First, today’s health problems are radically different from those of the last century. Addressing them requires a different approach from councils, developers, communities, and health care providers – and close collaboration between them all. Put simply, the acute illnesses that people tended to suffer from in the past could often be cured by a course of medicine or a short stay in hospital. Today a more typical patient might be an elderly widower, living alone, eating takeaways because he doesn’t know how to cook, suffering from diabetes and social isolation and becoming increasingly unfit and overweight. None of this can be ‘cured’ by a short course of pills – but social prescribing, such as encouraging him to join a cookery club for older men, could gradually improve his diet, get him out of his home and so increase his level of physical activity, and reduce his loneliness.
For planners, this means that the simple formulae that have been used until now to calculate the health care provision for a new place – for instance, the number of GPs required per 100,000 of population – are no longer adequate. Instead, planners, developers, communities and health care providers must collaborate at the earliest stages of planning a new place to ensure it is designed to make living a healthy life as easy as possible for all residents.
The second thing that the Healthy New Towns programme emphasised is the importance of focusing on the needs of people who have the poorest health in order to reduce health inequalities. For planners, this means working with colleagues in public health to understand specific local health priorities, and using this evidence to inform the council’s Local Plan, the framework that guides all development in the area.
Planners will need to think differently. For instance, cycle paths in new developments to facilitate active travel are now relatively common. But if these are only used by people who are already physically active, health inequalities will not be reduced. However, well-designed streets that enable someone who never leaves their home to go for a gentle stroll every day could be hugely beneficial to that person’s physical and mental health.
Another new challenge is to understand and try to improve the ‘food environment’, to ensure that fresh, healthier food be easily available, affordable and a normal part of everyday life. The Healthy New Towns programme suggests that planners should ensure that there are well-connected public spaces that could be used for street markets; that allotments and community gardens are provided close to new homes; that streets are planted with fruit trees; and that new school buildings are designed with attractive, spacious dining areas. It is also vital to ensure that kitchens in new homes are large enough for people to store and prepare fresh food and have a freezer. Homes built in England are some of the smallest in the world and, apart from in London, there are no statutory minimum space standards.
The lack of mandatory housing space standards is just one of the challenges that planners face in practice when trying to create healthier places. Although the Healthy New Towns programme provides useful new learning about 21st century health needs, much of what it recommends has been the essence of good planning for generations.
So why isn’t it happening? The reasons are complex. They include: weak policy and ‘optional’ built environment standards; wavering political will and – at heart – a deep-rooted ambivalence about the role of the state in shaping the places in which we live. The planning system is, too often, perceived to be a block on new development, rather than a democratic (and therefore imperfect) process of mediating between different demands to create places in which people can thrive. In 2018 the Town and Country Planning Association published the final report of the Raynsford Review, an 18-month inquiry into the English planning system that concluded it is no longer fit for purpose and needs re-thinking from first principles. In the context of such a dysfunctional planning system, high ambitions to plan healthier places can be undermined by multiple practical difficulties. The Town and Country Planning Association firmly believes that all new homes should be designed to support people’s health and wellbeing and has launched a campaign for a Healthy Homes Act.
If England is serious about planning healthier places, the state must play a stronger role. There must be a new set of built environment quality standards, informed by public health evidence, that are mandatory, not optional as is currently the case. In areas of low land value, where the private sector is unable or unwilling to develop good quality places, then the state will have to contribute, perhaps by taking a direct role in the development process.
The places we build today will be lived in for at least 100 years. If the state does not invest in ensuring they are good quality places that support communities to live healthy lives, then much of the cost of getting it wrong will be paid for, eventually, by the state itself in the form of the NHS.