Policy and intervention briefings

Ambient air pollution is a major public health concern. It has prompted novel policy interventions, in the UK and beyond, notably in the form of Low Emission Zone (LEZ) and Ultra-Low Emission Zone (ULEZ) schemes. This policy brief explores the impact of these schemes on physical health and mental well-being, using large survey and administrative data covering the whole of England.

Action in a wide range of policy areas outside of the healthcare system has the potential to have significant benefits for the health of the population. One example is the development of urban spaces, where a wide range of factors such as housing density, air quality, and cycling and walking infrastructure can protect, improve, or damage public health.

Currently however, policies shaping urban development in the United Kingdom (UK) are not delivering healthy places to work and live. In centralised systems like the UK, national government policy sets the context that urban development takes places in at the local level.

The need and potential for urban development and planning to combat the rise in non-communicable diseases (NCDs) such as obesity, hypertension, diabetes and mental depression and spatial health inequities, is clear. In the system of English devolved subnational governance, local planning authorities have substantial powers to control and influence the location, use, height, form, and density of development and the deployment of real estate investment capital in cities.

Reducing health inequalities requires upstream interventions to tackle the wider determinants of health. Wider determinants of health include things like education, employment and the places that we live and work.

The government’s 2022 Levelling Up White Paper set out an ambitious plan to reduce inequalities in the United Kingdom (UK). It includes 12 ‘missions’ through which this will be achieved.

Tackling complex health problems requires joined up cross-sector working between stakeholders with diverse objectives. Evidence is one tool that can be used to bring stakeholders together and to influence decision-making processes. However, the challenge of using evidence to persuade policy actors to think more about health is enhanced when working in a complex system with multiple stakeholder groups with different priorities, preferences, values and skills.

Examining how value is considered and placed in the decision making process for urban development reveals who shapes the rationale. Where is the influence and how does this affect urban development? What does this mean for health in decision making processes?

The design and quality of city development can have a positive impact on the health, wellbeing and opportunities for communities.

Current development and planning policies are not managed in a way to address and promote health issues and inequalities. Non-communicable diseases such as diabetes, heart disease or asthma account for 89 per cent of deaths in England and ill-health among working-age people is estimated to cost £150 billion a year.

Built and natural environments affect our physical and mental health. However, urban development can result in towns and cities that do not support good health and wellbeing: homes may be of poor quality; greenspaces may be insufficient; cars may dominate with limited infrastructure to support walking and cycling; and social infrastructure, such as community centres or health centres, may not meet the needs of the local community.

Non-communicable diseases such as diabetes, heart disease or asthma account for 89 per cent of deaths in England and ill-health among working-age people is estimated to cost £150 billion a year.

One way to improve and protect public health and reduce this economic burden is through the design and quality of city development. However, current development and planning policies are not managed in a way to address and promote
health issues.

Non-communicable diseases such as diabetes, heart disease or asthma account for 89 per cent of deaths in England and ill-health among working-age people is estimated to cost £150 billion a year.

One way to improve and protect public health and reduce this economic burden is through the design and quality of city development. However, current development and planning policies are not managed in a way to address and promote
health issues.

The meaningful consideration of health has been consistently low across the different elements of the urban development decision-making system. This encompasses both public and private sector, operating from the national to local levels.

While actions have been taken in the past to facilitate or encourage the consideration of health, they are often aimed at specific actors, domains, processes or otherwise bounded fragments of the larger system.

‘Lay knowledge’ – that is knowledge and understanding held by lay public/s based on their subjective experience – has attained new prominence as a form of evidence for public health in
the UK during recent decades. Collecting and sharing lay knowledge can illuminate the social determinants – that is the conditions in which people are born, grow, live, work, play and age – as well as structural processes which impact on health and lead to health inequalities.

The use of economic valuation approaches in measuring, and accounting for, non-market environmental and social “goods and services,” including human health outcomes, has a substantial history. However, its integration into mainstream decision-making has been slow for a number of reasons, not least the considerable challenge of quantifying intangible aspects of health in welfare terms.

Interest in the building blocks of health is increasingly focused on the role and contribution of spatial planning. The evidence is becoming clear about the effect of policy interventions in the built and natural environment on population health. Achieving healthy places requires planning processes and decisionmakers to proactively consider health and wellbeing.

Senior real estate industry professionals make clear the complex web of decision-makers involved in creating and recreating cityscapes both in the UK and worldwide. The specific objectives of a diverse range of domestic and international UK investor, shareholder, land and property owner, landlord, tenant, and public authority clients they advise and support, are vitally shaped by financial drivers and constraints that are reflected in the built form, environment, and healthiness of urban places.

Digital tools are increasingly used in urban planning for engaging the public in early-stage discussions and formal consultations in their local area. Investment in digital tools by
both national and local government growing apace. We want to examine how involvement of the public in urban planning and development, particularly those facing health inequalities, can be made more meaningful.

The impact of the urban environment on public health is well researched, yet using this knowledge to implements changes in practice is less so. We know that the ability to walk and cycle, the effect of traffic noise and pollution, access to public transport and location of trees and green spaces all impact population health. Translating that into on-the-ground change requires joined up and concerted effort, overcoming political, economic and organisational challenges. Several of the challenges may be most relevant at the scale of a metropolitan area.

Local government urban planners can lack legal capacity to promote healthy urban developments. This means, for example,they can lack confidence, resource or knowledge that would help them use the law to promote health; to reduce the risks of noncommunicable diseases (including poor mental health) and reduce health inequalities. This lack of capacity undermines their ability to effectively incorporate health into decisions about individual applications and ensure that health is given due weight in urban decision making.

When speaking to decision-makers in urban development, they make two things clear: one, current thinking around urban development and how it is practiced is not well suited to respond to complex issues such as climate change and health crises; and two, very few people feel they have sufficient power to be able to bring health and health equity more centrally into their own professional practice.