Cities, green infrastructure and health – Foresight Future of Cities project

Cities, green infrastructure and health – A paper for the Foresight Future of Cities project
by Dr Val Kirby FLI and Stephen Russell, Landscape Institute, July 2015

There is a growing body of evidence that supports investing in preventing illness and enhancing wellbeing, as a way of reducing the cost of health care in the UK. Some of this investment needs to be in supporting changes in people’s behaviour – eating healthier food, smoking fewer cigarettes, exercising more. But greater consideration needs to be given to ensuring that our towns and cities support and encourage healthy lifestyles.
National policy has only reflected this imperative for a relatively short time. This may be the reason why there has not yet been a major shift in delivery priorities and partnership working, although examples of best practice do exist.  A primary opportunity is to focus on improving the health and wellbeing of people in towns and cities through the delivery of comprehensive, multifunctional green infrastructure (GI)[…..]there is considerable support for the potential of GI to deliver a wide range of benefits for society, the environment and the economy. Enhancing people’s health and wellbeing is just one of these benefits.”


Over the past thirty years much attention has been given to building up a creditable evidence base. It is now widely accepted that there is enough evidence to support claims about the positive connections between health benefits and environmental quality. Public policy makers have only started to embrace GI relatively recently.

A Foresight report highlighted the importance of green infrastructure to quality of life, stating that “[…]there has been an upsurge in concern for green space in and around urban areas, including the development of green infrastructure[…]Two-thirds think it is important to have green space nearby and the majority think parks and public spaces improve quality of life.”  Source: Foresight Land Use Futures Project (2010) Final Project report. The Government Office for Science, London

Barton and Grant’s Settlement Health Map is a graphic summary of the ways in which health and wellbeing are strongly influenced by the character and quality of the places where people live and work. The paper that accompanies the map details the evidence on which the map is based (Barton and Grant 2006)

healthy Places2

Although both Ward-Thompson and Barton and Grant focused on the links between health, wellbeing and the physical environment in general, their work is undoubtedly relevant to discussions on GI. The connectivity that typifies a comprehensive GI network means that their conclusions are particularly relevant: continuous GI networks that are integrated within and between urban areas will be accessible to, and will therefore benefit, large populations.

In 2013 the Landscape Institute (LI) produced a position statement exploring the relationship between public health and landscape where they posed the question, “Can landscape help create healthy places?”  Their publication, “Public Health and Landscape” states that greater priority needs to be given to prevention of ill health in public health and social care.  They state that all those involved in creating healthy places – public health professionals, planners and landscape architects – need to recognise that landscape has enormous potential to improve our health and wellbeing.  Source: Landscape Institute (2013) Public Health and Landscape: Creating healthy places. London, Landscape Institute.

healthy Places

The Cities, green infrastructure and health report focuses on two key areas of public policy – planning and public health – which have the potential to deliver the kinds of changes necessary to enable enhanced delivery of green infrastructure.

  • The planning system
    The planning system establishes the framework within which decisions are made about land use. and therefore impacts on both the aesthetic and functional qualities of our towns and cities. The vast majority of these decisions have consequences on people’s health and wellbeing.  The National Planning Policy Framework (NPPF) acknowledges that the planning system needs to create “…a high quality built environment, with accessible local service that reflect the community’s need and support its health, social and cultural wellbeing” and that, “Access to high quality open spaces and opportunities for sport and recreation can make an important contribution to the health and wellbeing of communities.”  In addition the NPPF also highlights the importance of giving due consideration to future environmental changes, in particular climate change. In the context of health and wellbeing this is significant, given the relationship between public health and issues such as air quality, flood risk and the urban heat island effect.
  • Public health policy
    Public health policy exists to improve the health of the general population by addressing health issues before they have the chance to occur. It seeks to address longstanding health issues, reduce inequalities in health and wellbeing, and to ensure that, as far as possible, we can all live longer, healthier lives. The Marmot Review (‘Fair Society, Healthy Lives’) recommended that in order to reduce health inequalities, a key objective must be the creation and development of healthy and sustainable places and communities.  The Public Health Outcomes Framework 2013-2016, published by the Department of Health, presents a useful mechanism for focusing the attention of public health on the value of GI. A set of public health indicators has been developed including a range of indicators that can be positively influenced by integrating GI into our towns and cities.  However, Kirby and Russell’s report accept that these two key policy areas provide a significant degree of support for greater delivery of GI but that change on the ground is still lacking, which inevitably results in the need to consider what barriers might exist and which need to be overcome.


Despite the need for action, the policy opportunities and evidence to support the need to integrate GI into our towns and cities, we are not seeing this translated into delivery on the ground.  Kirby and Russell suggest a variety of barriers such as – local authorities who do not have GI policies, no statutory duty upon local authorities to protect or maintain green infrastructure assets, budgetary pressures causing significant reductions on spending on GI assets and key personnel with the skills necessary to demand and implement GI interventions and a lack of public health involvement in place making.


According to the King’s Fund the UK might face a scenario where it is spending up to 20 per cent of its GDP on funding the NHS. There is an urgent need to explore new ways of preventing ill health before it has the chance to occur, beyond more traditional programmes designed to encourage healthier lifestyles such as smoking cessation, healthier eating and more frequent exercise.  There is an opportunity to significantly improve health and wellbeing by integrating nature into the fabric of our towns and cities. Urban populations will be healthier and a number of other benefits will be gained for society, the economy and the environment. This is a result of the dynamic and multifunctional nature of GI, where land is planned and designed to deliver many services.
The policy support exists to encourage enhanced GI in our towns and cities, and recent initiatives, such as the Natural Capital Committee (NCC), have only strengthened the case. In its Third Report the NCC highlighted that “if every household in England were provided with more equitable access to good quality green space, then around £2.1bn in health cost savings could be achieved by the NHS per annum”.   However a number of barriers to delivery still exist.  With some local authorities suggesting that even the delivery of statutory duties is increasingly at risk, delivery of GI faces a challenging future. The Third Report of the NCC goes on to state that “Investment in GI is often the first to be sacrificed during periods of financial pressure, but this is a false economy”. We need to see increasing investment in GI to save in the future.
Opportunities to develop GI will be enhanced through a more creative, collaborative approach to the planning, design and management of our towns and cities. The potential offered by GI to address such a variety of economic, social and environmental challenges means that in future a wider range of interested parties need to come together to ensure that urban landscapes are rich, varied and truly multifunctional. This must include both landscape and public health professionals, given the enormous opportunity presented by GI to help ensure that people in our towns and cities live longer, healthier lives.



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