Healthy Cities Phase V evaluation: further synthesizing realism

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phase

The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review

<p>Abstract</p> <p>Background</p> <p>Spatial planning affects the built environment, which in turn has the potential to have a significant impact on health, for good or ill. One way of ensuring that spatial plans take due account of health is through the inclusion of health considerations in the statutory and non statutory appraisal processes linked to plan-making processes.</p> <p>Methods</p> <p>A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010.</p> <p>Results</p> <p>A total of 6161 citations were identified: 6069 from electronic databases, 57 fromwebsite searches, with a further 35 citations from grey literature, of which 20 met the inclusion criteria. These 20 citations reported on a total of 135 different case studies: 11 UK HIA; 11 non UK high income countries HIA, 5 UK SEA or other integrated appraisal; 108 non UK high income SEA or other integrated appraisal. All studies were in English. No relevant studies were identified reporting on low or middle income countries.</p> <p>The studies were limited by potential bias (no independent evaluation, with those undertaking the appraisal also responsible for reporting outcomes), lack of detail and a lack of triangulation of results. Health impact assessments generally covered the four specified health domains (physical activity, mental health and wellbeing, environmental health issues such as pollution and noise, injury) more comprehensively than SEA or other integrated appraisals, although mental health and wellbeing was an underdeveloped area. There was no evidence available on the incorporation of health in Sustainability Appraisal, limited evidence that the recommendations from any type of appraisal were implemented, and almost no evidence that the recommendations had led to the anticipated outcomes or improvements in health postulated.</p> <p>Conclusion</p> <p>Research is needed to assess (i) the degree to which statutory plan appraisal processes (SA in the UK) incorporate health; (ii) whether recommendations arising from health appraisal translate into the development process and (iii) whether outcomes are as anticipated.</p

Health-integrated planning at the local level in England: Impediments and opportunities

The project commissioned by the National Institute of Health and Clinical Excellence (NICE) aimed to examine the degree to which UK, mainly English local planning authorities, incorporate health in their land use plans and development decisions. The project involved systematic reviews of evidence together with case studies. The range of performance in relation to health identified in the project shows that best practice in England depends not so much on the planning system per se, as on the leadership, commitment and knowledge of politicians and practitioners involved. The barriers to health integration are organisational and professional silos, ignorance, resources, and reactive planning regime. Clear lessons for research and practice are emerging: first, well attested research evidence is quite scarce, for example in relation to sustainability appraisal and health; second, planning agencies need to forge good partnerships with public health, transport, housing and economic development decision-makers, and develop proactive, healthy plans; the new planning regime and move of the public health function into local authorities in 2013 in England will give policy opportunities for the consideration of health outcomes in planning decisions, and research should in time evaluate if results have been achieved on the ground. © 2012 Elsevier Ltd

Integration of health into urban spatial planning through impact assessment: Identifying governance and policy barriers and facilitators

This article presents the results of a review of literature examining the barriers and facilitators in integrating health in spatial planning at the local, mainly urban level, through appraisals. Our literature review covered the UK and non UK experiences of appraisals used to consider health issues in the planning process. We were able to identify four main categories of obstacles and facilitators including first the different knowledge and conceptual understanding of health by different actors/stakeholders, second the types of governance arrangements, in particular partnerships, in place and the political context, third the way institutions work, the responsibilities they have and their capacity and resources and fourth the timeliness, comprehensiveness and inclusiveness of the appraisal process. The findings allowed us to draw some lessons on the governance and policy framework regarding the integration of health impact into spatial planning, in particular considering the pros and cons of integrating health impact assessment (HIA) into other forms of impact assessment of spatial planning decisions such as environmental impact assessment (EIA) and strategic environment assessment (SEA). In addition, the research uncovered a gap in the literature that tends to focus on the mainly voluntary HIA to assess health outcomes of planning decisions and neglect the analysis of regulatory mechanisms such as EIA and SEA. © 2011 Elsevier Inc

The effectiveness and cost effectiveness of health appraisal processes currently in use to address health and wellbeing during plan appraisal

This is the second of a series of seven reports to NICE concerned with the degree to which the spatial planning system incorporates health and well-being effectively in its processes. Report 1 examined how projects (concerned with land use) are appraised as part of the planning process. It examines how far and in what ways the statutory and non-statutory appraisal of projects account for potential positive and negative impacts on health and the social and environmental determinants of health, and what lessons emerge from current practices. Report 2 examines the same issues, but looks specifically at plan appraisal. It looks at the appraisal of spatial plan-making, including geographical areas or functions (for example transportation), and how health objectives and issues are considered. The two reports will feed into further review work, which will take into account a wider range of evidence from a number of sources, aiming to provide a basis for NICE guidance