22 August 2006

Health Impacts of the Built Environment

The Institute for Public Health in Ireland has released a review on the health impacts of the built environment, complementing their earlier reviews of the health impacts of employment and transport. The review provides a useful basis for understanding the range of health impacts that may arise in relation to the built environment, though the lack of contextually-specific detail may make it more useful as a document that guides scoping.

The review includes the version of the determinants of health diagram developed by Goran Dahlgren and Margaret Whitehead that has been adapted by Barton and Grant to include a planning perspective. What I think is missing from the model is the important role health services still play in determining health outcomes, though their absence may be understandable given the audience for whom the diagram was adapted (land use planners, social planners, local government, etc).

I'm reminded of McKee's (2002) observation that McKeown's influence on public health was to popularise the view that improvements in mortality were mostly due to improvements in living conditions (McKeown 1979). Mackenbach and his colleagues refuted this, at least in part, by demonstrating the decline in deaths from conditions that could be altered through health care represented a major part of overall improvement in life expectancy in The Netherlands between 1950 and 1984 (Mackenbach et al 1988).

I think there's still an important role for health services in contributing to a reduction in health inequalities and ensuring population health gains. What do you think?

References
Mackenbach J, Looman C, Kunst A, Habbema D, van der Maas (1988) Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical interven-tion in The Netherlands. Social Science and Medicine 27:889-894.

McKee M (2002) What can Health Services Contribute to the Reduction of Inequalities in Health?, Scandanavian Journal of Public Health, 30(Supplement 59) p 54-58.

McKeown T (1979) The role of medicine: dream, mirage or nemesis? Oxford: Blackwell.