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First, do no harm

Updated: Aug 10, 2023

Anyone involved in medicine and the provision of healthcare will recognise this phrase and its origins in Hippocrates – it embodies the medical ethics principle of “non-maleficence” - to refrain from doing any harm first, before doing any good.

The principle lies at the core of medical training and practice, guiding all those who practice medicine and have the most direct impact possible on human health. But it is rarely acknowledged or adhered to in a unified or standardised way when it comes to non-medical practice, even when that practice has a significant impact on human health. Designing, creating and maintaining our built environment is one such practice.

Despite a growing body of evidence on the impacts our built environment incur on human health, the “do no harm” principle does not often play a central role in the planning and development process. When "harms" are identified, they are usually defined subjectively, and often discussed contentiously.

Part of the problem lies in agency. Who is the practitioner, responsible for incurring or avoiding harm? The practice of medicine has a robust system of regulatory, legal, educational and institutional frameworks designed and maintained to protect patients from harm. So you trust your doctor to do no harm not only because s/he has taken the Hippocratic oath but also because s/he is guided and supported by systems and organisations upholding the “do no harm” principle.

Things are not so clearcut in the planning and development world. There is a wide disconnect not only between the “regulators” – eg central government in the form of DLUHC, local government, professional bodies and institutions and the “practitioners” eg developers and housebuilders. There are gaps in understanding and agreement on what constitutes “harm” along many lines – environmental, social, economic as well as health - and, as noted earlier, these are often subjectively defined and contentiously debated.

If we can’t agree on what are harms, how then do we measure them, embed their prevention into an educational and regulatory framework and instil this into professional practice and public life?

In the absence of such a framework, it’s time for the practitioners to lead. My proposal last year to establish an alliance of developers and housebuilders focused on creating healthy places was well received in some quarters of the Built Environment sector; since then there has been progress, mainly in building the evidence base for action. The industry now has an opportunity to use this evidence and lead on agreeing principles, setting guidelines and defining best practice in developing healthy places. It needs to look to good medical practice and the trust this engenders between practitioner and patient, and seek to develop trust within the communities it is impacting.

First agree to do no harm. Build trust. Then, seek ways to improve everyone’s health and wellbeing.

Clare Delmar

Listen to Locals

9 August 2023


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