Setting a standard for place and health
As the old saw has it: ‘an epidemiologist is a man or woman broken down by age and sex’; to which one should add ‘time, place and person’. Of these, the focus on place has a history dating back to Hippocrates, who in his treatise ‘On Airs ,Waters and Places’ drew attention to the interaction of location with the weather and seasons in influencing a wide range of conditions including nose bleeds, epilepsy, menstrual disturbance, ‘dropsy of the testicle’, constipation and ‘suppurations in the lungs’.
Trying to capture this essence of place is not easy for planners who wish to make a difference to the human condition, with failed large-scale experiments of slum clearance and flawed projects still within living memory – but this hasn’t stopped some from trying. One recent example of a living tool, developed by public health scientists, urban planners and architects (and now a key component of the World Health Organisation’s Healthy Cities Project) is the Place Standard, a practical online interactive framework that enables local citizens to capture the lived experience of their own neighbourhoods and generate a summary ‘spider’s web’ diagram as a basis for neighbourhood planning and local action (see Figure 1 below). The Place Standard provides a simple framework to structure conversations about place, allowing consideration about physical elements such as buildings, spaces and transport links – as well as the social aspects including personal security and sense of control. Ultimately, it is variables such as these that help determine whether people are in control of their lifestyle choices and the determinants of many of the medical conditions that lead to the doctor’s surgery.
Huge improvements in population health have occurred over the past 150 years. These now appear to be slowing down, and the inequalities in life expectancy and healthy life expectancy remain a challenge. In one sense we are still in the foothills of epidemiology when it comes to linking our experience of ‘Place’ to a wide range of specific clinical outcomes, not least when it comes to men’s health. Maybe the use of the Place Standard will prove to be a milestone on that next stage of the journey.
What do you think? Please leave your comments in the section below. Will the new Place Standard give greater insight into the impact of environment on health?