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Healthy outlook

by Ruth Slavid
Evidence that shows that good landscape can have a measurable impact on people’s mental and physical wellbeing needs to be disseminated more widely.
In June, Public Health England produced a report called Longer Lives, which looked at the variation in premature deaths (defined as those before the age of 75) around the country. Crucially, this takes social disadvantage into account.

We all know that poverty and social deprivation shorten lifespans, but this report used peer grouping, so that areas with similar levels of deprivation could be compared across the country.

With this measure, one would expect most inequalities to be ironed out, but this was not the case. Instead the report found huge differences in premature death rates between local authorities with similar levels of social deprivation, a result which health secretary Jeremy Hunt branded ‘shocking’.

He said that local authorities with bad results needed to address this, while stressing that no blame attaches to them, since they only took over responsibility for public health from the NHS in April this year. But clearly people are dying unnecessarily in certain parts of the country, and things need to change.

The reasons for the disparities are not revealed in the research, but since they are not to do with the details of people’s lives in terms of deprivation, they must relate in some way to health provision, to culture, to education and to the environment.

When one thinks of environmental issues and health, it is too easy to become fixated on tough problems such as air pollution which is, of course, massively important. But the environment in which people live can have an enormous impact in other
ways on their health, in terms of both their physical and their mental wellbeing.

For landscape professionals this is a hugely exciting opportunity, since it potentially moves the provision of a decent landscape away from something that is nice to have (increasingly hard to argue for in our straitened times) to something that can bring good and save money, as providing healthcare for the sick is a major financial burden. And since good landscape does not necessarily cost more than bad, it should be relatively inexpensive.

It is in this context (although presciently before the publication of the Longer Lives report) that the Landscape Institute set out to produce a position statement, aimed not primarily at landscape professionals but at public health representatives and also at members of government who have responsibility for spending and legislation.

This statement, which will be published in October, aims to demonstrate how landscape, and the work of landscape professionals, can make a powerful and effective contribution to people’s health & wellbeing across the UK, and to suggest that this contribution could help reduce health expenditure in the NHS by reducing future costs through preventative interventions.

It should help public health professionals and landscape professionals, two groups that care passionately about the public good, to communicate and work together, and to understand more about each other’s areas of expertise.

Hugh Barton, who is one of the external reviewers for the publication, said, ‘We are wasting huge amounts of money on the NHS because we are creating an environment which is problematic in terms of human health. There is not always an extra cost in terms of making it better – it just needs extra care.’

Barton is well-placed to know. A planner,
he is an emeritus professor and former director of the WHO Collaborating Centre for Healthy Urban Environments at the University of the West of England. He identifies several ways in which he feels that better landscape can lead to better health. The first is to do with our physical environment. Linear green corridors in cities should have an impact on air quality, allowing fresh air to move into cities and polluted air to escape. This is in addition to the effect that trees, in particular, can have in absorbing pollutants.

The other way in which the introduction of greenery can help is in modulating temperature fluctuations, in particular the urban heat island effect. By bringing down temperatures, green spaces should help to reduce the number of excess deaths that occur during heatwaves. They should also reduce the demand for air conditioning, which is both an additional cost and a further generator of pollution.

‘The range of issues to do with open spaces in cities is huge,’ Barton said. Studies have shown that living within 300m of an open space can help to iron out the inequalities in health that result from social deprivation. This is why English Nature (now Natural England), a few years ago, set the following targets for access to open spaces:

• No person should live more than 300m from their nearest area of natural greenspace;
• There should be at least one accessible 20ha site within 2km from home;
• There should be one accessible 100ha site within 5km;
• There should be one accessible 500ha site within 10km.

But actually, Barton argues, we should not be so fixated on parks and open spaces that we forget the importance of having living material around us in the form of, for instance, street trees. After all, as Barton points out, some of the most liveable and admired European cities, such as Milan and Amsterdam, do not have large open spaces at their hearts. But we cannot do without nature in some sense, Barton argues. ‘We are creatures of nature,’ he says. ‘To pretend we can live in an artificial environment is false. Landscape professionals are providers of an artificial natural environment in towns.

The problem is, he says, that too often these elements are thought of in a piecemeal fashion. ‘Too many local authorities have a discrete approach to open space,’ he said. ‘They look at parks, playing fields and allotments all separately.’ And allotments in particular have been squeezed out of planning policies in the last 40 years or so, yet Barton believes they are immensely important. As well as allowing people to grow food that they can eat, and helping them to learn about fresh food, they provide healthy outdoor activity, and also
a way of interacting with a community.

Just as important as the provision of green space and of living things, Barton believes, is the way that a city’s streets are planned, and the networks that are created. The aim of course is for people to carry out as many journeys as possible on foot or on bike. This is good for their individual health, because of the exercise it provides, and good for the general wellbeing of the city, by cutting down on pollution and the creation of greenhouse gases.

The way that routes are planned is vital, Barton believes. He quotes research by retailers, who find that if they place a car park a few minutes’ walk away from their retail centre, they may be able to convince people to park and walk. The determining factors are, Barton says, whether they feel safe, and whether the walk is a pleasant one.

Similarly, Barton says, people will walk within their neighbourhood but only if they can find what they need – shops for example – within walking distance. If not, they will get in their cars and drive. ‘Distance, safety and environment add up to an environment that promotes physical activity or inhibits it,’ he said. ‘Where there are local facilities that we can go to easily, the number of local trips is up at least 50%.’

Barton believes that, ‘It’s absolutely central that we create an environment in which active travel occurs to get to places. If we make that natural and a pleasure and it feels reasonably safe, more people will walk and cycle. We have progressively undermined that for 40 years.’

The LI document should, he believes, help to redress the balance.’I am hopeful,’ he said, ‘that this can act as a pressure on the planning of settlements generally, including green infrastructure and extending way beyond. It is really important for us to be able to get quantitative evidence of the effects.’ Sheila Beck, principal public health advisor for NHS Health Scotland, is another external reviewer of the LI publication. Her hope is that ‘the work with the LI gives me the opportunity to advocate for the kind of things that I think are important.’ These things include the idea that ‘when places are being developed there is place making and that the needs of the local community are taken into account.’

NHS Health Scotland is a body set up to reduce inequalities and improve public health. It already has a programme of, for example, encouraging public activity and working with transport planners to make walking and cycling easier and more attractive. ‘We want places that are built at a human scale,’ Beck said. ‘There is evidence, for example from the US, that places are built so much to suit the car that they don’t suit people.’

One of the programmes with which Beck is involved is the Scottish government’s Good Places Better Health initiative, which sets out to improve the health of the country’s children, tackling the problems of obesity, asthma, unintentional injury and mental health and wellbeing. Green spaces and landscape within neighbourhoods are one of the areas that it covers. Awareness is growing, says Beck, but more information is needed. Planners will say, ‘We know that green space is good for health – just how much do you need?’

Beck is also interested in environments that can reduce stress. ‘We used to think it was peak stress that was important,’ she says, ‘but now we think its people with chronic stress who suffer most.’ Recent research at Herriott Watt University, published in a paper entitled ‘The urban brain: analysing outdoor physical activity with mobile EEG’ showed that people’s heart rates calmed when they walked through parks as opposed to busy shopping streets.

Not all the evidence that the landscape professions need is so readily available but there is a lot of information. It is becoming increasingly simple to show that good landscape is good for people and that it could save cash-strapped health services money spent on treating preventable illness. If the message gets across to the people who matter, the landscape professions should have a healthy future.

Movement for change

by Ruth Slavid
The Greenlink in central Scotland has transformed not only the appearance of a run down path, but also the behaviour of those living near it.
Fancy a walk? How about a walk along a rubbish-strewn path beside a waterway containing burnt out cars? Picking your way down crumbling steps littered with shopping trolleys? Would you like to walk there? Would you feel safe? Would it give you a sense of community? Would you like your children’s school to have an outing there?

Not surprisingly, most people would answer ‘no’ to all of these questions. The only positive thing one can say about such an environment is that if one makes a difference, it will be a difference that is really noticeable and noticed. And this is what the team behind the Greenlink in central Scotland found, when it turned this unpromising area into somewhere that is not only much nicer to look at but, essentially, is loved and used.

In an online poll carried out in 2009, every respondent agreed that the Greenlink was making a positive improvement to the local landscape – hardly surprising since they described the conditions before improvement as ‘terrible’ (56%) and ‘poor’ (32%). Following the works, 92% said they had made a positive difference to them personally, with this testimonial encapsulating just how pivotal landscape can be in enhancing mental and physical health: ‘It has brought a renewed sense of confidence, accomplishment and pride after a bout of illness. It has helped me to build my physical stamina, meet new people and feel part of a team. I’ve learnt more about the great outdoors and how doing my bit can make a difference not only to myself, but to others in the group and the local community. I absolutely love my time at the Greenlink, and it has certainly helped to lift my mood following depression.’

The Greenlink is important, not only because it has created such enormous improvements, but because it has done
so in an area where many of the neighbourhoods that it runs through are defined as being among the 15% most deprived in Scotland. The route runs for 5km along the South Calder Water Valley, from Strathclyde Country Town to Motherwell Town Centre, near to the former Ravenscraig steel works, which were once a major source of employment. Communities along the edges of the route – Forgewood, Orbiston and Daisy Park – had all suffered serious neglect.

The project, led by Central Scotland Forest Trust, worked with the community from the beginning, involving local people in ‘conservation’ work, which at first meant very basic cleaning up. The list of what was removed from within and alongside the water is staggering: 27 burnt-out cars, 91 tonnes of rubbish, 87 shopping trolleys, and even five World War 2 shells.

In addition to the main hard path, there are a further 3km of linking paths, some of them loose surfaces, within 20ha of managed greenspace and 20ha of woodland, funded by the Forestry Commission.

Technically, there is nothing particularly clever about the project. What is utterly admirable is the way that, having completed the physical infrastructure, those involved carried on, engaging with local people and responding to their needs and desires. ‘We have been skilling the local community to do this on its own,’ explained Mark Smillie, head of finance and operational development at Central Scotland Forestry Trust. ‘Over the years it has changed shape, as people have started cycling, and then founded
a mountain-bike club.’

This led to the development of a mountain bike skills zone – somewhere more challenging than the simple footpaths, where people can build their skills before feeling ready to tackle full-on mountain bike tracks.

Walking is important as well. There is a regular health walk, led by a health worker. Following the success of this, Scottish Action for Mental Health has also started leading walks. Smillie’s wife, who is a mental health crisis worker, also takes her clients for walks.

Another part of the community said that they wanted allotments for growing vegetables – a problem as there initially seemed to be no suitable land available, only contaminated sites. But now an area has been found, and 40 plots are being created.

Schools have also become involved, with local nursery and primary schools using the area on a regular basis. There is also a newsletter so that people know what is going on, and have a way of expressing their opinions and wishes. Smillie defines the aims of the project simply:

• To provide a place for recreation
• To help people get in the habit of recreation
• To get benefits from recreation
• To keep the place cleaner.

This is an area that had many attractive elements already, obscured by poor upkeep and by neglect. But few could
see beyond the surface appearance, and it felt like an insult to people many of whom were already struggling. As Smillie says, ‘If you feel that you live in a dump, then you do.’ That was exactly what people living around the Greenlink did feel. The fact that they no longer feel like that is a testament to the success of the project.

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