In the Manchester City Council region, there were 373 hospital admissions per 100,000 of the population in 2019, compared to the national average of 192.
It is this type of statistic, recorded by Public Health England, that a planning academic based at University of Manchester believes the real estate sector could help to rewrite through better housing and other development.
As the UK emerges from the pandemic, health and wellbeing have never been more under the spotlight. Yet, when it comes to the built environment, there is no requirement on developers to “health test” major schemes before proposals can secure planning permission.
As a result, not enough is being done to prevent badly designed buildings which encourage overcrowding and a reliance on cars for transport instead of walking or cycling, argues Dr Caglar Koksal.
This disconnect has prompted him to call for higher health-related standards to be set before permission is granted for major schemes. In a proposal likely to catch the eye of developers, he is urging local authorities to offer fast-track planning permission as an incentive for developments which actively incorporate design features that support healthier lives.
Speaking at a briefing today, Koksal, a research associate and lecturer in planning at the university, said: “When the demand for housing remains exceptionally high, developers have very little incentive to promote health with their schemes. The primary concern of most housebuilders is to deliver profits for their investors. However, local authorities can motivate and inspire developers to work together and create healthier places.”
A strong steer would be needed from local leaders responsible for establishing a unifying vision for their area. And within under-resourced local authorities, planning departments and public health teams would need to work together to implement that vision.
“Net health gain” clause
“For example, local authorities can ask all major developments to demonstrate a health net gain with their development, provided that local evidence substantiates such a requirement,” Koksal said.
“If a development demonstrates health net gain, for example, the local authority can grant an accelerated planning permission, which would lead to huge cost savings and contribute positively to the viability of the proposal.”
Local authorities could define “health net gain” to suit individual areas by tackling local problems such as high rates of asthma or obesity.
Koksal added that local authorities could set “robust design standards”, supported by the National Planning Policy Framework, to positively influence design quality. These could include a well-connected network of attractive, safe, convenient transport corridors with separated pedestrian and cycle routes, high-quality open and recreational green spaces, and decent homes built to the highest standards.
“At a minimum, local authorities’ corporate strategies should outline how they address local health and wellbeing needs with the help of their housing strategies,” Koksal said.
The briefing was hosted by cross-party think tank Social Market Foundation at Church House, Great Smith St, SW1.
Speaking on the panel, Dr Daniel Slade, policy and projects manager, Town and Country Planning Association, said: “The planning system was supposed to stop people from getting ill and the NHS was supposed to pick them up if they did get ill. The first part of that is broken.”
Slade said that far too often the starting point for conversations about improving the quality of new homes is “how can we make healthy homes viable?”. Instead, the cost of delivering the quality of homes needed should be priced in from the start, he argued.
Dr Sue Chadwick, strategic planning adviser, Pinsent Masons, said one cause for optimism was the “competitive pride” between developers over ESG targets, which councils should tap into to improve the quality of new schemes.
She also suggested that tax incentives should be used, such as a CIL rebate for homes that contribute to healthy outcomes.
James Kirkup, director of SMF, said including health in planning policy could help deliver some of the key goals of the levelling-up agenda, including “longer healthier lives”.
Ministers have promised that average healthy life expectancy will rise by five years by 2035, with an interim target to narrow the gap between local areas where it is highest and lowest by 2030.
Kirkup said: “Giving Britons longer, healthier lives will require making the places we live healthier. The relationship between building, local environment and health is hugely important, and understanding it better is vital to delivering better, healthier lives.”
Shaun Andrews, executive director, Nexus Planning
Is making health gain integral to the planning system realistic?
The built environment has a major impact on our health and therefore everyone involved in it has a huge responsibility. Achieving better health – or a net gain – in our existing places and those being planned is not just a realistic aspiration, but essential.
We believe that this is a key planning purpose and health should be centrally embedded in planning policy and decisions. This is because achieving good health requires a range of factors from removing pollution, for example, to providing affordable quality housing and good jobs, therefore a joined-up approach is essential.
This is why the role of local authorities is so important. They are best placed to understand what and where health needs are and plan accordingly. They are also the best agency to successfully leverage the private investment that is so often required to deliver the change required. That is why it is so disheartening to see the chronic underfunding of our local authorities and the slow deterioration of its strategic planning capabilities, and that the planning reforms that are so urgently required are likely to be reduced to just a ‘tidying up’.”
Is health gain the responsibility of developers?
“So, being much clearer about the health benefits arising from a proposal would be positive. Most, if not all, projects should contribute to our better collective health in some way. It should certainly be clearly understood if proposals are likely to generate a net health loss!
“Key though, is to ensure that health is looked at holistically and that the various components of good health are considered, and on a locally specific basis. Currently there is the absence of clear framework for this and this needs to be looked at. It is also important to acknowledge that not all developments can deliver or influence everything. Major new developments have more control and influence, but these are often already subjected to specific policies, standards, design codes and even masterplans which increasingly have a health focus.
“There is often less opportunity around smaller developments but they might, for example, be delivering much needed affordable homes, so we must be careful not to deter. We also need to be careful in that ‘major’ developments, in planning application terminology, can include, for example, small schemes delivering just a small number of homes.
“There is a concern that focusing on major new development that the health benefits arising are really only enjoyed by those using the scheme and within reasonably close vicinity. Health outcomes are often worse in poorer areas where development viability is marginal or negative. It is here, where private investment might not be readily available or naturally flow, that urgent improvement is most needed and that is where comprehensive local authority strategies, including planning, are required to leverage government attention and funding and the private sector.”
Is this happening already? If not, why?
“With regards to major new development, health gain is increasingly a key focus, although this is by no means universal and significant improvement is required. Often under-resourced planning teams do not have the resources to work with landowners or developers to create briefs, masterplans and codes for key sites that would achieve net health gain and be viably delivered.
“They also often do not have the capacity to work with investors and developers to mould and improve projects in this way. Sometimes health benefits are even being lost through schemes being unnecessarily or prematurely refused as a result of a broken planning application system. Unfortunately, without properly resourced Local Planning Authorities, achieving net health gain at a place or neighbourhood level, especially for those that are in most need, is likely to fail. This points to the need for additional central government funding and further decentralisation of control to local authorities. We cannot truly ‘level-up’ unless health outcomes are level across places and the country.”
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