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Planners and health professionals: evidence-based practitioners

I recently presented to a national conference of med students on the topic of planning for health. This required me to think really clearly on what the most important message was and how to get it across without using planning jargon. Using terms that resonate with health experts and providing concrete reasons to engage is what planners need to do generally to overcome the current barriers to collaboration. This ended up being a very reflective process about the role and power of the planning system. It’s fairly easy to present what planners do in theory but the practice of actually delivering things on the ground is full of challenges and sometimes disappointments. The best place to start the discussion is where planners and doctors would look first: what does the evidence say?

A slide from my recent presentation showing how the built environment and planning affects health.

Public health professionals have a great deal of data about the health issues affecting people in a given local authority area. Some of this information is freely available on the web from sources like the Public Health Observatories. This data alone is no use unless you know which changes or improvements to the built environment will help address health issues. There is now a growing body of research demonstrating the health benefits of high quality places (including: housing, public space, transport, green space, and more). In reviewing a sampling of Joint Strategic Needs Assessments it is clear that public health professionals in local authorities have awareness of how planning can help create a health promoting environment. But the evidence that planners would need to deliver these changes on the ground goes beyond proof that a problem exists.

In many cases the changes required to improve health are about the wider determinants of health, which are linked to planning, including: housing; accessible/inclusive environments that promote active and social lifestyles; jobs; education; and, crime. Given the scale of new housing required in England there is significant opportunity to ensure that the homes and communities of the future will support our good health, rather than contribute to ill health. And this is where the challenge comes in. Planners know what good quality design looks like. They have the knowledge and skills to work with communities, design teams, and developers to bring about high quality homes and places. And in recent years they have had nationally available standards (such as the Code for Sustainable Homes) to ensure developers consistently follow through with agreements made before houses are built.

The Coalition government’s deregulatory approach will mean that planners cannot use some of these tools to push for high quality development. Even if they are allowed to require quality through a new set of national standards they will need to prove that it is necessary and would not affect the viability of housing developments. Furthermore, planners are having a difficult time negotiating added community benefits from developments due to viability arguments. This means that those public health professionals who until recently thought that planning could be a tool to address health needs by improving housing and the built environment will soon be disillusioned – unless we can build a financial case that proves that prioritising the short-term gains of a developer/land-owner will mean significant cost to the public purse in the medium to long-term. This could be done through the help of public health professionals who have the data and methodology to show the cost-effectiveness of specific spatial interventions.

Diagram from my recent presentation showing the links between the planning and health functions of local government in the UK.

In addition to cost evidence, planners could use evidence that shows the spatial variation of health issues across a local authority area. For example, it is useful to know where pockets of deprivation have health issues strongly associated with the wider determinants of health (see really interesting work from the University of Houston’s Community Design Resource Centre mentioned in the RTPI’s recent paper, see reference below). This information can help prioritise change and underline the argument for high quality regeneration. This is an exciting time with increasing recognition of the value of these two professions supporting each other to create healthier environments. There are challenges to overcome but there is also a growing group of specialists who understand the potential to increase wellbeing for everybody in society, not just those who can afford to live in the nicest places.

Resources:

I reviewed the Joint Strategic Needs Assessments for Knowsley, Sheffield  and Hackney as a random selection of background for this blog post.

Chang, M., Ross, A. ‘Planning Health Places – report from the reuniting health with planning project’, Town and Country Planning Association, 2013

Royal Town Planning Institute, Planning Horizons No.3, ‘Promoting Healthy Cities‘, October 2014

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Should we charge suburbanites for the privilege of abundant space?

Our preference for living in large houses with big yards and tree-lined streets is at direct odds with healthy lifestyles and a healthy planet. It’s well understood by planners that higher levels of density reduce car use and result in homes that are more carbon friendly, through energy efficient design and proximity to centralised energy grids. City dwellers benefit from an ‘urban health advantage’ and can integrate more exercise into their daily lives by commuting on foot or bike. Yet, urban areas have disadvantages, and many of those who have the means relocate to outlying suburbs to access cheaper housing and better schools. Harvard economist, Edward Glaeser, argues that national and local policies should ‘level the playing field’ for cities and starting charging suburbanites for their privileges.

Glaeser’s book, Triumph of the City: How our greatest invention makes us richer, smarter, greener, healthier and happier, examines the effect of policy on development and asserts that in America, government mortgage subsidies, land-use controls and NIMBYs have resulted in the middle-classes leaving cities. This isn’t a uniquely American problem as Glaeser reminds us: ‘Some have suggested that American sprawl represents an English cultural heritage that puts an outsize value on single-family detached houses and backyards’ (2011, p.178). English cities, principally London, suffer very similar fates to cities like New York – only the very wealthy or subsidised social housing tenants can afford to live in the centre of the city.

The Garden Cities movement seeks to bring together the benefits of urban and suburban living, but has not succeeded in making this model a modern norm. Garden Cities would provide affordable well-proportioned homes in walking distance to shops and offices. The 2014 Wolfson Economics Prize was focused on identifying modern conceptualisations of the movement that could help solve England’s housing crisis. The winners’ approach required developing on greenbelt land. This is a hugely contentious undertaking but one that deserves due consideration. Glaeser reminds us that building on greenfield land close to a city is better than creating a self-contained new community (such as the Prince of Wales’ Poundbury estate) detached from existing densely populated areas that can better support amenities and public transportation.

Glaeser claims that NIMBYs who oppose greenfield development often do so with the misguided notion that environmentalism underpins their decision, rather than a preference for the status quo. It was particularly interesting that he highlighted a fault in environmental impact reviews (or assessments in the EU) for not considering the damage to other parts of a county or wider region if the development in question is displaced from one site to another. This issue should be picked up well before the planning application stage in a local area’s development plans, but where these plans are incomplete or not spatially broad enough, the planning system fails to properly direct development toward the most sustainable sites in a region.

So, where development sprawls and homeowners take up the quintessential Western lifestyle choice to drive everywhere, who should pay the consequences? Glaeser argues: “People who like suburbs should be able to live there, but their choice should be based on the true costs and benefits of suburbanization” (2011, p.268). His solution is to develop a carbon tax that would require energy users to pay for the full costs of their actions. Of particular importance to Glaeser is that Westerners do not hypocritically expect India and China to develop any differently to our sprawling settlements if we cannot ourselves find a way to manage our environmental and social footprint.

Triumph of the City is an extremely thought-provoking book for planners and urbanists. Glaeser takes on sacred figures like Jane Jacobs and highly-regarded movements such as New Urbanism and points out their faults and oversights with evidenced clarity. Some of his interpretations are perhaps overly focused on the economics of places and people, at times overlooking the subtleties of place-making. But maybe his approach is just what we need where traditional town planning methods are not delivering communities that meet today’s global challenges.

Reference:
Glaeser, E., (2011) Triumph of the City: How our greatest invention makes us richer, smarter, greener, healthier and happier, New York, Penguin Books.

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Do standards achieve higher quality homes?

The jury is out in Britain about whether or not we should have standards for housing. This is because the current government is all about cutting red tape. The term ‘standard’ can be ambiguous. Depending on the context, ‘standards’ could mean principles of quality or requirements (as in ‘she has high standards when it comes to men’). Or ‘standards’ could be interpreted as quasi-regulations (as in ‘we could have avoided the horse meat scandal if we had tougher standards for the food supply chain’). According to Scott Steedman, Director of Standards at the British Standards Institute, BSI standards are about knowledge. They shouldn’t be interpreted as regulations, benchmarks or specifications. So if standards aren’t benchmarks and specifications do we need them to achieve decent quality homes? And if the answer is no, what do we need? Continue reading “Do standards achieve higher quality homes?”

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What do you want to lead for?

I’ve just finished reading a short book on leadership that I should have whizzed through in a week, but ended up reading over several months. Perhaps it’s the depressingly short winter days that were clouding my thinking, but I felt it incredibly difficult to answer the simplest question in the book, and supposedly the key to effective leadership: ‘What do you want to lead for?’

Continue reading “What do you want to lead for?”