Changing the conversation about health

How living in urban environments affects health: Dr Michael Dixon delivers speech at House of Lords on new report by The Commission on Creating Healthy Cities

On July 13th, Dr Michael Dixon addressed the House of Lords on issues raised in a new report by The Commission on Creating Healthy Cities (CCHC).

The Commission was run by the Global Centre on Healthcare and Urbanisation (GCHU) at Kellogg College, the University of Oxford, in partnership with The Prince’s Foundation. The Commission’s role was to investigate the links between urban matters and their effect on our health and well-being. 

Launched in December 2020, the Commission concluded its work in in recent weeks, reporting its findings in the House of Lords.

Here’s Dr Dixon’s speech in full on what the Commission recommended:

A new report released by The Commission on Creating Healthy Cities (CCHC) was delivered to The House of Lords on July 13th (Pictured: Liverpool city centre Pixabay/Fietzfotos)

As a general practitioner, I want to discuss the specific health recommendations in our report but need to make a couple of general points supporting those already made by Lord Best.

Firstly, health and housing used to be part of the same Government department and we must now fully reconnect them nationally and locally.  Secondly, inequalities are a huge determinant of health.

Shifting the balance of power from developers, their shareholders and landowners to local people,  communities and their representative councils is crucial if we want to create a fairer and healthier society and stop the seemingly random sprawl of housing that I have witnessed as a family doctor.


Our health is much more dependent, as our report says , on our physical and social environment than on the health services we provide. Those services and our current way of living have failed to stop the rising epidemic of long-term disease or prevent, for instance, the 40% of eleven year old children in London who are overweight or obese or the 25% of girls between the age of 14 and 16 who are self-harming. 

Our proposals aim to ensure that the built environment will in future maximise the potential for physical activity, healthy eating and positive social connection. 

On physical activity, we need to better support our city population to walk, cycle and garden creating a green environment with parks and gardens that enable and encourage outdoor activities. 

Good food should be available to all and especially those that need it most – supported by the universal availability of allotments and of vegetables gardens in schools.  Some things will need to become less available – especially fast-food outlets, which are currently concentrated in the least affluent areas and have such a detrimental effect on health and the gut biome. 

Greater encouragement for city dwellers to walk, cycle and garden will improve health in urban areas, the report says (Image: Pixabay)

Implementation of the Dimbleby Food Strategy in the forthcoming Health Inequalities White Paper will hopefully supplement these recommendations with, for instance, the provision of vegetable and fruit vouchers for those least well off in selected areas. 

Then thirdly, our buildings must encourage and provide facilities for social interaction of all kinds for all ages, including the arts, as this has a significant impact on length as well as quality of life. 

Food poverty in urban areas was highlighted in the Dimbleby Food Strategy; vouchers for free fruit and veg could be a useful tool to helping encourage people to eat healthier food (Image: Pixabay)

Social prescribing will be the glue that maximises the impact of these improvements by informing, encouraging and motivating local people – especially those in most need –  to take advantage of them . It also acts as a Trojan horse for developing further opportunities in the voluntary and volunteer sector in health related areas, where they don’t currently exist and eventually developing healing and health creating communities. 


For instance, in Frome, Somerset, there are 1,800 voluntary community connectors – taxi drivers, hairdressers, supermarket assistants and students – ensuring that everyone has access to local opportunities for improving physical activity, diet and social connection, while in Ilfracombe, Devon, there is a volunteer coordinator on every street linking each inhabitant to relevant support from the volunteer and voluntary community. 

What has become absolutely clear during our work is that we can’t carry on as we are.  Mental health problems are ever increasing, life expectancy has plateaued and the misery on our streets is all too obvious.  I want to congratulate Lord Best and our amazing team on this  great report – but we must now act on it.