The Feb edition of The Lancet, ran an editorial calling on physicians and architects to lay the foundation for improved health in the urban setting. The complete article is available freely HERE
This is one more link in the chain of argument started by Michael Marmot who looked at civil servants in the UK starting in the 70’s. His work in this area, now collectively known as the White Hall Studies clearly and elegantly documented the relationships between social status and health. His famous 10 year study of British civil service workers found that the lowest class workers (doormen, messengers etc.) had mortality rates three times that of the highest social class of administrators. Unsurprisingly, smoking, obesity, sedentarism, and high blood pressure were more common in the lower classes, but even when accounting for these risk factors, the lowest class developed complications of CHD over 2 times more than the highest class over the decade of the study.
Many theories were postulated to explain this finding, and in the ensuing decades the picture of what determines health has become even more fuzzy. It turns out that pollution, noise, social inequality, your neighbourhood, unemployment, and a host of other factors impact on our health. This too would not surprise too many MDs. However, what is surprising to all of us, is just how “off the radar” such issues are, and how man made they are at the same time.
The UK is the birthplace of population models of health, and of social determinants of health; and It is not surprising that they set the pace in promoting healthier populations through better urban design. What I find most compelling though is that the article was a lead editorial in one to the leading medical journals of the land, and it will be interesting to see the response of the medical community. This is, after all a lateral attack on the health industry: a domain that was, once upon a time, all biomedical, and has only in recent years flirted uncomfortably with behavioural issues (cigarettes, obesity, diet, exercise, etc.). As a group, us docs have had a hard time figuring out how to deal with behavioural issues, but perhaps that struggle will prepare us all the more to accept urban design as yet another important determinant of our patient’s health.
There is a silver lining hidden in this story, and the editorialist underscores this by calling on architects and physicians to mobilize together for healthier communities. Health is so complex that great success requires that it become a priority for professionals, and bureaucrats at all levels of the society.
Ahhh … (hugh sigh of relief). Health promotion is not our job after all – it is everybody’s job. Thanks to the the UK and the Lancet for reminding us to think outside our box.