Matthew Lowther has worked in the public health sphere most of his academic and professional life. He has an honours degree in Sports Science and a PhD in Exercise and Health Psychology. He started his professional life as a Health Development Manager in a local authority.  He then took up a cardiovascular disease prevention post within the Public Health Institute for Scotland before going on a three year secondment to the Scottish Government as the National Physical Activity Policy Coordinator.  He then returned to NHS Health Scotland as a Principal Public Health Adviser, specialising in the critical appraisal and synthesis of public health effectiveness evidence. He has been honorary senior lecturer at both Glasgow and Strathclyde Universities and he now works for Public Health Scotland as the Head of Service for Place and Equity.

In this article he explores the potential public health impacts of 20 minute neighbourhoods.

The COVID pandemic has reminded us all just how delicate human health is, and of the critical role our public health system and wider NHS plays in protecting us from harm.

The pandemic has also helped to demonstrate the other side of the profession, more focussed on how we improve wider public health. The lockdowns we’ve endured have not only helped protect us from COVID, but have also forced us to live much more locally. In turn, demonstrating the importance of having a good quality local environment that provides easy and equal access to the things we all need to live a healthy and fulfilling life. Including; a safe and secure home, access to good quality local services, access to good quality green and open spaces, good quality local transport links, strong and supportive social networks and local employment opportunities.

Public Health Scotland (PHS) has been working with a range of partners to develop a series of evidence-based health and wellbeing outcomes that, when taken together, help to describe and articulate what a healthy and sustainable local place should look like. The outcomes and themes are based on the Place Standard tool that has been used extensively, across Scotland and beyond, to engage with local communities about what matters to them about their neighbourhoods.

The evidence is now crystal clear; accessible local services, meeting the specific needs of our communities and encouraging local active travel, will improve health as well as having a number of other social, economic and environmental benefits. This aligns perfectly with the aspiration for 20 minute neighbourhoods. That’s why PHS is supporting the programme as an important and potentially hugely effective public health intervention. We are also very supportive of the wider place-based aspirations of national and local government, including the Place Principle, and we are involved in a range of activity to help take these forward.

One such programme is Shaping Places for Wellbeing. The Shaping Places for Wellbeing Programme is a delivery partnership between the Improvement Service and PHS, funded and supported by the Health Foundation and Scottish Government. The Convention of Scottish Local Authorities (COSLA), who were a joint sponsor of Scotland’s Public Health Reform (precursor to PHS), will support the programme’s work around the role of local government learning and policy development in shaping places for wellbeing. The aim is to create the conditions for better wellbeing by enabling partnership based system-wide action on the social determinants of health at a local level. Supporting Local Authorities and their partners to deliver Scotland’s Public Health Priorities. Success for the programme will be demonstrable systems change in local processes to improve the Place and Wellbeing Outcomes described above. The programme will contribute to many National Performance Framework outcomes and key Government policy aspirations such as the Place Principle, town centre regeneration and 20 minute neighbourhoods.

Initially the programme will provide funding and support to a small number of projects to make sustainable changes to local systems, which are consistent with improving population health – in line with the place and wellbeing outcomes. The number of sites will range between three and five, with learning captured and shared to allow approaches to be applied in other areas and to wider health-related issues. The objectives of the programme are to:

  • Mobilise cross-sector action on the social determinants of health, using the place and wellbeing outcomes, to embed sustainable system change at a local level.
  • Support local authorities to engage with public health teams, facilitating and enabling local partnerships for system change on the social determinants of health and place and wellbeing outcomes.
  • Learn how to make changes that impact on the social determinants of health, using the place and wellbeing outcomes, so that learning can be shared.

One of the main drivers of Shaping Places for Wellbeing, and indeed one of the main drivers of the wider reform of the public health system, is to reduce the huge health inequalities Scotland unfortunately suffers. It does not matter what indicator of health you consider – it will be strongly socially patterned with the less well off in our society suffering worse outcomes. Typically, they suffer illness and disease earlier in their life and for longer, and die much earlier than people in more affluent communities[1].

Although the causes and drivers of health inequality are extremely complicated, a clear understanding has emerged in recent times that the underlying ‘fundamental causes’ of health inequalities are societal inequalities in income, wealth and power[2]. These societal inequalities shape and influence the social determinants of health (such as employment, poverty, housing, education, ability to influence your own life etc.) which lead to the divergent health outcomes we see across our society.

20 minute neighbourhoods have the potential to significantly influence the social determinants of health and therefore have the potential to significantly influence both health outcomes and health inequalities. However there is a risk (as with any similar intervention) that they could also widen health inequalities. If 20 minute neighbourhoods become more prevalent in our more affluent communities, health in those communities is likely to improve – potentially widening the gap further compared to the less affluent places. While we know from experience that more affluent communities are better placed to take advantage of new funding and interventions. It is therefore critical that the programme is rolled out in a way that ensures our most vulnerable and deprived communities are supported and gain the most.

PHS welcomes the introduction of 20 minute neighbourhoods as a potentially powerful public health intervention that can help the country recover from COVID. However, to deliver on this potential, they need to be fully integrated into other similar programmes and designed and implemented in a way that brings maximum benefit to our most deprived communities.

[1] https://www.gov.scot/collections/long-term-monitoring-of-health-inequalities/

[2] Beeston C., McCartney G., Ford J., Wimbush E., Beck S., MacDonald W., Fraser A. Health Inequalities Policy review for the Scottish Ministerial Task Force on Health Inequalities. Glasgow: NHS Health Scotland; 2013