The Inequalities in Health Alliance is a coalition of more than 250 organisations, convened by the RCP, who campaign for a cross-government strategy to reduce health inequalities. This blogpost from the Town and Country Planning Association (TCPA) is the first in a series by member organisations. TCPA director of healthier place-making, Julia Thrift, appeared in front of the Health and Social Care select committee last year, where she highlighted the work of the IHA and raised the need for a cross-government strategy with MPs.
There’s now widespread evidence that most of the things that keep people healthy lie beyond the NHS. Health is profoundly influenced by the homes people live in, and whether outside the home there is clean air, streets and parks that encourage day-to-day physical activity, easy access to shops and markets with affordable good food, and opportunities for work and meeting friends.
Many of these ‘wider determinants’ of health are shaped by the planning system. Planning policy determines the location and quality of homes, the proximity of local amenities such as shops and parks, and the way that places are (or aren’t) connected to each other. Planning policy also influences who gets what: which communities benefit from new development, and which don’t? Consequently, planning should have a significant role in reducing health inequalities.
In the late 19th and early 20th centuries, this was widely recognised. Planners and public health teams routinely collaborated to try to create healthier places. This collaboration dwindled, but in the last decade the TCPA has led the effort to ‘reunite health and planning’. We’ve worked with dozens of local authorities, bringing together their public health and planning teams and helping them overcome professional boundaries to ensure that the statutory local plan – a powerful document that sets out how a place will change in the next 30+ years – is informed by local public health data and addresses health inequalities. We’ve contributed to, and published, numerous free guides to healthy place-making and worked on projects such as NHS England’s Healthy New Towns. In addition, we try to influence politicians and policy makers to help them understand that planning policy is, in effect, a determinant of health and needs fundamental reform to ensure that health and wellbeing, and reducing health inequalities, are at its heart.
The TCPA is a relatively small charity, so working in coalition with others is essential. That’s why the TCPA is a member of the Inequalities in Health Alliance. We support the IHA’s demand for a cross-government strategy to reduce health inequalities – and are keen to raise awareness that planning must be included in this strategy.
Planning can seem (and often is) quite technical, so it’s easy for non-planners to zone out when changes are suggested. However, the consequences can be profound. A shocking example of this is that during the last decade the government has relaxed the rules around ‘permitted development’, making it possible to convert old offices or industrial buildings into flats without requiring planning permission. Of course, re-using old buildings is sensible – but not if the resulting flats are of atrocious quality. The consequence of this deregulation is that across England thousands of the most vulnerable people are being housed in tiny, poorly insulated, poorly ventilated spaces, with flimsy walls dividing one ‘flat’ from another, nowhere for kids to play, and often situated far from essential amenities such as shops, schools or public transport. Councils are powerless to prevent this happening as these conversions do not require planning permission. Many truly are the slums of the future. Inevitably, many people who have to live in the worst of them will become ill and health inequalities will widen.
The TCPA thinks that every new home should be designed to support the health of its occupants, not undermine it. That’s why we are campaigning for Healthy Homes. We invite you to support the campaign.
The TCPA will continue to support the important work of the IHA. We hope this blog will show how essential it is that planning policy is included in any cross-government initiatives to reduce health inequalities.