Putting Health & Wellbeing at the Heart of Neighbourhood Planning

Increases in population and the growth of towns created public health problems, and early legislation focused on creating sanitary conditions.

There is a sense that in recent decades planning has lost its way with health, yet our modern environments continue to have profound effects on our health and well-being. In the blog post What stops us from creating healthier places? author Rachel Toms notes that overall, the planning system has done a good job of designing infectious diseases out of the places in which people live, but has "inadvertently contributed to sedentary lifestyles, mental distress and social isolation".

Whilst the planning system has cured the public health problems of the industrial revolution, it faces a new set of public health challenges for the modern era.

In this post, I make the case for prioritising health and wellbeing through Neighbourhood Plans.

Health challenges

The World Health Organisation estimates that globally, 12.6 million people die each year as a result of living or working in an unhealthy environment.

In the UK, some of the nation’s greatest health challenges, such as obesity, heart disease, physical inactivity and mental health issues are greatly influenced by how we live our day-to-day lives, which is often as a result of how the places we live are planned.

The government’s Guide to Available Disability Data, shows that by 2021 more than 29% of households will include a person aged over 65. In addition, almost 30% of existing households include a person with long term illness or disability.

Britain has an ageing population. The government's data shows that the number of households with a person aged over 65 will increase by 20% in the decade 2011-2021.

A quarter of the UK's homes have no ‘visitability features’ such as level access, flush threshold (i.e. no obstruction to wheelchairs), sufficiently wide doors and circulation space, or a WC at entrance level. Just 5.3% of the nation’s housing stock provides all four visitability features.

The national data suggests the existing housing stock may not meet the accessibility needs of all occupants, and the issue could be compounded by a trend of an ageing population and older people remaining in their homes for longer.

The "New Town Blues"

Cambourne, located 10 miles west of Cambridge, was planned and developed as a new settlement. Last month marked 20 years since the first residents moved into the development. The Cambourne development provides an extreme example of how the planning system can directly affect people's mental health and well-being.

In 2006, a group of professionals working in Cambourne shared their concerns about the level of mental distress that had been observed in residents of the new Cambourne development by the GP practice, schools, church and other workers.Goh, S. Dr., Bailey, P., Dr., (2007) The contribution of the social environment to mental health. A case study: Cambourne. Cambridgeshire PCT.

Distress was observed across the community and not only in socially disadvantaged people or people known to have mental illness. Services were coming under strain, and practitioners struggled to meet needs of both adults and children moving into Cambourne. This led the group to question whether there is something about the "New Town" environment that  contributes to the mental distress observed.

Cambourne suffered from a lack of facilities and support necessary to create networks, friendships and social cohesion. For a long time after the first residents arrived there was no meeting place in Cambourne. The school and the medical practice offered limited facilities for groups but no casual meeting space existed; there was no place in which people could meet to chat, or bring their children and get together. For many people, access to existing support networks, such as family and friends, had been disrupted by their move to Cambourne.

The lack of social infrastructure and support for development of communities contributed to high levels of mental distress and increased risk for the most vulnerable. Practitioners described a disturbing level of unhappiness. Children in the new schools felt “bereavement” from losing their former lives. Many people turned to drugs and alcohol to ease their sense of loneliness and unhappiness. Episodes of violence erupted, and some residents experienced extreme intimidation.

Putting health and wellbeing at the heart of Neighbourhood Planning

There are many ways in which the places we live can affect our health, and Cambourne provides just one example of what can go wrong. The Cambourne example illustrates that to deliver good health, new developments need to do far more than provide access to play areas or outdoor gyms.The group of practitioners in the Cambourne example identified that the lack of facilities for people to meet and establish new networks and friendships directly impacted on people's happiness and mental health. The group made specific recommendations to support mental health and wellbeing in new communities, including:

• Ensure that the concept of social and community development is considered alongside physical developments. 
• Community facilities must be available from the start, alongside schools and health provision. 
• Provision of infrastructure for social cohesion should be kept under review and ensure any deficiencies are resolved during the later phases of the build.
• Involve existing communities in the planning of the new/ next phase of development.

Lessons have been learned from the experience of Cambourne, and the nearby 'New Town' development at Northstowe, Cambridgeshire has been designed to meet the principles of the NHS's 'Healthy New Towns' programme.

Earlier this month, the NHS published a collection of documents which present the findings from its Healthy New Towns programme. The programme explored a number of interesting case studies of new developments, and sets out ten principles to create healthier places:

• Plan ahead collectively
• Assess local health and care needs and assets
• Connect, involve and empower people and communities
• Create compact neighbourhoods
• Maximise active travel
• Inspire and enable healthy eating
• Foster health in homes and buildings
• Enable healthy play and leisure
• Develop health services that help people stay well
• Create integrated health and wellbeing centres

The focus of the NHS programme is on addressing health in 'New Town' developments and its principles and recommendations go far beyond the plan-making process, requiring the involvement of many different professionals and agencies. Neighbourhood Plans are prepared by established communities and most are unlikely to need to plan for new communities like Cambourne or Northstowe. However, it is possible to incorporate the Healthy New Town principles into neighbourhood planning to address health in a joined up way.

Drawing inspiration from the NHS's ten principles and the Cambourne example, a Neighbourhood Plan could address health and wellbeing in the following ways:

• Be informed by evidence of local health needs and issues, such as the 'Joint Strategic Housing Needs' Assessment' (JSNA) for the area. 
• Consult a range of different stakeholders and agencies involved in planning and delivering health services, and have regard to plans and strategies for the provision of local health services to ensure the needs of the community are met over the plan period.
• Require new developments to undertake Health Impact Assessments and encourage developers to work in partnership with planners and health services.
• Use design policies or a Design Code to set requirements for new developments and neighbourhoods. These should ensure development is well-connected, promote active lifestyles through encouraging walking and cycling, and ensure local services and public transport are supported. 
• Provide new (and maintain existing) open spaces, sports and recreation facilities and provide access to the countryside. Consideration should be given to how open spaces can encourage healthy eating, such as by providing allotments, orchards and urban growing spaces.
• Provide homes and neighbourhoods which meet the needs of all occupants and users, including the elderly, people with disabilities and long-term illness. This can be achieved through existing standards and tool-kits, for example the Optional Technical Housing Standard for accessible and adaptable dwellings and wheelchair dwellings as set out in Parts M4(2) & (3) of the Building Regulations; and the Dementia Friendly Communities checklist.
• Reduce exposure to pollutants and hazards, such as flood risk and air pollution. Sticking with the Cambridgeshire theme of this post, in the county in 2010 there were 257 deaths attributed to air pollution.
• Ensure new development is integrated with the existing community, and create opportunities for people to mix and create new friendships and networks.

For real examples of policies from recent Neighbourhood Plans which deliver health benefits, see my briefing note, prepared jointly with the National Association of Local Councils, Neighbourhood Planning and Community Health and Wellbeing.

Gaining support from the wider community

What sets Neighbourhood Plans apart from other aspects of the planning system is that they are produced by the community the plan serves. 

Preparing a Neighbourhood Plan requires the support and involvement of the local people, many of whom may have little understanding of the planning system.

Many of the principles for improving health also deliver other sustainability objectives. For example, rhetoric around encouraging walking and cycling has tended to focus on the importance of reducing carbon emissions, rather than the health benefits such a shift in behaviour can bring. However, concepts such as 'sustainability' may be totally alien to many people.

Conversely, health is an issue which everyone can relate to and can get behind. By expressing the Neighbourhood Plan's benefits in terms of its positive effects on health may help more people understand and engage in the plan.