome which may actually exacerbate inequalities” [reference: British Academy, Academy of Medical Sciences. Historic and Geographic Patterns of Health Inequalities [Internet]. London; 2022 [cited 2023 Dec 13] p. 1–38. Available from: https://www.thebritishacademy.ac.uk/documents/3662/Historic_and_Geographic_Patterns_of_Health_Inequalities_-_report.PDF]

8. How can new towns be designed to ensure they are inclusive and accessible to all groups throughout their lives?

4. As above regarding health inequalities, this is a difficult task, and this question itself might presume (perhaps wrongly) that a place can offer everything, and that people stay in one place throughout their lives.

4.1.                      To maintain any local services put into a place to begin with, local residents’ sociodemographic profiles and tax-base need to be able to support these specific services (e.g., to maintain quality and maintenance of all services including public, the density and income levels to maintain operational sustainability of the many services provided by the private sector predominantly).

4.2.                      If new towns favour deprived residents initially with an aim to reduce inequality, then (with lack of other policies to disrupt) market forces will dictate who is ultimately able to stay and who moves into the area over time. A more desirable area will likely attract services with higher costs, higher rents and house prices.

4.3.                      Results from our project’s early community and policy stakeholder workshops indicate that it is important to not just consider the type of services provision in new towns, but who is providing these services as well as how they are provided. The demand for service provision will differ from neighbourhood to neighbourhood, meaning public engagement is key to the development and implementation of inclusive and accessible new towns.

4.4.                      This also emphasises the point that a ‘one size fits all’ approach will not be sufficient to meet the goal of creating inclusive towns. Service needs are determined by who is in the local population. There needs to be overlap between need (demand) and supply, as not every neighbourhood is likely to need the same things. For example, proximity to services is not everything, not everyone will need (or want) every service to be directly on their doorstep (e.g., some people choose to live rurally with little access to services precisely for that reason).

4.5.                      There’s a distinction between ‘essential’ and ‘nice to have’ services, which will vary across the life course. The need for proximity of certain services was described in our workshops as being entirely dependent on the population (e.g., their identity, stage in life course) and area (e.g., urban versus rural). Individual’s needs will change over time and different neighbourhoods will fulfil different functions, for example transit neighbourhoods versus family neighbourhoods. Further, needs for specific services to be in-person versus online will also vary through an individual’s life. Neighbourhoods need to be diverse in terms of services to fulfil needs of heterogeneous populations, meaning a ‘standard’ set of services might not make sense.

4.6.                      High-quality public transport is seen as distinct from other services (allowing a link to further areas/services), particularly important for more rural areas. The largely privatised nature of public transport in the UK (unlike most of the rest of the world) might prove particularly difficult to plan effective changes to this service sector.

4.7.                      Participants at our workshops also suggested that specific types of services and spaces, such as libraries and other multi-use spaces or community hubs, might act as community anchors and be more important than others for creating community cohesion, which might be necessary for things like passing down skills, safety and feeling ownership.

4.8.                      Our participants emphasised that current international ‘gold standard’ examples of neighbourhoods have developed organically over time, and also gave many examples of ‘laughable’ planned neighbourhoods, which have gone awry in the past that might also offer learning (e.g., the historical Glasgow slum clearances) (see, e.g.,: https://warwick.ac.uk/fac/cross_fac/iatl/research/reinvention/archive/volume1issue1/paice/).

29 November 2025