As the new government tries to reconcile how to grow the economy by accelerating investment in new housing with a commitment to public health and prevention, while at the same time reforming both the planning system and the NHS, the good people of Wales are quietly getting on with developing their own approach to improving health through the planning system.
Wales, like England, faces considerable public health challenges, including increasing rates of chronic diseases eg diabetes, an ageing population, and growing health inequality.
Amongst the many factors contributing to both the origins and solutions to these challenges, public health teams in Wales recognise the importance of wider determinants of health, and place influencing these as its top priority in the current public health strategy.
A further recognition that wider determinants of health are impacted by the built environment - homes, places and the infrastructure that supports and connects them – has led to some innovative approaches to adapting planning practice to promote good health and health equity.
One such approach is a Health Impact Assessment Toolkit, developed three years ago and now adopted by local planning teams across Wales.
I spoke recently to Liz Green and Cheryl Williams, public health practitioners in Wales who have been at the forefront of developing and implementing the toolkit.
Liz Green, Consultant in Public Health, Policy and International Health at Public Health Wales, was part of the team that developed the toolkit in 2021. She pointed to the pandemic as a pivotal event in revealing the integral connections between places, spaces and our health:
Developing a clear understanding of this interconnected nature of health and planning in local areas is at the heart of the toolkit.
“Living in environments that both enable and promote good health and wellbeing would see a dramatic improvement to people in Wales’ health and wellbeing outcomes. The aim of this HIA toolkit is to make integrating health and wellbeing into any future development plans as easy and simple as possible so we can all look forward to a healthier future.”
The aims of the Toolkit are to:
Outline the strategic considerations that can support the maximisation of public health input into land use planning policy
Highlight specific points within the policy development process where key Public Health contributions can be made to support and inform the policy
Provide supporting information to a maximise a consideration of health and well-being in planning development processes via the application of Health Impact Assessments
Provide real life recent case study examples and the insight from the officers who worked on these
Provide practical resources to apply Health Impact Assessments within the policy development process, primarily at a local level but could be applied at a regional or national level where and when applicable (See Part B, Sections 3 and 4).
The HIA Toolkit for Practice is focused on the preparation of Local Development Plans (LDPs) and Supplementary Planning Guidance (SPGs) but could equally inform and support the development of Strategic Development Plans (SDPs) and reviews of LDPs.
And this is what Cheryl Williams does as Principal Public Health Practitioner at Cardiff and Vale University Health Board. I spoke with her recently about how the toolkit plays out at the local level.
Cheryl’s remit focuses on health improvement and spatial planning, and this requires continually building links between planning teams and public health teams in producing Local Development Plans and planning guidance.
She emphasises the importance and value of the nationally established HIA toolkit and the thinking and legislation that underpin it. This provides a foundation of understanding and acceptance that health is a key factor in planning decisions. “It means that we can take local action with confidence and a real sense of mission,” she says. “in this case, policy does drive planning practice”.
At a practical level, the HIA toolkit provides a workshop framework – called the Rapid Participatory Workshop -- that allows Cheryl and her team to engage with stakeholders in local development plans. These provide a forum for local participation and for the generation of data that can inform future plans.
The approach has been reviewed by a number of national and international bodies. A review last year by the Cardiff University School of Social Sciences summarised the approach:
Community initiated HIA – A Welsh Case study example
· Community initiated HIA brings communities together for a common cause and helps to build relationships both between communities and between the public and statutory organisations
· Community initiated HIA requires some level of statutory sector involvement in order for it to be a material consideration in the planning process
· When conducted in a reliable and balanced manner, community HIA can provide a valuable evidence base and support for existing protest campaigns
Conclusions and recommendations
Within Wales members of the public and representatives from community groups take an active role in health impact assessment, either through participation in HIA workshops, attending focus groups or sitting on the steering group for the HIA. The majority of the respondents who were interviewed as part of this research reported that they had found their involvement in the HIA to be a positive experience, and that they welcomed HIA as a vehicle for them to be able to voice their views to decision makers. For many this was the first opportunity they had to interact with the statutory sector in this way.
The Welsh experience demonstrates how the integration of health with planning is a multi-layered process – involving national policy, local implementation and community involvement to make it work. Its approach to integration through the HIA process also demonstrates an awareness, acceptance and commitment to health equity – something not universally acknowledged in planning processes across England.
At the heart of the Welsh approach is an informal set of day-to-day relationships between policymakers and practitioners across public health and planning organisations – which generates its own energy, ideas and levels of trust. While this aspect may be hard to replicate elsewhere, it is an outcome of some replicable policies and tools. Planners and public health practitioners in England take note.
Clare Delmar
Listen to Locals
29 July 2024
