The importance of planning in public health

by Matt Ashton, Policy Lead for Healthy Places, Association of Directors of Public Health

Directors of Public Health (DsPH) have a responsibility to improve and protect the public’s physical and mental health and, because health is influenced by a wide range of factors, we work closely with a wide range of people to do it. 

Very often, these people have no mention of ‘health’ in their job titles and work for organisations that are not obviously health related. Planning is one such area. So too is architecture, design, construction, landscaping, and transport. However, all these roles (and more) have a direct influence over the population’s health. 

The wider determinants of health

After all, if I live in a crowded, cold, damp house, in a densely populated area with heavy traffic, limited access to outdoor areas, no public transport links to shops and only fast-food outlets on my doorstep, there is a high chance that I will develop one or more (preventable) health conditions as a result. 

For example, the air we breathe – indoors and out – is closely linked to respiratory conditions, as are damp living conditions, which also contribute to cardiovascular disease. Overcrowding can result in a multitude of infections and accidents. Our wellbeing too is influenced by where we live, with community isolation and poor insulation both contributing to mental health problems. We also need to have easy access to fulfilling, stable jobs that have no negative impacts on our physical health and keep us mentally stimulated and contributing to our communities.

Critically, people who live in the most deprived areas are the worst affected by living in areas which have not been planned with our health in mind. 

Housing prices themselves are a limiting factor, ever increasing in more affluent areas. People living in poverty, however, are more likely to live in poorer housing. Poor health caused or compounded by living in poverty, then becomes a barrier to choice and the ability to access – and keep – safe, stable homes and jobs. 

It is not just the individual that suffers. Without fit and healthy individuals, communities and local economies suffer through workplace absence and decreased engagement. 

It is therefore vital to improve – and protect – the health of all our populations. We need to keep the well well, help the sick get better and crucially, we need to prevent people from getting sick to start with. 

Doing this is not only morally right but would save the health and social care system billions of pounds and ensure our population is fit to drive the UK forward. 

Health in all policies

The Association of Directors of Public Health, who are the collective voice of local DsPH across the UK, regularly contribute to Government consultations. Most recently, we have submitted responses on national planning policy, the environmental outcomes report and the infrastructure levy – all of which will help to inform laws and policies prescribing how our places are built, maintained, lived and worked in.  

The common thread to these – and all our consultation responses – is a call for policy makers looking at areas which are seemingly unrelated to health, to consider the implications for our health and wellbeing. The question: ‘What impact will this have on the population’s health?’ should be asked at every stage of every decision. 

In our Manifesto for a Healthier Nation, we outline why this ‘health in all policies’ approach should be central to the next Government’s strategy to prevent, or at least mitigate, potential harm, creating a much healthier society. 

In the case of planning healthy places for example, although there is already widespread collaboration between departments at a local level, delivery is even more likely to advance if a dedicated lead is appointed to champion and coordinate the process.

Of course, that is only half the battle. Even if effective national policies exist, they need to be implemented and despite the best intentions, inadequate funding or resources mean policy cannot be effectively translated into practice. 

We must move on from short-term thinking

Sadly, this is the reality facing public health. In England, the public health grant has been cut in real terms by 26% since 2015/16. Instead of providing local authorities with consistent, adequate funding to spend on public health programmes that are proven to positively impact people’s health, one-off, ring-fenced injections of money – like the £40million obesity drug pilot – have been given to fund quick-fix schemes that may help a small number of individuals, but are unlikely to make a difference at a population level. 

Meanwhile, earlier this year, the Transport Secretary announced a cut to active travel, including a two thirds reduction in investment to infrastructure that would have supported more people to walk and cycle. Without this type of funding, planning officers, who work closely with public health teams across the UK, are unable to implement schemes which give both immediate health benefits and offer long-term ways to prevent a myriad of mental and physical health issues. 

This short-term thinking will negatively impact individuals, communities, our health and social care services and our economy.

What is needed is bold thinking and partnership working between every department and agency to create environments where people can thrive. This will not only save money, time and heartache, but importantly, allow everyone, regardless of their background, to live happier, healthier and longer lives.