Where We Live Determines Our Health

This month we hear from Professor Ruth Hunter from Queens University Belfast about the Connswater Community Greenway and how it is a City Laboratory for Health, Climate Resilience and Equity

“The places where we live, work and connect with others are fundamental determinants of health. Urban environments shape our opportunities for physical activity, access to green space and nature, social interaction and exposure to environmental risks. As we respond to challenges such as chronic disease (e.g., cancer, mental ill-health, heart disease), climate change and health inequalities, cities provide an important opportunity to develop and test solutions that create healthier and fairer communities.

“Health is not primarily produced in healthcare systems. It is shaped by where we live, how we move, what we are exposed to, and whether we feel safe and included. Urban environments structure everyday behaviours, such as walking, social interaction, stress, and those accumulate into health outcomes and inequalities. So, place is not just context. It is also a mechanism.

“City laboratories bring together communities, researchers, policymakers and practitioners to understand how changes to the urban environment influence health and wellbeing, and how evidence can inform future action.”

Transforming East Belfast: from neglected rivers to a healthier urban environment

“The Connswater Community Greenway is a powerful example of a city laboratory in action. This major investment in green and blue infrastructure transformed a network of neglected rivers and surrounding neighbourhoods in East Belfast into a connected landscape of parks, walking and cycling routes, improved public spaces and flood alleviation infrastructure.

“However, the Greenway was never only about improving the physical environment. It aimed to reconnect communities, enhance health and wellbeing, improve access to high-quality green and blue space and contribute to the social, economic and environmental renewal of East Belfast.

Over a decade of learning: evidence from a natural experiment

“Since 2010, researchers from Queen’s University Belfast and partner organisations have studied the Greenway as a natural experiment, generating evidence on the health, social, economic and environmental impacts of a large-scale, real-world transformation of the urban environment.

“The findings demonstrate the substantial impact that place-based investment can have on communities. The Greenway has been associated with a 114% increase in overall use, including 203% increase in female users and increases of over 400% in cycling at some locations, highlighting its contribution to creating safer and more accessible environments for active travel. Research has also identified improvements in physical activity, mental wellbeing, quality of life, social capital and perceptions of neighbourhood quality. Economic evaluation demonstrated a positive social return on investment, with every £1 invested generating an estimated £1.34–£1.59 in social value (focused on property values; flood alleviation; tourism; biodiversity; climate change; health and wellbeing; crime; and employment and productivity). Together, these findings provide evidence that thoughtfully designed and community-centred investments in green and blue infrastructure can deliver wide-ranging health, social and economic benefits.

“The Greenway has provided a unique opportunity to understand the complex relationship between place and health. A key lesson has been that creating healthier places requires more than new infrastructure. The benefits of green and blue spaces depend on whether they are accessible, welcoming, safe, well-maintained and supported by opportunities that encourage people to use them.

Creating places that reduce inequalities

“The Connswater Community Greenway experience demonstrates that successful place-based interventions require attention to the social conditions that enable people to benefit from environmental improvements.

“This is particularly important for reducing health inequalities. Communities experiencing the greatest social and environmental disadvantage often face the greatest barriers to accessing and benefiting from high-quality green spaces. Understanding who benefits, who remains excluded and why is essential if urban transformation is to improve equity rather than unintentionally widen existing inequalities.

Co-producing healthier places

“One of the most important lessons from the Connswater Community Greenway is that healthier places are not simply designed for communities, they are created with them.

“Community involvement was central to the original vision and delivery of the Greenway. This approach has involved genuine co-production, recognising residents as experts in their own lived experience and equal partners in research, planning, decision-making and evaluation.

“Co-production requires sharing power, building trust and creating meaningful opportunities for diverse voices to influence change. This is especially important when addressing health inequalities, as those who experience environmental disadvantage are often least represented in decisions about the places where they live.

“Working alongside local residents, including older adults and people living with disabilities, has provided deeper insights into how the Greenway is experienced in everyday life, the barriers that remain and the changes needed to ensure everyone can benefit. The Greenway is a living system that continues to evolve through ongoing relationships between communities, researchers and practitioners.

Green infrastructure for a changing climate

“The Greenway also illustrates the role that urban environments can play in responding to climate change. As a multifunctional landscape, it provides benefits beyond recreation, including flood alleviation, improved biodiversity, enhanced environmental quality and opportunities for active travel and social connection.

“As cities adapt to increasing environmental pressures, green and blue infrastructure can deliver multiple benefits for climate resilience and population health. However, adaptation must be equitable. Community involvement and co-production are essential to ensuring that the benefits of healthier and greener environments are shared fairly across society.

From studying places to shaping healthier futures

“The Connswater Community Greenway experience demonstrates the value of long-term partnerships between communities, researchers, policymakers and practitioners. City laboratories enable us to actively shape healthier, fairer and more resilient places.

“The greatest lesson from the Connswater Community Greenway is that investment in green and blue infrastructure alone does not create healthier cities. Lasting change requires rigorous evaluation, sustained collaboration and genuine partnership with the communities who live there. By combining urban innovation with co-production, city laboratories can generate the knowledge and relationships needed to create healthier environments for current and future generations.”

Further information:

Connswater Community Greenway research: https://www.groundswelluk.org/Projects/TheConnswaterCommunityGreenway15YearsofResearchPartnershipandImpact/ 

Communities in Action. Co-producing the Connswater Community Greenway: https://www.groundswelluk.org/Filestore/CCG%20Co-prodcution%20Guide.pdf 

EastSide Greenways: https://www.eastsidegreenways.com/ 

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