Physical environment: introduction
The environment has been recognised as a key determinant of health throughout history, and is described as such in many of the current models of health. The important advances in public health in the 19th century were based on controlling the built and natural environment, in particular improvements in water supplies and sewerage systems. In the 20th century improvements in housing reduced overcrowding and its associated diseases (e.g. tuberculosis). Similarly, the clean air acts in the latter part of the century significantly reduced the levels of respiratory disease in the population. As illustrated by Good Places Better Health, the potential for the environment to create and nurture health is now recognised as a vital counterpart to the ongoing challenge of reducing and eliminating environmental hazards.
Key physical environment factors that can nurture health and wellbeing include:
- Having good quality greenspace within walking distance
- The ability to move around places easily and safely on foot or by bike
- Contact with nature in everyday life
- Good maintenance of streets and public spaces
- The availability of services and amenities
- Effective public transport
- Having places to meet people
- Feelings of safety
- Thriving communities with access to job opportunities
The aspects of the physical environment that are important to health and wellbeing in 21st century Scotland therefore cover both traditional environmental health issues (such as air, water, pollution) and those related to the social sphere (housing, neighbourhoods, safe areas etc.). The benefits and the adverse influences that the environment can have are not fairly distributed across society, and the environment is part of the causal chain of health inequalities.