Intended for healthcare professionals


Ten towns that promote health to be built in England

BMJ 2016; 352 doi: (Published 01 March 2016) Cite this as: BMJ 2016;352:i1259

Re: Ten towns that promote health to be built in England

We are pleased that in ten areas of England an estimated 170, 000 residents will be involved in a new healthy towns’ project as we believe that some of the country’s most urgent health challenges such as alcohol misuse, mental health issues and obesity, can be influenced by positive changes to the environment.(1) In addition this initiative may also help to inform politicians and other policy makers about the importance of the environment to public health. However, whilst we fully agree that this type of initiative is needed - in terms of the current housing crisis and the nation’s health, the size of the project is far too small.

The healthy towns’ concept fits with the settings approach to promoting health which is not new. This year will be the thirtieth anniversary of the Ottawa Charter a seminal document of the new public health.(2,3) The charter emphasised creating supportive environments in the pursuit of health and gave rise to the concept of healthy settings. It is important to realise that in creating a healthy town, the town is just one level where activity will need to take place; action will also be needed in schools, hospitals and workplaces. There is now a considerable evidence base in this area including evaluation reports, reviews and standard texts.(e.g. 3-8) Theoretical frameworks and case studies are available.

Creating a health promoting setting such as a school or general practice is a complex process and requires considerable knowledge and skills.(3-5) Staff will need to be trained and coordination across settings will need to be facilitated. In the past public health professionals have undertaken such roles, but in public health departments there are now capacity and resourcing issues to be overcome.(9,10)

We hope that when the healthy towns are being planned there is not a relatively narrow fixation on the prevention of disease with its associated risk of “victim blaming”. The plans should be based on the principles of the Ottawa charter with a major focus on positive health. This would involve a relatively broad ecological perspective on health and a multi-disciplinary method which integrates action across determinants of health.(6) Crucially, the ubiquitous problem of inequalities also needs to be carefully considered both within the towns and across the country.(11,12)

To conclude, we think that developing healthy towns is an excellent idea. Environments need to be created that positively promote the physical and mental health of all age groups as well as address obesogenic and other risk factors. However the initiative only deals with a relatively small population - we need Healthy Towns across all of England.

1) Iacobucci G. Ten towns that promote health to be built in England. BMJ 2016;352:i1259.

2) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.

3) Watson, M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

4) Baric L. Health Promotion and Health Education in Practice. Module 2. The organisational model. Altrincham: Barns Publications, 1994.

5) Poland B, Green L and Rootman I (eds) Settings for Health Promotion. London: Sage Publications, 2000.

6) Tones K and Tilford S. Health Promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001.

7) Rao M, Prasad S, Adshead F and Tissera H. The built environment and health, The Lancet. 2007; doi:10.1016/S0140-6736(07)61260-4

8) Tsouros A and Green G. Health Promotion International: special supplement on European Healthy Cities. Health Promotion International. 2009; 24: i1-i3.

9) Watson MC and Lloyd J, 2014. Action is needed to tackle current public health threats. BMJ 2014;348:g2721.

10) Watson M C and Lloyd J, 2016. Need for increased investment in public health. BMJ 2016;352:i761.

11) World Health Organization. Declaration of Alma-Ata. Geneva: World Health Organization, 1978.

12) Marmot M, chair. Fair society, healthy lives (the Marmot review). UCL Institute of Equity, 2010. file:///C:/Users/ntzmw4/Downloads/fair-society-healthy-lives-executive-summary.pdf

Competing interests: No competing interests

06 March 2016
Michael Craig Watson
Associate Professor in Public Health
Professor Sylvia Tilford (President elect, Institute of Health Promotion and Education, Welwyn AL6 0UD, UK.
University of Nottingham, Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA