Learning from Tower Hamlets Health Impact Assessment (HIA) policy implementation programme 2019-2021

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By Laurence Carmichael…..

Tower Hamlets (TH) Health Impact Assessment (HIA) policy was adopted as part of the London Borough of Tower Hamlets (LBTH) Local Plan in January 2020.

The policy aimed to be part of a set of local planning policies addressing major health challenges in the borough, including poor housing quality, overcrowding, social isolation, poor air quality, lack of access to affordable healthy food, and lack of green spaces.

Tower Hamlets HIA policy aims to tackle overconcentration of hot food takeaways and betting shops and promote healthy habits and environments (Credit: Laurence Carmichael)

In September 2019, I was recruited as HIA Officer on a secondment from UWE Bristol’s WHO Collaborating Centre to lead on the policy implementation programme. The focus of this shifted quickly from its original quality assurance ambition towards a broader political-economic approach to maximise HIA policy leverage. Outputs of the programme included:

  • An internal cross sector planning/public health partnership to maximise the legal levers of the policy
  • A suite of capacity building and review tools including:
    • Guidance tools for officers and applicants
    • Training for internal and external stakeholders
    • Evaluation work (NIHR funded)
  • National HIA policy advocacy and development:
    • Contribution to Public Health England’s national HIA guidance[1]
    • Leading on submissions to the Ministry of Housing, Communities and Local Government consultations on the reform of the English planning system on behalf of London Association of Directors of Public Health[2]

Over the two-year review period a number of significant challenges were identified, including:

  • A lack of cross sector knowledge and silo working

The programme had to be adapted to reflect planning governance and policy drivers. These challenges reflect earlier findings from the literature[3].

  • The lack of a HIA statutory policy

HIA was not a statutory instrument despite being embedded into the local plan. Planning power is also limited as the local HIA Policy does not benefit from a Supplementary Planning Document (SPD) which would give it more leverage. Planning officers will decide to give or refuse planning consent on the basis of interpretation and judgement in the light of the development plan and other material considerations. They weigh up HIA evidence potentially against other material considerations and other legal obligations and this can be at the expense of health (e.g. Heritage considerations, established land use)

  • Housing policy drivers

The London Plan sets high housing targets for TH, leaving upper density levels open and giving developers the opportunity for more speculative planning applications. Government policy requires local planners de facto to lower scrutiny over some standards which have health implications and could be highlighted by HIAs (e.g. reducing affordable housing requirements)

A challenge for Tower Hamlets planners and public health officers: managing housing targets in the highest density environment in London – Here residential developments in Canary Wharf (Credit: Laurence Carmichael)
  • Poor understanding of HIA and emerging practical issues

Over a period of 22 months, the HIA Officer commented on 64 planning applications. HIAs were in the main very weak (poor methodologies, poor identification of baseline, no recommendations).  

The practice of HIA in development management process also raised a number of practical issues in relation to various types of planning applications, for instance, can we expect a detailed HIA on a S73 amendment application? (i.e. minor amendment)

The in-depth understanding of these challenges acquired over the two-year period of the review facilitated the following recommendations:

HIA in development management:

  • Focus HIAs on the largest applications
  • Ensure a public health presence in pre-applications
  • Review assessment criteria of the HIA guidance focussing on assessment topics where end user/community knowledge is most appropriate.  
  • Strengthen the Statement of Community Involvement guidance for applicants
  • Continue capacity building efforts internally
  • Design a quality assurance framework “for the reality of planning “  
  • Supply developers with a locality baseline
  • Continue monitoring/evaluating HIA effectiveness through research 

HIA in planning policy:

  • Consider the upstreaming of HIA in planning policy and strategy
  • Identify a timeline of strategic masterplans to ensure health is considered in strategic place-shaping decisions.
  • Promote HIA approach for local design guides or codes
  • Learn from HIAs over time to inform design policies in local plans

Local authorities interested in progressing their HIA agenda on urban developments are advised to learn from Tower Hamlets experience and be mindful of challenges. This should not deter them from ensuring new urban developments promote health and equity, in particular as the Covid-19 pandemics has further demonstrated the importance of the living environment on health.

For more information on the Tower Hamlets HIA policy, please contact Matthew Quin, Public Health Programme Lead – Healthy Environments Public Health, London Borough of Tower Hamlets matthew.quin@towerhamlets.gov.uk

For information on the two-year LBTH HIA review and NIHR funded evaluation,

Please contact Laurence Carmichael, Senior Lecturer in Healthy Cities, UWE, Bristol. laurence.carmichael@uwe.ac.uk


[1] https://www.gov.uk/government/publications/health-impact-assessment-in-spatial-planning

[2] https://adph.org.uk/networks/london/2020/11/03/https-adph-org-uk-networks-london-wp-content-uploads-2020-11-adphlresponse-planning-wp-final27102020-002-pdf/

[3] •           Carmichael, L., Townshend, T., Fischer, T., Lock, K., Sweeting, D, Petrokofsky, C., Ogilvie, F and Sheppard, A. (2019). Urban planning as an enabler of urban health: challenges and good practice in England following the 2012 planning and public health reforms, in Land Use Policy, 84, p. 154-162, https://www.sciencedirect.com/science/article/pii/S0264837718307361 .

Getting public health evidence into planning policy

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By Danielle Sinnett, Miriam Ricci, Janet Ige, Hannah Hickman, Adam Sheppard and Nick Croft (UWE), Michael Chang (PHE), Julia Thrift and Tim Emery (TCPA)

The Getting Research Into Practice 2 (GRIP2) project was commissioned by Public Health (PHE) England and delivered in collaboration with the Town and Country Planning Association. The project had two aims:

  1. To facilitate the implementation of health evidence set out in key PHE publications by directly engaging with local and regional policy makers, and practitioners across place-making professions and communities.
  2. To provide evidence-informed resources to assist local authorities in developing planning policies to improve health and wellbeing.

Following the publication of Spatial Planning for Health in 2017, PHE commissioned a further research project: Getting Research into Practice (GRIP). This sought to explore the use of the principles set out in Spatial Planning for Health, and the challenges of applying these in local planning policy and decision making. The findings informed the basis of this second phase of Getting Research into Practice (GRIP2).

What we did

We selected four locations to take part in the research and develop local resources from 39 Expressions of Interest. Workshops were then held in each of the selected locations, below, to understand how health evidence could be used in the development of planning policies, with a different focus:

  • Worcestershire: template Technical Research Paper on Planning for Ageing Well that could form the evidence base for new Supplementary Planning Documents (SPD).
  • Hull: template SPD on Healthy Places to address the considerable health inequalities.
  • North Yorkshire, York and East Riding (YNYER): framework for planning for health.
  • Gloucestershire: template to integrate health into neighbourhood plans.

The four workshops took place in November 2019 and each was attended by approximately 30 key representatives from across planning and public health, the relevant local authorities or county councils, and locally identified stakeholders. Workshops consisted of a series of short ‘scene setting’ presentations followed by short interactive workshops.

Written notes from workshop discussions and other background documentation from the local areas were then analysed using the qualitative data analysis software NVivo.

The notes and analysis were used to develop:

·         Framework for a healthy places supplementary planning document (SPD)

·         Developing a healthy planning principles framework

·         Guide to creating a technical research paper on ageing well

·         Guide to embedding health and wellbeing in neighbourhood plans

A suite of guidance to integrate health evidence into planning policies

Key findings and recommendations

We found that across the four locations examined there is a genuine recognition of the ongoing need to develop places that improve health and wellbeing outcomes and reduce health inequalities. However, integration and partnership working across the professions is key, and there are areas of good practice where this is already taking place. It was seen as crucial that all those involved in the planning and development process understand the importance of planning in tackling poor health and health inequalities, including central and local government planning policymakers, and those working in development management, private developers and their consultants.

Despite this, barriers remain related to a lack of leadership, experience, financial resources and capacity in local authorities. Participants were positive that these barriers could be overcome through, for example, increasing communication and joint working between planning and public health teams, learning from best practices and successes in other locations, making better use of the powers available to planners and including a wider range of voices and contributions in the local planning policy process.

There is also an opportunity to make more effective use of health evidence in local planning policy by improving stakeholders’ understanding of the types and sources of available evidence and their strengths and limitations.

The effective use of health evidence in practice, in turn, can further strengthen the case for healthy places at the local level, encouraging buy in from politicians and local communities.

The use of workshops was seen as a key engagement mechanism that helped to initiate and strengthen these local appetites for better integration.

The research report provides a series of recommendations, for example:

  • Tailored local evidence with specific objectives and audiences in mind could be provided to allow planning policies and decisions to be made more effectively and robustly.
  • All stakeholders could develop a shared understanding of the role of planning in improving population health and reducing health inequalities.
  • Make best use of public health evidence, including that generated by communities, to help planners use their powers more effectively.
  • Ensure that health inequalities, and their relationship with the built environment, are well understood and explained in planning policies.
  • Support the creation of an effective evidence base which can be applied within a planning context, including through monitoring and evaluation of planning policies.

The resources provided above provide detailed guidance towards achieving some of these recommendations and are a valuable resource for planning and public health teams.

The key to post COVID-19 recovery: community leadership

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By Robin Hambleton….

As well as causing appalling suffering and misery, the COVID-19 pandemic is opening up new possibilities for the future.  An uplifting feature of the way that communities have responded to the COVID-19 calamity has been the spectacular expansion of self-organising community groups working at neighbourhood, or village, level to help the vulnerable and the needy.

While researching my new book, Cities and communities beyond COVID-19. How local leadership can change our future for the better, I encountered many heart-warming stories of how local communities have responded with great imagination to the disruption of local food supply chains, taken steps to protect the most vulnerable in society, and engaged in all manner of creative, problem-solving activities at the local or hyper-local level.

My research suggests that cities and localities across the world now face four major challenges at once: 1) The COVID-19 health emergency, 2) A sharp, pandemic-induced economic downturn, 3) The climate change emergency, and 4) The disastrous growth of social, economic and racial inequality in many countries.

The good news is that many cities and localities are already developing and delivering progressive strategies that address these four challenges at one-and-the-same time.

An example of good civic leadership – Freiburg, Germany

The photographs in this piece are from one of the cities now leading the way in responding to current societal challenges.  Freiburg is, of course, very well known for pioneering high quality city planning and urban design. 

For example, the Academy of Urbanism joined with the City of Freiburg in publishing The Freiburg Charter for Sustainable Urbanism in 2011.The Academy wanted not just to recognise the achievements of civic leaders and city planners in Freiburg, but also to spread the word about their approach to an international audience.

What is not so well known is that Martin Horn, the young and energetic politician, who was elected as Mayor of Freiburg in 2018, is stepping up the progressive ambition of Freiburg’s policy making.  For example, he is insisting that, as well as meeting very high environmental standards, over 50% of new housing in the city must be affordable. Yes, that’s 50%. 

Detailed plans for Dietenbach, a new eco-friendly neighbourhood for 15,000 people, deliver on this objective.  Submitted to Freiburg City Council last month, these plans also provide open space, schools, sports facilities, day-care centres and local shopping opportunities.  

Meanwhile, the imaginative Freiburg holds together (Freiburg halt zusammen) digital network bundles together numerous citizen-oriented information services and activities for residents struggling with COVID-19 pressures.

Freiburg is just one of the progressive cities featured in my book.  Other cities discussed include Bristol, Copenhagen, Dunedin, Mexico City and Portland.

Children enjoying outdoor space in Vauban, Freiburg, Germany. (Source: the author).

Lessons for UK policy, practice and research

Three lessons for UK policy, practice and research emerge. 

First, the government’s 2020 White Paper, Planning for the Future, needs to be discarded as quickly as possible.  It contains proposals that will not just destroy effective approaches to local planning but also weaken councillor and citizen involvement in local decision-making.[i]   

The evidence from Freiburg, and other enlightened cities, demonstrates that high quality urban development designed to address the climate emergency, provide housing opportunities for the less well off in society, and build liveable communities requires more planning, not less.[ii]

Second, councillors in Freiburg, like all those in Germany, have the constitutional protection to do what they think is right for the people living in their locality.  German local authorities have, then, the freedom to do things differently.  This is not the case in the UK and it is essential to rebalance power within our country via a constitutional convention.  Comparative research can help to make the case for giving local power a major boost.

Third, researchers studying how to create sustainable cities and localities need to give much more attention to power relations.  Advancing our understanding of what needs to be done to co-create liveable cities and towns is vital.  However, just as important, research needs to explore how to bring about progressive change in society. 

What is the power system that is leading to unsustainable urban development?  How can this power system be changed?  What lessons can we learn from cities that are already delivering sustainable development?  These are the kinds of questions that deserve more active consideration by researchers studying modern urban, rural and regional development.

Robin Hambleton is Emeritus Professor of City Leadership at the University of the West of England, Bristol.

Film of book launch

Robin Hambleton’s new book, Cities and communities beyond COVID-19, was published in October 2020.  The book launch, organised by the Bristol Festival of Ideas, includes contributions from Marvin Rees, Mayor of Bristol, who has written a Foreword to the book, and Professor Sheila Foster, University of Georgetown, Washington DC.  This discussion, which was chaired by Andrew Kelly, Director of the Bristol Festival of Ideas, is available here: https://www.ideasfestival.co.uk/events/cities-and-communities-beyond-covid-19/


References

[i] Hambleton R. (2020) ‘Strong place-based leadership is instrumental in the battle against COVID-19’ The Planner, 19 October.

[ii] The key suggestion here is that public policy needs to advance caring in modern society – meaning caring for others and caring for the natural environment on which we all depend.  See Hambleton R. (2020) ‘COVID-19 opens a new political window’, Town and Country Planning, November/December, 89, 11/12, 366-370.