GOOD PLACES BETTER HEALTH A New Approach for a New Era George Morris and Lorraine Tulloch

Why did we initiate a process of change in the way we looked at environment and human health in Scotland, a process which has led to Good Places Better Health? In Short, What needed fixing?

A disarticulation at the level of policy and amongst practitioners Policy and practice in environmental health which was narrow, compartmentalised and still had a very strong (although huely important) hazard focus A sense, that despite their importance activities in environmental health had become slightly removed from the ‘big issues’ in public health Policy and action on environment was not fully exploited for better more equal health

Env and human health had become a little old fashioned and was not serving public health and the wider policy constituency as well as it might

We believed a modern policy-relevant approach on E & H would require to: reflect the complex interaction of physical environment with socio-demographic factors represent the psychosocial dimension to the relationship between people and places exploit the close articulation between public health and sustainability consider the health promoting potential of the environment

Success, we believed, could deliver some fairly alluring benefits. reinforce concern for environment and the wider concept of place at the heart of the public health agenda Extend the reach of environment to the health improvement agenda Make explicit the relevance of environment to health inequalities Offer some generic pointers on stakeholder engagement and cross- sectoral working Re-energise and develop new approaches for health protection

5 KEY PILLARS OF A NEW APPROACH 1.Holistic problem framing 2.Wide stakeholder engagement 3.Exploitation of a mixed economy of evidence 4.Qualitative synthesis of evidence to develop key messages 5.Consistent challenge to professional institutional and policy silos

We are in an Era of Ecological Public Health and we need to engineer an appropriate response across the board.

An ecological approach implies we must: “..comprehend the composite interactions between the physical, physiological, social and cognitive worlds that determine health outcomes in order to intervene, alter or ameliorate the population’s health by shaping society and framing public and private choices to deliver sustainable planetary, economic, societal and human health” Source: Lang and Rayner – Expert submission to Foresight obesity project (published in Obesity Reviews, January 2007)

Exposure (or Experience) Environmental Hazard or ‘Good’ Health Effect We need to consider more carefully the way those (hazards or good) environments translate to disease or better health?

Exposure (or Experience) Exposure Environmental Hazard or ‘Good’ Health Effect Context Social and economic factors, cultural influences, factors relating to the individual A more realistic representation!

Exposure Environmental Hazard or ‘Good’ Health Effect Context Influences risk for the individual Policy and Action A more realistic and policy-relevant representation The Drivers that shape environment or place