Health and spatial planning

Good spatial planning helps improve the ‘liveability’ of areas (Barton 2009). The 2012 National Planning Policy Framework acknowledges the role of spatial planning in improving health, and requires local authorities to help develop the evidence base further.

'Local planning authorities should work with public health leads and health organisations to understand and take account of the health status and needs of the local population… including expected future changes, and any information about relevant barriers to improving health and wellbeing.' (Department for Communities and Local Government 2012)

How can spatial planning affect health?

Spatial planning is not an intervention in itself, but an enabler. How places are planned affects, for good or ill, how the other areas discussed in this resource impact on health.

  • Planners have considerable potential to improve active travel and ‘viability’ of neighbourhoods. A higher density of shops and schools is linked to more active travel (Lee and Moudon 2008), which is in turn linked to local populations having a lower average body mass index (Brown et al 2008).
  • Experience in the Netherlands shows that spatial planning to increase the number of people who cycle improves road safety (de Hartog et al 2010; Jacobsen 2003).
  • Increasing access to planned green space has a positive influence on physical activity levels (Croucher et al 2007), particularly for those from lower socio-economic groups (Mitchell and Popham 2008). But well-planned green space also has wider effects, including reducing the heat island effect (which can protect vulnerable people from heat stress), reduction in skin damage due to tree shading, lower risk of flooding and risk of related psychological distress, reductions in noise, and reductions in air pollution (Faculty of Public Health with Natural England 2010).

What are the possible priority actions for local authorities?

Local authorities need to ensure that the health impacts of different policies are assessed and health considerations integrated into planning across all departments. This will ensure that health benefits are realised across the broad spectrum of local authority functions, rather than remaining as isolated strands of good practice.

'The health and well-being of communities cannot be an afterthought. It must begin with the planning process.' (Chang et al 2010)

To ensure that spatial planning incorporates health issues and impacts, local authorities can:

  • increase local capacity and knowledge of health and spatial planning issues, with key staff and their teams taking the lead (director of public health, environmental health service, and chief planning officer)
  • use the Spatial Planning and Health Group (SPAHG)’s health checklist (Spatial Planning and Health Group 2011) when scrutinising planning strategies, plans and proposals, and implement the recommendations set out in Planning Healthier Places (Ross and Chang 2013)
  • consider employing accessibility criteria in planning policy (for example, ensuring that new homes should be within specific distances from bus stops and ‘walkable’ distances from local shopping centres)
  • be aware of how different planning decisions affect take-up of services, by carrying out robust health impact assessments. For example, recent evidence (Audrey et al 2012) shows that initiatives such as free swimming, while being attractive to more disadvantaged residents, were not taken up as anticipated because the distance between people’s homes and the pools proved much more of a disincentive than it was for wealthier residents.

The business case for different interventions

It is hard to accurately measure the economic impacts of better spatial planning. However, exploratory work for the National Institute for Health and Care Excellence (NICE) (Gray et al 2010) suggests that the benefits of undertaking high-quality, comprehensive spatial planning significantly outweigh the costs.

NICE modelled whether high-standard spatial planning for areas such as improving walking and cycling infrastructure and retrofitting local homes with insulation were worthwhile in terms of outcomes. In both cases, outcomes significantly outweighed costs, by 60:1 for walking, 168:1 for cycling, and 50:1 for insulating local homes.

Further resources and case studies

Key resources to help local authorities ensure that spatial planning contributes to improvements in public health are detailed below.

  • Planning Healthier Places (Ross and Chang 2013) sets out the latest policy context and case studies showing how planners are ‘designing in health’ in communities.
  • The Spatial Planning and Health Group has produced Steps to Healthy Planning: Proposals for action, which sets out 12 action points to help local authorities integrate health and planning strategies (Spatial Planning and Health Group 2011).
  • ‘Land use planning and health and well-being’, provides a good academic review of the impact of land-use planning on health outcomes (Barton 2009).
  • Reuniting Health with Planning: Healthier homes, healthier communities is an up-to-date handbook produced by the Town and Country Planning Association. It includes case studies from Bristol, Gateshead, Knowsley, Lincolnshire, Luton and Sandwell, showing how spatial planning can improve health through integrated analysis, partnership working, and engagement with communities (Ross and Chang 2012).
  • Spatial Planning for Health: A guide to embedding the Joint Strategic Needs Assessment in spatial planning emphasises that spatial planning should take local JSNAs into account (Chang et al 2010).
  • Spatial Planning & Health: Identifying barriers & facilitators to the integration of health into planning, is a review, commissioned by NICE, of how the spatial planning system incorporates health and wellbeing effectively in its processes (Gray et al 2010). It includes 10 local authority case studies, plus NICE’s collation of evidence and reviews on the role of planning and health (National Institute for Health and Care Excellence 2013).
  • The former NHS London’s Healthy Urban Development Unit includes the Health and Urban Planning Toolkit (NHS London Healthy Urban Development Unit 2013). Although it was designed for boroughs and primary care trusts (PCTs) working together, it is still highly relevant despite recent organisational changes to the NHS.
  • The University of the West of England’s WHO Collaborating Centre for Healthy Cities researches and disseminates evidence and best practice, and offers short courses on designing and planning healthy urban environments (University of the West of England 2013).

For references please see Improving the public's health: references appendix

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