Viewing Planning as a Public Health Tool

The origins of planning, in particular in the UK, can be closely traced to increasing public health concerns.  The growing industrialization of nineteenth century cities created specific health impacts, from the air pollution generated by factories to the overcrowded housing for workers.  Early urban planning models were therefore partly driven by a desire to address the worsening state of public health.  Most notably, Ebenezer Howard’s Garden City Movement referred to a utopian town where the air and water were pure and smoke and slums had been eliminated.  Even the urban renewal of the 1960’s was loosely justified as a tool to eliminate overcrowding and the associated negative health conditions.  Yet reading most current city plans it would be easy to forget the close connections between health and the built environment.  Health issues may crop up in relation to environmental impacts, but very rarely is public health fully considered as a topic to which planning can effectively contribute.

It was therefore refreshing to attend the Walk21 conference held in Vancouver in early October to reconnect the health and planning professions. 
The conference brought together a wide range of professionals from urban planning, transportation, architecture, health and many more.  As the name suggests the conference focused on promoting walking, in particular retrofitting the auto city to facilitating more walking trips.  But it was also much more than this, as reflected by the mix of speakers.  Notable talks were provided by Geoff Anderson (Smart Growth America), Dr William Bird (Natural England), Allan Jacobs (city planner and streets guru) and Dr Jim Sallis (Prof at San Diego University and advocate of physical activity).   

Clearly we have major public health problems.  In England nearly 30% of the population are classified as obese and this is expected to rise to a staggering 60% by 2050.  Likewise the rates of diabetes and depression are at worrying levels and forecast to keep rising.  This public health crisis has severe financial impacts with obesity and physical inactivity costing England £2.5 billion and £8.2 billion respectively.     

                           

Unfortunately the urban planning models that have dominated since the post-war period have contributed to this health crisis and appeased the demands of the car above all else. This has had major impacts on urban form, with large areas of sprawl allowing people to own large homes in the suburbs and drive to the necessary places for jobs and services.  Walking, physical activity and access to greenspace have been slowly eliminated from everyday life.   

So why is it important for planning to re-engage with the health agenda?  Firstly, the health sector is forecast to swallow up an ever increasing proportion of the national budget.  This is what Penny Ballem, City Manager in Vancouver, terms the 'health hoover' and starkly presents how other government departments will be squeezed by the demands of healthcare costs.  This includes planning, parks and recreation as well as education and social services.  So it is vital that planning makes the case for why a proportion of the healthcare budget must be redirected away from primary care and into proactive sustainable community building.  If the profession fails to do this it will be hoovered up by the health sector. 

Secondly, planning is fundamental to allowing early and sustained interventions to promote physical activity.  At the regional scale this includes strategic policy on where to locate housing, jobs and transit.  At the city scale this translates into promoting access to greenspace, approving developments within walking distance to shops, services and transit.  And finally, at the neighbourhood scale this means urban design which prioritizes walking and cycling as well as funding programmes that encourage walking (to school or amongst seniors etc).  All of the above require joined-up thinking across government departments and money obviously.  SO once we can accurately monetize the health benefits of walking and sustainable planning decisions, it will be recognized as a worthwhile investment.  As I learnt at Walk21, for every $1 invested to enable active transportation (walking, cycling etc), $4 is saved on healthcare costs further down the road.  Something to think about surely?