The developed world is experiencing a perfect storm of exponential growth in medical science. We can cure more diseases, but the resulting longevity increase has resulted in spiralling health costs. Free market environments such as the US now spend nearly 20% of GDP on health, yet their citizens are about to lose their hard fought safety net of Obamacare. Managed healthcare environments, such as the UK’s National Health Service (NHS) fund the service through direct taxation, keeping costs below 10% of GDP through direct and indirect rationing of the service.
However, the overstretched NHS is in the news every day. There is general agreement that the root causes of the problem are the increasing levels of expectation placed on our health services in parallel with an increase in the range of treatments that can now be delivered. In many instances, this leads to too many elderly patients being treated in hospital when other community settings or home care could support them. Coupled with continuing pressures on social care budgets, and baby boomers reaching their 70s, we now have a potential demographic ‘time bomb’ that will swamp the health service if this issue is not addressed.
That said, all is not lost. In 2000, the 2020 Vision predicted that by 2020 there would be a revolution in our attitudes to maintaining our own health through direct access to the internet and increased awareness of the dangers of smoking, alcohol abuse and obesity. Smoking and binge drinking are declining and exercise is becoming more popular, all leading to better long-term health. This trend towards self-awareness and healthy living should reduce our passive use of precious community health and hospital services. In tandem, we are seeing a growing consciousness of health and wellbeing issues penetrating the construction market place.
There is a growing awareness that appropriate urban planning and design can contribute to healthy living and potentially reduce reliance on health services. NHS England has recognised this through its Healthy New Towns Initiative which seeks to demonstrate how, through effective masterplanning, health can be designed into the built environment. When coupled with new models of care and supportive technology, the initiative will demonstrate how development can help address this global challenge. The Healthy New Towns programme is an innovation programme for NHS England, and innovation, whether in models of care, new ways of working, or new development typologies provides our societies with the evidence that there are viable solutions.
The challenges of climate change, accelerating urbanisation and political extremism make the future design of our cities and communities of crucial importance to our future survival, let alone our prosperity. Future health provision cannot be separated from the development of the overall environment.