The article looks at the lessons on the health and planning evidence base, evidence-sharing and integration that have been emerging from an ESRC seminar series on reuniting health and planning bringing together academics and planning and public health professionals

Carmichael, Laurence

Fischer, Thomas B

Lock, Karen

Sweeting, David

Townshend, Tim

English

UWE Bristol Research Repository

Town & Country Planning November 2016 461Healthy Planning – Securing Outcomes from United Action The transfer of public health functions from theNHS back into local authorities in 2013 representsan opportunity to improve the health and wellbeingof the population through planning. This is in linewith policy set out in the National Planning PolicyFramework (NPPF), issued in 2012, which at variouspoints mentions the need for planning to supportlocal public health and healthy communities.However, consideration of the determinants ofwellbeing and local population health needs in planningdecision-making is impeded by a number of barriers.These are rooted in the contrasting knowledge bases,institutional settings, professional networks, andlegislative and policy environments in which planningand public health practitioners traditionally work. A multi-disciplinary series of eight ESRC-fundedseminars (over the period 2015-2017) has beenbringing together academics and practitioners acrossEngland to address these challenges and consideropportunities for inter-sectoral collaboration.The seminars have repeatedly highlighted twoissues. The first is the demand from planning andpublic health professionals to improve both theirmutual understanding of the uses of evidence andthe methods and instruments available to achievethis. The second is a call for better approaches tosharing evidence and good practice that are fit forpurpose within an increasingly resource-poor localauthority environment. How might these issues be addressed?Mutual understanding of the uses of evidence –a necessary step towards policy integrationThe fundamental issue is that planners operatewithin a rigid statutory system of adopted policiesand plans, while public health practitioners are moreaccustomed to advocating proactive strategies inresponse to population health needs. To be able to work together effectively, they need to betterunderstand each other’s professional backgrounds,work-related processes and legal and policyframeworks, and how these influence theconceptualisation and use of evidence in practice.1The central purpose of planning is to achievesustainable development through plan-making anddecision-taking.2 It exists to promote economicreuniting theevidence base for health andplanning –lessons from an ESRC seminar seriesLaurence Carmichael, Karen Lock, David Sweeting, Tim Townshendand Thomas Fischer look at the lessons on the health and planningevidence base, evidence-sharing and integration that have beenemerging from an ESRC seminar series bringing together academics and planning and public health professionals462   Town & Country Planning November 2016Healthy Planning – Securing Outcomes from United Action growth and social progress, to deliver high-qualityhomes and healthy communities, to meet thechallenges of climate change, and to enhance thenatural environment. Evidence in planning is basedon case studies and is shaped by guidance and key laws (such as the Planning and CompulsoryPurchase Act 2004). In essence, the evidence basefor supporting built environment interventions islinked to planning processes, instruments, visions,objectives and delivery mechanisms. Moreover, theplanning process is about understanding and actingwith planning practices, vocabularies andstakeholders, and implementing and co-producingoutcomes.Although the public health function in localauthorities is also shaped by strategy and policy, thefundamental aim of public health practice is oftenarticulated more broadly. For example, ‘Public healthis about creating the conditions in which people canlive healthy lives for as long as possible.’3 Publichealth decisions are taken based on the considerationof current local knowledge, uncertainties, and socialand economic issues, and will always consider theresearch evidence base.Evidence in public health is often defined in scientificterms and draws on research from a wide range of disciplines, such as economics, various socialsciences, epidemiology, health services research,and medical sciences. It covers topics ranging fromindividual risk factors and health outcomes (includingphysical activity, diet, obesity, and sexual health, andthe harmful effects of alcohol, illicit drugs, tobacco,gambling, unemployment and poor housing), tointerventions, policies and service delivery.It has long been recognised that a betterunderstanding of systems thinking is required inorder to fully consider health impacts that may berelated to various social, economic or environmentalfactors – see, for example, the obesity system mapidentified in the Foresight report of 2007.4 Indeed,there is already a strong and growing evidence baselinking aspects of the built environment and health.5Public health knowledge can help support thecreation of sustainable communities – one of thekey purposes of planning – through facilitatingwalkable environments, enhancing transport andtraffic planning, improving housing, and supportingthe availability of high-quality green spaces andother opportunities for increased physical activityand improved mental health.With regards to the instruments and methodsavailable to achieve a better integration of health intoplanning, different types of impact assessments playan important role. On the one hand, there is HealthImpact Assessment (HIA), which is applied in a widerange of policy, plan and project situations.6 However,it is not a statutory instrument. On the other hand,Strategic Environmental Assessment (SEA) for plansand programmes and Environmental ImpactAssessment (EIA) for certain projects are statutoryinstruments and can play a key role in integratinghealth into planning. SEA is applied to local, transport,waste, energy, minerals and other plans, and theunderlying European Directive (Directive 2001/42/EC)explicitly asks for human health to be considered.7In the UK EIA is applied about 700 times everyyear to large projects giving rise to significantenvironmental impacts. The new EIA Directive(Directive 2014/52/EU), which will come into force in May 2017, for the first time explicitly requireshuman health to be considered, possibly through a type of integrated EIA/HIA.8Better approaches to sharing health evidenceand good practice to inform planning policyHowever, given the divergent disciplinary traditions,processes, governance and institutional arrangementsthat are in place, integrating public health and planningpriorities is a challenging task. Traditionally, planningdecisions are made on a case-by-case basis,considering information on local factors relevant to a specific area. In contrast, public health considersevidence at a broader population level, which maynot have direct links to a particular development, or ageographical location, and thus may not appear to bedirectly relevant to planning. Public health practitionersand planners need to work more closely locally toaddress this mismatch, to better translate the widerevidence base to a local context, and to findappropriate ways to evaluate local policies andinnovations, thus increasing the ‘local evidence base’.There are, however, already good examples of howto integrate public health evidence into planningpractice. One approach is to allow public healthevidence to filter through the planning process, inessence mainstreaming it through strong policyhooks. Bristol’s development management policy 14(Policy DM14)9 requires an HIA for developmentslikely to have a significant impact on health andwellbeing. The policy is the result of a long-standingco-operation between Bristol City Council and theWHO Collaborating Centre at the University of the West of England (UWE), Bristol. It promotes co-operation between health colleagues andplanners, supporting greater understanding amongthe professional groups.From Conwy County Borough Council, we alsolearn that leadership at executive level is key topromoting the use of HIA. The local public healthteam has a strong advocacy and influencing role toplay, but HIA needs to be championed by thecouncil executive team too, to promote awarenessamong council officers of their contribution to healthand wellbeing impacts.Another way to integrate advances in publichealth evidence bases is to adopt specific ‘healthy’planning policies – for example restricting hot-foodtakeaways in close proximity to schools and youthTown & Country Planning November 2016 463Healthy Planning – Securing Outcomes from United Action facilities, where they have been proved to influencebehaviour harmful to health. It has been demonstratedthat a policy hook is not always necessarily neededto impose healthy planning on developers. InCopeland v London Borough of Tower Hamlets,10the Administrative Court ruled that, in failing to takeinto account the proximity of a secondary school witha healthy eating policy as a material consideration,Town Hamlets Council had acted unlawfully ingranting planning permission for a takeaway, eventhough there was no Council planning policy relatingto this issue.In Bicester, a novel way forward is being taken by developing a strong consortium approach toplace-based and proactive planning and design,implementing the principles put forward in the FarrellReview11 on improving levels of connectednessbetween institutions and professions, as well aslevels of public engagement. Residents are giventhe opportunity to learn how to make the ordinarybetter within planetary boundaries, by participating increating healthy living together, from the promotionof warm and comfortable homes, to active lifestyles,social activity and internet connectivity. Another keyaspect of place-making in Bicester is that monitoringis already required by planning consent, throughwhich the success of measures can be assessed.At a strategic level, Public Health Englandrecommends the integration of Joint StrategicNeeds Assessments and Health and WellbeingStrategies as part of the evidence base informingthe development of Local Plans, hence influencingthe shape of the local physical environment.Challenges and opportunities for inter-sectoralintegrationLooking forward, one of the challenges in movingtowards a more inter-sectoral approach to healthand planning is the need for new approaches toprofessional training and organisational capacity-building in every local authority. Realistically, wide-scale change across England is unlikely within thecurrent context of ever-decreasing local finances.However, opportunities remain in each area forpublic health to support the delivery of sustainabledevelopment polices and plans, and to input evidencestrategically into key local planning policies wherethey can have important effects on the localpopulation, be they transport, housing, green spaceor air quality policies.As evidence on the role of the built environmenton health mounts, finding ways to integrate publichealth data and evidence into planning policy-makingcan have wider policy and governance implications.The viability clause in the NPPF has given rise to muchdebate as to whether it causes sound planningdecisions to be circumvented. Understanding thelong-term impacts of new development on healthcould help rebalance the meaning and testing ofviability, potentially contributing to redressing thebalance of power. Using Joint Strategic NeedsAssessments and sharing health data to informLocal Plans could support the mainstreaming ofsystems thinking, or at least inform more complexbuilt environment interventions.Engaging with communities to generate the healthevidence base for Local Plans could also contributeHigh-quality public space in Copenhagen – public health knowledge can support the creation of sustainable communities© Mark Drane464   Town & Country Planning November 2016Healthy Planning – Securing Outcomes from United Action to a more participatory, proactive planning system.And despite the fact that further research is neededto consider its effectiveness and also to develop itsuse at a strategic level, HIA has been identified as a useful tool to facilitate the inclusion of healthconsiderations and integrate local knowledge intoplanning decision-making, in particular in the contextof SEA and EIA (see, for example, Glasgow CityCouncil’s City Plan 2, of 2009, which included anHIA for one part of the city – the HIA of the draftEast End Local Development Strategy12).None of these changes will happen overnight.However, the seminar series has demonstrated thatthere is an appetite for change – and that closerworking between public health and planningprofessionals has the potential to deliver realbenefits and healthier communities.● Laurence Carmichael is Head of the WHO CollaboratingCentre for Healthy Urban Environments, University of theWest of England, Bristol. Karen Lock is with the Faculty ofPublic Health and Policy, London School of Hygiene andTropical Medicine, London. David Sweeting is with the Schoolfor Policy Studies, University of Bristol. Tim Townshend iswith the School of Architecture, Planning and Landscape,Newcastle University. Thomas B. Fischer is with theEnvironmental Assessment and Management Research Centre,University of Liverpool. The authors wish to acknowledge the ESRC for funding the seminar series (grant numberES/M001733/1) and all the academics and practitioners whohave contributed to the seminar series, but especially CarlPetrokofsky, of Public Health England. The views expressedare personal.Notes1 T. Lorenc, E.F. Tyner, M. Petticrew, S. Duffy, F.P. Martineau,G. Phillips and K. Lock: ‘Cultures of evidence acrosspolicy sectors: systematic review of qualitative evidence’.European Journal of Public Health, 2014, Vol. 24 (6),1041-7. doi: 10.1093/eurpub/cku038. Epub 2014 Mar 27;and E. McGill, M. Egan, M. Petticrew, L. Mountford, S. Milton, M. Whitehead and K. Lock: ‘Trading quality forrelevance: non-health decision-makers’ use of evidence on the social determinants of health’. BMJ Open, 2015, Vol. 5(4), e007053. doi: 10.1136/bmjopen-2014-0070532 National Planning Policy Framework. Department forCommunities and Local Government, Mar. 2012.www.gov.uk/government/uploads/system/uploads/attachment_data/file/6077/2116950.pdf3 Strategic Plan for the Next Four Years: Better Outcomesby 2020. Public Health England, Apr. 2016.www.gov.uk/government/ publications/public-health-england-strategic-plan4 Tackling Obesities: Future Choices – Obesity System Atlas.Foresight. Government Office for Science, Oct. 2007.www.gov.uk/government/publications/reducing-obesity-obesity-system-map5 H. Barton, S. Thompson, S. Burgess and M. Grant: TheRoutledge Handbook of Planning for Health and Well-Being. Routledge, 20156 See, for example, the World Health Organization’s‘Health Impact Assessment (HIA)’ webpages, atwww.who.int/hia/en/7 T.B. Fischer, M. Martuzzi and J. Nowacki: ‘The considerationof health in strategic environmental assessment (SEA)’.Environmental Impact Assessment Review, 2010, Vol. 30 (3), 200-10. doi: 10.1016/j.eiar.2009.10.0058 T.B. Fischer, R. Therivel, A. Bond, J. Fothergill and R. Marshall: ‘The revised EIA Directive – possibleimplications for practice in England’. UVP Report, 2016,Vol. 30 (2), 106-12. doi: 10.17442/uvp-report.030.199 Policy DM14: ‘The Health Impacts of Development’. SiteAllocations and Development Management Policies.Local Plan. Bristol City Council, Jul. 2014.www.bristol.gov.uk/documents/20182/34540/BD5605%20Site%20Allocations_MAIN_text%20V8_0.pdf/46c75ec0-634e-4f78-a00f-7f6c3cb6839810 R (on the application of Copeland) v Tower HamletsLondon Borough Council. [2010] All ER (D) 72. 11 Jun. 201011 Our Future in Place. Farrell Review of Architecture andthe Built Environment, Mar. 2014.www.farrellreview.co.uk/12 E. Ison: Health Impact Assessment (HIA) of the DraftEast End Local Development Strategy Entitled‘Changing Places: Changing Lives’. Commissioned bythe Glasgow Centre for Population Health, 2007.www.gcph.co.uk/publications/196_hia_of_the_draft_east_end_local_development_strategyPublic healthpractitioners andplanners need to work moreclosely totranslate thewider evidencebase to a localcontext© Mark Drane

Evidence base for health and planning – lessons from an ESRC seminar series

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Evidence base for health and planning – lessons from an ESRC seminar series

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