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Working on well-being
Planning – 3 December 2010

Planners and health professionals are likely to be working in closer conjunction now that councils must lead the way in promoting public health, Mark Smulian predicts

Local authorities now have a role in promoting strategies to tackle rising obesity Planners and health professionals are likely to be working more closely now that councils must lead the way in promoting public health.

Local government planners will soon have some new colleagues bringing their expertise to bear on the evidence base used for setting new directions for communities. For those who missed the finer points of this summer's health white paper, the present system of primary care trusts (PCTs) in each area will be dismantled and the bulk of health care commissioning handed over to groups of doctors.

This shakeout has left no obvious home within the NHS for the PCTs' responsibility to promote public health, so it will move to local government. With it will come a grant that will be one of the few sources of local government finance to remain ring-fenced for spending on a specific purpose. But why does this concern town hall planners?

While promoting better health through strategic planning and individual decisions ought to be part of council planners' work anyway, public health will suddenly become one of their employers' most high-profile responsibilities and the pressure to take account of its demands will surely grow. Planners and public health professionals are already working closely in some places, but this has been driven mainly by individual enthusiasm. The two professions in general know little about what the other does.

Last month, The Town and Country Planning Association (TCPA) published a guide on spatial planning and health in a bid to bridge this gap. Its sub-title refers to the joint strategic needs assessments (JSNAs) that have been carried out in each area by councils and PCTs to provide an evidence base for "the health and well-being needs and inequalities of the local population to inform and enable local services to plan in accordance with locally agreed priorities".

This may sound like jargon, but "inequalities" is a constant refrain in public health. Practitioners seek a levelling up so those who are poorer, less well educated and reside in less desirable environments do not continue to have such noticeably worse health than their wealthier counterparts. The TCPA illustrates the effects of health inequality with a map of the London Borough of Brent showing an average male life expectancy of 70 to 71 in impoverished Harlesden and 80 to 81 just 6km away in salubrious South Kenton.

It's a deplorable gap, certainly. But if planners want to tackle health inequalities, are there any tools at their disposal? "We thought that town planners did not have the powers they needed for this, but when we researched the project we found them scattered across various planning policy statements, in particular PPS1. It's all there," says TCPA planning policy officer Michael Chang. "The health sector needs to work with planners to inform their decisions around creating places in ways that improve health. That includes housing, the spatial environment and how people access services and food, for example," Chang adds. Such powers should, he says, "give confidence to planners to use health evidence to back up their decisions and judgements".

Health data provides application evidence

Local JSNAs will be the most immediate evidence for most, providing data that planners have no ready means of finding for themselves says. "The health sector is looking to planning to recognise that both policy and decisions on applications can have a positive impact on health outcomes," says Wakefield Council spatial policy manager Neville Ford. Wakefield's JSNA has informed policy across all council departments for two years.

Health problems tend to be concentrated geographically, so awareness of them may arm planners with the evidence they need to secure section 106 contributions to make improvements. Ford recommends that planners get involved in the JSNA process and use its findings on initiatives such as providing recreational facilities and encouraging people to walk or cycle rather than drive. "It may even be only at the margin, but good-quality environments can help the public to be both more active and safer," he reasons.

Yet despite such recognition, Wakefield's JSNA and local development framework (LDF) were produced to different timetables with little overlap. "Planners were not fully involved in the JSNA. I hope we will be in future because this is evidence we need for the LDF," says Ford. "JSNAs will be important because they provide data planners cannot easily collect themselves. If public health officials have collected it we should use it."

He adds: "I don't think that dealing with spatial planning was a priority for our PCT. But it is a large organisation that has been through a lot of changes, so perhaps you can see why we struggled to get proper engagement. With public health coming into councils, we will be working with the people responsible for its promotion."

Council joint working produces benefits

At Sandwell Metropolitan Borough Council in the West Midlands, one result of joint working with public health officials over the past two years has been a supplementary planning document to control the spread of takeaways. Sandwell also has an intelligence project to draw together data held by the council, the NHS and the police. "There will then be a more centralised focus on these issues to direct resources where they are needed", predicts senior planner Alan Goodman.

"We haven't yet used a lot of health evidence in planning, except for location of services in making sure that doctors' surgeries and health centres are accessible," he acknowledges. "This borough hits all the indices of deprivation so things like lack of exercise, obesity and lack of jobs are what we tackle. The JSNA did not add a great deal, but once public health is part of local authorities there will be better integration."

Goodman's counterpart at Sandwell PCT, public health development manager Paul Southon, notes that planners may not be aware of the review of health inequalities carried out by Sir Michael Marmot last year. This produced a set of six priority objectives, one of which is the creation of healthy environments and places. "That includes physical activity, housing and access to fresh food. You need the spatial aspect to make those things happen. Health impacts need to be built into plans from day one," says Southon.

He agrees that integration of public health responsibility into councils will make it easier for health professionals to work with planners. "The majority of things that affect health rest with councils in education, employment and exercise. By the time cases get to the health service, there is a limited amount it can do," he says.

Health will become a more central concern to planners than at any time since the slum clearance drive of the post-war years. As TCPA chief executive Kate Henderson puts it: "Public health responsibilities will place local authorities at the forefront of delivering the long term well-being of our communities."

Fast food targeted

Sandwell Metropolitan Borough Council has already used evidence provided by public health services to draw up a supplementary planning document on takeaways. Their proliferation is seen as damaging drives to counter obesity, particularly among children.

Last year the London Borough of Waltham Forest became the first local authority to ban fast food outlets from opening within 400m of schools, leisure centres and parks. This planning stipulation was backed up by a drive to improve the quality of school meals.

In the following year, Waltham Forest rejected all five applications received and the number of outlets in the borough fell from 253 to 241. The council has had enquiries from 15 other local authorities about the policy. Many are concerned about the effectiveness of planning controls to limit takeaways.

"There is a particular issue here of permissions for fast food outlets close to schools and we will have to deal with that," says Wakefield Council spatial policy manager Neville Ford. "We are starting to use health impacts as a material consideration when operators apply for planning permission. But there are not many places where the issues are as clear cut as they are near to a school."

Bridging the divide

Catherine Gregson, deputy regional director for health development at the East of England Public Health and Social Care Directorate, has initiated work with planners across Suffolk to improve understanding of each profession.

"Public health people don't know a great deal about planning and would not know how planners go about creating a new community, but hopefully there are areas where we can contribute. It may be that there are already links at a strategic level when a big application needs health input, but this is about making sure there are good-quality environments and better quality of life by bringing together the two professions," says Gregson.

"We know that access to green space and views over it encourage good mental health, as does making sure that in a new community people are not isolated. When the new town of Cambourne was built in Cambridgeshire mental health issues were raised because the infrastructure isolated people."

Gregson suggests that health professionals could be involved in design evaluations, extending beyond obesity prevention into less predictable medical areas. Air pollution is another field where she feels planners might benefit from more health input. "Once public health moves within local government there will be new opportunities because people will be working next to each other," she concludes.