Briefings and submissions

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.

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.