Director of Public Health Annual Report 2018: Healthy places

The communities we grow up, play, work and live in profoundly affect our happiness, physical and mental health and our chances of success in life. People thrive in communities where there are strong social ties, a feeling of community and a sense of belonging and where everyone has the opportunity to participate fully in community life. Having a voice in local decisions also makes a vital contribution to health and wellbeing.

All communities have strengths and assets as well as needs that can contribute to the health and wellbeing of community members. This includes members of the community themselves, local groups and strong social networks, physical assets like buildings and parks and resources and assets brought by the public, private and voluntary sector. Involving and empowering communities is central to health and wellbeing particularly for disadvantaged groups.

Nationally, around two in every three people feel a sense of belonging to their neighbourhood with around a quarter of people (27%) feeling that they could personally influence decisions affecting their local area.

People who have strong social networks tend to live longer and have better mental and physical health than those who don’t. Strong well connected communities can benefit everyone throughout life. Children and young people growing up in communities with positive social norms are less likely to participate in health harming behaviours such as smoking and drug taking and more likely to engage in health promoting behaviours such as being more physically active.

The health benefits of social interaction include reduced risks of depression, high blood pressure and cardiovascular problems and faster recovery from episodes of ill health. Older people with strong social connections have better physical health, less fear of crime and lower rates of early death. Social participation has also been associated with a reduction in dementia and cognitive decline. At a community level cohesive communities also have lower levels of depression, loneliness and crime.

Social isolation and loneliness can affect people at any age through a range of circumstances related to the individual and the local community. Some of the common factors causing social isolation and loneliness include living alone, bereavement, ill-health, reduced mobility, caring responsibilities, job loss, access to local services and amenities, fear of crime and transport issues. These factors affect different groups to different extents. For instance, poor transport can contribute significantly to isolation in rural areas.

Communities play a crucial role in supporting people. Having the right support network can have a large impact on the ability of an individual to cope with adverse events in life including promoting recovery from illness. Conversely, being lonely for long periods of time has also been shown to affect health related behaviours, resulting in higher chances of having unhealthy lifestyles such as smoking cigarettes and drinking in excess.

As social isolation and loneliness fluctuate over time and because they are difficult to measure, understanding how many people are isolated or lonely is difficult.

However, nationally about one in every six older adults are in contact with family and friends less than once per week and one in nine are in contact with family and friends less than once per month.

Estimates of loneliness nationally, show that approximately one in 20 people feels lonely all of the time or often.

It is increasingly being recognised that loneliness and isolation can be experienced earlier in life and may even be more common among younger age groups. The most recent survey of community life found that a higher proportion of 16 to 24 year olds expressed feeling lonely often or always (10%) compared to any other age group and that as age increased the proportion who felt lonely decreased, with the lowest levels among the over 75 year olds.

Children and young people who are at increased risk of being isolated and lonely include those with a disability, learning difficulty or special educational need, children who are homeless, children who are in care and children who have suffered from abuse or neglect.

The health impacts of social isolation and loneliness affect both physical and mental health. Individuals who are socially isolated are more than three times as likely to suffer from depression and anxiety and nearly twice as likely to develop dementia. Social isolation and loneliness have also been shown to make an individual two to three times more likely to be physically inactive and have been linked to higher blood pressure and an increased risk of heart disease and stroke.

People experiencing social isolation are more likely to visit their GP and Accident and Emergency Departments, more likely to be admitted to hospital as an emergency and three and a half times more likely to enter local authority funded residential care.

Loneliness increases the likelihood of death by a quarter and the likelihood of premature death among people without strong social ties is between 2 and 5 times higher compared to people with strong social ties.

Communities that promote connections and a community spirit can reduce levels of social isolation and loneliness and consequently improve the health and wellbeing of residents.

Neighbourhoods lacking positive social connections have higher rates of social disorder, anxiety, depression and crime.

Planning, policies and design alone cannot create strong, well-connected communities but they can make it easier for people to come together, make friends and get involved in their communities.

Good design can help by creating safe, attractive multi-use indoor and outdoor public spaces that are accessible and welcoming for all and make it easy for people to interact with each other on a daily basis.

Well-designed public spaces should be incorporated into all new developments and there is much that can be done in existing towns and neighbourhoods too.

In existing neighbourhoods this can range from significant redesign and regeneration to trialling temporary features to improve public spaces which if successful and popular could lead to more permanent changes of use. Interventions that improve public spaces have included pocket parks, reclaiming derelict land for community gardens and temporary street closures for play or events.

Involving a wide range of residents in the design of public spaces can improve wellbeing, helps foster a sense of community and place and is more likely to result in spaces that people will use and care for. Joint decision making and co-production, involving communities and stakeholders in the design, governance or delivery of local infrastructure in lower income communities, is associated with improvements in depression, sense of community, social capital, partnership working, adult skill development, learning and training, sense of empowerment and self-esteem.

However in a minority of cases there were adverse impacts related to consultation fatigue, distress and frustration and stress from accessing and participating in the decision making processes.

People who live in environments that encourage people to walk or cycle rather than use the car have a stronger sense of community, are more positive about the places they live and engage more in community life. People are more likely to walk or cycle where housing, shops, amenities and workplaces are all close together and there are safe and attractive routes between them.

Conversely areas where there is high car use and busy roads reduce interaction between neighbours and people have fewer friends locally. A pedestrian environment enables the development of art and culture in the public realm, encouraging more visits and contributing to the vibrancy of the area.

Crime and the fear of crime impacts on people’s mental health and can make people reluctant to leave their homes to socialise and access vital facilities. Good design can help reduce the level of crime in an area and make people feel safer.

Crime can be reduced by making places more attractive, and by promoting a mix of land uses, dwelling sizes and types of dwelling. This makes it more likely that there are people around throughout the day and evening leading to reduced crime and increasing feelings of safety. Good design has been shown to reduce likelihood of graffiti, litter, vandalism and broken windows by up to 60%. ‘Secured by Design’ is a national police initiative to incorporate prevention of crime into the design and build of new homes.

The quality of the built environment is key to maintaining mobility and independence for older people and people with disabilities and also works for families with children and parents with pushchairs. Wide, clearly defined and obstacle free pedestrian routes, crossings with dropped kerbs, tactile paving and adequate signals and wayfinding aids may improve comfort and safety for a wide range of residents. Adequate road crossings, toilets, regular public seating, shade and shelter and the attractiveness of the environment are important factors in encouraging people to get out of their homes and to use a public space. People are also more likely to socialise in areas with interesting features and with natural landscaping and this is covered more in the section on green spaces. Children need safe child friendly environments that are easy to get around, free from pollution with green spaces and places to play.

Throughout this report we have highlighted that children and young people, older adults and people with long term conditions or poorer health are more susceptible to and often more likely to experience the adverse effects of poorer environments. There are helpful guides and initiatives such as the UNICEF child friendly cities and communities and the WHO guide to creating Age Friendly environments that can support communities, towns and local areas to help make communities that work for everyone.

A strong programme of cultural and social activities co-designed with residents also helps develop cohesive communities and foster a sense of place and pride in an area. Regular engagement with social, art and cultural activities can benefit health and wellbeing at all ages. Engagement in structured art and cultural opportunities improves the cognitive abilities of children and young people.

Older people attending art, music or other types of educational classes have better mood and life satisfaction than those who don’t. Older people say art and culture is important in making them feel happy, helping them meet other people and encouraging them to get out and about. Specially-designed art activities have also been found to have a positive impact on health conditions like dementia, depression and Parkinson’s disease.

Many people contribute to community life through volunteering which also benefits their health.

Volunteering is associated with better health and life satisfaction and less depression. However sometimes volunteers may experience burnout and stress from responsibilities so a balanced approach helps to ensure that both volunteers and their community can benefit.