In the past decade, there has been a shift in the types of diseases affecting populations around the world, particularly in the more developed world. This shift requires new approaches to human health that extend beyond formal health care systems and include the built environment, says Sir Malcolm Grant, chairman of the National Health Service in England.

Grant, who has also served as the provost and president of University College London, explained the global transition “from the plague of infection to the plague of human behavior” in his remarks at ULI Global Trustees and Key Leaders Midwinter Meeting in Paris. In most of the world, 90 percent of the years of life lost to disease is now from noncommunicable illnesses. Grant said most of these illnesses come from individual behaviors such as a lack of physical activity, poor nutrition, and smoking.

Traditional models of care lack the resources and focus to confront this emerging class of diseases, he said. Noting that health care expenditures are reaching their limit, Grant emphasized the importance of investing in disease prevention measures outside of formal health care systems. “If our money is going into health care at the end of the health cycle—as opposed to investing in prevention of ill health—we are just putting money in the wrong place, and it’s a very deep hole,” he said.

Cities and the real estate industry can play a significant role in disease prevention, both by providing healthy environments and encouraging healthy habits, Grant said. He pointed out the strong ties between human health and the places where people live. In Beijing, for example, poor air quality causes nearly a half million deaths per year. Other places contend with health challenges related to human behavior, like high obesity rates in communities with little green space and poor food choices.

No magic bullet exists for solving these problems in cities, Grant said. “Not every city has the same demographic, not every city has the same health issues, and not every city has the same leadership.” He recommends that to tackle obesity, cities build the need for exercise into mundane tasks. He cited the example of Mexico City, which offers free subway transport to passengers who do “squats,” a full-body exercise, before their journeys. Grant also discussed the dangers of smoking, noting a recent report that called for smoking bans in London’s Trafalgar and Parliament squares.

With regard to real estate, Grant highlighted the importance of health-focused housing. Features like smart refrigerators that dispense medications and alarms that remind the elderly to eat can provide residents with much-needed guidance and support, he said. “It’s inevitable that health and the population’s health have to be built into every decision you take around investment in real estate,” he said.

Grant believes that healthy places have the potential to improve health worldwide. The next step is to test their impact. “We need extraordinary rigor in our evidence; metrics and monitoring around reduction in emissions, around food quality; promotion of physical exercise; and demographically aligned housing models for independent living,” he said.