Landscape and Health: Effects, Potential and Strategies ... - WSL

Keynotes
18
Can your neighbourhood be a doctor?
Mitchell Richard
Public Health and Health Policy, 1 Lilybank Gardens, University of Glasgow, G12
8RZ, Richard.Mitchell@glasgow.ac.uk
Overview: The presentation will begin by considering the current state of public
health in Europe and the challenges we face. It will then examine why and how
landscapes might be part of the response to this challenge. It will present results of
studies which both support and contest the notion that different attributes of
landscape can be a positive influence on health and wellbeing, discuss what public
health wants from those interested in landscape and health in terms of evidence, and
consider tensions around experimental studies.
Detail: The presentation will begin by defining “population health” as the health and
wellbeing of thousands to millions of people. It will then discuss how modern
medicine has become very successful at keeping people alive; life expectancy
continues to rise across Europe and mortality rates from cardiovascular diseases and
many cancers are falling. However, it will then argue that whilst we may be “more
alive”, we are in many ways “more ill”. Evidence will show that, although mortality
rates are falling, the prevalence of chronic diseases remains high. Poor mental health
remains a vast and serious problem and the so-called “self-destructive” problems,
such as drug addiction and alcohol-related harm are increasing in some nations. It
will then be suggested that this “new public health” poses a challenge which clinical
medicine alone cannot meet; it cannot prescribe to, or operate on, everyone who is
affected.
These emerging health problems will then be considered in the context of how health
is defined. The 1948 WHO definition of health (“a state of complete physical, mental,
and social well-being and not merely the absence of disease or infirmity”) will be
revisited and it will be noted that whilst the WHO definition gave permission for life
satisfaction and wellbeing to sit alongside clinical definitions of health, a true focus on
“how people feel”, and “what they can do” has been slow to come. The presentation
will then suggest that there has been a recent growth of interest in wellbeing and
functional capacity as part of a broader definition of health, and that life satisfaction is
emerging as a measure of greater importance. Critiques of this perspective will be
offered, including that it may be exploited as a means to ignore inequality but, more
importantly, note that making wellbeing, life satisfaction and functional capacity
significant measures of “health” begs questions. Do we know how to protect or
improve them? Can we adopt the same theories, empirical approaches, practices
and policies we use when focused on more medical or clinical definitions of health?
Next, the presentation will suggest that asking “what keeps us well?”, rather than
“what makes us sick?” could be a good route to both tackling contemporary problems
of poor mental health, and promoting satisfaction with life and wellbeing. It will follow
Antonovsky and label the protection or creation of good health “salutogenesis”. It will
note that whilst some theoretical frameworks exist through which salutogenesis can