The aim of the project is to make current and future health impacts
a priority for strategic decision-makers in urban development planning.
The relationship between the built environment and health is complex. Research in this area does not yield clear results from methods relying solely on linear causality (Lawrence, 2003). However, a consensus is beginning to emerge, particularly around the need for whole-systems analysis (Roux, 2011; Bai, 2012). Decision makers are increasingly recognising the importance of investing in cross-cutting strategies (Wilhelmine et al, 2011), comprehensive stakeholder analysis and interdisciplinary co-production (Carmichael, 2013; Cooper, 2011).
By addressing the urban environment rather than narrowly focusing on healthcare, effective solutions are more likely to be found (Bai, 2012). Research evidence demonstrating that the physical environment has a direct impact on health is growing (Barton, 2009; Braubach and Grant, 2010; Dannenberg et al., 2011, Rao, 2011). Examples of specific links include: density of urban area and car use (Newman and Kenworthy, 1996, 2006); walking, body weight and carbon emissions (Davis et al., 2007); quality green spaces, social interaction, greater physical activity and health inequalities (Croucher et al., 2007, Mitchell and Popham, 2008); land use, connectivity, population density, overall neighbourhood design and physical inactivity (McCormack and Schiel, 2011); active travel and stress (Paez, et al, 2010).
Though still outside mainstream indices of growth, economic valuation methods attempt to quantify these external costs, linking the quality of urban environment with consumptive behaviours: e.g. the £10.7bn annual cost of physical inactivity to the NHS for the treatment of non-communicable diseases (DoH, 2004); £1.12trn willingness of OECD member states to pay for prevention of 3.5m deaths caused by air pollution (OECD, 2014); £1.3bn annual damages to UK properties from fluvial and coastal flooding (HM Government, 2013); £740m cost of UK floods in 2007 (HM Government, 2013); £4.5bn cost of flooding to insurers since 2000 (ABI, 2014); £14trn estimated cost of global biodiversity decline by 2050 (Natural England, 2009).
Existing mechanisms intended to successfully mitigate external costs in urban development are evidently insufficient. Environmental Impact Assessment (EIA), introduced across Europe in 1985 (Directive 85/337/EEC) and now implemented globally, was created to minimize environmental damage caused by large-scale, single-use infrastructure projects, not to ensure the design quality of mixed-use urban environments (Barton et al, 2008). A principal criticism of EIA is lack of stakeholder involvement (DCLG, 2006). Strategic Environmental Assessment (SEA) (Directive 2001/42/EC), an extension of EIA in to evaluation of development plans and programmes, also suffers from lack of stakeholder engagement and clear spatial focus (DCLG, 2010). The UK Government now places health as a Core Principle in national planning policy, and recommends the use of Health Impact Assessment in National Planning Practice Guidance (DCLG, 2014). Unlegislated for and lacking prescriptive methods, this policy support provides a window of opportunity for new approaches in health appraisal, but the situation is confused by “the plethora of different kinds of appraisal each responding to a different political or institutional need; there is a real problem in moving from this disaggregated situation to one that is integrated and holistic in relation to health and sustainable development” (Barton and Grant, 2008).
Exemplary neighbourhood-scale urban developments are extremely rare; any aspirations are “frustrated by outdated public policies and conservative fund-holders” (Barton et al., 2000). A common theme in better quality development is that the primary equity investor, the landowner, is “committed to the objective of creating a better form of urbanism” (Prince’s Foundation/Savills, 2007). A leading global exemplar was developed on public land in Vauban in Freiburg, Germany’s fastest growing city (Hall, 2014), where among other exceptional outcomes – rate of car use is 16% (Grant et al., 2008) compared to a UK national average of 64% (ONS, 2014). Critical factors include strong links between landowner and community, active community involvement and leading technical expertise (Hall, 2014).