THERE IS AN OLD public health story that goes something like this. Some people are standing beside a river. They hear a cry for help from someone who fell in upstream. One observer asks, “Why can’t you swim?” A do-gooder offers some coupons towards the cost of a lifejacket. Another observer who, luckily for the drowning person, is a nurse from the local accident and emergency unit, jumps in and saves the person’s life.
Over time, more and more people fall into the river and it gets very crowded. The nurse from AE is joined by many colleagues, including researchers, doctors, social workers and health educators, who are exhausted with the effort of saving people. Not everyone is saved and many go back upstream and fall in over and over again. This is very frustrating for the health professionals and it is costing the HSE a fortune to keep pulling people out.
After many months, a government task force heads upstream to see why so many people are falling into the river. They find that the bridge connecting one side of the river to the other was badly designed and people are falling through the cracks that developed since it was built. The people need to cross the river because they live on one side and their places of employment and schools are on the other. The task force, with the help of architects, are able to build a new, safe, bridge which is also a joy to use every day. People stop falling into the river and the health professionals are able to spend more time delivering primary care services (adapted from Media Advocacy and Public Healthby Wallack et al).
I was reminded of this story last week when separate events were organised by the HSE and The Irish Architecture Foundation (IAF) which could have had synergistic outcomes if only the two organisations had talked to each other. The events were the launch of the Get Ireland Active website by the HSE and the Open House festival by the IAF. How, you might ask, are the events connected?
The IAF website says its role is to champion the power of architecture "which is the art that acts the most slowly but the most surely on the soul". This resonates with a 2006 report, The Health Impacts of the Built Environment, from the Institute of Public Health in Ireland (IPH) which states, "We shape our buildings and thereafter they shape us."
The report notes that the average person in Ireland spends up to 85 per cent of their lives in buildings of various kinds, or in enclosed forms of transport travelling from one building to another.
Architecture and the built environment have a huge impact on our health and particularly on how physically active we are. A World Health Organisation (WHO) report in 2006, The Solid Facts: Promoting Physical Activity and Active Living, argues that "design elements in the built environment, such as street layout, land use . . . parks, public buildings, and the transport system, can either encourage or discourage physical activity. For example, an average public transport trip includes 19 minutes of physical activity, nearly two-thirds of the minimum daily requirement. When streets are designed for walkers and not cars, people are 25 per cent more likely to walk to work."
This month, the WHO published the Global Atlas on Cardiovascular Diseases Prevention and Control, which re-emphasises the key message that "an enabling environment facilitates regular physical activity" and for the umpteenth time calls for "health in all" policies.
The Atlas further states, “Only such a policy environment can provide people with opportunities and affordable choices to maintain healthy behaviour. systems in all countries remain inadequate to coherently implement whole-of-government strategies . . . to address these issues.”
None of this is rocket science, yet in Ireland and most of Europe we get the same tired responses to obesity, heart disease, diabetes and cancer, such as websites to encourage physical activity. This is equivalent to the observers on the river bank blaming people who can’t swim or exhorting drowning people to save themselves.
The boom has created many built-environment problems which will affect our health for years to come unless all sectors act now. Last week was a missed opportunity for synergy between health and architecture. There will be many more unless the health sector develops a dialogue on why health is a shared goal across society and identifies how other sectors will benefit from “health in all” policies.
Dr Jacky Jones is a former regional manager of health promotion with the HSE