3. Health and Well-being

Introduction

It is increasingly recognised that place and space have an impact on human health and wellbeing and that individual actions to improve lifestyle or health status are likely to be influenced by the environmental and socioeconomic context in which they take place. Urban policy-makers have increasingly been exploring the links between urban planning and public health, specifically in relation to the potential for urban environments to have positive impacts on health outcomes and healthy lifestyles, such as through well-designed and walkable cities, access to ‘nature’/biodiversity and the distribution of urban green space.

A number of health risks can be influenced by spatial planning including inter alia heart disease, respiratory disease, mental health and obesity. It is recognised that decisions regarding land use and the built environment can affect these health risks in different ways and that good urban design policies can be linked with positive health outcomes.

The spatial planning system has an opportunity to become an enabler of urban health as research shows that policies regulating land use, connectivity, density, transport and green infrastructure can offer a pathway to improved health outcomes. The role of spatial planning and the land development process in supporting health is becoming more prominent as policy-makers now seek to develop more sophisticated models of urban governance and integrated urban policies to deliver sustainable development.

While sophisticated healthcare such as immunisations and antibiotics have become common place, society is constantly faced with new, complex, and growing health challenges and accompanying health-related costs. In this regard, the topic of Health & Wellbeing and the Built Environment has never been more relevant than in recent times, with the worldwide pandemic of COVID-19 emerging in 2020. The impacts of COVID-19 and the requirements for social distancing, or physical distancing, has brought up new conversations around the importance and role that the built environment plays in the health and wellbeing of society.

This section of the Strategy aims to examine the current context of Carlow Town and its health profile, whilst also assessing the relationship of the Built Environment with Health & Wellbeing. Additionally, this section will examine the innovative objectives for Carlow Town that have been incorporated into this Strategy.

Health & Carlow: In Context 

Healthy Ireland is a Framework for action to improve the health and wellbeing of the population of Ireland over the coming generation. It sets out four central goals for improved health and wellbeing, and outlines clear routes and strategies to achieve these goals, in which all people and all parts of society can participate. The Four Healthy Ireland Goals are:

1. Increase the proportion of people who are healthy at all stages of life.
2. Reduce health inequalities.
3. Protect the public from threats to health and wellbeing.
4. Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland.

A key action of the Healthy Ireland Strategy was the creation of County Health Profiles. The aim of these county profiles is to help identify health priorities in these areas and highlight health inequalities which may exist. The County Health Profile for Carlow was published by the HSE in 2015. It should be noted that the information used was taken from the previous Census (2011) and as a result, the current health profile in Carlow may be somewhat altered. The key results from this profile can be summarised as follows:

• Carlow has above average birth rates per 1,000 for all ages of 17.3 and above average rate for those aged under 20 years of 21 compared to national rates of15.8 and 12.3 respectively;
• For males all invasive cancers, malignant melanoma, prostate and lung cancers are higher than the national average;
• Females have higher than the national average of lung cancer but below national average for malignant melanomas and colorectal cancers;
• Deaths for all ages for cancer and respiratory disease and all deaths are higher than the national average;
• Suicide rate of 13.8 per 100,000 is higher than the national rate of 11.3

The County Health Profile for Carlow provides a snapshot of the local demographics, health issues and wider determinants of health of that area, compared with the national picture. The 2015 Profile demonstrated that Carlow had a number of health issues that were above the national average including suicide rates, invasive cancers in males, lung cancer in females, deaths for all ages for cancer, respiratory disease and all deaths.

The Healthy Carlow County Plan 2018-2021 sets out to support the people of County Carlow in attaining greater, more sustained and equitable levels of health and wellbeing. The vision of the Healthy Carlow Plan is: “A county where everyone can enjoy physical and mental health and wellbeing to their full potential, where wellbeing is valued and supported at every level of society and is everyone’s responsibility”.

In line with the Healthy Ireland Framework, the Healthy Carlow Plan seeks to obtain the Four Overarching Healthy Ireland Goals. Additionally, the Healthy Carlow Plan aligns under 6 no. priorities: Physical Activity; Healthy Weight; Tobacco Free; Sexual Health; Alcohol and drug related harm; Mental Health, as well as local scale health priorities. A number of objectives for implementation are also outlined under the Healthy Carlow Plan.

The Healthy Carlow Plan identified that the number of people with a disability in Carlow accounted for 14.5% of the County’s population (c. 8,237 persons) as of April 2016. The Plan also identified that the National Office for Suicide Prevention (NOSP)’s 2015 Annual Report outlined Carlow as having one of the highest rates for suicide in the Country with 26 recorded suicides in the period 2014 and 2016.

There are a number of factors that contribute to the health and wellbeing of a town. While a lack of accessible health and mental health services within a town will contribute to poor health outcomes, other factors such as the provision of adequate recreational spaces, green spaces and incentives are just as important when it comes to the general wellbeing of a population. In this regard, while it is important to improve local healthcare services, it is also imperative that broader health and wellbeing initiatives are undertaken to improve the general health profile for a Town. NPF recognises that specific health risks can be influenced by spatial planning and that a whole-system approach to addressing the impacts on health and wellbeing is needed to enable individuals and communities to make healthier choices and to improve health outcomes. The NPF has a number of NPOs in this regard:

NPO 26: Support the objectives of public health policy including Healthy Ireland and the National Physical Activity Plan, though integrating such policies, where appropriate and a applicable scale, with planning policy.

NPO 27: Ensure the integration of safe and convenient alternatives to the car into the design of our communities, by prioritising walking and cycling accessibility to both existing and proposed developments, and integrating physical activity facilities for all ages. 

The Built Environment and Health & Wellbeing 

Placemaking is the way in which we plan, design and manage our towns and cities.

The connection between the built environment and public health was apparent from the time when infectious disease was the primary public health threat during the industrial revolution, with unsanitary conditions and overcrowded urban areas facilitating the spread of infection. In modern times, it has come to be considered that the primary public health problems are chronic diseases rather than infectious disease, however, the connection between population health and the built environment remains important.

As research shows, health and wellbeing is strongly influenced by the built environment. It is recognised that individual actions to improve lifestyle and health status can be influenced by the environmental and socioeconomic context in which they take place, and as a result place and space will have an impact on human health and wellbeing.

Aspects of the built environment, including man-made and natural features, impact human health directly

and indirectly through air quality, traffic injuries, and toxic substances. These aspects can also modify and influence physical activity levels, social connectedness and interactions, access to healthy foods, mobility, and housing quality. Many of these environmental and social determinants contribute to the rising prevalence of chronic diseases and related health conditions.

This section will examine four broad relationships between the built environment and health & wellbeing; physical activity, mental health, air quality and community. These relationships between the built environment and health & wellbeing often overlap and interconnect. In this regard, principles of integrated planning and design can result in policies and design measures which are cross-cutting in nature, resulting in some policies having multiple positive health outcomes. For example, the promotion of walking and cycling may be aimed at tackling air pollution and climate change with the added benefit of increasing physical activity.

01 Placemaking and physical activity 

The changing nature of society has resulted in greater car dependence and reduced levels of physical activity. Physical activity can occur during everyday activities within the built environment and not just for leisure. The built environment can, therefore, play a significant role in facilitating more active lifestyles by reducing barriers to, and creating opportunities for,physical activity. In this regard, the quality of a built environment is important for the encouragement of increased physical activity to levels that are beneficial to people’s health and wellbeing.

It is widely acknowledged that the provision of more sustainable and active modes of travel such as walking and cycling resultin increased physical activity. The public health benefits of increased levels of physical activity are extensive, leading to improvements in mental health and wellbeing as well asphysical fitness. Physical activity has an important role in the lives of everyone including children and the elderly.

Features of the built environment which have an impact on physical activity include:

• location, density and mix of land use, street layout and connectivity;
• physical access to public services, employment, local fresh food and other services;
• safety and security;
• open and green space;
• affordable and energy-efficient housing;
• air quality and noise;
• resilience to extreme weather events and climate change;
• community interaction;
• transport.

02 Placemaking and mental health 

There is a clear role for improved design and planning in supporting good mental health and wellbeing; creating places that minimise excessive stress responses, promote feelings of safety and security, encourage community interaction and increase productivity and happiness at work. In this regard, there is evidence that supports ways in which urban design can help promote good mental health, prevent mental illness and support people with mental health problems.

Research has shown that accessible green spaces have an important relationship with mental health and wellbeing, with access to natural settings in urban areas and in the course of people’s daily routines likely to improve and maintain mental health and wellbeing. Additionally, positive, regular activity has been proven to improve mood, wellbeing and many mental health outcomes.

The Centre for Urban Design and Mental Health states that one of the most important opportunities for promoting good mental health is natural and positive social interactions, from relationships to feeling part of a community.

Additionally, a sense of safety and security is integral to people’s mental health and wellbeing and some threats to this within the built environment include traffic, getting lost, environmental pollutants, and risks posed by other people.

03 Placemaking and air quality 

Air pollution is an important determinant of health. Research has shown that ‘lifestyle illnesses’ such as heart disease, obesity, diabetes, osteoporosis, mental illness and some cancers are increasingly attributed to the poor quality of the environment in urban areas. WHO estimated that in 2012, 1 in 8 deaths were attributed to exposure to air pollution, making it the largest environmental risk factor for ill health.

It is considered that smart placemaking and urban design has the potential to both reduce polluting behaviour and lower exposure to existing pollution. The quality of the air that we breathe should not be compromised by new or existing development. Innovative placemaking can assist in tackling air pollution, through the creation of sustainable places that are vibrant and healthy to live and work in. Placemaking policies such as prioritising public transport, walking and cycling networks as well as improving the energy efficiency of buildings and making urban areas more green and compact, and thus energy efficient can act to reduce air pollution.

Public realm improvements, alongside transportation measures, have increasingly promoted the creation of health supporting urban environments through the enhanced provision of urban green space. Integrating greenspaces and greenery into the built environment can act as both a barrier and a counterbalance to air pollution, as well as to noise pollution whilst also providing active open spaces for walking, cycling and nature. Green spaces in urban areas are associated with a range of benefits including reduced cognitive fatigue, stress and headaches, and better healing, cardiovascular health, blood pressure and mental wellbeing.

Research has generally endorsed the view that urban green spaces, as part of the wider environmental context, promote health and well-being in urban areas and provide health services as part of a wider array of ecosystems services. These health services are understood to range from direct positive effects on mental and physical health from increased biodiversity, to improved well-being resulting from increased exposure to nature, physical activity and social engagement in green spaces.

04 Placemaking and community

In the creation of health-promoting places, the requirements involving the social environment should also be considered. The quality of social relationships and community networks has a major impact on health and wellbeing. It is considered that community involvement leads to higher levels of wellbeing. Opportunities for social interaction in a local neighbourhood is important to develop good health and a simple facility like a small café or landscaped garden with seating can be an important meeting place and the focus of community life in urban areas.

Reclaiming street space and maximizing access to parks and plazas is the start of bringing more people together in the public realm. The creation of an “everyday” public realm can be a fundamental shaper of the community, filling it with civic engagement, exploration, and connections to people and place. In providing more open space, activating that space more of the time and enabling it to be more responsive to the community, it can help people spend more time outdoors, together.

The built environment features which affect social isolation and engagement include: residential density; mixed land use; street layout and design; transition between public/private space; environmental cues for crime and safety; greenspace; public transport; and local facilities for leisure and recreation (including cafés, pubs, religious facilities, etc.).

Carlow: Opportunity for Transformational Change 

Urban regeneration is the process of renewal or redevelopment of the social and built environment through policies, programmes and projects aimed at urban areas which have experienced disadvantage.

It is considered that urban regeneration can be an important public health intervention and that through a change in the urban physical, social and economic environment this can facilitate health improvements for disadvantaged communities. As such, this Strategy seeks to ensure that Health & Wellbeing is a feature outlined in each Intervention Area and their associated proposed outcomes.

The previous section highlighted how it is universally acknowledged that people’s health is affected by community networks, the local economy (access to work and opportunity), the physical environment and many other factors that are within the powers of placemaking to influence. While there are some obvious changes which can be made such as reducing traffic to improve air quality and providing better open spaces for people to exercise, this Strategy has sought to understand how Carlow Town can innovatively contribute to the concept of Health & Wellbeing.

Carlow

This Strategy includes a number of outcomes in relation to the proposed Intervention Areas with the aim to not only achieve the overarching strategic goals set out in policy, such as Healthy Ireland and the Healthy Carlow Plan, but also to provide Carlow Town with innovative measures that prioritise health & wellbeing.

Carlow Town seeks to provide plentiful, accessible and exciting public spaces that are filled with people all day and all year round, providing a fundamental element of urban life. The goal is to help more people spend more time outdoors, together. By improving the quality of, and enhancing the accessibility to, public open spaces it is sought to produce multifunctional benefits including health and wellbeing as well as sustainable transport, biodiversity and recreation.

In the first instance, more public space will be created in Carlow through new urban squares, blueways, greenways and the upgrading of existing open space areas prioritising pedestrians. Alongside transport outcomes such as increased walking, cycling and public transport usage, the aim is to reclaim street space for the public realm. The expansion of public open space in Carlow Town will enable increased public activity and also more space for the greening of the Town Centre, resulting in positive health & wellbeing outcomes. It is also an aim to enable public open space to be activated throughout the day. This includes having adaptable and active ground floor uses in key Town Core locations including traditional retail, social or community initiatives.

Outcomes and Actions 

A set of Outcomes have been derived and formulated in relation to the Health and Wellbeing Core Theme. An associated Action accompanies each that provides a clear direction for the delivery of the Outcome. 

1	The impact of COVID-19 on the built environment has resulted in a number of restrictions affecting social and economic activity in urban areas. This Strategy includes a number of outcomes which through their implementation will support urban life and public health in a post-COVID society.
	* Open up streets for people.
	* Creates a safe space for the public to undertake physical activity in line with the restrictions placed on social interactions, without the risks associated with trafficked roads or crowded paths.
	* Responds proactively with initiatives which make sustainable travel options safer and more appealing

2	Promote physical activity. The importance of physical activity in children as well as adults has been a priority across all Intervention Areas in this Strategy.
	* Provision of more sustainable and active modes of travel.
	* Improvements in mental health and wellbeing as well as physical fitness.
	* Provision of informal play areas in public realm.
	* Improved pedestrian links within the Town Centre.
	* Promotion of active travel to reduce car dependence within Town Centre.

3	Promote the role of improved design and planning in supporting good mental health and wellbeing as part of the regeneration of the Town Centre outlined in this Strategy.
	* Provides accessible green and blue spaces to improve and maintain mental health and wellbeing.
	* Promotes physical activity in the public realm which will improve mood, wellbeing and deliver positive mental health outcomes.
	* Enhanced public realm that will contribute to a positive outlook and an improvement in overall mental health.

4	Actively seek to improve air, water and soil quality. Air pollution is the single largest environmental health risk.
	* Reduction in car numbers leading to an improvement in air quality.
	* Urban greening within Town Core and along the River Barrow
	* Use of Eco-Design measures such as LED lighting, rainwater harvesting and solar panels
	* Enhancement of greenways

5	Undertake actions in line with this Strategy to ensure all members of the community have good opportunities to be healthy regardless of their age, income level, gender, ethnic background, or any other social or economic reasons.
	* People will spend more time outdoors.
	* Improved access to green spaces.
	* Creation of more public open space at Potato Market, Barrack Street link and new urban node connections.
	* The public realm will be active and exciting, with well-designed and well- lit open spaces.
	* Social interactions and community activity will be faciliated and encouraged.