The link between environmental factors, health inequalities and impacts on health are summarised in the table below which is based on the findings of the Marmot Review: Implications for Spatial Planning.
These are the factors where the evidence of the relationship between spatial planning and health inequalities was strongest.
* Note that the review finds that the links between transport and health are “multiple and complex” – as well as the negative health impact set out above, transport (of some form) provides access to work, education, social networks and services, which can also have a positive health impact. Source: Plugging health into planning (Local Government Group, 2011)
The evidence base for the links between the wider determinants of health, health promotion interventions targeting these, and health outcomes continues to improve – updates from organisations such as Public Health England and NICE should be kept under review. However, waiting until a perfect dataset is produced is not a sensible option.
Collecting evidence on the efficacy and impact of local interventions targeting wider determinants of health can be challenging but this should not lead to a focus only on intervening downstream and in lifestyle behaviours (so called ‘lifestyle drift”) rather than in the ‘causes of causes”. Research indicates that a “whole system” approach (addressing both the wider determinants and behaviours) is necessary to achieve a significant impact on health outcomes and health inequalities (see Institute of Health Equity draft report for more on this).