Building for health

Birmingham City Council recently launched its Our Future City Plan, setting out a bold vision to transform England's city over the next twenty years into the gold standard for green, healthy, affordable and enjoyable living.

The plan aims to double the green space in the city, which would it comparable to Vienna, and double the active travel routes to nearly 200km of routes for cycling and walking around the city, bringing it on a par with cities like Copenhagen. It's an approach which doesn't ignore the growing population of the city, instead looks to integrate green and built environments and learn from best practice from around the world, while also intentionally developing corridors and communities that connect the central business centre of the city through creative, academic, retail and cultural networks out across the wider geography of the city.

It is a bold plan and when it was launched at the UK Real Estate Investment & Infrastructure Forum 2023 it was lauded as dynamic, ambitious and the kind of change that we need to see in cities to adapt to the post-pandemic way of living.

So what is in it for public health and why as a director of public health, and local resident, am I so excited about the opportunity of this direction of travel?

The environment in which we live, both physical and social, contributes to an estimated 40% of the burden of disease and premature death. This is both direct and indirect, but some of the direct impacts are obvious but perhaps under-valued.

The physical environment in which we live and work and play has a direct impact on us. This ranges across almost all aspects of health and behaviour, at it's very simplest if a building has only fire escape stairs hidden away and shinny beautiful lifts, then people using the building will have lower levels of everyday physical activity and this will increase their burden of preventable diseases like type 2 diabetes, heart disease and some forms of dementia and cancer. There many examples of this, from the physical barriers to healthy lives like multi-lane roads that cut communities in half, or the lack of access to green space to exercise and play in, through to the more subtle barriers like poorly lit canal towpaths that become a haven for crime, or the houses built with kitchens too small for a decent freezer creating a practical block on cheaper bulk purchase of healthy frozen vegetables.

Birmingham is a city that has evolved through the 21st century with a close alignment with car manufacturing, although for centuries it has been a city of trades and artisan crafts people, and you can't have trade without transport. From the canals to the motorways and New Street station interchange, this is a city that has grown around a circulatory system of transport infrastructure. Perhaps most crystallised in the canal networks and the infamous spaghetti junction that recently had it's 50th birthday. This network of roads, canals and railways are the lifeblood of the city but also dissect communities, creating barriers between people and services, jobs and opportunities and bring pollutants, noise and danger of accidents.

Few of us would choose to live on top of a motorway or next to main railway line because of the pollution, noise and risks, so almost by definition these transport arteries cut through some of the most deprived communities. It is a bit of a chicken and egg, and probably one of historians, whether the deprivation came first or the transport infrastructure, but the reality now is that some of the most deprived communities are burdened with a built environment that damages their health.

There are many more examples I could expand on but this gives a flavour of why the built environment is so important to health and wellbeing and fundamental to addressing the challenges facing the NHS and social care.

So back to the Future City Plan and why it matters for health. The city plan has a vision of Birmingham as 'A global city where prosperity is shared by all - happy, health and affordable. Our connected culturally distinct neighbourhoods showcase the best environmental quality resilience and adaptability. A city proud of our unique identity and diversity that embraces technology and creativity, beauty and imagination.'

The plan anchors around six themes each of which has a opportunity to improve the health and wellbeing of our citizens:

City of centres - creating a network of vibrant, liveable, distinct neighbourhoods with the concept of the 15 minute neighbourhood and supporting urban growing at its core. The local neighbourhood concept being pioneered in cities like Paris, creating liveable communities where daily life can be walked or cycled easily, but not ignoring the value of travelling further for the experiences like theatre and art.

City of growth for all - recognises the paradigm challenge of economic growth not providing opportunities for local existing communities and business and this is key to improving health. Too often we see inclusive growth forget the communities that were there before the unattainable jobs and unaffordable housing were created. So the intentional commitment to addressing inequalities in the growth is both welcome and challenges our status quo.

City of nature - this is the segment perhaps closest to me currently, within our public health team we have co-lead the Future Parks Accelerator work that helped developed this theme and collaborating with the University of Birmingham developed a new framework of metrics to define environmental justice in our city. There is a well established evidence base linking contact with nature and health and wellbeing, so this pillar of the plan is really exciting in the opportunities to support health and wellbeing through nature.

City of layers - Birmingham is one of the most diverse cities in the UK and this theme recognises the need to consider this in our approach to the built and natural environment. Culture and identity is an area of public health that needs to continue to grow and evolve, the short hand of socio-economic diversity is not enough to really value and understand the needs of our communities and as part of this we must explore the opportunities of arts and culture as well as sport and faith, these are the layers in this plan that are exciting opportunities to lean in more.

City of connections - this theme focuses on enabling connection through walking and cycling in a way that recognises that this is not a transition that happens overnight and needs practical solutions that support businesses and individuals, so talks about digital innovation, freight solutions and public transport as well as cycling and walking routes. The connections of the city are the essentials of our lives and enabling everyday movement, that is so essential to healthy lives, means creating connections between foot, bike, bus and tram that works efficiently and affordably in the way people lead their lives.

City of knowledge and innovation - creating space, environments and resource for innovation is more than just digital, the plan talks about creative and cultural start-up hubs, maximising the benefits of our nine universities and the intellectual and entrepreneurial assets of the city. Bringing this innovation to bear for health doesn't stop at the laboratories and medical academics who link with our hospitals but it opens out into innovation that make moving easier through lighter, cheaper efficient public transport vehicles, healthy eating more affordable through more efficient urban agriculture, accessibility more open to people with disabilities and impairments through new solutions that we have yet to imagine.

The plan is an exciting opportunity for public health and to ensure we make the most of it we have created a new public health team within the Council public health division to focus on the Built and Natural environment and support this plan as it becomes a reality. This team of public health specialists will work as a matrix across with our Place and Prosperity Directorate as they collaborate to bring the vision to life.

I am excited about the future for the city, both as a public health professional and as a local resident, the plan and the vision are bold, now it is up to us as a system and a city to make it a reality.