• Planning for better health outcomes – where are we? Planning for better health outcomes – where are we?

12 February 2020

Planning for better health outcomes – where are we?

Direct relationships between health and the built environment have long been understood and are well explored. One classic example is how John Show quelled a cholera outbreak by mapping the relationship between water pumps and the epicentre of a cholera outbreak in 1854. Even so, it has been a long journey towards effective integration between planning objectives (which primarily concern land use) and health.


The introduction of the National Planning Policy Framework (NPPF) and the Health and Social Care Act in 2012 created direct institutional structures and requirements to facilitate health goals at the local authority level, for example through the Joint Strategic Needs Assessment. These institutional shifts facilitated a direct link between planning policies and health outcomes. But eight years on, how is this integration process going?


Using planning policy to secure health outcomes

A report by the Town and Country Planning Association (TCPA) in January 2019 (The state of the union – reuniting health with planning in promoting healthy communities) carried out a comprehensive review of all 326 English local authorities’ Local Plans (alongside 22 Local Development Plans in Wales) to assess the extent to which health considerations have been integrated into planning policy. Eight criteria were used, including the incorporation of Joint Strategic Needs Assessment findings into Local Plans, and requiring major planning applications to submit a Health Impact Assessment (HIA). Only 30% of Local Plans in England has a HIA requirement, though this varies regionally – the highest uptake rate is in London (55%) and the lowest in the West Midlands (17%).

This finding is echoed by the Public Health England report titled Spatial Planning and Health: Getting Research into Practice published in October 2019. In a survey of public health and town planning professionals (overwhelmingly from the public sector), only 46% of respondents agreed that planning policies and decisions in their local authority area support local health and wellbeing strategies. Around 10% of respondents consider health to be taken account of, but not integrated into, planning policies in their local authority.

However, a recent survey of existing and emerging London local plans at WSP | Indigo in November 2019 reveal that at the London level, planning policies are becoming increasingly focused on HIA requirements. Out of the 33 London authorities, 20 have an existing HIA requirement (around 61%). Three local authorities (Brent, Harrow and Havering) have an emerging HIA requirement, and five local authorities will increase their requirements through adopting their emerging plan (Hackney, Hounslow, Islington, Merton, and Waltham Forest). Hackney’s emerging Local Plan policy LP9, for example, reduced the HIA qualifying criteria from 100 to 50 units for housing developments, and requires below-threshold schemes to demonstrate health impacts through their Design and Access Statements.

What is our role as planning professionals?

The emerging but spatially uneven landscape of integrating planning with health outcomes provides opportunities but also risks irrelevance. Respondents to the Public Health England Spatial Planning and Health report ranked private developers the 8th most responsible out of 12 categories and placed private sector consultants at 11th. This is more likely a skewed perception given that private sector is under-represented in the survey, but nonetheless an important perception to address. Even amongst private sector consultants there is a sense that HIAs can be marginal in the development proposal process, especially if they are commissioned as an afterthought and then become tick-box exercises carried out late in the design process.

But is this necessarily the case? In my view, private sector planners can play a central role in delivering health outcomes in both the long term and short term.

In the long term, we can communicate to clients the concrete financial gains with taking health objectives into design considerations. A publication by TCPA titled Securing constructive collaboration and consensus for planning healthy developments (published in February 2018) collated evidence from a range of sources (including from housebuilders themselves) that show a clear linkage between property premiums and quality of design. For example, a high number of street trees increased land values by up to 17% (CABE Space Design Council, 2004). As further revealed by the TCPA publication, larger developers (such as Barratt Homes and Berkeley Homes) are increasingly devising place-making frameworks with health promotion being an important objective – this is driven by both market demand and a level of corporate social responsibility.

These effects exist for all developments, albeit in varying degrees. We are in a good position to convey these messages to developers who may not have incorporated such systematic mechanisms to promote health. Through dialogue with clients, we aim to engage earlier in the design process, so our evaluation of health outcomes can have a more effective influence on scheme design.

In the immediate short term (i.e. over the life cycle of a planning application), planning consultants can inform applicants of HIA requirements in a particular area and deliver comprehensive HIAs that provide valuable insight on how a scheme sits within the larger health and deprivation context. This helps avoid delays in the planning process and optimises the delivery of health objectives within the existing submission timeframe.

Healthy place-making: the role of LPAs

Planning consultants’ facilitation of health outcomes through the planning process must be matched with equal effort from LPAs. Planning policies need to incentivise the production of quality HIAs by giving them genuine weight in LPAs’ consideration of planning merits. In the ever-expanding list of planning validation requirements, there is a risk of inflating expectations for applicants to deliver increasingly detailed HIAs, merely as a minimum requirement to be ticked off by the LPA. If the costly process of producing HIAs cannot translate into a planning benefit in the application process, applicants would be discouraged from going beyond the basic validation requirement.

Identified by Public Health England’s Spatial Planning and Health report above, planning policies would also benefit from better integration with strategic health priorities identified by the Public Health Team. For virtually all LPAs, there is currently a disconnect between planning policy wording (e.g. requiring an HIA for major developments) and identified health priorities (e.g. mental health and child obesity), which can lead to schemes not addressing the most pressing local health needs. Differences in local plan cycles and health-related evidence production timeframes may contribute to this disconnect, but ultimately it is an issue that requires dialogue and formalised processes between the respective teams.

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