Building foundations for community health

By Paul O'Brien and Dr Daniel Slade | 01 September 2020
  • Paul O'Brien

News that Public Health England is to be scrapped and replaced with a new National Institute for Health Protection was greeted witha heavy dose of scepticism amongst many who argued that Ministers were taking a narrow view of ill-health prevention; dealing with a crisis today without considering the longer term. The same can be said of housing; one crisis leads to yet another tranche of announcements but the longer-term implications of poor housing on health are oft ignored. We know that the environments in which we live will have a critical role in the health and wellbeing of communities. From obesity and heart disease, to depression and poor educational outcomes, housing is a critical determinant of public health. In the context of COVID-19 it has also exposed its role in communicable diseases.

Our new report At a Crossroads: Building Foundations for Healthy Communities is therefore a timely reminder of the role of housing and place-making. Drawing upon five case studies, interviews with healthy-place making experts, as well as interviews with 216 councillors and planners from across the UK, we set out to identify barriers to healthy place-making, and make recommendations to local and central government. It was clear early on in our research that there is a significant divergence between England, where a plethora of deregulatory planning measures have undermined the role of local authorities, compared to Scotland and Wales, where a stronger coordination role between local authorities and their partners supports, rather than hinders, healthy place-making.

It is therefore disappointing to find that the recent announcements on expanding Permitted Development Rights (PDR) and the white paper on planning reform look likely to bring about more changes which will thwart efforts by local authorities to drive up quality in new housing developments. We have seen the social cost of deregulating housing and planning. Indeed,  the government’s own commissioned evidence review on the quality of new homes coming through PDR was damning, but there is the potential to do things differently.

First of all, we are calling upon central government in England to acknowledge the vital role of the public sector in delivering healthy place-making. This means empowering local councils and public health agencies to influence and shape developments that support good health; not actively working against it. We have to stop imposing national planning reforms on local councils with little input from those councils. We need genuine devolution of decision-making powers from the centre to the strategic level. We need to strengthen the coordination and communication between public health and planning. We also suggest that local plans which do not sufficiently address health and wellbeing should be found to be unsound. Let us be bold with this – if plans do not consider their health impacts, what are they really for?  

We also know that to undo the years of deregulation we have to be more ambitious about how we regulate the quality of the built environment; only by proper and fair regulation will we achieve consistent standards, not determined by local property values. This alone will level up the playing field between developers, many of whom insist they would prefer to compete on quality. This should include the passing of a Healthy Homes Act, which would place a statutory duty on the Secretary of State to secure people’s wellbeing through policy, making it a legal requirement for all new homes to support their residents’ health and wellbeing. Finally, whilst we await the profound changes, we are imploring local authorities now to take up the cultural changes needed to develop healthy place-making in local plans; planners will need the support of public health colleagues (which ever agency they may ultimately sit under) to support quality new developments. Now is the time to build the foundations for healthy place-making.

Paul O’Brien is Chief Executive of APSE and Dr Daniel Slade is Policy and Projects Manager at the TCPA and lead author of the report.

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