The healthy roots of planning

by Claudia Carter

While too young to have witnessed the coal-ash smog years (though briefly experienced in Tuzla, Bosnia[i]) the issue of acid rain and air pollution was well-ingrained in my childhood years in Southern Germany, where aged 10 or so I was wondering how safe it was to eat my dad’s garden-grown tomatoes worrying about all the polluting particles that would have been absorbed and settled on them!  I washed and ate them in the end savouring their full flavour and sweetness.  Moving to the UK in the late 80s the political / environmental narratives slowly shifted to biodiversity, climate change and water/flooding, though in the past year or two air pollution has climbed back onto the political radar.  And so have health concerns more generally, with increased awareness and diagnostics of cancers, obesity, stress and mental health impacts of a fast-paced, fast-consumption society.

How much of UK planning seems to have forgotten its roots seems, however, astonishing!  Last week I attended a Royal Town Planning Institute (RTPI) West Midlands CPD event on ‘Planning and Health’ where the topic rightfully took centre-stage with a full room of planning practitioners and researchers absorbing the facts, figures and wide-ranging examples how health is and should be intrinsically connected with planning. 

Yet, neo-liberal politics and associated goals manifest in current planning and development have created hospitals, homes, neighbourhoods and city regions that are neither resilient to a changing climate nor fit for an ageing population, paying the price in many early deaths, poorer physical and mental health and less happy children.

Evidence was presented relating to macro and micro-level planning-health links, including work for/by the World Health Organisation (WHO), healthy and sustainable urban extensions, planning for marginalised / disadvantaged groups, and dementia-friendly environments.

Emeritus Professor Hugh Barton highlighted a range of health crises where planning and development decisions, characterised by ‘big development’ and car-based design, play a direct role.  The freedom of individual mobility and love of the (diesel) car has its almost invisible but very real consequences.  For example:

  • Annual premature deaths associated with air pollution in London are now greater than in the Great Smog of 1952.
  • Lack of physical activity and sugar and fat-rich foods leading to obesity are now widespread within the population, even amongst children.
  • Stress through exploitative or long-hour indoor jobs, noise and lack of relaxing activities in communal, healthy (nature-rich) settings have led to many physical and mental disabilities especially in socially and economically deprived populations.
  • According to a 2013 Unicef report, British children are amongst the least happy in Europe.
Figure 1: One of Hugh Barton’s figures to illustrate shared responsibility of planning in a pluralistic society. Source: Hugh Barton
Figure 1: One of Hugh Barton’s figures to illustrate shared responsibility of planning in a pluralistic society. Source: Hugh Barton

WHO identifies climate change as the biggest health concern, experienced through more extreme, i.e. higher intensity and frequency, weather events and associated direct and indirect impacts.  It is therefore somewhat astonishing that well-being oriented, ‘sustainable’ development seems the exception rather than the norm.  While in the 19th century health was the trigger for planning policies and the birth of the planning profession, by the 1990s most planning chief officers no longer saw health as a key ingredient of planning[ii].  This seems an oversight that has come at a huge social, environmental and economic cost.

Putting health back into the portfolio of city regions / local authorities across England offers great potential in helping shape healthy neighbourhoods and sustainable city redevelopment acknowledging shared responsibility in planning and development (see Figure 1).  There certainly does not seem a shortage of inspiration and examples from abroad looking at the planning approaches and developments in Freiburg, Copenhagen, Kuopio, Portland (Oregon) to name but a few[iii].

Dr Nicholas Falk, URBED, largely drew on Dutch examples to highlight what healthy communities look like, arguing that the Dutch offer advanced and effective solutions when it comes to housing and new successful settlements (pointing to France for transport; Germany for the economy; and Scandinavia for the environment).  Five useful principles, URBED’s 5 Cs, were used to help explain what made the new settlements healthy and successful places:

  • Connectivity (transport)
  • Community (neighbourhood management)
  • Climate proofing (environmental sustainability)
  • Character (design)
  • Collaboration (organisation and finance)
Figure 2: A multiple use school building at the heart of Houten community. Source: Nicholas Falk
Figure 2: A multiple use school building at the heart of Houten community. Source: Nicholas Falk

Connectivity was highlighted as the most crucial and fundamental principle.  Excellent access and travel between jobs and homes / recreation with rapid transit provisions and giving priorities to cyclists are key in enabling active, healthy and happy citizens.  A network of safe cycle routes is also crucial in allowing children to be ‘free’ (rather than hemmed in) and safe in exploring and going places (a key factor why Dutch children count as one of the happiest on earth).  One particular visually and socially impressive case study that resonated with the audience was that of a primary school in Houten (Utrecht).  The development concept aimed to be highly adaptable and multi-purpose, acting as a community hub and providing flats above the school (see Figure 2); no cars are allowed with footpaths and cycle routes providing access.

In the UK, we are likely to see some kind of revival of the garden city concept, for example in Oxford’s 2050 vision and proposed new settlements as developed under the Wolfson Economics Prize 2014 that was won by the URBED-led team.

Professor Rod Thompson, Director of Public Health for Shropshire, shared some of his diverse experiences across the UK and abroad where health and planning clearly intersect and matters of health and wellbeing, abilities and liabilities play out at the micro and the macro level.  His first example was from his work with Liverpool Local Authority addressing the health and wellbeing of sex workers, their customers and the impact on neighbouring communities.  While planning in the UK somewhat hesitates to be quite as proactive as for example the Netherlands, design features applied in Utrecht benefitted everyone involved: a purposefully designed safe prostitution zone included special parking bays, bicycle access, sensitive natural screening and offering support plus safe disposal for any substance misuse related items.  Ensuring safety without actively supporting or increasing certain habits is a delicate balance, but a worthwhile challenge benefitting a marginalised group in society.

Sarah Walller CBE, University of Wolverhampton, presented her work on dementia in relation to place-making, moving attention from the macro-scale to the micro-scale, considering outside and inside design features that enable those suffering from dementia (and many of the symptoms also are common in other illnesses and disabilities) to live more independently and actively, reducing agitation and stress.  A series of examples from the insides of hospitals, care homes and ordinary houses along with street scenes and signage illustrated effectively how environmental design matters for people with dementia.

Figure 3: RTPI’s Planning Practice for Dementia
Figure 3: RTPI’s Planning Practice for Dementia

Dementia-friendly design principles also seem attractive and meaningful more generally, including decluttering (less but clearer signage; unobstructed paths); greenspace / gardens with resting points; noise reduction; distinctiveness and familiarity rather than blandness and anonymity.  Education about dementia and following design guidance for dementia friendly environments were highlighted as the two critical steps that make most difference.  The RTPI in association with the Alzheimer’s Society published in January 2017 Practice Advice on Dementia and Town Planning to help raise awareness and encourage better design and planning practice (see Figure 3).

The work on dementia and all the other examples linking health, housing, transport, food production and place-making made clear how the built environment affects people; and how design and planning can disable rather than enable people if we ignore existing evidence and insights.  Planning is key to making inclusive and thriving communities possible, implementing effective design and strategic solutions (rather than adding barriers) benefitting those with and without disabilities.

While the presentations covered much on the need and principles of planning for health and wellbeing, less was said about how to address the current ‘delivery gap’ in a systemic way (e.g. current / new policies; ways of operation and cross-sectoral partnerships).  There seems to be a persisting gap between the existing evidence and UK policy and practice, and/or a lack of implementing existing policies effectively.  One element that was made clear in some of the presentations and the Q&A session was the importance of visionaries and champions in enabling innovation and transformation.  There are plenty of opportunities ahead to show that retrofitting and better design / planning with health in mind is the way forward and will pay off in multiple ways if we adopt a mindset of thinking about habitat rather than housing, and of human wellbeing rather than profit.


A summary of the event and fuller account of each speaker’s contributions will feature in the Autumn 2017 edition of the Tripwire (the newsletter of the RTPI West Midlands branch).


[i] Castán Broto, V., C. Carter and L. Elghali (2009) Research Note: ‘The governance of coal ash pollution in post-socialist times: power and expectations’, Environmental Politics, 18(2): 279-286.

[ii] See e.g. Barton, H., Tsourou, C., 2000. Healthy Urban Planning. Spon, London; and Barton, H. (2009) Land use planning and health and well-being, Land Use Policy, 26S: S115-S123.

[iii] More inspiration and planning guidance can be found in: Barton, Hugh (2017). City of wellbeing: A radical guide to planning. London & New York: Routledge.

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