Getting public health evidence into planning policy

Posted on

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

Posted on

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.

‘Creativity sustains us, and so does community’: reflections on listening to art in the city.

Posted on

By Katie McClymont….

I was privileged to be invited by Rising Arts Agency[1] as a ‘keynote listener’ in their performance of a conversation on the question of ‘who is allowed space to create in Bristol?’ on 4th October 2020. This was part of the Centre of Gravity exhibition in Soapworks/the old Gardiner Haskins[2] building in Bristol. Sitting in a circle for part of a conversation which carried on all afternoon and featured inputs from various young artists, I was one of a selection of ‘listeners’ who were allowed to contribute only one sentence to this conversation.

I will here try to outline to some of the things I heard, and reflect on where this conversation may lead. I will not do justice to the depth or breadth of the conversation in this small space, nor do I claim that the voice written here is anything other than mine, but I am doing this because I want to express what I heard when I was listening because I feel being in a position which gives me an audience for my words, I have a responsibility to take this conversation forward.

I am going to focus on three themes which I heard weave throughout the conversation: change, ownership, and the nature of space. This does not represent the totality of what was said, or the totality of what I heard (and I don’t assume these to be the same thing), but these ideas resonated with me, thinking as a planner about more equitable and inspiring urban spaces for the future.

The conversation opened with a discussion about the (in)affordability of space, for living and for arts, and the need for the democratisation of space at all scales- the room, the building and the city. This rapidly linked to ideas of gentrification- including a reflection on whether this conversation itself was a form of gentrification- and the nature of change. Participants saw change as inevitable: but the emotional impact (as well as financial benefits) being unevenly distributed. Questions were raised about who has to let go of the things to which they are emotionally attached for change to come about in ‘the ecology of capitalism’. Change in the city is about the movement of people, and the acceptability of this is tied to money- who brings money in by making changes, who brings a cost by arriving somewhere? Who is let in, what is protected?

Participating in the the conversation as a ‘keynote listener’

These questions on belonging, and voice in change linked to the discussions of ideas of ownership. Ownership as paradoxical term- it implies ‘home’, safe space, and comfort but also unfairness, because not all have it- not everyone has somewhere they (feel they) own. Ownership was described as individual, financial, emotional- and questions raised of how can cities accommodate all of these sorts of ownership. More negatively, ownership was also seen as limiting, tying down, holding back, stuck in one place. This relates to the impact a space has on the product or performance of all artists and the implications of the difficult balance between stability and trappedness. Moreover, this is of particular concern to young artists, asking how old do we have to be to be taken seriously- when are we no longer emerging, and therefore have the legitimacy to claim space and to remake the city in their ways, rather than being invited into space: having space for guests and visitors, rather than being visitors and guests in spaces which are owned by someone else.

Debating change and ownership in this way questions static understandings of space and place. These are questions of scale (the city itself as a space) and of purpose (the role of arts as bring about social change).  Physical space is important for reflection and connections and for new ways of experiencing ourselves- beyond the space of the phone. A particular point here was the potential of abandoned buildings: emptiness may be seen as a problem in planning/property development but offers so much scope for artists, particularly young artists, who need for ‘test space’ for experimentation without gatekeepers. Emptiness or abandonment here are not just physical or economic states, but ones of meaning-the creation of a vessel waiting to be (re)filled with a different essence. In some ways, this comes back to the first point- about being priced out of the market and the fear of gentrification. Where can be left empty for temporary inhabitation, experimentation and expression when everything has a price tag?

At a time of such uncertainty brought about by Covid, and compounded by proposed reforms to the planning system, we have scope to rethinking priorities in society- and in the cities and neighbourhoods in which this society lives. Can we think more deeply about sustaining places- places which sustain us, and in which we manage change in more inclusive and just ways- so that who is allowed space to create, and allowed to create space, is a question of conversation not just of cost.


[1] See https://rising.org.uk/ and in particular https://rising.org.uk/who-is-allowed-space-to-create/

[2] https://www.centreofgravity.uk/about

New review finds that better access to green spaces has a beneficial impact on anxiety and depression in young people, aged 14 to 24 years.

Posted on

By Issy Bray, Danni Sinnett, Rebecca Reece, Rob Hayward and Faith Martin

Mental health of young people is a serious concern, particularly since the Covid-19 pandemic which has had a massive impact on the lives of young people.

The Wellcome Trust commissioned 30 reviews over Summer 2020 to better understand the ‘active ingredients’ for tackling high rates of anxiety and depression in young people, aged 14 to 24 years. You can read more about their programme and the other projects here: https://wellcome.org/what-we-do/our-work/mental-health-transforming-research-and-treatments. Our team was commissioned to conduct a review of the evidence for better access to green spaces as a means to prevent anxiety and depression in young people. This is a multidisciplinary team bringing together public health (Dr Issy Bray, Dr Rob Hayward, Centre for Public Health and Wellbeing https://www1.uwe.ac.uk/hls/research/publichealthandwellbeing.aspx), green infrastructure and planning (Dr Danni Sinnett, Centre for Sustainable Planning and Environments) and psychology (Dr Faith Martin, University of Coventry, Rebecca Reece, Centre for Public Health and Wellbeing). This blogpost is drawn from the summary findings we submitted to the Wellcome Trust as one of the deliverables for the project.

Evidence shows that exposure to green space and having a connection with nature can benefit mental health. However, reviews of the evidence have tended to focus on children or adults. Our review looked at the evidence specifically for 14-24 year olds, and tried to better understand how green space can reduce the risk of anxiety and depression for this age group.

What we did

  • A review of a wide range of scientific research explored the role of exposure to green space in preventing anxiety and depression among young people aged 14-24 living in urban settings
  • This evidence was used to develop a model to help us understand the relationship between green space and mental health for this age group
  • Young people with lived experience of anxiety or depression were consulted about the design of our study and the model.

What we found and what this means?

  • There’s strong evidence that walking or being in a green space like a forest or park improves mood and reduces feelings of anxiety for young people aged 14-24
  • This is likely to be due to the restorative (psychologically healing) properties of green spaces. Time away from noise/work/people/social media enables young people to notice and appreciate nature, which encourages mindfulness and increases resilience to cope with stress
  • Although even short walks (15 minutes) in a green space are beneficial, there is some evidence that larger parks are more helpful, and excursions to natural environments outside the city also have psychological benefits
  • Green spaces also enable social interaction and physical activity, both of which are likely to prevent depression
  • Young people tend to under-estimate the mental health benefits of their local green space, and therefore do not use it as much as they might to improve their mood.

These findings are summarised in the infographic below.

Infographic summarising the main findings of the review

What types of studies were included?

Many of the studies included in our review were experiments which involved young people walking through a green environment (e.g. forest, park) or an urban environment. These studies compared mood and feelings of anxiety in the two groups. They tended to be carried out in Asian countries with students as participants. Some studies compared outcomes for young people before and after they completed an outdoor activity programme (e.g. a hike in the wilderness). We also included non-experimental studies that assessed the relationship between levels of neighbourhood vegetation and various outcomes, including mental health.

What were the problems with the studies?

The participants in the experimental studies were not representative of all young people aged 14-24 (e.g. often students), and some of them were based on quite small numbers of people. Few studies had depression or anxiety disorders as the main outcomes of interest, and few studies measured outcomes over the longer term.

How can those planning and designing places use this evidence?

Young people experience high levels of anxiety and depression; 1 in 5 young people have symptoms of these conditions and rates are increasing. Young people are also often disadvantaged in terms of access to private gardens, and the ability to travel long distances from where they live. This means that their neighbourhood green spaces and those in educational settings are crucial. Therefore, those planning and designing places must prioritise better access too these types of green spaces for young people, both in terms of the physical proximity to where they live, but also in ensuring they are designed to accommodate the needs of young people. Given that young people are often not aware of the beneficial role of green spaces for their mental health, there is also a need to engage young people in making better use of the green spaces they can access.