Improving health through the built environment: taking leadership in delivering Health Net Gain

I launched Build for Health last year to link up practitioners from multiple disciplines who, firstly, supported the principle that our health is impacted by the built environment, and, secondly, were motivated to change their practice to accommodate this.

It followed a programme of research from the Institute of Health Equity, which gave evidence to the role of the property sector in supporting health & wellbeing.  Acknowledging the scale, influence and resources of the sector, the report proposed that members form a collective leadership, a “Compact”, to develop, implement and share practice that actively promotes good health.

This was not taken up, and I launched BfH as a next step to continue and advance he discussion within the sector, with a particular focus on identifying and understanding good practice. During this time I’ve been on constant lookout for an industry champion to help define what it means to build for health, to undertake specific projects to demonstrate its value and to set standards for others in the sector.

Our workshop in July brought together fifty enthusiastic practitioners to discuss and debate what it means to build for health, and to spotlight what good practice looks like. Along the way I’ve been exploring good practice through my blog, showcasing places and organisations like Springfield Village, Thermify, Hillbrow Health & Wellbeing, Places for London, Urban and Civic, the Harold Moody Health Centre, and I’ve even dipped into some local history with the Peckham Experiment.

In so doing I’ve come to understand better what it will take to establish standards for what it means to build for health. There has been considerable progress: we have developed a widespread appreciation for examples of good practice; an array of tools to understand and measure health impact; and some effective evidence-based interventions. But building for health at scale requires something currently missing – industry leadership.

We need an organisation that operates with authority, autonomy and at scale. I believe that Places for London, the commercial development arm of Transport for London, one of London’s biggest landowners, can do this.

What is striking about Places for London is that many of the foundations for Building for Health are already in place. Through its Sustainable Development Framework, Approach to Social Value, and Contribution Report, Places for London has already embedded a measurable, place-based approach to improving health outcomes across its developments. The opportunity is to further mature, integrate and scale this work into a formal Build for Health model.

I met with some of the Places for London leadership earlier this year and explored what it means to build for health. This focused on social determinants of health, metrics and measurement, the critical role of NHS collaboration and design principles.

As Places for London’s Chief Executive Graeme Craig points out, much of this is already encoded in the KPIs they have developed and implemented, including:

·      measurable targets for air quality, daylight, noise and thermal comfort;

·      design requirements that promote active travel, access to nature and healthy streets;

·      metrics for social cohesion, community engagement and inclusion; and

·      indicators that drive local economic opportunity, skills and employment.

Taken together, these already represent a systematised approach to improving the wider determinants of health through property and place development.

It is important that organisations operating in the built environment take on some health specific targets that they might define, measure and ultimately achieve at scale. One is to adopt a Do No Harm policy on new developments, and to create a framework for applying this to the development of healthy homes and places.

Pretty much all agree that development and regeneration of the built environment – new housing, office & retail development, investment in new infrastructure– should do no harm to local population health and this is why Health Impact Assessments are undertaken (and why Section 106 agreements are designed to mitigate harms that are incurred). But HIAs are not done universally and when they are standards can vary widely. So one target is to adopt a Do No Harm approach and set a standard for HIA that demonstrates and communicates this.

Another, more ambitious target is to achieve health net gain. That is, to develop homes and places that go beyond doing no harm or providing mitigation for harms, but actually improve local health though investment in the built environment.

To date Health Net Gain has not been defined, measured or applied at any scale in the property or built environment sectors. As Michael Chang and colleagues stated in 2024, given the emerging arguments for the consideration of health as a distinct policy objective and outcome, a new mandate for health net gain (HNG) in spatial planning is merited.

Two years on, the timing is ideal to undertake a mandate for HNG, for several key reasons:

1.   A precedent in Biodiversity Net Gain (BNG)

Biodiversity Net Gain (BNG) is a mandatory requirement in England, under the Environment Act 2021, forcing developers to ensure wildlife habitats are left in a better state than before development, with a minimum mandatory 10% increase in biodiversity value. Mandatory from February 12, 2024, for most projects, it requires habitats to be improved or created, secured for at least 30 years.

Much of Chang and colleagues’ inspiration for a HNG mandate rests on the development, acceptance and ultimate legislation for BNG. He points out,

“lessons from the operationalisation of BNG in the English planning system can inform the development of a comparable framework for health that could be applied in other national contexts, supporting international actions to bring health to the fore.”

2.   The Health Data for London Strategy

This is a collaborative health initiative led by the Mayor of London aiming to join up health data, enabling insights and intelligence to be shared across the health system in London. It illustrates how current challenges, including poor childhood immunisation, low cancer screening rates, and the need to manage cardiovascular risks, can only be tackled with better access to data.

The strategy aims to redress London’s lack of system-wide intelligence, which underpins fragmentation and prevents the delivery of care being informed by research and analysis. “Without high-quality joined-up health data, it will not be possible to tackle the health challenges facing Londoners, or to improve the health of the city. The opportunity is significant as London has some of the richest health care and clinical research data assets world-wide”

3.   A deeper, evidence-led understanding of health Inequalities across London

The Health Equity Data Collaborative  reported in 2024 on inequalities in health across London by deprivation and ethnicity, from the upstream wider determinants to the ultimate outcomes such as disease and mortality.

"Given the complex intersection of environment, social factors, health behaviours and health status, tackling health inequalities will require joined-up working and partnerships" it stated, adding "the data available does not currently allow us to capture a full picture of health inequalities in London. Efforts to improve systematic and consistent collection, recording and coding of data relating to geography, across all protected characteristics, and of key inclusion health groups should remain a priority to provide more effective intelligence."

4.   A Preventative and Neighbourhood health focus in the NHS

NHS England published A Neighbourhood Health Service for London in May last year.  This was a direct response to what it described as a Case for Change, which argued that

"London is experiencing a 'perfect storm' in which deep-seated economic and health inequalities are driving ill-health, resulting in increasing pressures on the NHS, local authorities and local partners. In turn, these pressures exacerbate those same inequalities, and limit the ability of our boroughs, health and care providers and systems to respond effectively."

The document The Case for Change in London sets out that our current structures, including acute, community, and mental health providers; integrated care systems (ICSs); primary care networks (PCNs); GP federations; local authorities, and wider place-based partnerships in London, will not be able to respond to these challenges without a clear, shared vision and the mechanisms to deliver this vision. 

This includes a consistent approach to developing Integrated Neighbourhood Teams (INTs) in London as part of the shift to neighbourhood working, 

5.   Increased Public awareness of health and wellbeing as a valued asset

a.   Health awareness

In recent years, there has been a significant rise in global health and wellness awareness. This shift is driven by factors such as increased access to health information, the prevalence of lifestyle-related diseases, an aging population, and the impact of global health crises like COVID-19. As a result, more people are focusing on preventive healthcare, adopting healthier diets, engaging in regular exercise, and recognizing the importance of mental health. While this trend presents some challenges, such as information overload and health disparities, it is leading to healthier lifestyles and more informed healthcare decisions.

b.   Health as an asset

The Health Foundation has built an evidence base on the social and economic value of health which it continues to develop, and its influence on the value of health to businesses, institutions and national prosperity is considerable. This asset-led approach to improving health has led to organisations such as Legal & General, the nation’s largest pension fund, to target health inequalities and invest in healthy places..

The growth in awareness and asset value makes health a positive, tangible and personal platform to engage all stakeholders in the development of the built environment.

Crucially, Places for London has begun to quantify its wider impact through its Strategic Impact Framework and publishing details in its Contribution Report, which measures the combined net economic, social and environmental value created by its activities. This includes health-related benefits, such as improved housing stability, reduced cost-of-living pressures, and associated NHS savings. This capability – to measure net impact rather than isolated outputs – is a key building block for operationalising Health Net Gain.

All of the above developments align to support a health-led approach to investment in the built environment and focusing on defining and delivering health net gain is an ideal way to do this.

Critical to the approach will be a focus on the wider determinants of health, including:

·      access to affordable, high-quality homes;

·      walkability and active travel;

·      access to green space and nature;

·      social connection and community cohesion; and

·      access to employment , education and skill development

These are the factors that most strongly shape long-term health outcomes.

By adapting and enhancing what it is already doing into a clear, measurable Health Net Gain framework, Places for London has the opportunity to redefine how value is understood in the built environment – shifting the focus from development outputs to long-term health, social and economic outcomes for the city.

In doing so, it will benefit us all – practitioners, policy makers, government, health providers and most of all those who inhabit our homes and places.

Looking ahead, we will track and communicate how Places for London can translate its existing approach into a clear, measurable, scalable and transferrable model for delivering Health Net Gain through the development of homes and places.

Clare Delmar

Listen to Locals

13 April 2026