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Planning for healthier places
Health Service Journal – 13 January 2011

How will health and council planners work together, asks Mark Smulian

Local authority planning services have probably rarely impinged on public health professionals. But the transfer of public health work from the NHS to local councils, proposed by the government in the Liberating the NHS white paper, brings see new opportunities for integration.

"Planning" is more than arguments over householders' loft extensions - it goes far wider into spatial planning, transport, open space, measures to encourage walking and cycling and the siting of polluting processes.

There are essentially two parts to local planning: development control, which decides on applications for new or altered buildings, and spatial planning, which deals with a council's policy on what may be built where.

The Town and Country Planning Association, a charity that promotes sustainable development, published Spatial Planning for Health in November. It suggested that planners could use joint strategic needs assessments as part of their evidence base of health inequalities "to inform and enable local services to plan in accordance with locally agreed priorities".

The association's planning policy officer, Michael Chang, says planners have all the powers they need to "use health evidence to back up their decisions and judgements", although these powers are inconveniently scattered across several government planning policy statements.

At Sandwell Metropolitan Borough Council there has been collaboration with public health for two years, with one result being a change in planning policy that will control the spread of fast food takeaways.

Sandwell primary care trust public health development manager Paul Southon says: "One of the Marmot review's priorities was the creation of healthy environments and places. That includes physical activity, housing and access to fresh food, and you need the spatial planning aspect to make those things happen."

Planning can be a powerful tool in improving health. For example, in 2009 Waltham Forest in London became the first local authority to use its planning powers to ban fast food outlets from opening within 400m of schools, leisure centres and parks.

Clearer relationship

Alison Kiloran, a public health analyst at the National Institute for Health and Clinical Excellence, who contributed to Spatial Planning for Health, says: "What will be important will be public health recognising that aspects of the built environment such as urban design, transport and open space influence health, both indirectly in opportunities to engage in healthy lifestyles and directly in issues like reducing road traffic accident injuries and pollution."

But she says there is a lack of understanding between the two professions. "The two professions do not talk the same language," she says. "Public health moving into local government will provide opportunities to have a clearer relationship."

She cites those joint assessments that include geographical mapping, which could open opportunities to consider how spatial planning policy might lessen health inequalities in deprived areas.

John Pounder, technical director of planning at consultancy Colin Buchanan, cites Plymouth as an example of public health and planning working together.

"Because public health is a corporate priority of the local strategic partnership, it comes right from the top and there is a downward pressure on officers to work together," he says.

But such places are exceptions. Planners may be used, for example, to promoting walking and cycling to reduce car traffic, "but they would not normally argue that on health grounds too, and planners will need their public health colleagues to give them the data," Mr Pounder says.

A joint planning and public health conference in the North East in November showed some opportunities.

David Marshall, of the Spatial Synergy consultancy, who was one of the organisers, gives the example of how planning and public health could both gain from less "school run" traffic.

"Changing perceptions of the school run has a double benefit: lower traffic volumes and fitter children," he says.

The two professions know little of each other's work as yet, but both have plenty to gain from integrating their expertise at local level.