A new survey comparing housing density and the amount of green space in a given area with public health issues such as obesity and diabetes has found that there is a clear link between land-use and public health in cities.

The healthiest local authorities in the UK's major cities have almost half the housing density and a fifth more green space than the least healthy ones, says the survey by RIBA, the Royal Institute of British Architects

It says that £675 million could be saved every year from the UK's public health budget if 75% of those who currently don't get enough exercise walked the recommended amount each week.

The report looks at London and England’s eight Core Cities - Birmingham, Bristol, Leeds, Liverpool, Manchester, Newcastle, Nottingham and Sheffield – examining three major health problems and comparing the amount of green and public space available.

Of course income inequalities play a large part as well, if only for the fact that property prices in leafier areas are far higher than those in areas of increased density.

But the report examines data from the Index of Multiple Deprivation to correlate the deprivation levels across the line cities with the amount of green space and health and well-being. It finds a strong link between better health and the amount of green space, regardless of socio-economic status.

Levels of deprivation:


 City average

 Ranking (least deprived = one)































When asked, residents report that it is the quality, not the quantity of streets and parks that will encourage them to walk more. It's no use providing green space if it is not interesting enough and safe to walk in.

Streets and parks designed to be safer and more attractive were the most common changes people reported would encourage them to walk more. "If we design places people want to use we can, quite literally, lay the foundations for regular physical activity and thereby reduce obesity, related health problems and their public cost", it concludes.

The report calls on local authorities to integrate public health considerations into planning policies and programmes and to have a truly joined-up approach to improve their city’s health.

The best and worst

The survey finds that London and Bristol have the highest life expectancies for men and women, while Liverpool and Nottingham have the shortest. Overall there is a difference of between three and four years in life expectancy.

The total percentage of green space in the five worst performing local authorities outside London was 51.2% and the percentage of land occupied by housing 6.1%. The five best performing local authorities outside London have 73.2% of green space and only 3% of housing.

Liverpool suffers from the highest level of childhood obesity with 22.8% of children being obese, followed by Newcastle (22.6%), Nottingham (22.2%) Birmingham (22%), London (21.9%), Sheffield (20.9%), Leeds (19.9%), Manchester (19.6%) and finally Bristol (17.3%).

Good examples

Brownfield estate, Tower Hamlets, LondonThe report cites the Brownfield Estate (right) in the London Borough of Tower Hamlets as an example of good practice.

This urban regeneration project transformed a rundown and poorly connected estate by revitalising the most useful routes and destinations with new trees and a green grid along the routes throughout the estate.

Underused spaces were reactivated by creating functional public spaces to give people a reason for using them.

For example, play spaces were created and there is now a new play space and a refurbished play space.

Parking was rationalised to help make streets more attractive and easier for pedestrians to navigate. Public and private spaces were better defined and some public at was installed.

The budget for the operation was £7 million.

High Hazels estate, NottinghamshireAnother example is given as the High Hazels estate in Huthwaite, Nottinghamshire (right and below), a former mining town containing 80 homes.

Following a consultation exercise with the residents a disused field was transformed through new landscaping to provide a natural children's play area, water fountain and wetland.

It includes a meeting place for parents, pass was decorated with bricks designed by residents and some of the volunteers who helped do the work have gone on to set up a community food growing club in underused gardens.

High Hazels estate, Nottinghamshire

The third example is New City Quarter in Hungate, York. This is a new riverside quarter on a brownfield site containing over 700 apartments and houses and 9800 m² of employment, retail, leisure and community buildings and public spaces. It includes a network of pathways connecting the new developments to the established areas of the historic city following the routes taken by pedestrians.

New City Quarter in Hungate, York.It incorporates the urban design characteristics of York into the new streets, squares and public spaces. So it reflects York's narrow streets with variety and order, spaces and views that connect them to the surrounding areas.

This placemaking strategy retains the characteristics of the location with the architecture as well, such as the scale and form of the fragmented buildings, the undulating roof scape and local materials.

The urban design therefore both knits the old and new communities together and provide safe, inviting and well overlooked attractive routes between them.

To ensure that the public spaces would be well used a community forum was tasked with feeding into the design and planning process.

To ensure that the facilities remain attractive and appealing, a Community Development Trust has been set up.

Who should pay?

Some local authorities, whose budgets are already being squeezed as a result of government cutbacks, are saying that if they are to make these changes then portions of the budget of the National Health Service should be allocated to them to do so.

The report includes sections on the cost of unhealthy places, the role of the built environment, public health preferences and how to design fitter cities, followed by a set of recommendations, including that:

  • local authorities composed of less than 50% green space and/or with a housing density of over 5% should produce a Healthy Infrastructure Action Plan as part of their Local Plan in conjunction with their Health and Well-being Boards. This would contain a strategy for making streets and parks safer and more attractive and prescribed the principles they expect to see in new developments in order to gain planning permission.
  • redirect a proportion of their Community Investment Levy to fund their Healthy Infrastructure Action Plan.
  • guidance for planners and developers on how they can support healthy lifestyles should be embedded within National Planning Practice Guidance.
  • the worst performing cities should also receive more grants to spend on providing public health services.
  • developers and architects should prove how the new developments will benefit public health through their design of the public realm and its links to existing infrastructure.