What places mean to people, and why this is important for health and wellbeing?

Research in health geography is building a significant body of knowledge about how and why places matter for our health and wellbeing. The research links to a wider body of interdisciplinary research on the ‘wider (social) determinants of health’ [1] which include aspects of the natural, built and social environment that are important for our health and wellbeing. These attributes of places act together with other factors that influence our health, such as our individual characteristics and behaviours and the medical care and treatment we receive. The research contributes to strategies for ‘place making for health’ and health impact assessment, informing spatial planning, economic development and urban design, and public health strategies of Health and Well Being Boards of local authorities [2].

Geographical research on health is concerned partly with causes of diseases and things which make us unwell, but also what contributes to good health and wellbeing. This reflects the World Health Organization view that: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ [3].

Some important lessons for policy and practice flow from geographical research on health and wellbeing. Below are just two examples which both show how the material, social and symbolic aspects of our environment contribute to what have  been described by Wil Gesler [4] as  ‘therapeutic landscapes’ – places that help us to keep well, or help us to recover from, or cope better with our ailments when we are unwell.

Example 1: The importance of home and homeliness for health and wellbeing. 

It has been understood for a long time that the material quality of the homes we live in is important for health and wellbeing. Aspects of our homes such as thermal comfort and damp proofing, sanitation and cleanliness, lighting, and domestic equipment are all important. Beyond this, there is a growing awareness of the importance for health of the social and symbolic importance of feeling ‘at home’. These aspects of home are socially and culturally determined and they reflect the life course experiences of individuals, as well as collective senses of identity and belonging [5]. Housing that allows for healthy social contact and interaction, and that corresponds to our sense of what ‘feels homely’ may be as important for our sense of wellbeing as the material aspects. Also the stability and security of the places we think of as home are very important for us psychologically. This helps to explain, for example, the significant mental health impacts caused by flooding that threatens people’s homes [6,7,8].  This research is also important for the design of public and institutional spaces. For example, research highlighting these issues includes studies on hospital design, funded by the British Academy [9] and National Institute for Health Research [10], and on residential care homes [11].

Example 2: Green spaces and their importance for health and wellbeing

Green spaces may be ‘natural’ landscapes or managed green settings such as parks or community gardens/allotments. Their material benefits for our health and wellbeing is evident in research showing that they provide ‘green lungs’ in urban areas, reducing the impacts of air pollution and help to mitigate the impacts of extreme heat or flooding that are now occurring more frequently under conditions of climate change [12]. Green spaces that are well managed and designed can provide opportunities for healthy physical activity [13]. A growing body of research also shows how important access to green space, and activities like gardening, can be for mental health and sense of wellbeing [14,15,16]. Some of this research comes from intensive studies in particular green spaces, helping us to understand just how and why green space is important for us, and underlining the importance of individual reactions to green settings. (For example, for some people, woodland spaces can seem intimidating rather than attractive [17].) Another strength of geographical research is the potential to use geographical information systems to examine data for many small areas and large populations. Across large numbers of people and places we can measure the strength of the positive link between proximity to green space and better health. For example, recent research [18] shows that the differences in health associated with socio-economic inequality are less extreme in populations with good access to green spaces. This raises the possibility that green spaces may help to offset the damaging health impact of growing inequalities in wealth in countries like the UK.

Where to read more on Geographies of Health and Wellbeing

A growing number of geographers internationally work on research concerned with geographies of health and wellbeing.  Several British Academy Fellows have worked on these issues and there is a Research Group of the Royal Geographical Society with the Institute of British Geographers focussed on this work. Recently specialists in this field from around the world met in Vancouver for the 2015 International Medical Geography Symposium, which covered diverse aspects of this field of research. Geospatial research on health and disease was also a major theme, and focus of plenary sessions, in the Annual Conference of the Association of American Geographers in 2015.

Those interested to learn more about research in geographies of health could refer to sources including  journals such as Health and Place and Social Science and Medicine, and several books reviewing the field [19,20,21,22,23,24]

Sarah Curtis
Sarah Curtis, (FBA, FAcSS, FRGS, PDhil,) is Professor of Health and Risk at Durham University, UK. Her research and scholarship explores how and why places matter for people’s health. Her extensive publications explore how social, economic and geographical processes in the places where we live are linked to our physical and mental health. Sarah also works on environmental hazards, especially those associated with climate change, and their impacts on human health and health care. She has worked for organisations and agencies such as: the World Health Organization, NHS Sustainable Development Unit, Department of Environment of  Food, and Rural Affairs, Environment Agency, Improvement and Development Agency and the Department of Health UK; Public health agencies across England; the National Collaborating Centre for Healthy Public Policy, Canada.

References

[1] WHO (2010) Commission on Social Determinants of Health – final report: Closing the gap in a generation

[2] Learmonth, A. and Curtis, S. (2013)  Place shaping to create health and wellbeing using Health Impact Assessment: health geography applied to develop evidence-based practice,  ‘view point’ in Health and Place, 24, 20-22.

[3] World Health Organization (1946) Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946.  At: WHO Definition of health

[4] Gesler, W. (2003)  Healing Places.  Lanham, MD., Rowman and Littlefield.

[5] Blunt, A. and Dowling, R. (2006)  Home.  Abingdon, Routledge.

[6] Alderman, K., L.R. Turner, and S. Tong, Floods and human health: A systematic review. Environment International, 2012. 47, 37-47

[7] Tapsell, S., Tunstall, S. (2007). The mental health aspect of floods: evidence from England and Wales. Flood Hazards and Health. In Few R. and Matthias, F., Ed. (2006). Flood Hazards and Health. London, Earthscan.

[8] Carroll, B., H. Morbey, et al. (2009). “Flooded homes, broken bonds, the meaning of home, psychological processes and their impact on psychological health in a disaster.” Health & Place 15, 2, 540-547.

[9] Curtis, S., Gesler, G., Fabian, K., Francis, S., and Priebe, S. (2007) Therapeutic landscapes in hospital design: A qualitative assessment by staff and service users of the design of a new mental health inpatient unit. Environment and Planning C, 25, 591-610.

[10] Wood, V.J., Gesler, W., Curtis, S.E., Spencer, I.H.,Close, H.J. and Mason, J., Reilly, J.G. (2015) ‘‘Therapeutic landscapes’ and the importance of nostalgia, solastalgia, salvage and abandonment for psychiatric hospital design.’, Health & place., 33 . pp. 83-89.

[11] Milligan, C. (2009)  There’s No Place Like Home: Place and Care in an Ageing Society.  Farnham, Ashgate.

[12] Norton, B.A., Coutts, A.M., Livesley, S.J., Harris, R.J., Hunter, A.M., Williams, N.S.G., (2015) Planning for cooler cities: A framework to prioritise green infrastructure to mitigate high temperatures in urban landscapes Landscape and Urban Planning, 134, 127-138.

[13] Coombes, E., Jones, A, P,. & Hillsdon, M. (2010) ‘The relationship of physical activity and overweight to objectively measured green space accessibility and use’. Social Science & Medicine 70, 816–822.

[14] Finlay, J., Franke, T., McKay, H., Sims-Gould, J. (2015)  Therapeutic landscapes and wellbeing in later life: Impacts of blue and green spaces for older adults.

[15] Curtis, S. (2010) Space, Place and Mental Health, Farnham, Ashgate

[16] Milligan, C., Gatrell, A., &  Bingley, A. (2004) ‘Cultivating health’:therapeutic landscapes and older people in northern England.’, Social Science & Medicine 58, pp.1781–1793

[17] Milligan, C. & Bingley, A. (2007). Restorative or scary spaces?  The impact of woodland on the mental well-being of young adults. Health and Place 13,4, 799-811.

[18] Mitchell, R.J., Richardson, E. A., Shortt, N.K., Pearce, J.R. (2015) Neighbourhood environments and socioeconomic inequalities in mental wellbeing. American Journal of Preventive Medicine, 49, 1, 80-84

[19] Atkinson, S., Fuller, S., and Painter, J. (editors) (2012)  Wellbeing and Place, Farnham, Ashgate

[20] Brown, T., McLafferty, S., Moon. G. (editors) (2010)  A Companion to Health and Medical Geography, Oxford, Wiley – Blackwell.

[21] Pearce, J. and Witten, K. (editors) (2010) Geographies of Obesity: Environmental Understandings of the Obesity Epidemic.  Farnham, Ashgate.

[22] Gatrell, A. and Elliott, S. (2009)  Geographies of Health: An Introduction. 2nd Edition.  Oxford, Wiley-Blackwell.

[23] Curtis, S. (2004)  Health and Inequality: Geographical Perspectives, London, Sage.

[24] Jones, K. a. M., G. (1987). Health, Disease and Society: An Introduction to Medical Geography.  . London, Routledge.