A report highlighting links between health problems and modern urban conditions recommends that health professionals and planners work together, writes Fiona Tyrell
Poor housing conditions and urban sprawl may be contributing to the chronic health problems of the 21st century, according to the authors of a new report.
While most people accept that living in crowded conditions or spending three hours a day commuting to work is bad for your quality of life, a new report highlights the link between our built-up environment and conditions such as obesity, cardiovascular diseases, asthma and psychological stress.
Planners and policymakers must pay more attention to what makes for a "healthy habitat", according to Teresa Lavin, co-author of the Institute of Public Health report that was published last week.
Entitled Health Impacts of the Built Environment, the report reviews a broad range of international research on the subject and argues for greater dialogue and co-operation between public health professionals and policymakers when it comes to urban planning and design.
According to Lavin, some of the housing policy measures designed to combat the health problems of the 20th century, are now the cause of some of the unhealthy environments of today.
She says the concept of zoning, introduced in the early 20th century, for example, aimed to combat infectious diseases such as TB, typhoid and cholera through the decentralisation of populations and the separation of residential and business areas. Decentralising, such as clearing out Dublin's slums, was one of the most important public health measures of the last 100 years and helped to significantly increase life expectancy, says Lavin.
However, she adds that the move out of the city centre without proper planning or building design has led to a more sedentary lifestyle, which she says is contributing to some of the chronic health problems of this century - heart disease, cancer and respiratory disease.
Lavin notes that the last 10 years in particular have seen significant urban sprawl in Irish towns and cities, with 60 per cent of the population living in urban areas and city populations continuing to move outwards.
According to Lavin, such communities are often removed from shops and services and do not have walkable neighbourhoods, and as a result residents are more car dependent. This sprawl can affect health by increasing obesity, air pollution, road traffic injuries, stress and isolation, she says.
The report finds that, compared to those living in compact areas, people living in sprawling areas walk less, have higher weight levels and are more likely to have high blood pressure. Long commuting times can also impact on mental health, family life and social opportunities, it adds.
"The World Health Organisation recommends 30 minutes of moderate exercise every day. The most effective way to ensure good health is to be physically active and the easiest way to be healthy is to walk more," says Lavin. "A person who gets public transport to work will walk on average 15-20 minutes a day. Compare this to a person who has to commute to work and just walks to the car outside the door."
Added to this, she says, is the fact that many modern buildings discourage people from walking by having conspicuous lifts and inaccessible or unappealing stairs.
In addition, the report says there is substantial evidence to suggest that car-dependent communities are characterised by poor neighbourhood networking and social relationships, which can lead to increased rates of social isolation and mental health issues.
According to Lavin, changes in urban design and planning can promote a healthy human habitat and help prevent 21st century ill health such as obesity and stress.
"Roads and pathways suited to cycling and walking, as well as quality green spaces, can do much to encourage physical exercise. Similarly, housing schemes need to be built in close proximity to shops and services in order to reduce car dependency," she says.
HIGHER-DENSITY HOUSING paves the way for more sustainable communities, but there is political and voter resistance to this concept, according to Deirdre Scully from the Irish Planning Institute.
She notes that many people want to live in a development that has 10 houses to the acre, but it is not sustainable to have proper transport services and facilities in such a scheme. Best practice is to have people as close as possible to services, she says, adding that Adamstown, the new town planned for west Dublin, aims to ensure all residents are within a five-minute walk from services.
According to Scully, it is hard for people to give up what they are used to - the three-bed semi - but with higher density it is possible to make a built environment that is friendly to pedestrians, has more facilities and is sustainable in the long run.
The report from the Institute of Public Health also highlighted a clear link between poor housing quality in Ireland and a range of conditions, including respiratory disease and stress.
According to Lavin, annual household condition surveys conducted by the EU indicate that damp and cold are the main causes of poor quality housing in the Republic. The association between damp and mouldy homes and respiratory ill health, allergies and skin disorders is well documented, she says, adding that new research has also linked damp and mouldy homes to cardiovascular problems.
Lavin notes that house temperature also has major implications for health. Her report cites UK research which found an association between low indoor temperature and increased mortality, particularity in the elderly. According to Lavin, fuel poverty (insufficient money to heat a house properly) is likely to become a growing problem in Ireland, particularly for older people.
The report found that noise pollution in built-up environments can prevent people opening their windows, and this has been linked to increased asthma rates and mental stress. It also highlights the fact that children, older people and those in lower socio-economic groups are particularly vulnerable to the influences of the built environment.
People live in cold, damp or overcrowded conditions because they don't have any other option, says Lavin, and it is largely people from lower socio-economic groups who live in poor housing conditions.
This point is also emphasised by Dr Joe Barry, a specialist in public health medicine with the Health Service Executive and a senior lecturer in public health at Trinity College Dublin.
According to Dr Barry, respiratory problems can be a big issue for people living in poor housing conditions and, while a person living in a damp or cold house may not die as a result, they can experience significant disability and hardship.
Safety is also a major issue in a poorer housing area, he says, noting that international research indicates that those living in multi-occupational houses and flats, particularly high-rise flats, are at higher risk of injury or death from fire, burns and scalds.
The report highlights the growing interest in using health impact assessments (HIAs) as a tool to demonstrate the links between the built environment and health when new developments and projects are being planned.
Similar to an environmental impact assessment, a HIA takes on board the social and mental health as well as the physical well-being of populations affected by a development. Unlike environmental impact assessments, HIAs are not mandatory, but according to Lavin, increased use of HIAs should be considered by planners.