Health Challenge Wales Seminar 10 Supporting the implementation of a healthy urban planning approach

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Health Challenge Wales Seminar 10 Supporting
the implementation of a healthy urban planning
approach at a local level progress and
challenges Professor Stephen MonaghanPublic
Health Director, Cardiff LHB Consultant in
Public Health Medicine, NPHS Honorary
Professor, UWIC.Susan TonerPrincipal Health
Promotion Specialist, NPHS
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Structure

• Obesity and our obesogenic environment
• Towards a Healthy City
• The WHO Healthy Cities Programme
• Healthy urban planning
• Challenges

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Most modern health problems and diseases are

• Problems of maladaptation between human biology
  and the modern environment

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Maladaptation

• (Genetic) Evolution to adapt to the environment
• glacially slow
• Change in human environment
• now v. fast
• Humans adapted for
• scarce food environments
• for physical activity as way of life to get food
• Humans hard wired to eat
• and for this to be pleasurable set as default
  state
• Satiation is the only protective mechanism
• tricked by empty calories high sugar foods

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Given most modern health problems and diseases
are problems of maladaptation to modern
environment

• Then if we truly want to tackle them
• have to consider changing the environment
• Economic, social, physical
• not just treating human biology consequences
• not just educating/informing people re choices

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Obesity

• Trends
• Health consequences
• Mortality
• Financial costs
• Issues are well known and will not be covered here

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What is the explanation?

• What in particular has changed in recent years to
  potentially explain the rise?

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Foresight Report 2007
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Foresight Report 2007
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Genetics / Biology?

• Our genetics have not changed
• in fact they cant (naturally) change this fast
• evolution too slow
• Sure, the gene pool has changed (only) slightly
  via immigration
• But population obesity rising globally
• Changes in population obesity are not explained
  by intrinsic biological factors

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Causes of obesity

• Causes of obesity are complex and the Foresight
  Report summarises
• Technology
• The built environment
• Opportunities for physical activity
• Food and drink availability
• The price of food and drink
• Food marketing
• Purchasing capacity and impact on eating patterns
• Impact of working practices

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It appears that it is the external environment
which is changing

• .and our adaptive response is making us fat

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Can a city make you fat?

• How can a city change its environment to help
  prevent its people not to be obese?

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WHO Healthy Cities

• The original idea was that between four and six
  cities would develop local action plans for
  health promotion based on Health for All
  principles. Within a short time, the project had
  all but been eclipsed by a world-wide movement of
  city-based public health initiatives
• In one sense the Healthy Cities Project was a
  new initiative, in another it was the Health of
  Towns Association of Exeter 1844 rebornthe
  challenge to us is to pick up where Chadwicks
  thinking left off 100 years ago (John Ashton
  1992)

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Origins

• Sir Edwin Chadwick
• Health of Towns Association of Exeter 1844
• British Public Health Act 1848

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The Healthy Cities Approachvision, principles
methods

• Post modern movement is ecological
  environmental focus on positive subjective
  health
• Requires adoption of WHO Health for All
  principles
• Seeks to put health high on the political
  social agenda of cities to build a strong
  movement for public health at the local level
• Strong emphasis is given to equity, partnerships,
  action to address the determinants of health
  adapting to new challenges

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Healthy Cities Projects

• Launched in Lisbon in 1986 by 21 European cities
  78 designated cities in Phase IV (2003
  2008)
• As well as designated cities, over 1,200
  cities towns from more than 30 countries in WHO
  European region involved

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Four elements for action

• Explicit political commitment at the highest
  level to the principles strategies of the
  Healthy Cities project
• Establishment of new organisational
  structures/infrastructure to manage change (or a
  focus for existing structures)
• Commitment to developing a shared vision for the
  city, with a health development plan work on
  specific themes (products outcomes)
• Investment in formal informal networking
  co-operation

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Some tangibles of Healthy Cities

• Cities are becoming more assertive in the domain
  of public health Council leaders are leading by
  example
• A range of action has been planned implemented
  in participating cities across Europe
• Almost one-third of Healthy Cities had a high
  level of activity on Healthy Urban Planning in
  2006 07
• Over 50 of Healthy Cities had undertaken Health
  Impact Assessments in 2006 - 07

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Phase V themes (2009 2013)

• Caring and supportive environments
• Healthy Living
• Healthy urban environment and design
• Overarching theme
• Health and health equity in all local policies

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WHO Healthy Cities

• Cardiff an applicant city
• Application also for an all Wales Network of
  Healthy Cities / Healthy Towns
• Obesity proposed as a unifying theme -
• incorporating healthy urban planning as a major
  element (alongside physical activity, food, work
  place health and weight management)

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Progress and next steps

• Application form now available
• Executive strategic level group considering the
  elements of the application reporting to the
  Vision Forum and Cardiff Health Alliance
• Progress to date
• formal Expression of Interest letter sent from
  Leader of Cardiff Council to WHO Healthy Cities
  lead in Copenhagen
• regular engagement with WHO and the UK and
  Ireland Healthy Cities Network
• commitment to achieving WHO Healthy City status
  and implementing a programme included in Proud
  Capital (the Community Plan), the HSCWB Strategy
  and the CYPP
• scoping exercise undertaken to map existing work
  across the core themes
• Develop a Healthy Weight Strategic Framework
  that incorporates city design and healthy urban
  planning

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THE URBAN ENVIRONMENT

• AND HEALTH

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Lifestyle access to physical activity
opportunities Community facilitate social
cohesion and inclusion Economy access to
work Activities access to schooling, healthcare,
open space, healthy food, social and retail
facilities Built environment quality of housing
and safety of the environment Natural
environment air and water quality Global
ecosystem reduce emissions and threats from
climate change
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• Urban planning
• Makes decision about the use and development of
  land and buildings in cities
• Quality of the environment and the nature of the
  development are major determinants of health

• Health
• Shifting to social model of health
  socioeconomic, cultural and environmental
  factors, housing conditions, employment and
  community
• Is an important stimulus to economic productivity

• Links between health and urban planning
• Lifestyle and household decisions shape health,
  but these decisions are constrained by the
  economic and social opportunities, income,
  education and quality of the environment
  experienced by the households members
• Urban plans are prepared for physical
  development, but the goals of these plans are
  essentially social

Barton and Tsourou 2000
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HEALTHY URBAN PLANNING

• Involves planning practices that promote health
  and well-being and has much in common with the
  principles of sustainable development
• Focuses on humans and how they use their
  environments rather than concentrating on
  buildings and economics

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Healthy Urban Planning

• Garden CitiesPublished in 1898, Tomorrow A
  peaceful path to Real Reform which was
  republished in 1902 as Garden Cities of
  Tomorrow By Ebenezer Howard

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Communitarian and Feminist Neighborhood Schemes
Letchworth Garden City, 1909-13
Homesgarth, or Letchworth cooperative houses, A C
Lander, 1913, architect
Source Hayden D. 1981. The Grand Domestic
Revolution. Cambridge, MA MIT Press, pp.234-5
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The WHO Healthy Urban Planning (HUP) initiative

• Origins the healthy cities network identifies
  the issue in mid 1990s
• Stage 1 1998-2000 Academics and practitioners
  work together on the WHO guide to HUP
• Stage 2 2001-2003 City Action Group on HUP, 11
  cities learning from each other
• Stage 3 2004-2008 HUP is a core theme for
  Phase 4 of the Healthy Cities movement
• Stage 4 2009-2013 Healthy urban environment
  and design continues as a theme for Phase 5

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Local implementation

• Partnership approach with local authority (Health
  Partnership Team, Strategic Planning, lead for
  the LDP Environmental Health)
• Incorporated health indicators into the Strategic
  Environmental Assessment of the LDP
• Healthy Urban Planning Workshop, led by Hugh
  Barton and Marcus Grant from the WHO
  Collaborating Centre for Healthy Cities and Urban
  Policy (University of the West of England), in
  December 2008

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Local implementation (continued)

• Action plan developed following the workshop
• Key action achieved - influenced the LDP by using
  the Watch Out for Health tool developed by the
  NHS London Healthy Urban Development Unit

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Self Appraisal Matrix Watch Out for Health
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Local implementation (continued)

• Other actions in the plan
• Identify/appoint a healthy urban planning
  champion within the Planning Dept
• Access training (free module within the Spatial
  Planning Course available from UWE)
• Engage with transport colleagues
• Strengthen design guidance on usable open space

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Next steps

• Co-ordinate and deliver actions within the action
  plan
• Review and revise action plan (eg add in use of
  already completed walkability score)
• Incorporate actions into WHO Healthy Cities
  Programme and the Healthy Weight Strategic
  Framework
• Raise the profile of the approach
• Link with WHO Healthy Cities networks
• Identify research opportunities