People, power and places: The keys to good health

It has been accepted for some time that place affects health. But we can never say that often enough. As we create a new system of public health in Scotland, attention on the public’s health will also increase. So we have an opportunity to make sure that the evidence on the impact of the spaces and places in which we live, work, learn and play has the prominence it needs – and that communities have the power to act on it.

All the evidence shows that access to good housing, work, transport, social contact, play, green space (and so on) all have a huge positive impact on the public's health. When we ask people directly about what affects their health, they back up what that evidence says. It’s easy to work out why.

• Poorly lit streets strewn with litter and broken glass, a smashed bus stop barely served, or concrete space rather than a green space, are a turn off for physical activity.
• Living in an area with low pay, or insecure work, makes it hard to afford to make healthy choices.
• A lack of social or community spaces to meet and spend time with friends and neighbours makes it easy to become socially isolated.
• Damp and poorly insulated housing causes all sorts of health conditions, often worsened by the inability to afford fuel and bills. 

It’s a pretty sure thing that if you look at the data for places with conditions like these, there will be a correlation with poor health. The amount of power we have over our own circumstances, and what’s around us, matters too.

If we want a healthier nation, it’s not enough to just ensure that people have fair and equitable access to the things that make us healthy. We have to empower people and communities to act when they can’t access them, or take advantage of them when they’re there. This means we need to tackle the things that disempower health promoting options – like the poorly lit street or the row of takeaway shops and bookies – and empower people to influence, and take advantage of more health promoting environments.

I’m proud to say that this approach (of participation, empowerment and addressing the wider social determinants of health) is increasingly embodied in the work of my own organisation, NHS Health Scotland. We support action on equitable health improvement that delivers fair access to the things that make us well – the things that most people take for granted. This means access to fair work, good quality affordable housing, good play facilities, green space and safe areas to walk and exercise. Crucially, our approach is to help empower people to make the changes needed to create these conditions.  

In collaboration with Architecture and Design Scotland and the Scottish Government, we have developed the Place Standard Tool to help communities shape their own spaces and places. This has been a big breakthrough in my opinion. I believe most professionals are wholly committed to the communities they serve. Yet we hear how hard it is for people to access services, or have a meaningful voice about their local services in the first place. The Place Standard Tool supports communities to have the conversations needed with service providers, local authorities, decision makers and so on, about the places they live, work and play. It provides a practical way for citizens and communities (regardless of their name, wealth or perceived social status) to have some real influence over their own places, which affect their health and life expectancy. It provides the framework needed to help distribute power throughout communities so that the spaces and places we occupy are truly health promoting.

At NHS Health Scotland, we take our inspiration from Article 12 of the International Covenant on Economic and Civil Rights – the right to health. I feel privileged to work in an organisation which prides itself in taking a human rights-based approach to its work. I’ve committed staff time (including my own) to understand the impact of place on health, and to implement a tool that supports action on it. This really matters to me – and not just because I have seen first-hand the damaging impact disempowerment has. I also know we have the potential to be the fairer, healthier nation we want to be when we share the income, power and wealth to do it.

George Dodds is Director of Health Equity at NHS Health Scotland (@NHS_HS)