Landscapes of Health
The National Health Service and our National Parks both emerged from the post-war era; a time of simultaneous loss and hope. Now, 75 years on it's time to renew the social contract bonding the health of our societies and that of the natural world
In 1949, in the midst of post-war upheaval, The National Park and Access to the Countryside Act was signed. The act received cross-party support and arose in the wake of a fundamental effort to rebuild after Europe had been torn apart by conflict. Britain emerged from this crisis with a renewed rural romanticism, together with a growing vision of our countryside as an idyll in need of protection - in what was to lay the foundations for both the modern industrial revolution, as well as contemporary nature conservation movements.
Before the war, this sentiment was already sending up shoots. John Dower - one of the key architects of British National Parks began his work in the 1930s - spurred on by social movements calling for greater access to the countryside - most notably, the Kinder Scout Mass Trespass in 1932. His report was inevitably delayed due to the outbreak of war, and Dower himself suffered from tuberculosis, preventing him from joining the frontline. Instead he continued with his work while convalescing in the Yorkshire Dales. By the time the war ended, Dower had completed his report which became a cornerstone, alongside the Hobhouse Report, for the formation of the National Parks. The report was the product of a very personal recognition of the benefit these landscapes hold for natural as well as human health.
In 1949, two years after Dower's death from TB, the National Parks and Access to the Countryside Act was passed. This momentous piece of legislation paved the way for the Countryside Commission which later became Natural England. Uniquely - this act gave these bodies the power to acquire and designate land for the benefit of both nature and the public, which it did through National Parks and Areas of Outstanding Natural Beauty. For the first time in our history we had a legal framework for recognising the intertwined value of human and more-than-human lives and livelihoods within protected landscapes.
Meanwhile, the same political momentum was birthing another radical idea: the formation of the National Health Service. The NHS was launched in 1948 under the central understanding that healthcare should be available to all, without exception or privilege. The instrumental necessities of war had meant that previously autonomous local hospitals had to work together and pool resources and information. From crisis came an opportunity to reform the way in which we see health and wellbeing; and, in the same breath, our obligations to one another and to these islands we call home.
Our protected landscapes and our NHS was born from the same post-war understanding, that public goods for public benefit was a central undertaking of legislation and leadership. We gained a system of protected landscapes and a national healthcare service. As a result, millions of people have benefited from inclusive access to public goods where once this was the exclusive domain of privilege.
Now, 75 years on, we are once again at a crossroads, precipitated by sedimentary layers of crisis. While the intention of the 1949 act was bold, in many ways it represented unfinished business, and fell short of the needs of many. Access to the countryside is sorely lacking in many of our counties and elsewhere the access which remains is being eroded. Nature continues to freefall within our protected landscapes, ravaged by exploitation and mismanagement. So too, our healthcare system is in critical condition - hospitals are underfunded and under equipped; staff are striking for better conditions and pay; and piece by piece this great public asset is being sold off to private investors.
All the while, our recognition and knowledge of how closely linked our own health is with that of the natural world is growing. Recent studies have shown that nature connection is closely linked with health and wellbeing, yet Britain has the lowest level of nature connectedness across Europe. We are not only losing our connection with the natural world, we are losing the wildlife which lives there too. Meaningful relationships with nature underpin conservation and pro-environmental behaviours; motivating people to act in wild service of places they love. Physical activity helps reduce the risk of chronic conditions such as heart disease, stroke, diabetes and cancer. Regular exercise reduces stress and improves mood, while spending time in green and blue spaces can help to alleviate anxiety.
Yet, shockingly, we are 20% less active now than we were in the 1960's. This is set to become 35% within the next six years. Physical inactivity is associated with 1 in 6 deaths in the UK and is estimated to cost taxpayers £7.4 billion annually (including £0.9 billion to the NHS alone). As our awareness of the benefits of time spent in nature brings to our health and wellbeing grows, our ability to access the countryside is often seriously lacking.
A fundamental weakness of National Park designation is that many people's lives are very distant from these areas of "relatively wild country" - celebrated as they are for their remoteness. The lottery of proximity to protected areas does not meet the needs of distant communities, or those without use of a car. Only 8% of England has a right to roam, with most of this confined to the north and the south west. While some counties have large amounts of access land, others have very little. Even when footpaths are taken into account, vast differences exist between areas. Access to the English countryside is marred with inequality.
Additionally, there are significant social and cultural barriers to access and participation - identified as key challenges in the Glover Review in 2019. Children are spending less time unsupervised outside, and those from black, Asian and minority ethnic, and low income communities are even less likely to do so. 20% fewer children from minority ethnic backgrounds go out into green spaces weekly compared to white children. 18% of children living in the most deprived areas never visit the natural environment at all. Communities are becoming increasingly cut off from the countryside, and our NHS is underfunded and overstretched. There are many challenges which are giving rise to these facts and overcoming them will require a huge effort by, and on behalf of, society.
Just as the intention to protect people and planet emerged from great loss three quarters of a century ago, now we must see the twin roles and responsibilities of nature and health as intertwined. Our National Health service and our natural environments should be something we can be proud of, something we have fair and inclusive access to and which transform and save lives.