Stoke-on-Trent is integrating health improvement and reducing health inequalities into how it plans the city. This includes drafting a ‘health proofing' design guide for masterplans and writing planning guidance on healthy urban planning. The policy work is linked to a community development programme targeting deprived areas in the city called ‘My health matters'.
Key learnings for other councils
Initially staff from Healthy Cities found it difficult to engage planners because of how busy they were. Healthy Cities Programme Manager Judy Kurth observed:
"When planners say ‘we haven't got time for this', they really don't."
But, gradually, they have found ways of aligning health with existing planning priorities. As Kurth explains:
"We've taken quite a steady ‘learning together' approach. We have kept showing planners different things to encourage involvement. I think they have just decided that they could probably do it better than us, which is great, because they can."
One well-received initiative has been the health impact assessment (HIA) training provided by the city council. Senior Planning Officer at Stoke-on-Trent City Council Vicki Cheshire says:
"If other councils do only one thing that has been done at Stoke-on-Trent it should be training and the awareness raising. The attitude of a lot of planning and regeneration officers is they think they already know about and consider health, but that's not necessarily the case."
Stoke-on-Trent is a World Health Organization (WHO)-accredited Healthy City. This European-wide recognition of a city's desire to improve health emphasises the role of urban planning. In addition, the 2010 Marmot Review provides similar justification for any other council to develop more robust links between planning and health.
The problems and how they were tackled
Kurth has worked closely with planners over the last three years to develop policy, guidance and practical projects.
Draft agreement on health, planning and regeneration
NHS Stoke-on-Trent, the local primary care trust (PCT), and the city council's Planning and Regeneration teams have written a draft agreement. This sets out how the two organisations will work together to ensure that health is written into policy development and implementation.
Crucially, PCT representatives will now attend Development Management team meetings that discuss planning applications received by the city council. Health experts can thus make sure that health inequalities are considered when policies are written and decisions are made about what should be built in the city.
Draft statutory guidance on healthy urban planning
Stoke-on-Trent is preparing a draft ‘Healthy urban planning supplementary planning document (SPD)'. The SPD will include the reduction of health inequalities as a legitimate consideration for planners making decisions about future developments in the city. It will build on an adopted core strategy policy that requires new developments to "contribute positively to healthy lifestyles".
The SPD is likely to include a healthy planning checklist for planners and developers, as well as a requirement for a health impact assessment (HIA). This is to be prepared for significant planning applications and planning policy documents.
The city council's draft ‘Urban design guidance SPD' contains good links with health. This is due to be formally adopted in December 2010.
More use of health impact assessment (HIA) in planning
Planners believe that HIA is important to help identify the potential impact of a development on health inequalities. They have decided that developers should be encouraged to undertake and pay for HIAs when putting forward significant development proposals. This will be included in the draft SPD.
SPD author Cheshire acknowledges:
"Developers may see this as another burden. But it could help them by avoiding confrontation and delay later on in the planning process."
To ensure sufficient in-house expertise to judge the quality of submitted HIAs, the city council has commissioned a consultant. They will provide HIA mentoring and training to around 10 council and PCT staff. This includes undertaking HIAs on existing council policies, for example, local development framework (LDF) documents and the forthcoming local transport plan (LTP3).
Health proofing masterplan designs
This guide was commissioned to help non-planners comment on the potential health consequences of masterplans submitted as part of development applications. Feedback from health specialists suggested that a lack of understanding of masterplans had previously affected their ability to comment constructively.
‘My health matters'
This community-based programme is situated in three areas of high health inequalities in the city. Development workers are helping communities to:
- identify barriers to improving health
- find ways to solve them
- refer possible solutions onto area implementation teams and relevant service areas.
The programme was created because the city council's head of planning wanted to find out what local communities felt would improve their health. Topics to emerge so far include improving green spaces, better street lighting and reducing traffic congestion and speeding.
Outcomes and impact
Integrating health into the planning process has taken time, but planners are now much more able to include health aspects in their work. Senior management also endorses this link, especially through the agreement with the PCT. Kurth believes that:
"We've now got a commitment that spatial health is discussed at a very senior level… PCT managers, regeneration staff and planners will now talk to each other. In terms of planning for the city that is really important."
Policy planners and development management staff both have structures to remind and support them to consider health and health inequalities in their work. This is backed up by good working relationships with health experts and practitioners.
The work on HIA has helped planners focus on reducing health inequalities. This contrasts with only seeing planning's health role as providing sites for health facilities, such as GP surgeries. This will be reinforced by the Healthy urban planning SPD.
Costs and resources
The Health and Spatial Planning programme in Stoke-on-Trent has developed over three phases.
In year one, NHS Stoke-on-Trent invested £45,000 in three HIAs.
Communities for Health (C4H) funding was used to commission a consultant to write the ‘Health proofing masterplanning guide' in year two (£5,000).
Finally, £20,000 was spent in year three on the current mentoring programme that trains internal staff to become proficient using HIAs.
"Commissioning full-scale HIAs is expensive, so our approach has meant that we really are getting value for money."
What could have been done better?
It has taken time to bring the different worlds of health and planning together. One of the challenges has been providing evidence of health interventions to a planning system that is driven by targets, indicators and evidence bases.
One of the enablers has been linking the city into national and international healthy urban planning networks. This has happened through the WHO Healthy Cities scheme and the regional healthy urban planning public health network. The opportunities for sharing ideas and tools have been invaluable to help keep the momentum going locally.
The personal relationships that have built up mean there is now more mutual respect for both the need for, and the difficulty in quantifying, health successes. Kurth says:
"You do have to be dogged and be able to talk around the barriers that people put in the way."
But she adds:
"All councils should now be doing this because of the emphasis in the Marmot Review on creating and developing healthy and sustainable places and communities (policy objective E).
She sums up:
"Marmot is the hook, definitely."
Contacts and links
Healthy Cities Project Coordinator
Stoke-on-Trent City Council
Telephone: 01782 236344
Stoke-on-Trent City Council
Telephone: 01782 236153