Thursday, 18 June 2015 16:10

Planning, Public Health and Well-Being

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The Routledge Handbook of Planning for Health and Well-Being: Shaping a Sustainable and Healthy Future is, as its title perhaps hints, a long (617 pages) and weighty tome. However, the reader’s spirits are raised by the opening sentence in the Introduction: “This book is about urban planning as a positive force for change in the twenty-first century.” It goes on to pose fundamental questions: “how do we plan and design our settlements to promote health and well-being? How do we create the conditions for healthy behaviour, equitable environments and resilience in the face of climate change?” It argues that health and well-being should be at the heart of planning.

Health and Place: A complex relation

Despite these inspirational clarion calls, a number of chapters recognise that the relationships between place and health are not easily reducible to simple causes and effects. For example, a chapter on obesogenic environments highlights the risks from growing levels of obesity globally, and says there is enough expert evidence to implicate the built environment. However, the authors point to the difficulties of establishing unambiguous causal links. Diets are influenced by access to food which may depend on where you live, but also on how foods are promoted and on peoples’ income. Furthermore, findings from one country may not be transferable to others: evidence of clear links between “food deserts” (areas where it is difficult to buy healthy food) and diets and health is strong in the USA, but not in the UK.

To further muddy the waters, many studies, again mostly from the USA, have pointed to the health benefits of “walkability”, and pointed designers to the value of higher densities, mixed uses, pedestrian safety and an attractive public realm with good public transport access. However, a recent study found that while there was indeed increased physical activity in walkable US neighbourhoods the key measure of obesity, the Body Mass Index, was unaffected.

However, it is because health and place have a complex relationship that joined up thinking and action is needed. The book strongly makes the point that the separation of policy making for health and for planning is a recipe for failure. Across much of the globe, health policy is seen as providing services to people who are ill. Similarly planning decisions on development are usually guided by returns in terms of economic development or environment, but rarely is health and well-being the overriding consideration. Tackling this disconnect is a central purpose of the book.

A comprehensive overview

The breadth and depth of this book make it an invaluable source. It covers mental health as well as physical health, play as well as commuting, cities in hot climates and lessons from the earthquake in Christchurch, housing and greenspace. This list is incomplete. I would be surprised if any built environment or health professional did not find something here to capture their interest.

Inequality is a theme running through many of the chapters. Jason Corburn argues that planners need to “get inside” neighbourhoods to understand how physical and social forces are shaping health inequalities. He suggests that the skills planners have to facilitate inclusive and participatory processes are valuable ones to apply here. My own chapter, dealing with rapid urbanisation, points to the barriers that slum dwellers face in gaining access to health services. It says that “if urban planning is to become a positive tool for improving the health of people who are driving slum-led urbanisation, then it needs a new outlook and new practices.” Herbert Giradet then makes the case for “the regenerative city” as a building block for a healthy planet.

A passionate blockbuster

In short, this is a book bursting with passion for mobilising those working in planning and design to improve health and reduce health inequalities, and those working inhealth to start thinking about the built environment. Its 41 chapters are packed with examples, statistics, illustrations and arguments from around the world.

At its heart is Hugh Barton’s conceptual diagram of the human settlement health map, which connects People at the centre to the Global ecosystem through lifestyles, communities, local economies, activities, and then the built and natural environments. It provides a way of looking at planning that is urgently needed today.

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