Place, community and health
Communities and the social environment
Our network of support, sense of belonging and participation in the community around us are important aspects of our daily lives and can have a significant influence on health and wellbeing.
Social isolation and a lack of support can be major causes of stress, particularly for those living on low incomes and for those with children. And living with chronic stress has been linked to serious illnesses and early mortality. For people living in difficult or chaotic circumstances, where they may feel they have little control of influence over their lives, the effects of living with stress for long periods of time can have an adverse, and often significant, impact on their wellbeing.
These stresses, which may be linked to the social determinants of health, require interventions beyond the scope of traditional healthcare models. The effects of long term stress may be relieved through access to good, fair employment opportunities, or improved housing,
The influence that place has over many of the social determinants of health means that it can be a powerful asset to create health in our communities.
The biology is very clear; chaotic, difficult circumstances lead to an increased risk of physical ill health. So let’s not spend a fortune trying to find drugs to fix that; lets change the chaotic and difficult circumstances
Sir Harry Burns
Place and social interaction
Social interaction is important to health and wellbeing. Having good social networks and active social participation is associated with a number of health benefits, including lower levels of depression, protective effects against dementia, and reduced morbidity and mortality
Social isolation is a growing problem, particularly for older people, and is negatively associated with a number of both physical and mental health problems.
A review of the prevalence of social isolation and loneliness in Scotland (undertaken before the COVID-19 pandemic) highlighted that:
- 6% of adults have contact with family, friends or neighbours less than once or twice a week
- 18% of people have limited regular social contact in their neighbourhoods
- 21% feel that they don't have a strong sense of belonging to their local community
- 48% of people exhibit a degree of social mistrust, which is connected to their level of social contact and feelings of belonging to the local community
- 28% of people volunteer
- 46% have been involved in some kind of community action to help improve their local area
- A significant minority of children are vulnerable to social isolation because of poor peer support or bullying
On the other hand good social networks can offer a range of support, giving people a way to cope with problems and reduce stress levels.
Greater levels of neighbourliness and a sense of belonging to the community are likely to nurture community wellbeing and to stimulate community activities aimed at improving the local environment. Such activities can in turn help to foster feelings of neighbourliness.
Importantly, living in a supportive and inclusive community may benefit those in lower income groups more than others and could be an important factor in reducing health inequalities.
The built environment can play an important part here: environments designed to be walkable (safe and easy to get around in on foot) and that provide well-maintained public and green spaces can give people the chance to meet opportunistically, potentially increasing social interaction and togetherness.
Access to greenspace and the natural environment
Research has shown that good access to green and natural environments can have a positive effect on physical and mental health, particularly for those living with disadvantage.
Greater proximity to greenspace has been associated with lower prevalence of a number of diseases, reduced premature mortality and improved mental health and wellbeing.
People living closer to greenspace are likely to be more physically active than those who do not. In urban areas, closer proximity to greenspace has been associated with a reduction in crime, particularly of violence and aggression.
People are more likely to make use of greenspace if they think it is safe, well-maintained and easy to reach.
Those living in areas of the greatest socioeconomic deprivation are less likely to live within walking distance of greenspace and are less likely to be satisfied with that greenspace. Improving access to and the quality of greenspace in proportion to need therefore has the potential to reduce health inequalities.
Natural environments can also improve the social connections within a neighbourhood by offering places for people to meet and interact and for children to play.
Noise pollution is associated with poorer mental wellbeing and greater levels of stress.
The maintenance of streets and public spaces
How well a place is maintained can influence neighbourhood satisfaction, perceptions of safety and how people use their neighbourhood. It also has a bearing on social connections and neighbourliness within communities. Poor maintenance can create negative perceptions of a place, damage community resilience and discourage people from investing in their homes and communities.
Anti-social behaviour, such as vandalism, litter and dog fouling, can lead people to feel dissatisfied and unsafe in their own neighbourhood, and is more common in areas of greater deprivation. However, places that are well cared for can improve perceptions of safety, discourage crime and encourage greater use of the neighbourhood with an increase in outdoor activities.
Community empowerment and participation
Community empowerment, community engagement and co-production (working with communities to achieve positive outcomes) have the potential to improve health and social outcomes and reduce inequalities through action on place.
To do this the greatest focus needs to be on communities in relatively deprived areas where the worst health outcomes are seen.
Ensuring that all local people are heard and are able to influence decisions that affect them can give people a sense of control and strengthen communities. The work of Community Planning Partnerships and Integrated Joint Boards provides opportunities for the public sector to support communities by planning investment, development and services according to their needs. This may require capacity building to equip communities with new skills, a challenge in which the third sector will be key.
If relatively affluent communities are able to benefit most from such activity there is a risk of increasing inequalities. Resources such as the National Standards for Community Engagement can help to guide and support work with communities.
Working with communities should be embedded within a wider approach to tackling health inequalities that addresses the whole causal chain including the fundamental causes of power, income and wealth.
Useful publications
History, politics and vulnerability
Explaining the drivers and interconnections that influence our health is complex. However, this research report sets out how issues related to the physical and social environments, alongside poverty and deprivation, can play significant roles in public health.
The research illustrates how urban change, housing and the physical environment can be positive or negative factors in influencing health outcomes, particularly for those living in disadvantaged circumstances.
The report was produced by the Glasgow Centre for Population Health, NHS Health Scotland, the University of the West of Scotland and University College London
A Connected Scotland strategy
A Connected Scotland is the Scottish Government's national strategy for tackling social isolation and loneliness and building social connections.
It sets out key priorities in seeking to tackle social isolation and loneliness and lays out a clear roadmap for implementing the strategy in a cross-cutting and collaborative way.
The Scottish Health Survey (SHeS)
A useful collection of documents relating to the Scottish Health Survey is available, including summary reports, historical publications and a useful dashboard.
The documents provide a detailed picture of the health of the Scottish population in private households and is designed to make a major contribution to the monitoring of health in Scotland.