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It’s time to put health at the heart of planning decisions

We’re now all too familiar with the catchy phrases and the repeated taglines presented to us by the government each day – “Levelling up”, “Build back better” “Covid recovery” “Housing crisis” “Vaccination dividend” – and while opinions differ on their meaning and significance, we are all involved, like it or not, in the changes happening around us that are impacting our local environment and personal health.

Attention and awareness levels for both Planning and Health are at an all-time high. Yet, like so much in our public life, how this plays out varies considerably depending on who you are and where you live. Discussion on planning reform and housing need pits Nimbys against Yimbys,, while the pandemic has revealed deep divisions and inequalities in health experience and outcomes across population groups and locations.

Amidst these divisions and their often rancorous noise levels lies a glaring truth: local communities impact individual health, and vice versa. The evidence is abundantly clear.

Last week, the eminent medical journal The Lancet published a report on levelling up health in the UK. Its author, Jacqui Thornton, asked if the government’s plans to “level up” opportunities for people and communities across the country will improve health. She quoted Michael Wood, head of Health Economic Partnerships at the NHS Confederation, who described this moment as important because “COVID-19 has accelerated the understanding of inclusive growth—economic growth that is distributed fairly across society and creates opportunities for all”. He commented that “In the past we were having to argue why health should be a part of economic development and why local economies should focus on being more inclusive. Now I think health is absolutely front and centre.”

She also references Sir Michael Marmot, who in his Marmot review demonstrated that “place matters – living in a deprived areas of the Northeast is worse for your health than living in a similarly deprived area of London, to the extent that life expectancy is five years less.” Just last week these figures shocked the nation when it was revealed that residents of Manchester suffered disproportionately from Covid.

Sir Michael’s report revealed that the Covid death rate in Greater Manchester was 25% higher than the England average during the year to March, leading to “jaw-dropping” falls in life expectancy and widening social and health inequalities across the region over the past year.

He emphasised that the findings of the Greater Manchester report were “generalisable” across other deprived areas of England, and said “It’s pretty bad for life chances to live in poorer parts of London, too. Levelling up shouldn’t only be about the Midlands and the north-east and the north-west. Deprived parts of London need attention as well.”

On this latter point we can point to research from Impact Urban Health, based at Guy’s & St Thomas’s NHS Trust, which found that in the London boroughs of Lambeth and Southwark more than one in five people (23%) in the most deprived areas live with multiple long-term conditions, compared to only one in ten (11%) in the least deprived neighbourhoods. Anna Garrod, its Director of policy, said

“this pandemic has shown that the greatest gains to our health will come from focusing change on where we live and work throughout our lives. This is something that our evidence at Impact on Urban Health tells us again and again.”

Sir Michael, Impact Urban Health, the King’s Fund and others have spelled out with crystal clarity how disparities in health experience and health outcomes are based on where you live.

Such is the acknowledgement of this that the Financial Times has created a podcast on How to Build a Healthy City in which its political editor Robert Shrimsley discusses how the pandemic has exposed “the inequality across locations of options about your health”

These inequalities are entirely within our power to address and the planning system is an obvious channel for this, as it determines who lives where, with who, and under what conditions.

So how on earth does this square with what is currently happening in London and other parts of the country when LPAs and the Mayor of London himself review planning applications? We continue to see planning proposals and applications that simply do not address, or even disregard, local health needs. Why do planners ignore their communities’ health?

One of the largest proposed developments in London is the soon-to-be-decided Stag Brewery regeneration in Mortlake which, if allowed to go ahead as currently proposed, will increase the local population by 90%. Yet the one key document that addresses the development’s impact on local health, an investigative report known as the Health Impact Assessment (HIA) is out of date, remotely produced with no on-the-ground understanding of local health needs and, astonishingly, no mention of the pandemic, its impact on the local community or the learnings taken from it as applied to a significant population increase. It is a missed opportunity to involve the local community, reduce health risks and support longer term health improvement.

This must change, and we have opportunities to make this change.

We urge the Mayor to use the Stag Brewery regeneration as an opportunity to demonstrate the importance of redevelopment supporting and promoting the health of local communities, and to set an important precedent for post-pandemic planning applications in London and across the nation.

We also call on NHS bodies, planning authorities and thought leaders and local community groups to support us in rethinking how HIAs can be used in local planning, and in redesigning them to both involve local communities and promote better health.

Clare Delmar

Listen to Locals

6 July 2021


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