One of the positive contributions of the Covid era to both global and local health has been the vast collection of data on who, how, when and where the virus impacted, enabling an important transition from anecdotal observation to evidence-based validation that place and health are inextricably linked.
We are fortunate here in the UK that several individuals and organisations are looking closely at these links, developing policy proposals, tools and new metrics for understanding how these links can be measured, assessed and ultimately used to benefit communities. Here are a few that have influenced me in my thinking about place and health:
1. We have Sir Michael Marmot to thank for exposing inequalities in health across place, race, age, gender amongst and most importantly evidencing what determines these inequalities. The Marmot Review, originally published in 2010, was updated in 2020 and showed that inequalities across most categories had increased.
He continues his work through the Institute of Health Equity at UCL, where measures of the social determinants of health are developed and applied.
2. The Quality of Life Foundation has worked with a range of organisations to measure health and wellbeing in local communities, and it has developed a framework that addresses the changes that can be made across the development industry “to ensure that homes are acquired, planned, constructed and managed to actively provide a better quality of life for everyone.”
3. A full range of data measuring quality of life and wellbeing in the UK has recently been updated by the Office of National Statistics. This is a rich data trove which offers an overview of the UK’s progress across ten domains of national well-being – personal well-being, relationships, health, what we do, where we live, personal finance, economy, education and skills, governance, and environment.
4. The Healthy Streets Scorecard has measured the “healthiness” of local authorities based on a range of critieria mainly around mobility and active travel.
5. An academic research initiative called TRUUD (Tackling the Root Causes Upstream of Unhealthy Urban Development) is working with decision makers and communities to develop and test ways that prioritise health in urban decision-making processes.
6. The Centre for Thriving Places is a non-profit committed to measuring, understanding and improving wellbeing in cities, town and local communities. Its focus on evidence-based measurement tools and specifically its Thriving Places Index enables all involved in local placemaking to ask the questions “are we creating the right local conditions for people to thrive? Are we doing that equitably, so everyone can thrive, and sustainably, so current and future generations can thrive?”
7. One potential contribution of “proptech” and “plantech” – eg digital platforms and tools that support property and planning activity - is integrating health and planning data into tools that can be used by local residents, local planning authorities and developers alike to understand the links between health access and outcomes in their area and engage in meaningful evidence-based dialogue around this. To this end plantech company Placechangers have considered health impact in their community engagement tool.
8. Within the NHS data on the sources and conditions underlying health inequalities, many of them place-based, is being collected by Bola Owolabi and her team via the Core20Plus5 programme at the Health Inequalities Unit . They are examining a range of disease areas and seeking to understand why there are inequalities across place, race, gender and age in access to healthcare and health outcomes.
9. Central to the Life Sciences Community is UK Biobank which contains longitudinal data on all aspects of health from 500,000 volunteer participants across the UK. Its goal is to “inspire the imaginations of health researchers around the world to meet the challenge of greater understanding, prevention, and treatment of a range of serious illnesses.”
We now have both a challenge and an opportunity to integrate and embed these data sources, tools and policy approaches into our planning systems. At present health and health impact are almost afterthoughts in far too many planning applications, and assessments of health impact, when advised or required (this varies across the country), are commissioned by applicants and produced by consultants acting on their behalf.
Three developments are potentially going to drive some change. One is a recognition amongst some local planning authorities that health is an important element in the future of their communities, and that consensus is needed to embed measures and concerns about health into local plans. Oxford City Council has done exactly this last week when it launched a consultation on key priorities for its 2040 local plan, citing reduction of health inequalities as one of those priorities.
Second is the development of “Marmot Cities”, local authorities committed to adopting practices to redress health inequalities as outlined by Sir Michael Marmot. To date six UK local authorities have identified as Marmot Cities:
Third is the growth and acceptance of ESG principles and practice amongst corporates in the property sector.
Increasingly corporate shareholders and the investment community are seeking assurance that their investments are causing no environmental or social harm (E and S) and that corporate organisations establish and maintain the governance (G) to ensure this. In many cases the “no harm” assurance is progressing to delivering positive benefit, and with this an entire set of metrics and rankings have developed.
There are valid questions about words and deeds here, and good reason to question the accountability of ESG pledges and actions in the property sector, but there is also a recognition that the definition and measurement of social impact and the ways these are applied must involve local communities in design and execution.
Reducing health inequalities and promoting public health in local communities where the property sector is investing fits comfortably into the ESG agenda - whether the scale of investment is offices and commercial complexes, housing estates or large-scale regeneration schemes. There are encouraging signs from several organisations in the property development and investment sector that they are listening and exploring ways to take action in ensuring that the impact of developing land and property has a positive impact on the health of local communities. Watch this space.
Listen to Locals
7 October 2022