The places where we live, work, and play—and how we access them—are fundamental determinants of health, with staggering differences in outcomes between people living in the UK’s most and least deprived areas. A woman born in Wokingham, for example, can expect to live 15 more healthy years than a woman born in Blackpool. A man born in Richmond upon Thames, meanwhile, can expect to live 17 more healthy years than if he’d been born in Belfast.1
The reasons for these inequalities are many, but housing, the environment where we live, and access to transport are important factors that can affect our physical and mental health. If we always applied this knowledge to the planning processes for how and where our homes are built, and how we travel to and from them, it would allow everyone to live healthier lives.
Our homes have an enormous impact on our physical health. As we saw in the tragic case of Awaab Ishak, a 2 year old boy who died as a result of black mould in his home,2 cold, damp living conditions can be lethal and are linked to a range of illnesses, including respiratory and cardiovascular disease and mental health problems. Cold homes have also been implicated in excess winter deaths, with deaths almost three times higher in the coldest quarter of homes than in the warmest.3
Poorly designed homes also exacerbate illnesses such as asthma in excessively hot conditions, and 4.6 million bedrooms in England are currently susceptible to overheating.4 Overcrowding, meanwhile, can result in respiratory conditions and infections, is likely to increase the risk of accidents, and may also be linked to poor psychological health in children.5 The build-up of indoor air pollutants caused by inadequate ventilation is also a potential factor in thousands of deaths.6
As well as enabling affordable, good quality housing, local planning policies should ensure access to safe, open, green, social spaces that encourage community inclusion, alongside easy access to a wide range of healthy food and leisure activities. More than six million people in the UK have no access to a park or green space within a 10 minute walk from their home, and fast food outlets are more likely to be concentrated in England’s poorest areas.78 Active travel infrastructure also needs to be considered, allowing everyone safe access to walking and cycling routes and public transport.
Continuing an important legacy
Promoting health and preventing illness should be at the centre of spatial planning, and planning policies are critical to consider as part of a country’s public health agenda. The Association of Directors of Public Health made these arguments during the recent UK government consultation on England’s national planning policy.9
Yet initiatives that partner planning with health are nothing new. As far back as 1868 John Leigh, the first public health official in Manchester, realised its importance and worked to eradicate cellar dwellings, back-to-back houses, and midden privy toilets. More recently in the 1960s, John Reid, then director of public health for Buckinghamshire, helped to plan the new town of Milton Keynes, relocating thousands of people from overcrowded city slums.
Directors of public health are still closely involved in town planning in their local area. In England, moving the role from the NHS to local authorities helped to further facilitate partnerships. Directors of public health in Scotland, Wales, and Northern Ireland are also working collaboratively to use planning to prevent ill health, saving billions of pounds and lives. In Gateshead, for example, planning policy has been used to ban new fast food outlets, reducing the number of outlets and tackling the high levels of childhood obesity in the area.10
Under the public sector equality duty, public authorities have a responsibility to consider how policies affect people who are protected under the Equality Act 2010. With this in mind we need to consider, for example, whether our community spaces are perceived as safe by women, whether they’re accessible to wheelchair users, or whether they inadvertently favour people from one ethnic group over another. One way to ensure that everyone’s needs are being met would be to implement a health impact assessment during planning decisions. This would ensure that considerations of health, wellbeing, and inequalities inform decisions and that certain groups or areas aren’t disadvantaged.11
It’s irrefutable that planning is an important part of the prevention agenda, and the topic of “healthy places” has even been recognised by the Health and Social Care Committee as important for consideration in the new inquiry into preventing ill health.12 However, this recognition must not be confined only to planning new spaces—we must also support the communities and spaces that need it most, to help advance health equity.
Ignoring the role of planning in preventing ill health comes at a considerable cost to our economy, through lost economic productivity and increased demand on the NHS and social care. Yet the most devastating outcome would be to miss an opportunity to close the deeply harmful gaps in health equity, which continue to compromise people’s lives and cut them short.