Place, public health reform and the case for change

The impact of good spatial planning on public health is well documented but the real challenge facing Scotland is putting these evidenced links into aligned policy and practice. Irene Beautyman, Planning for Place Programme Manager at the Improvement Service argues that by using a whole system approach we can support, enable and drive action that goes beyond physical impact, such as carbon emissions, to indirect social effects such as the exercise we take and the people we meet…

With Public Health Scotland due to launch in April 2020 we’re faced with a golden opportunity and by becoming an early adopter of the collaborative whole system approach we’ll be able to create places and communities that create and sustain health and wellbeing.

You don’t have to look far to see progress elsewhere. Spatial planning in England and Wales has been enabled to proactively shape built and natural environments to help promote health and wellbeing. In both cases progress is led by National Planning Guidance documents and statements in the Health and Social Care Act 2012.

This direction is also supported by World Health Organisation and Public Health England research which evidences that the way places are planned impacts, for good or ill, on health. This includes:

• Safe, convenient active travel and neighbourhood design that promotes physical activity, enhanced social connections and strengthened mental health.
• Compact neighbourhood design with walkable local facilities and public transport accessibility through car free access to jobs, delivering health benefits but also reducing the impact of poverty.
• Increased access to natural and planned green space with varied and safe opportunities to play and meet. This has a positive impact on physical activity levels and mental health.
• Wide choice of good quality affordable homes, enhancing health and reduces poverty.
• Each of the above reduce carbon emissions and enhance air and water quality.

What about Scotland?

There’s currently no direct statement in Scotland around the need for planning authorities and health organisations to collaborate around the above evidence. Glasgow City Council’s Equally Well Programme and West Lothian Council’s Health Impact Assessment Guidance are the exception rather than the rule. In both cases, support has been heavily enabled by staff from one service area physically spending time in another to understand shared ambitions and how to collaborate on local issues.

As we look to build more effective relationships across the whole system it’s important to understand each other’s perspectives. In this context, the Improvement Service’s Place Programme have led conversations with practitioners from both Planning and Health to identify how place can play a bigger part in the whole system delivery of the public health priorities. We’ve found a strong appetite for change focussed on how to mainstream a Health in all Policies approach in Local Development Plans and / or the use of Health Impact Assessments. Both are designed to lead and guide the creation of places taking full account of impact on public health.

Next steps

What would help now is a clear national statement, akin to Public Health England’s, on evidenced links between planning principles, the Places created and their impact on positive health outcomes. This would focus national level leadership and support for both the emerging Public Health Scotland and Scottish Government’s National Planning Framework. 

As the reform team look to reaffirm the ambition for Public Health Scotland to be outward looking and collaborative this is an opportunity to examine how the new organisation’s remit can support - and its people lead - mainstreaming an approach. Turning evidence into policy and policy into action needs greater levels of understanding of our shared ambition and implanting greater levels of cooperation to achieve them.