Delivering Health through Spatial Planning

1
Delivering Health through Spatial Planning

• Paul Tomlinson
• Associate, Scott Wilson
• Birmingham

2
Introduction

• Policy drivers
• Health in SEA and EIA
• Challenges

3
EU Thematic Strategy on Urban Environment

• A high quality and healthy urban environment is
  unlikely to emerge spontaneously
• Integrated decision making across authorities and
  administrative units
• Cultural changes towards public involvement,
  transparency and accountability
• Integrated management with environmental targets
  and monitoring

4
EU Health Strategy, 2004

• The EU must empower citizens to make healthy
  choices and involve them in policy-making from
  the start.
• If the EU is to help its citizens achieve good
  health, it must address the behavioural, social
  and environmental factors that determine health.
  This involves understanding better how different
  issues and policies affect health.

5
EU Health Strategy, 2004

• We need to ensure that health is at the very
  heart of policy making at regional, national and
  EU level. We need to promote health through all
  policies.
• Policy measures as different as inner city
  development, regional transport infrastructure,
  applied research, air pollution, or international
  trade must take health into account.

6
Health Policy

• Acheson Report 1998
• Wanless Report 2002
• RCEP, 2007
• Foresight Report 2007

7
Health Policy

• Saving Lives Our Healthier Nation 1999
• Local authorities given clear remit to work in
  partnership with the NHS
• Local decision-makers instructed to consider the
  effect of their policies on health and how they
  can reduce health inequality
• Encourage all local agencies to make local health
  impact assessments when planning investments

8
Health Policy

• Shifting the Balance of Power 2002
• Tackling the determinants of health both within
  the PCT role and through Regional Directors of
  Public Health alongside Government Offices for
  the Regions
• Directors of Public Health to forge partnerships
  with, and influence, all local agencies

9
Health Policy

• Tackling Health Inequalities A Programme for
  Action 2003
• Closer links between the NHS and local government
  identified as crucial in delivering the agenda

10
Health Policy

• Delivering Choosing Health Making Healthier
  Choices Easier, 2005
• Shared priorities include
• creating safer and stronger communities
• improving the quality of life of older people and
  children, young people and families at risk
• promoting healthier communities and narrowing
  health inequalities
• promoting the economic viability of localities
  and getting people back into work
• transforming the local environment

11
Health Policy

• Guidance on Joint Strategic Needs Assessment,
  2007
• sets out the future health and social care needs
• to be taken into account in the Sustainable
  Community Strategy
• local development plans, regeneration strategies
  and housing strategies should be linked with the
  JSNA

12
Sustainable Development Policy

• A Better Quality of Life - Strategy for
  Sustainable Development, 1999
• Address causes of ill health and secure healthier
  life spans
• Sustainable development and health strategies
  must reinforce each other

13
Sustainable Development

• Strong and Prosperous Communities 2006
• Duty to co-operate on Local Area Agreement
  targets
• Local authorities to deliver a commissioning
  role

14
Sustainable Development Policy

• Creating Strong, Safe and Prosperous Communities
  Statutory Guidance 2008
• broadening remit of local government to respond
  to public health, climate change and demographic
  fluctuations
• Sustainable Community Strategy to address health

15
Planning Policy

• PPS 1 Delivering Sustainable Communities 2005
  Para 13
• Regional planning bodies and local planning
  authorities are to ensure that development plans
  promote outcomes in which environmental, economic
  and social objectives are achieved together over
  time
• Development plans should also contain clear,
  comprehensive and inclusive access policies in
  terms of both location and external physical
  access. Such policies should consider peoples
  diverse needs and aim to break down unnecessary
  barriers and exclusions in a manner that benefits
  the entire community

16
Planning Policy

• PPS 1 Delivering Sustainable Communities 2005
  Para 16
• promote development that creates socially
  inclusive communities
• ensure that the impact of development on the
  social fabric of communities is considered and
  taken into account
• seek to reduce social inequalities
• address accessibility (both in terms of location
  and physical access) for all members of the
  community to jobs, health, housing, education,
  shops, leisure and community facilities

17
Planning Policy

• PPS 1 Delivering Sustainable Communities 2005
  Para 16
• take into account the needs of all the community,
  including particular requirements relating to
  age, sex, ethnic background, religion, disability
  or income
• deliver safe, healthy and attractive places to
  live and,
• support the promotion of health and well being by
  making provision for physical activity

18
Planning Policy

• PPS11 Regional Spatial Planning, 2004
• Local Health authorities, NHS and HSE are to be
  consulted
• Planning Policy Statement 12 Local Spatial
  Planning 2008
• Provision of health facilities, green
  infrastructure and consultation with the
  strategic health authority.
• Planning and health strategies/processes must be
  aligned

19
Planning Policy

• PPS23 Planning and Pollution
• Health can be a material planning consideration
• Detailed consideration of any health effects
  arising from processes or emissions themselves is
  a matter for the pollution control authorities
• Health consequences of potentially polluting
  development to be reported within the local
  development documents

20
Policy Context

• Partnerships needed between local authorities and
  PCTs
• Impact of policies on health should be assessed
• Health inequalities to be reduced
• Health and sustainable development reinforce each
  other
• JSNA to be considered in Sustainable Community
  Strategy
• LDF Core Strategy to align with Sustainable
  Community Strategy
• Planners have a duty to exercise their functions
  with a view to contributing to the achievement of
  sustainable development
• Planning and health strategies and processes must
  be aligned

21
Health within SEA

• Public health professionals should help test the
  plan, forecast the health effects and propose
  mitigation
• PCTs should co-ordinate the response from local
  NHS Trusts and Foundation Trusts
• Public health organisations to contribute to
  monitoring health impacts

22
EIA Regulations in England

• Health is not referred to explicitly instead the
  regulations refer to the affects on population
  or humans.
• A focus on the health impacts due to the
  environmental risks to health.
• Although a need to consider nuisance exists there
  is no explicit definition of health or reference
  to the wider social determinants of health and
  well-being.

23
Challenges

• Ageing population
• Health spend cant match demand
• Climate change
• Increase in disease vectors, extreme weather
  events, urban environment not designed for very
  wet weather, or very warm weather
• Housing/development demand
• Migration of population
• Changing health services
• Community based services
• Centralised hospital facilities
• Telemedicine

24
Challenges
Adapted from Dahlgren Whitehead 1991
25
Challenges

• Limited consultations
• Planners rarely seek advice from health sector
  instead focus on statutory responsibilities
  noise, air pollution, contaminated land, odours,
  waste issues and water quality. Things outside
  the enforcement remit are rarely commented
  upon.
• Timely and meaningful advice on health
• Differing needs of forward planning and
  development control
• Local Strategic Partnerships (LSPs)
• Seen as having a key role in integrating health
  into planning but are they?

26
Challenges

• Helping planners developers to address health
  inequalities
• Converting health data into knowledge
• Tools to evaluate health impacts
• Planners can help with NHS Good Corporate
  Citizenship

27
RTPI Response

• RTPI calls upon allied professional institutions,
  the NHS and the responsible Government
  departments to make a commitment towards improved
  consideration of the health agenda.
• While the RTPI supports the systematic and
  rigorous consideration of health issues in
  planning decisions, such consideration ought to
  take place within a system of integrated
  assessment, building on EIA,SEA and SA rather
  than creating a new layer of health impact
  assessment.

28
Delivering Health through Spatial Planning

• Paul.Tomlinson_at_scottwilson.com
• Tel [phone]
• Mob [phone]