EVENTS IN the real worlds of human health and of global sustainability seem to have stepped up a pace. In tandem,the ‘constructed’ worlds of ‘public health’ and ‘planning’ are struggling – not struggling to keep up; but struggling to meet up. This article tracks a year in the life of a small research centre that has been at the heart of the planning-health domain for nearly ten years. The Collaborating Centre, designated by the World Health Organisation (WHO) Healthy Cities Campaign, is part of the Faculty of the Built Environment at the University of the West of England (UWE) in Bristol. It is one of only two collaborating centres in the world based within a builtenvironment faculty, expressly linking health with design and planning

Grant, Marcus

English

UWE Bristol Research Repository

February 2007  Town & Country Planning 47Marcus Grant records the key events in a year of working to bring the worlds of public health and planning togetherus is just to get planners and public healthpractitioners to speak to each other. In asense they share common goal but theycertainly don’t share a common language.They don’t have a similar modus operandiand hold few joint conferences – untilthis unusual year.Here in the UK, I am at a Royal TownPlanning Institute (RTPI) conferencecalled ‘Spatial Planning and Health’ beingheld in Birmingham. This bodes well: it isa good start to a year to have plannersand professionals from the NHS and theDepartment of Health (DOH) in a singledialogue. My overriding impression is ofplanners discovering that they didn’tknow what health actually meant, andthat they would need to develop adefinition. I always find it encouragingwhen people start to see things throughnew eyes: redundant patterns of thoughtstart to be challenged; the table is laid forchange. The summing-up from CarolineBrown has been influencing our approachhere at the WHO Centre and I hope manyothers. In a nutshell she discerns threedistinct agendas for planning and health:n 1 – planning of health care facilitiesand estates;n 2 – planning that reducesenvironmental causes of disease; andn 3 – planning that promotes healthylifestyles and healthy communities.Our WHO collaborating centre is mainlyconcerned with 2 and 3 – although if associety we do 1 properly, I think it will bethrough realising that it, too, should bemore concerned with 2 and 3!MarchThe beginning of the month seesHugh giving a masterclass on healthimprovement through the new planningsystem for the healthy cities team andstakeholders in Brighton, hosted by theBrighton and Hove City Primary CareTrust.In mid-month, Hugh and I travel toTelford for the 14th Annual Public HealthForum. This two-day event, with about 600attendees, has become a key debating andnetworking date in the annual calendarfor a wide range of those who identify witha broad health and well-being agenda.The event is run by the UK Public HealthAssociation (UKPHA), with Angela Mawleat the helm. In addition to the communityhealth specialists and NHS healthpromotion teams, the forum is increasinglythe place for environmentalists, urbandesigners, planners and those involved inall aspects of community regeneration tochallenge the medical hegemony on‘health’. It is where those researching thelinks between the built and naturalenvironment and health can testassumptions and learn from practitioners.I am pleased that a small team of us,called the Strategic Interest Group (StIG)at the UKPHA, has prepared a specialconference strand as a hub forpractitioners working in the built andnatural environments. Participants hearhow we have been literally buildingunhealthy conditions into our localhuman habitat.During the two days of presentation, itbecomes clear that recent concerns aboutlevels of physical activity, obesity andasthma and increasing environmentalinequality have put planning back on thehealth agenda. Human health is beingcompromised by both the manner ofhuman intervention in the natural worldand the manner of development activityin our built environment. However,taking action is not necessarily simple:the links between health and planningare indirect and complex.planning for healthy communitiestEVENTS IN the real worlds of humanhealth and of global sustainability seemto have stepped up a pace. In tandem,the ‘constructed’ worlds of ‘public health’and ‘planning’ are struggling – notstruggling to keep up; but struggling tomeet up. This article tracks a year in thelife of a small research centre that hasbeen at the heart of the planning-healthdomain for nearly ten years. TheCollaborating Centre, designated by theWorld Health Organisation (WHO) HealthyCities Campaign, is part of the Faculty ofthe Built Environment at the University ofthe West of England (UWE) in Bristol. It isone of only two collaborating centres inthe world based within a builtenvironment faculty, expressly linkinghealth with design and planning.FebruaryHugh Barton – Director of the WHOCollaborating Centre – is working on theEuropean front, while I tend (or try tolight!) some home fires. Hugh is in Milanat a WHO Healthy Cities sub-networkmeeting to promote a healthy urbanplanning theme. Hugh is working withthe cities leading this theme, such asBelfast, Brighton, Bursa, Turku and Milan,to set some ground rules and an agendafor the next three years.Our main role has always been tosupport the WHO Healthy Cities networkacross Europe. These cities have all signedup to the current five-year phase of theHealthy Cities programme. This phaseplaces an emphasis on what has beentermed ‘healthy urban planning’ – whichmeans using spatial planning, at allavailable scales, to help create settlementswhere it is easier to live a healthy life. Inpractice, in addition to spreading theoryand good practice, often the key task for2006 – a year ofhealth and planningThe forum gives Hugh and me theopportunity to give our ‘health map’ itsfirst major public outing. Feeling that atool to improve understanding and fostercollaboration between planning andhealth decision-makers was badly needed,we have designed the health map as adynamic tool to promote dialogue andprovoke enquiry. It has been deliberatelycomposed to provide a focus forcollaboration across practitioner professions– for practitioners such as planners, publichealth professionals, service providers,ecologists and urban designers – andacross topics such as transport, air quality,community development and economicdevelopment.1AprilHugh is invited to put the case for‘putting human well-being at the core ofplanning’ to a plenary session at theSeventh International Health ImpactAssessment Conference, held in Cardiff.We are missing a trick, he suggests: thenew planning system and the communitystrategy offer mechanisms to integratehealth and planning – we need to graspthe opportunity.Later in the month, we host a publichealth showcase at UWE, sub-titled‘Convergence of the Public Health andSustainability Agendas?’. The questionmark (big and pregnant) is an attempt tohighlight the importance of connectingthese two all too separate worlds. TheUKPHA lends us its Chair, Professor DavidHunter, to open the event and I find itencouraging that our Regional Director ofPublic Health, Dr Gabriel Scally, challengesplanners to get more serious aboutplanning for healthy communities. Wedeliberately try to immerse participants inthe debate using exhibitions, workshops,talks and locally-sourced green organic fare.In the interstices of the month Hughputs the finishing touches to a series ofpapers, for the WHO, the Smart GrowthFoundation and the National Heart Forum.MayHugh and I work on split fronts again.Hugh draws the short straw, having toattend the WHO Member StatesIntersectoral Consultation on promotingphysical activity for health in Ljubljana,Slovenia! His presentation on urbanplanning is to help shape the WHOrecommendations to the MinisterialConference on Counteracting Obesity(held in Istanbul in November 2006).Meanwhile in the UK, and just up theroad from UWE, our local Director ofPublic Health, Chris Payne (of SouthGloucestershire Primary Care Trust), linesup speakers from Sustrans, Arup andother built environment consultancies toaddress health practitioners. I present anoverview of how urban design can affecthealth. Presentations drive a coach andhorses (or should that be tram and lightrail?) through traditional divisionsbetween sustainable development, health,community, design and planning.JuneYou win some, you lose some. TheNatural Environment Research Councillaunches its new Environment andHuman Health programme. I am invitedto the speed-dating process that will buildbidding partnerships. Although I meet alot of fine people doing fine work, all the‘social scientists’ (as planners have becomein this forum) bemoan the lack of anyreal understanding of ‘interdisciplinary’processes and ‘holistic’ systems. I amdisappointed; the funders only wantresearch directly linked to provable causal‘pathogen’ style pathways. No room,then, for a healthy cities approach!Later in June another bunch of citiesapply to join the Healthy Cities Network.Hugh and I assess the ‘healthy urbanplanning’ element of the applications andreport our conclusions to Healthy CitiesHQ. We get applications from a numberof cities in Eastern Europe – Dimitrovgrad,Trazbon, Kuressaare, Sarpsborg, Tiranaand Istanbul. We find it encouraging thatcities struggling with (sometimesimmense) basic infrastructure problemsnevertheless grasp the importance gettingthe underlying emphasis right.JulyOh dear, that time of year when weneed to provide WHO Healthy Cities HQin Copenhagen with information for itsAnnual Report to the cities. Lots of data-crunching and deadlines. We try to assesswhat cities are up to, who is working welland which cities might benefit from extrasupport.At UWE we have a large and establishedplanning teaching programme. Last yearthe Faculty was commissioned by theDepartment for Communities and LocalGovernment to provide online resources to‘change the culture’ of planning. I thinkthis refers to giving planners a ‘spatialplanning’ mind-set. Inspired by the RPTIconference in February and otherdevelopments earlier in the year, I auditthe new ‘Spatial Planning’ distancelearning course to make sure that ‘health’is adequately addressed. As a result Icommission Ben Cave to write a topicwhich will serve as a primer for theplanning-health agenda. Hugh writesanother topic focusing on one of our ‘tools’– ‘spectrum appraisal’, which links healthand sustainable development, combiningrational and stakeholder approaches.AugustNo sooner have we written the topic onspectrum appraisal than we are asked toundertake another assessment using thistechnique. We are been asked, throughPowell-Dobson Urbanists, to undertake asustainability appraisal of current housingpolicy for Merthyr Tydfil CountryBorough Council. Armed with thespectrum approach and the ‘health map’,we successfully argue for undertaking anintegrated health and sustainabilityappraisal. Hugh uses the fallow period toplan a new planning text book whichputs health at the heart of planning.SeptemberThe month is mainly spent vetting the‘healthy urban planning’ elements of newtWHO Healthy Cities Network Phase IV (2003-2008)48 Town & Country Planning  February 2007cities wanting to join the Europeannetwork. Applications to become HealthyCities arrive from Kirrikale, Gijón,Cherepovets, Sarajevo, Salamanca andNancy. For some cities, the concept of‘healthy urban planning’ does not yet gomuch further that some open spaceimprovement works and a cycle lane. Butthe leading cities demonstrate how theagenda goes beyond just the physicalinfrastructure as an end in itself, to how itbecomes the means for inclusion, capacity-building, governance and partnership.We are also invited to undertake a pre-planning-application update of a healthand sustainability appraisal for the Clarks’residential Houndwood development inStreet. The former shoe factories are givingway to 400 houses, and the client wants anexemplary scheme of a healthy sustainablecommunity! The development brief isexcellent, but once financial and designreality kick in, the difficulties mount.Later in the month Hugh is invited toThe Lancet expert group on energy andhealth – a review meeting in London,planning a broadside on conventionalwisdom. And two new PhD studentshipslinked to the Centre are confirmed: onmental well-being in neighbourhoods,and on car-free developments.OctoberThis month sees a major newsfesttriggered by the publication of the SternReport, following hard on the heels of AlGore’s An Inconvenient Truth. The healthagenda was for a while eclipsed by thesustainability agenda – but balance hasbeen restored by the WHO statement that‘climate change represents the greatest threatto world health’. Hugh goes on his travels: tothe 16th century new town of Sabionetta,near Màntova, to explore the potential fortrans-Atlantic research; and to Turku, as theexpert adviser to the WHO Healthy CitiesNetwork’s Annual Business and TechnicalMeeting. Then, back here again in Bristol,he presents an excellent final paper titled‘Healthy cities: beyond urban design’ to theUrban Design Group Annual Conference.Also this month, Healthy Urban Planning(written by Hugh and Catherine Tsouroufor the WHO) comes out in its Portugueseedition – that makes seven languagetranslations and counting.NovemberI am with the Healthy City team inBelfast. I have been invited to facilitate ahalf-day ‘Healthy Urban Planning’ seminarin the morning with about 60 planning,health and community developmentstakeholders. In the afternoon I give amasterclass to the core Healthy City team.I am impressed by the Northern Irelandhealth policy called Investing for Health. Ithas kept more of an emphasis on howsociety can improve health than theEnglish equivalent Choosing Health. InEngland and Wales the useful emphasison healthy settings found in the earlierSaving Lives: Our Healthier Nation WhitePaper of 1999 (settings such asneighbourhoods, workplaces and schools– a spatial approach) has lost out infavour of ‘individual responsibility’ – it isup to the individual to chose health. Buthow does anyone make a ‘healthy’ choicewhen the options are cycling for miles ona dangerous road or taking the car?Where are the healthy choices in aneighbourhood without local facilities?Later in the month I participate in theForesight ‘Tackling Obesity: Future Choices’project. And CABE (the Commission forArchitecture and the Built Environment)hosts a workshop looking at whatopportunities there are for using theenvironment to combat obesity over thenext 40 years. Anyone mentioning ‘theOlympics’ or ‘sport’ is shot down in flames.We hear evidence from research at theUniversities of Bristol and East Anglia andothers that sport provision only changesactivity levels of those already active, andeven then only has a marginal influence!Couch-potatoes are not inspired to activityby elite gymnasts, at least not in thenumbers needed for an impact on thenation’s health! Moreover, the activity thatis probably keeping most of us healthy,and is widely inclusive, not requiringspecialist facilities – namely waking – isoutside the sport lobby’s orbit of concern.DecemberA workshop organised by the ScottishHealth Impact Assessment Network on‘Integrating Spatial Planning and Health’is postponed at the last minute, and I usethe opportunity to visit Caroline Brownat Heriot-Watt to co-ordinate our inputfor this Town & Country Planning specialissue. Hugh attends the final consultativeworkshop (organised by the Departmentof Health) on ‘Strategic EnvironmentalAssessment and Health’ – pending newGovernment guidance; and he inspires (sohe says!) the participants at the RegionalStudies Association annual studentsconference with new ways of assessingsettlement sustainability. The health maphas just been published for the first time:Hugh and I have managed to get a verygood reproduction with an associated shortarticle into the Journal of the Royal Societyfor the Promotion of Health.2 We celebrate!January 2007A month mainly of preparation andreflection (apart, that is, from a milepostin the huge SOLUTIONS (Sustainability ofLand Use and Transport In OuterNeighbourhoods) research programme intosustainability of outer neighbourhoods –early results of a household survey of localaccessibility make fascinating reading).We are preparing for training sessions inIstanbul – to help some of the cities thatare struggling most with the task ofaddressing health through planning andurban design. These are often cities fromTurkey, Russia and Eastern Europe thathave only recently joined the network.Then there are plans for a series ofcross-cutting workshops in Bristol,another UWE showcase, and ‘HealthyUrban Planning’ short courses andseminars in Greenwich, Milan andStroud. And of course, we are alsopreparing for the 15th Annual PublicHealth Forum organised by the UKPHA,which this year will be held in Edinburghon 28-29 March. Hope to see you there!As I reflect on the year, the message thatthe environment in which we live is amajor determinant of health and well-being is being accepted as a crucialcontext for action in an ever wideningconsensus, like ripples on a lake. Thesentiment that ‘modern town planningoriginated in the 19th century inresponse to basic health problems, but inthe intervening years has become largelydivorced from health’ is a statement thatwe have heard echoed in conferencesthis year from platforms organised by theRTPI, CABE, the Urban Design Group,and a host of other built environmentinterests. Health conferences, too, arenow beginning to reverberate to thesame message.Over the year we have seen adeveloping pace of interest in debate;but dialogue and activity often remainfrustratingly superficial. It is not thecomplexity of the two professionalspheres that is a barrier per se, but we arestill awaiting the development ofprofessional mindsets that can hold suchcomplexity without a need to simplifyand lose the gifts that it has to offer. Myhope is that planners will make a genuineattempt to grasp the depth of their rolein bringing into play spatial planning asan approach that has the capacity tomake a difference. nMarcus Grant is a Senior Research Fellow in the WHOCollaborating Centre for Healthy Cities and Urban Policyat the University of the West of England in Bristol.Notes1 For details, see the short article in this specialissue – H. Barton: ‘A settlement health map’. Town& Country Planning, 2007, Vol. 76, Feb., pp.57-58.For a deeper explanation from the perspective ofplanning theory, see H. Barton: ‘A health map forhuman settlements’. Built Environment, 2005, Vol. 31, No. 4, pp.339-3552 H. Barton and M. Grant: ‘A health map for the localhuman habitat’. Journal of the Royal Society for thePromotion of Health, 2006, Vol. 126, No. 6, pp.252-261February 2007  Town & Country Planning 49

2006 - A year of health and planning

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2006 - A year of health and planning

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