The future of healthy places — a first glimpse - Public Health Dorset


The future of healthy places — a first glimpse


The Future of Healthy Places — a first glimpse…

Are you interested in working towards a future that has healthier places to live, work and learn? If you are, read on. We are using futures studies methods to envision what that future might look like, and my colleagues and I will use this blog to share our insights.

Wider determinants and healthy places

It is well established that the health and wellbeing of a population is largely determined by a host of non-health system factors, known as the ‘wider determinants of health’, such as education, employment, socioeconomic setting, engagement in your community, personal relationships, etc.

Additionally, it appears likely that our health and life chances are pretty much determined by the time we are three-years-old, but don’t despair – all is not lost! However, do consider how important it is to get ‘place’ right for the ‘little ones’, because the under-3 crowd does not participate in a lot of risky behaviours: few of them smoke tobacco or drink alcohol, they don’t get a lot of choice in their overall diet, and as for exercise – they are pretty much always up for some!

Therefore, healthy places must be settings where the ‘little ones’ get the best possible start in life, and where all of us live and age well. We know what this must entail. These must be places that support healthy eating, encourage active physical and social lives, provide opportunities for individuals to grow and reach their potential including through meaningful employment, and these places must minimise population exposure to health damaging pollution and hazards.

How do we arrive at a future of health place? How do we create the conditions that we know support a good start in life, healthy living and aging?

Talking about it, sharing insights we glean from our horizon scans is a good place to start.

The past

By the late 1800s, we began to sort out (the Romans got there a lot earlier…will we never learn?) urban hygiene and sanitation issues such as clean water, functioning sewers, rubbish removal and even before that we had managed to implement some urban fire safety measures, vermin control and very rudimentary infectious disease epidemic procedures. Although now refined many times over, these basic public health measures are hugely effective in making places healthier everywhere good processes remain in place – this isn’t a given!

Despite a lot of effort, we are still not very good at helping people (including ourselves) develop healthier behaviours as is evident by the numbers of people who still smoke, who drinking too much, who are not physically active enough, who don’t eat a healthy diet, who are socio-economically deprived and who are socially isolated.

The present

Behaviour change: What population level progress we’ve made in reducing smoking has been achieved by changing the environment – not directly through behaviour modification. You can’t smoke in public places, work environments, schools, hospitals or pretty much anywhere where you are around other people anymore. We’ve also changed the tax environment to make it more expensive to smoke. We’ve regulated the sales and marketing environments, and we’ve recently introduced plain packaging. The indications are that these place based interventions are effective in reducing smoking levels.

There are a lot of things that our partner organisations do every day to mitigate public health hazards in the places where we live, work, go to school and recreate: Alcohol and drug misuse, fast food, pesticides, air/water/noise pollution, indoor air pollution, road traffic, industrial and home use chemicals, the spread of infectious disease, food contamination, poor quality housing, occupational and public safety. Unseen and undervalued activities perhaps, but necessary preventative work.

Our partner organisations also undertake many activities that improve population health: Urban greenspace – as in parks, sports fields, wood lots, lawns, gardens, back yards, fallow fields, rights-of-way, and even overgrown verges all benefit the health of urban populations. Promoting active travel – one of the great ‘low hanging fruits’ – to get people walking and cycling through their daily commute by maintaining safe foot and cycle paths that usefully connect residential areas with work and schools. Enabling fresh food markets to provide communities with more opportunities to eat better. Communities with urban food gardens, allotments and other food related activities may be more conscientious about what they eat.

The future

The future is unclear. This much everyone knows. But let us have a closer look…

Here are five ‘mega trends’ that have so much momentum that they will almost certainly increasingly impact upon our lives and work environments over at least the next 30 years or so…

  1. Aging populations
  2. Increasing concentration of wealth
  3. Environmental degradation
  4. Pervasiveness of the Internet of Things (IoT)
  5. Growth of automation and artificial intelligence

Aging populations: We are an aging population. Aging workforces mean more of the challenges of old age will be coming into the workplace impacting ergonomics, absenteeism, productivity for example. There will be more demand on social and health services and fewer working age individuals to generate wealth and pay taxes. Aging well will be increasingly dependent on living in places conducive to maintaining good health and living independently as long as possible into later years.

Increasing concentration of wealth: The richest eight people now have the same wealth as the poorest half of the global population and this concentration of wealth is increasing. The last time we saw this pattern was just before the ‘great depression’ when the richest 1% of Americans had the same wealth as the poorest one-third, which precipitated massive changes in government policy that redistributed wealth across society. Until such a time as we have another massive spontaneous ‘economic adjustment’ or the entire economic system is restructured, it appears that socio-economic and associated health inequality drivers of unemployment, underemployment, low-paid, and low-security employment will continue to grow.

Environmental degradation: The climate is warming, precipitation patterns are changing, the chemical composition of the atmosphere and oceans are changing, land ecosystems are fragmented and getting smaller, ocean food webs are collapsing, we are producing waste that we are unable to reuse, recycle or even dispose of safely.

Pervasiveness of the Internet of Things (IoT): Almost every aspect of our home, school and work environments is now touched by the IoT. We are more socially connected, but lonelier than ever. We are more aware of global happenings in a non-stop 24/7 news cycle, and we suffer from more stress and anxiety than ever before recorded. We have never had more access to data, information and knowledge, and we have surrendered considerable personal privacy in return. The very technologies offering huge gains in efficient living, through smart homes, smart cities, smart power grids can also distract us from the focus on essential elements of a healthy physical world – including green environments, social spaces, safe active travel.

Growth of automation and artificial intelligence (AI): A great number of employment opportunities available to people today, will soon be handed over to computers with AI capability – insurance adjusters, risk assessors, copy editing, online customer service, booking agents… in fact any job you can learn by watching someone else do the work is at risk. Computers are watching. On the plus side, just the automation and AI involved in self-drive vehicles is something to get excited by, with promises of reduced pollution and traffic…unless of course you are driving for a living!

This futures blog

This blog is going to be about ‘healthy places’ and what our possible ‘futures’ could be given current trends and momentum within society, the economic and political systems, and the environment. I use the plural ‘futures’ intentionally, because our future is not pre-determined (I hope), we can and should work towards the future we want. This blog aims to generate discussion (maybe even some debate) around ‘Healthy places futures’ in the hope that if we all put our minds to it, a collective vision may emerge, which would inform any strategy we might put in place to get us to our preferred future. We’ll be leaning on futuring tools provided by our partner, Shapingtomorrow.

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