Creating Health Promoting Environments

Implications for Regeneration Grace Moore MBE

Outline

• Link to Government vision

• What is a Health Promoting Environment?

• Is it an environment where the healthy choice is the easier choice?

• Is it an environment which promotes health without the individual having to make a choice at all?

Outline

• Research on the design of health care buildings and their impact on health of staff and patients

• Other areas where design for health has been researched

• What are the building bricks of evidence based policy?

Vision

• “A thriving Scotland with appropriate working, housing and living conditions, less smoking, healthier eating, more activity in daily life and less binge drinking…...

Vision

• ……producing an improvement in the quality of people’s lives, enhanced well being and increased life expectancy for men and women, fewer early deaths from heart disease, diabetes and cancer…...

Vision

• Individuals and organisations taking more individual and corporate responsibility, with more people living their lives in good health both physically and mentally…..

Vision

• All Scotland’s children have a positive expectation of appropriate housing, education, community and family life with the aim of maturing into positive, confident and productive citizenship.”

» Improving Health in Scotland: the Challenge

Improving Health

• Multi-factorial - Regeneration is one of the factors

• Evaluating cause and effect is difficult

• Constantly try to simplify what is in effect a complex issue

Focus on factors - what are the links with regeneration?

• Determinants of Health

• Lifestyle Issues

• Consider from perspective of people, place, method, health issue

Health Promoting Environments

• Environments where the healthy choice is the easy choice - e.g. smoking ban, Hungry for Success

• Environments where little choice is needed -Evidence based policy

• There is clear evidence of the impact of the built environment on our physical activity and health

Health Promoting Environments

• You could make an argument that the greatest advances to improve health in the western world haven’t come from doctors at all, but from civil engineers and from public health specialists. Clean water, safe disposal of waste water, highways, transportation, economics, education, electrical power—all civil engineering advances. These developments have had the greatest significance in terms of life span.

And….

• I think we could add designers, artists, musicians and architects to this list.

• Focus on their role in health care design.

American System - cost driven - business principles

• Improve the quality of care for patients • Attract more patients • Recruit and retain staff • Enhance operational efficiency and

productivity • Roger Ulrich, University of Texas

Focus on environment - patient at the centre

Results from research on building design The more attractive the environment, the higher the

perceived quality and the lower the anxiety.

Patients underestimated longer (30+ minutes) actual wait times; and overestimated short (0-5 minutes) actual wait times.

Significant relationship between perceived wait times and perceived quality and perceived anxiety.

What do staff think?

• A survey of 734 staff members in 2004 found that the majority feel that the design features, - access to natural light, improved airflow, separation of public/patient transport areas, and "homelike" patient room design - positively affect the quality of their worklife and help them provide care more effectively.

Impact of noise reduction Noise levels were reduced by designing larger

private rooms, carpet in hallways, acoustical tiles on walls and ceilings, and relocating machinery and nurse charting away from patients.

Average decibel rate per patient room was less than 51.7 - Quality of sleep improved from 4.9 to 7.3 (on a scale of 0-10).

Patient satisfaction scores improved during a three-month comparison period.

Patient Safety and Care Patient falls are down 75% due to design,

which allows for better observation.

Patient room layout, equipment integration, and other design features have helped push patient transfers down 90%.

Overall patient dissatisfaction has dropped from 6% in 1998 to 3% in 2001.

Patient Safety and Care Decrease in patient transfers and nurses more

consistent knowledge of each patient's condition have contributed to an improved medication error index.

Unit design has helped reduce the caregiver workload index, resulting in improvements in nursing efficiency.

Cost Benefits

• Do buildings designed for health cost more?

• Yes - approximately 5% more - but costs recovered almost in first year.

Questions

• How could learning from this work be used when thinking about regeneration?

• Could it be used in workplace/school/other public service building - if so how?

• What impact on health and well-being could be possible or could we strive for?

Building Design for Health

• Healing gardens• Open Spaces• Paths and nature• Sustainable Products in Building Design• Links with Sustrans

Sustrans

• Pedestrian deaths experienced more in areas of deprivation

• Also, people in deprivation take less exercise

• Obesogenic Environments

Cycling

• Countries with highest rates of cycling in children e.g. Denmark, have lowest rates of obesity

• Nearly a quarter of car journeys are less than two miles

• Innovative transport strategy

Possibilities to impact on health and well-being

• Design in exercise and design out obesity

• Design in Healthy Transport Policy and Design out Accidents

• Design in Community Safety and Design out Crime

Conclusion

• In regeneration we need to think more about the effect of the built environment on health - could hospital in the city form part of the regeneration agenda

• Profile our communities and highlight the key health risks and how these might relate to design

Conclusion

• Design in evidence based policy - health and well-being happens

• Create links between the Arts and Health Design

• Would linking the HP model with the design paradigm result in synergy?