Healthier planning made key

Planning, 12 June 2009

Planners have been challenged to follow in the footsteps of their Victorian predecessors, who battled against chronically unhealthy living conditions in the UK's towns and cities, and lead the fight against the 21st century scourge of obesity.

In the same way that overcrowded 19th century urban environments promoted contagious diseases, the National Institute for Health and Clinical Excellence (NICE) believes that we are now living in environments that promote diseases of lifestyle. "Planners recognise that what they do has implications for the health of communities, but this is not always considered in a systematic or consistent way," says Professor Mike Kelly, NICE's public health excellence director.

Kelly is leading the production of guidance showing how planners should consider the impact of spatial plans on public health. NICE advised the profession last year that the design and layout of towns can encourage or discourage physical activity that affects the levels of coronary and vascular disease, some forms of cancer and mental health.

Yet developments continue to be approved that fail the "pint of milk test", which establishes whether a resident can reach a shop in under ten minutes without using a vehicle. "It's not only about whether facilities are physically nearby. They can be five minutes away as the crow flies but it may be easier to drive because of cul-de-sac street layouts," explains Living Streets chief executive Tony Armstrong.

In another indication of the multiple links between spatial planning and health, many of the quarter of UK households that do not own a car live in so-called "food deserts". For them, Armstrong points out, only fast food outlets and shops selling processed food are within easy walking distance. Fresh fruit and vegetables are scarce by comparison, he adds.

The RTPI agrees that planners can do more to promote public health and tackle health inequalities. It is publishing a range of recommendations for the profession at next week's Planning Convention. "Reading between the lines, there is much in existing planning guidance that encourages developments which contribute to healthy communities. But planners are not generally dealing with this, so we need to make the message much clearer," says environmental planning and protection network leader Paul Tomlinson.

The institute's call for a planning policy statement (PPS) on health was backed by the Commons select committee on health in March. The government has yet to respond to the MPs' demands. "We accept that ministers want to reduce the number of PPSs but we still want to see more explicit guidance given the issue's importance," Tomlinson insists.

This importance is underlined by estimates that tackling the health consequences of obesity will cost the country up to £50 billion a year by 2050. The team behind the 2007 Foresight report on obesity, appearing before the health select committee earlier this year, called for less Whitehall focus on promoting gym membership and more on making the built environment more conducive to walking and cycling.

Promoting healthier living through spatial planning is not only about reducing car dependency. It also demands more careful consideration of other aspects of residential developments. As the RTPI has hinted, it might be better for urban areas to be less dense and expand into the green belt to protect green space in towns and cities. "If local development frameworks were subject to assessments of their health impacts, that would probably make it more important to include new green space in the plans," Tomlinson suggests.

The RTPI's Delivering Healthy Communities guidance, to be launched at the convention, backs up this argument. The document points to the health benefits of having views of green space from homes and offices, the need for allotments and market gardens and tighter control over fast food outlets. But even ahead of its emergence, a number of local planning authorities have been starting to act on the issue.

Several London boroughs, most notably Tower Hamlets, have been identifying the health impacts of developments and seeking to mitigate adverse effects through section 106 agreements. Planners developing the joint core strategy for Broadland, Norwich and South Norfolk worked with GPs' surgeries and the primary care trust (PCT) to assess the implications of spatial strategies for their practices. Chorley Borough Council in Lancashire has compiled evidence on health priorities with its PCT to inform planning policy and decisions on food takeaways.

The RTPI guidance advocates using existing planning powers to control the number and location of fast food outlets, particularly near schools. The health select committee urged stronger powers after celebrity chef Jamie Oliver, appearing before the MPs, urged the placing of a cap on the number of takeaways in local areas.

NICE emphasises the need for best practice to become the norm. Kelly believes that more detailed guidance outlining the effectiveness of different methodologies for delivering change, which the institute aims to publish in 2011, will "make it easier for planners to encourage healthier living". The RTPI agrees, while insisting that the recommended appraisal methods have to be efficient if they are to be effective. For example, it does not encourage the production of separate health impact assessments.

"Health must be considered but in an integrated way," Tomlinson argues. A good first step, he advises, is for planning authorities to fully involve PCTs and surgeries in drafting local development frameworks rather than simply consulting them on drafts. "Our profession was born out of the environmental health movement. We need to go back to our roots and make this central to what we do," he maintains.