By Dorothy Laing

“The environment in which we live, work and spend leisure time – both the physical nature of places and the social environment of communities – has an enormous impact on our health and wellbeing. Health problems such as obesity, chronic heart disease, stress and mental health issues are intricately linked to the environments in which people live and work”. (RTPI, 2014)

Earlier this month the RTPI published Promoting healthy cities: Why planning is critical to a healthy urban future, the third in a series of Planning Horizons papers launched to mark the RTPI’s centenary. The report looks at how planning can help to create healthy cities – one of its main arguments being that health and wellbeing need to be at the core of city design and development.

With a growing number of people living in urban areas, and health problems such obesity and diabetes on the rise, planning for healthy cities is vital. And interest in the links between planning and urban health is nothing new.

In the late 1800s the social reformer Octavia Hill was concerned with improving housing conditions and providing access to open spaces to improve urban wellbeing. And Ebenezer Howard’s 1898 garden city principles were based on the idea of holistically-planned settlements which enhance the natural environment and provide high-quality affordable housing and locally accessible jobs in beautiful, healthy and sociable communities.

Evidence of the association between where people live and health outcomes was highlighted in the findings of the 2010 Marmot Review which revealed a ‘social gradient’ in health: those living in the most deprived neighbourhoods die earlier and spend more time in ill health than those living in the least deprived neighbourhoods.

Marmot’s recommendations included that planning, transport, housing, environment and health systems should be fully integrated to address the social determinants of health.

The RTPI’s paper Promoting heathy cities looks at the impact of the urban environment on health focusing on the following key areas:

• Urban form and health

Low residential density development and low ‘connectivity’ are associated with less walking and more car travel according to US research, while recent research on urban form and density has shown that sprawl correlates with higher rates of obesity and physical inactivity.

• Access to healthcare

According to research, the location of healthcare facilities in urban environments is a key dimension of healthy cities and provision of accessible healthcare facilities in new developments crucial. The Bromley by Bow Centre in Tower Hamlets is cited as a good example of a local centre providing a range of accessible community services including healthcare.

• Housing

Poor quality housing is estimated to cost the NHS at least £760m and society £1.9 billion annually. The design as well as the quality and context of housing can affect health and wellbeing, and planners have a vital role in ensuring that quality housing is located in the right place with appropriate services nearby. Internal design is also important to health, particularly fuel efficiency and ventilation.

• Transport

Transport policies, and planning decisions over transport issues, can affect health and wellbeing. Traffic accidents, air pollution, stress related to travelling, access to services, and health problems caused by inactivity and isolation can all be linked to transport. A new law in Wales – Active Travel (Wales) Act 2013 – makes it a legal requirement for local authorities in Wales to map and plan routes for active travel. By connecting workplaces, hospitals, schools and shopping areas with active travel routes, its hoped that the Act will encourage people to rely less on their cars when making short journeys.

• Open space and green infrastructure

The health benefits of open space and green infrastructure in cities have been well documented, and in many cities opportunities to increase green spaces are evident through the increase in green roofs, green networks and urban parks. Green spaces and water features also have a role to play in reducing urban heat islands, which have a negative health impact.

• Urban agriculture and urban food

Access to healthy food and the cost of fresh food is also an important issue in cities. ‘Food deserts’ are a feature of some deprived neighbourhoods that lack supermarkets and local stores, and food poverty develops where there is lack of access to healthy food. Planning also has a role to play here – the Black Country Core Strategy incorporates a food accessibility standard, and Brighton and Hove has released a Planning Advice Note on how food growing can be incorporated in new developments.

The new RTPI report suggests that the urban health agenda should be part of a broader sustainable urbanisation agenda, and notes that in July 2014 a specific urban goal was included in the proposed Sustainable Development Goals (which will replace the current Millennium Development Goals from 2015). This aims to “make cities and human settlement inclusive, safe, resilient and sustainable”.

Finally, the report calls for:

• Intelligence – data to help people make good decisions using tools such as health impact assessments
• Institutions – planning and health organisations to work together to produce integrated strategies and promote healthy cities
• People – professionals and communities working together in planning for health

Integrated urban planning that places the wellbeing of communities at centre stage is paramount for the future health of people living and working in towns and cities. Projects like Glasgow’s Equally Well initiative, a partnership initiative involving Glasgow City, Council, the Glasgow Centre for Population Health and NHS Greater Glasgow and Clyde shows what can be done at the local level. However broader strategies at city level are needed if our increasingly urbanised population is to remain healthy.

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We’ve written other bogs on the relationship between health and planning:

• Healthy places, healthy people?
• Does where you live affect your wellbeing?

The Idox Information Service has a wealth of research reports, articles and case studies on planning issues. Some further recent reading on the topic includes:

The contribution of green and open space in public health and wellbeing. James Hutton Institute (2014)
Bridging to public health: using scenario planning in broader ways, IN Planning, Vol 80 No 9 Oct 2014, pp12-16
Planning for public health: building the local evidence base, IN Town and Country Planning, Vol 83 No 8 Aug 2014, pp341-347
Urban form, sustainability and health: the case of Greater Oslo, IN European Planning Studies, Vol 22 No 7 Jul 2014, pp1524-1543
Reuniting health with planning in Scotland: a TCPA scoping study. Town and Country Planning Association (TCPA) (2014)
Make cities fit for life (links between land use and health), IN RIBA Journal, No 121 No 2 Feb 2014, pp40-41

N.B. Abstracts and access to journal articles are only available to members of the Idox Information Service.