Anisha Mayor Chair of the NLA Healthcare Expert Panel reflects on the panels latest roundtable exploring how London's built environment can drive better health outcomes.

It is no longer news that in some parts of London, there is a 10-year life expectancy differential between populations within the same borough and an even wider gap for a healthy life expectancy. The hugely anticipated NHS 10-year health plan, due out imminently, will be predicated on three shifts: from hospital to community, from sickness to prevention and from analogue to digital. It is hoped that it will move the dial on the prevention agenda in London, but to do so effectively, it will mean we must think beyond the red line boundaries of our anchor institutions and regeneration developments.

To support this mission-led agenda, the NLA’s roundtable brought together a panel of experts from across the built environment, including anchor institutions such as borough councils and the NHS, design practices, VCSEs and international institutes. The key discussion topic was London – A Health Creating City.

From the very beginning, it was clear that none of the panel wanted yet another discussion on a vision but rather a focus on turning vision into a reality.

How do we make complex simple? There are numerous indices, such as the Quality of Life index, deprivation index, local borough targets, datasets and maps. Put simply, we need an easily navigable, tangible process for developers to understand how to produce spaces that intrinsically improve healthcare outcomes. This includes:

For this process to be simplified and have all the right ingredients, there needs to be guidance / a framework that is driven at the macro GLA / city-wide level and then a bespoke approach applied and implemented at borough level.

The importance of a bespoke approach at borough level is fundamental, as those with the closest intelligence of what is affecting populations hyper-locally are VCSEs and micro-VCSEs. Platforms such as One Planet amplify and increase the visibility of these populations, but is there a role for the GLA to be the voice of the unheard? For instance, discussion centred on potentially creating a platform, sponsored by the GLA, which could include VCSEs from across London’s boroughs matched with corporate organisations, who, through each corporate organisation’s ESG investment mandate, could provide funding to improve local population health.

Equally, the everyday language of built environment professionals and local populations is often a dialogue of the deaf. Whilst professionals in the built environment space speak in a certain professionalised language, it can often be alienating for local communities who do not talk about their local area in the same way. There needs to be a focus on place literacy and a discussion on how this is shared as an educational tool. One of the first tests might be to determine whether the term “Health Creating City” is universally intelligible and accepted.

One such example is trying to develop what built environment professionals call “soft infrastructure” or “social capital”, but what does that mean, for example, to the youth of today? It is the glue that brings communities together and delivers on the basic human need of a right to a good and enjoyable life with access to wellbeing, safety, creativity and play. It could be warm banks, food banks or something as simple as access to a chicken shop. The Gehl Institute carried out a study of why teenagers prefer to hang out in chicken shops across South London. The study revealed that the key reason was not about eating chicken, but it was more about being in a warm space with access to a toilet and Wi-Fi.

Arguably there should be a fourth shift from the individual to the structural. There is a danger that individuals are being made hyper-responsible for their health, whilst at policy level and within the built environment we need to do more to reduce individual responsibility.

What do we mean by this? The UK government has already taken steps to execute a junk food advertising ban. However, we also need to increase accessibility to affordable nutritional food.

Equally, the built environment should automatically influence positive health-benefitting behaviours, such as safety being embedded in the design of our streets so that they are not hostile places.

For example:

It is a substantiated fact that access to green space improves population health. But how can this be funded? It is an age-old conversation on how we can attract private sector investment into the public realm, with often the suggestion being the pooling of CIL and S106 monies.

The current way in which investment in green space is delivered is in funding green space within the red line boundary of an individual investor’s land ownership. The greater the size of the scheme, the greater the investment into the public realm, but still largely only within the red line boundary. Examples include developments at Barking Riverside, King’s Cross and Earl’s Court.  There is a gradual market shift for ESG investment in the public realm. It is important in this context to either quantify the premiums associated with ESG and/or the discounts.

It is unlikely, however, that there will be an ability to attract investors into just investing in the public realm without the development of a building attached to it, which unfortunately means that we are unlikely to attract funding into the “in-between” spaces, i.e., those spaces between developments that are often forgotten and the spaces which are the connecting nodes for a cohesive green and blue masterplan across the capital.

Pockets of improving practice are Business Improvement Districts who are engaging with investors and occupiers to pay a levy for well-maintained green spaces.

It is clear that currently development and investment are associated nearly exclusively with monetary considerations rather than health considerations. We need to find other definitions of value that consider population health as well as an investor’s return. Reducing the number of sick people is vital, as, unfortunately, sick people, particularly those with multiple comorbidities, cost more in the long term.

When considering a local government business case that is made to Treasury as part of the Green Book process, there is very little requirement to quantify the short, medium and long-term health outcomes and benefits. Understanding the value of good health and a longer, healthier life expectancy undeniably has a long-term financial benefit.\

On the subject of prevention, there were many questions still left unanswered, such as:

Whilst the roundtable did not find the solutions to all these questions, it was the start of a conversation that is to be continued… in a wider symposium on this subject in autumn 2025.