The recent Commons select committee investigation into health inequalities called for a planning policy statement on the subject (Planning, 3 April, p10). The government has asked Professor Sir Michael Marmot to lead an independent review to propose an evidence-based strategy for reducing health inequalities from next year.
His report at the end of this year will include policies to tackle the social determinants of health inequalities, such as transport, housing and social support. Activity in these sectors is key to a healthy, thriving society. Health impact assessment (HIA) aims to improve well-being and reduce health inequalities.
Improving fitness is good in itself and it reduces the burden on the health care sector. Well-being is central to discussions about sustainability and visions for the future. The National Institute for Health and Clinical Excellence (NICE) sees a link between the built environment and health. For example, a car-dominated environment contributes to rising obesity and fear of crime contributes to poor mental health.
The Commons scrutiny unit estimates that obesity costs the economy £3.6 billion a year and the national director for mental health services states that poor mental health costs £77 billion a year. NICE and the RTPI have each issued good practice guidance on planning and health. These call for improved access to green space, support for walking and cycling, social infrastructure and community cohesion.
HIA enables plan-makers and developers to identify the effects that a programme or project might have on health inequality and the distribution of these within the population. It also identifies actions to manage these effects.
Wary of extra burdens, some say that legislation framing planning and environmental assessments already includes considerations of human health, such as limits governing noise, air, water and soil. These afford a measure of protection that is deemed acceptable but are not necessarily the way to improve health and reduce inequalities.
Despite an absence of government legislation, HIA is on the rise in spatial planning. Five out of the nine regional spatial strategies (RSSs) for England discuss or carry policies for HIA. The other four refer to the importance of improving health. As RSSs become single regional strategies, the challenge will be to demonstrate the importance of health and well-being to economic stability.
The RTPI says health should feature in statutory assessment procedures rather than being a stand-alone process. Some local planning authorities require an HIA for major developments. The EU strategic environmental assessment (SEA) directive requires plan-makers to identify effects on a range of factors including human health. The Department of Health (DoH) prepared guidance in 2007, but assessment is still done with scant reference to the public health community.
There is no consultation body responsible for health as a principal topic. The DoH is developing proposals for a gateway to act as a point of contact for health advice for responsible authorities carrying out SEA. Responsibility for health inputs will be passed on to regions and primary care trusts when appropriate. Health professionals must prepare to meet this requirement.
Organising our environment to protect the public against adverse health effects has always been valuable. Examples include the London Building Acts, the water closet, sewers and fresh water. Walking, cycling and public transport increase physical activity, improve mental health and reduce carbon emissions. Planning has a vital role to play in steering today's priorities.
In the search for improved health, reduced health inequalities and sustainability, public health professionals, planners, developers and environmental scientists need to rediscover a common language. HIA is one way in which this can be done. The RTPI has a healthy communities interest group that is open to members and non-members.
Ben Cave is a member of the RTPI environmental planning and protection network. To join, please email firstname.lastname@example.org. For more information on planning and health, read the RTPI practice note GPN5 - Delivering Healthy Communities at www.rtpi.org.uk/item/1795/23/5/3 or visit www.hiagateway.org.uk