The way in which we plan our towns can have enormous benefit to our health
Good planning can hardwire “health” into the fabric and infrastructure. Conversely getting it wrong can have adverse consequences.
Here are a relatively random set of thoughts on the interfaces for those getting into this space.
Locally we have said we want SCC to be a “public health” organisation.
Obviously this is vague, slippery and a bit nebulous. We need to define what that means.
SCC has nearly agreed a health in all policies approach – implication here = “health” is very squarely positioned as something that’s a corporate responsibility and there’s a great deal of opportunity. We need to unpack this.
Here in the context of the “planning system”
2 Language issues
I don’t speak planning language
Maybe planners don’t speak health and well being language
Both of these are understandable. So maybe there is some common ground. If we use the word “well being” or “community sustainability”, rather than “health” does this help bridge the language gap?
Economy and well being are obviously inextricably linked – fair economy, amongst other things.
There IS an issue that when we use the word “health” we mentally slip into an automatic mind set that this is about “the NHS”…..?
The key is the notion of getting “health” to be everyone’s business – not the “public health” department (or whatever we call it)
3 probably five main areas of work
To my mind
1. Planning policy development – both Core Strategy, SPG. What does “health” as a core part of core strategy actually mean?
2. “health” as a consequence of planning applications and downstream consequences on other sectors. ‘health in all policies’ in policy development, SPG, application, early work with developers. Mitigation of negative effects, optimisation of positive potential at all stages. Minimising barriers to being healthy – make it as easy as possible to be healthy, if we haven’t done this its hard to talk about how people should be changing their lifestyles
3. Support planners (policy, strategy, SPD) with planning process – develop policy, review applications with a particular lens, support planners put “health” into applications.
4. Proactive planning – a list of considerations that prospective developers might consider. Prioritisation process of planning prioritises against the list.
5. Community impact assessments and formal HIA
4 Role of job, person, function
If I were designing a “boundary spanner” sort of role I’d think about a few things:
- Ultimately has to influence the planning committee – so political saviness needed.
- to nudge this agenda along and hardwire the infrastructure and thinking into the system. Spanning boundaries between sectors. Not just more staff to planning waiting lists
- Build health and well being considerations as core objective – HIA of planning policy at instigation – ie now – what are the opportunities at question forming stage. If health isn’t well positioned well in local plan affecting individual applications is much harder, with DC Planners more reluctant to dig heels in against applicants on health ground
- Develop and review SPDs, HIA of these
- Development control – greening applications, enabling developers to make more attractive and saleable developments (profit), that go through DC more smoothly.
- linking this with academic depts – how can we capitalise on this as an opportunity to get both of the unis engaged in this….
- “Dealing with the opposition” – The private developers ‘experts’ argued with internal experts and there is a strong need for ‘evidence’. They wanted actual numbers of how many people would die of air pollution if IKEA was built and we argued against just making up numbers but rather using the weight of evidence that more air pollution = more premature deaths. People “ask for evidence” when someone opposes their view. We need to be able to handle this issue. Need to make or appropriately counter spurious opposition with data – health and clinical or economic. (This is similar to handling spurious arguments from pharma in clinical evidence appraisal.)
- Discuss with communities – link communities to planning process. Taking a CD approach – getting to talk to developers, finding out their issues and concerns / constraints. Ditto communities – what is it that they would like planning process to do to improve their lives etc. Issues about being involved in the planning conversations with developers before they finalise their plans so we don’t annoy them. pre-planning thing is key– also how can producing plans for healthy developments make them better, (more profitable?), more likely to meet other guidelines, therefore actually better for developer rather than pain in the backside
5 What are the things we want to achieve with such an approach.
Build “well being” as a more central default into the process. Some overlap in the below
· Inequality – creating more equal societies where all have equal opportunity and going further proactive effort to increase the lot of those with least faster
· Transport – air q, activity, carbon and sustainability
· walkable environments being the default option and the hierarchy given to different modalities of transport – car = last etc. Research best summarised in the Arup report… walkable environments being the default option and the hierarchy given to different modalities of transport – car = last etc
· Obesity – food environment, activity, obesogenic environment etc. hot food outlet density. Concentration.
· Open green space – mental well being, activity. building green space, municipal space, parks / playgrounds INTO new developments the default – activity, mental well being,
· Play facilities
· Housing standards – trip hazards, cold homes and insulation, housing design, age friendly homes,
· Transport / housing / employer links – issues around agglomeration etc Agglomeration – There’s something to be said about building employment zones miles away from residential zones and how this structurally builds in air pollution etc…
· Healthy building standards inc Age and disability friendly housing
· Demographic stuff and planning health care facilities within developments – GP / pharmacy / optom / dental. Avoiding the last minute “have we thought about more GP capacity, who do we tell”. This is challenging – from experience with schools very few single developments in Sheffield will justify new services by themselves – so how do we interact with the planning and development system in our planning? School planning used SHLAA data to look at expected levels of development across the city and expected demand per household to estimate cumulative impact – which is useful – but then if need for eg new GP surgery, what is the process for identifying location, bringing forward development etc
· Land use and mix, land density – Social regeneration – and role of planning in this. Not segregated – socially mixed developments. Build on the Glasgow research, referenced at bottom.
· living wage type discussions as a default expectation in applications for new retail or industry developments
· Noise pollution
· Stuff around Retail Offer – not all takeaways
· Stuff around community safety – defensible spaces, planning out crime, reclaim the streets, space for community events and gathering
6 What are the constraints of additional “public health” resource being used in this space?
Im told there was a “health and planning” post in the past, Got sucked into DC and went native. Thus not plugging holes on development control staff being cut.
Stable contribution over time needed. someone, or function, who has skills and language to work across multiple areas.
NOT an “extra pair of hands for planning dept” but someone with skills and gravitas to change system or squeeze more “health” out of it than would otherwise be the case
Past experience suggests that policy staff tend to be amenable and development control staff tend to focus on removing obstacles to progress (including people asking about “health”. Being healthy = meeting other policy requirements too
7 Advice from those that have made progress in this area:-
- The time taken to develop the understanding of the planning system and terminology, build relationships with the various parts of planning and to attend meetings and contribute in a meaningful way takes time. “plnning” is a complex system as is “social care” or “the NH”.
- Need to align with the issues that have the most traction at the moment. One area had been able to develop their work on obesogenic environments under the guise of improving poor air quality ·
- Outreach into planning rather than “a healthy planner” based IN planning. MUST be able to speak multiple languages and work across multiple cultures. Must have “cred” in many worlds.
- Approach is “how can we help you do your job better”
- Start by EIA / HIA for critical policy and planning applications. Help get the job right
- Get into it gently, become a trusted ally across worlds. Not just the policy types but also DC and amongst communities and developets. Learn the languages of different systems and worlds
London – HUDU. need to think about making effective use of s106/CIL monies, as per HUDU in London: http://www.healthyurbandevelopment.nhs.uk/our-services/delivering-healthy-urban-development/hudu-model/. Could we replicate HUDU model and have a joint city-region funded resource, ie a couple of ‘healthy planners’ who work across the city-region?
People at Stoke have been doing interesting stuff for some time: http://webapps.stoke.gov.uk/uploadedfiles/Healthy%20Urban%20Planning%20Supplementary%20Planning%20Document.pdf
Links to Wakefield’s HIA materials here
Some other thought courtesy of a recent meeting
We talked through “health” and “planning” and some of the practical challenges
· Maybe need to revise / refine what we mean by “health” here. Deeply ingrained into people’s minds that health = service, and individually focused rather than policy / environment and ecologically / environmental focused. So with that latter in mind, lots of common ground with well being. So “health” is just as much about “built environment” as it is about “social policy” as it is about “early years services” as it is about “health care services” etc etc. Gran and eggs I know… but…..
· Challenge 1 – Getting policy framework right that “health” is built into the process from the DNA upwards. Even then the challenge is to turn nebulous into tangible, doable actions or considerations
· Challenge 2 is also one of where to focus the “planning and health” effort. One or all of the following – influencing communities (what sort of outcomes would they like from the planning process), developers (how can we help them make greater profit and secure health gain at same time), policy writers (core Plan and SPG – changing and influencing the rules), development control (making their job easier, giving some practical applications and questions). All of the above needed.
· Challenge 3 is – planning is going to happen, job is to squeeze a little more well being gain from it than would otherwise have been the case.
· Challenge 4 = strength of evidence. Nobody likes having to do more, so many developers may challenge evidence base. We need to 1) be prepared to challenge back and have arguments ready and 2) build better evidence
We talked a little re HIA, you know my views here – need to take care re not being completely process focused and HIA dominated. Just churning through process for its own sake?
Opportunity – Infrastructure funding – SIL 123, section 106 in new money. What “health” things do we want in here. Where are we on this?
8 Refs of interests
TCPA – “Building the foundations” – http://www.local.gov.uk/documents/10180/7632544/L16-6+building+the+foundations+-+tackling+obesity_v05.pdf/a5cc1a11-57b2-46e3-bb30-2b2a01635d1a
six elements described in the document as starting points to define what actions could be taken locally to make things happen.
TCPA – Planning and health http://www.tcpa.org.uk/data/files/TCPA_FINAL_Reuniting-health-planning.pdf
Journal of the Town and Country Planning Association – Healthy planning issue
Planning for better health and well-being in wales – https://www.tcpa.org.uk/Handlers/Download.ashx?IDMF=f5e87fe2-c146-48b6-8a67-c7426fd77e4d VERY helpful resource
Reuniting Health with Planning ‘Developers & Wellbeing’ #healthyplanning project – http://www.tcpa.org.uk/Pages/Category/health
Lancet – Lancet series on Urban design transport and health – http://www.thelancet.com/series/urban-design
Salliss – physical activity and built envt and associated editorial – http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01284-2.pdf & http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00348-2.pdf
Land use, transport, and population health: estimating the health benefits of compact cities – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30067-8/fulltext?rss=yes
Use of science to guide city planning policy and practice: how to achieve healthy and sustainable future cities http://www.thelancet.com/abstract/S0140-6736(16)30068-X
City planning and population health: a global challenge – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30066-6/fulltext?rss=yes
Urban design: an important future force for health and wellbeing – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31578-1/fulltext?rss=yes
Mark Stevenson: systems thinker for cities – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31665-8/fulltext?rss=yes
Development of bicycle infrastructure for health a nd sustainability – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31671-3/fulltext
Healthier neighbourhoods through healthier parks in NYC – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31579-3/fulltext
Building Healthy Communities. NYC approach to neighbourhood health – http://www1.nyc.gov/nyc-resources/building-healthy-communities.page
Community Parks Initiative : NYC Parks – https://www.nycgovparks.org/about/framework-for-an-equitable-future/community-parks-initiative
SHU – tackling poverty through housing and planning policy. http://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/tackling-poverty-housing-planning-city-regions.pdf?utm_content=buffer1e90d&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
Glasgow planning sturdy – History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow
Instructive lesson from history
Neat eg of long term well being impacts of spatial planning + macro social change (ie mass job losses) and breakdown of infrastructure etc…..(sound familiar…. Steel / coal….)
- even after for adjusting for deprivation – the way in which social, economic and spatial planning decisions are made has long lasting impacts on the health outcomes of a population.
- Way in which we approach social regen, alongside built envt / spatial planning has profound long term impacts.
- And maybe some pointers to ways in which planning system can have bearing. Its not just planning obviously….
Main report –http://www.gcph.co.uk/publications/635_history_politics_and_vulnerability_explaining_excess_mortality
The policy recommendations http://www.gcph.co.uk/assets/0000/5587/Excess_mortality_-_Policy_recommendations.pdf
Appendix – acronym buster
aha ta – SCC = Sheffield City Council, the local authority,
SPG = supplementary planning guidance (basically guidance written AFTER the main planning policy document that the local authority is responsible for to counter some eventuality that wasn’t considered in main policy),
SPD = same (d = document),
CD = community development,
SHLAA = strategic housing land availability assessment