The determinants of health, access to green and blue spaces, housing condition, and noise and air pollution, highlight the breadth of impact that spatial planning can have on people’s health and wellbeing and inequalities[1]. In Wales the importance of improving health and wellbeing and reducing inequality is recognised through a placemaking approach to development[2], aiming at creating public spaces that strengthen connections between people and the space.
Placemaking plays a key role in addressing health determinants and creating healthy and happy places to live and work. Shaping the built and natural environment through the lens of health and wellbeing can support the creation of communities that enable people to make healthier lifestyle choices, prevent illness, address inequalities, and improve access to services and facilities.
Liz Green, Consultant in Public Health, Policy and International Health and Programme Director for Health Impact Assessment at Public Health Wales discusses the development being undertaken in Wales.
The impact of COVID-19
The COVID-19 pandemic has further highlighted the importance of placemaking and planning for health and equity in a collaborative manner. It has explicitly exposed, and in some examples, exacerbated the health and inequalities impacts across the population, which are derived from determinants of health such as the environment, land use, transport, the economy, and housing.
This is explored in further detail in recent work carried out by Public Health Wales, contained in a report entitled ‘Maximising health and well-being opportunities for spatial planning in COVID-19 pandemic recovery’.[3] The report highlights the major positive and negative health impacts of spatial planning policies during the COVID-19 pandemic on the population of Wales, shares learning, and highlights positive interventions and co-benefits which can support and shape a healthier future environment for all.
The report is aimed at a wide range of stakeholders including: planning, environment, sustainability and public health officers and practitioners, community leads and policymakers. It considers the pandemic response and recovery through the lens of spatial planning, health, wellbeing and inequalities, and explores interdependent issues such as mental wellbeing, climate change and environmental sustainability. Spatial planning also has a key role to play in addressing the ‘Triple Challenge’ posed by the COVID-19 pandemic, climate change and Brexit.[4]
This work and evidence review was steered by a Strategic Advisory Group which included representatives from the Welsh Government, Natural Resources Wales, Local Public Health teams and local municipal Spatial Planners, alongside Multi-Disciplinary Officers from Public Health Wales.
Several key themes were identified which are all relevant to Spatial Planners, Public Health Officers and communities. These included the importance of engagement and collaborative working to improve health and wellbeing, the role of placemaking for health, local foundational economies, the importance of access to green and blue infrastructure, housing and future home working requirements, and digital access and infrastructure.
It also explores the social and geographical differences which can have an impact on health and equity. For example, the pandemic was experienced differently across urban and rural communities in Wales. Although evidence demonstrates that urban communities had statistically higher COVID-19 related mortality rates than rural areas, rural areas faced a unique set of challenges when dealing with COVID-19, such as older populations, higher levels of pre-existing conditions and poorer access to healthcare.[5]
One key theme is the change around access to healthy food and food growing environments with, for example increases in people growing their own food and improving their gardens identified but also negative health impacts such as increased use of hot food delivery takeaway services.[6]
So, what positive changes can Planners, Public Health Officers and Policy Makers build on, or mobilise for a future recovery through spatial planning for health?
Future opportunities for health and planning that were identified include adopting and implementing placemaking principles, for example by signing up to the Welsh Government’s Placemaking Charter; promoting early involvement / joined up working between sectors to address wellbeing challenges; and promoting and utilising existing and innovative approaches to engage with communities and other key stakeholders, for example using participatory Health Impact Assessment or tools such as the Place Standard from Scotland. This is important, as it can enable Policy Officers, Planners and Local Public Health teams to consider specific actions, to address themes in the local context.
There needs to be a further consideration of the resultant impacts of the pandemic, for future healthy planning and design. This can help the mitigation of detrimental impacts, maximisation of positive ones and promotion of opportunities and co-benefits, which link to other priorities such as addressing climate change and improving health equity.
[1] Geddes et al, 2011.The Marmot Review: implications for spatial planning. London: The Marmot Review Team. NICE. Available at: The Marmot Review: Implications for Spacial Planning - IHE (instituteofhealthequity.org)
[2] Welsh Government, 2021. Planning Policy Wales (Edition 11). Available at: https://gov.wales/sites/default/files/publications/2021-02/planning-policy-wales-edition-11_0.pdf
[3] Green L et al, 2022.). Maximising health and well-being opportunities for spatial planning in the COVID-19 pandemic recovery. Cardiff, Public Health Wales NHS Trust. Available at: Maximising health and well-being opportunities for spatial planning in the COVID-19 pandemic recovery - Wales Health Impact Assessment Support Unit (phwwhocc.co.uk)
[4] Green L et al, 2021. Rising to the Triple Challenge of Brexit, COVID-19 and Climate Change for health, well-being and equity in Wales. Available at: https://phwwhocc.co.uk/whiasu/wp-content/uploads/sites/3/2021/10/PHW_Strategic_Paper-ENGLISH-Final-1.10.2021.pdf
[5] Mishra V et al, 2021. Health Inequalities During COVID-19 and Their Effects on Morbidity and Mortality. Available at: https://www.dovepress.com/health-inequalities-during-covid-19-and-their-effects-on-morbidity-and-peer-reviewed-fulltext-article-JHL
[6] Chang et al, 2020. All Change. Has COVID-19 transformed the way we need to plan for a healtheir and more equitable food environment? Urban Design International. Available at: https://doi.org/10.1057/s41289-020-00143-5
Liz Green
Liz is a Consultant in Public Health for Policy and International Health and the Programme Director for HIA at the WHO Collaborating Centre (WHO CC) on ‘Investment for Health and well-being’ Public Health Wales (PHW). She is lead for the International Health Coordinating Centre in PHW. She is also Visiting Professor at the WHO CC for 'Healthy Urban Environments' at the University of West of England, UK’. Liz has extensive knowledge, understanding and practical application of HIA, ‘Health in All Policies’ and spatial planning and provides training, advice and guidance about HIA and other IA processes. Liz has worked on approximately over 400 HIAs of varying strategic levels, complexity and topics including the comprehensive ‘The Public Health Implications of Brexit in Wales: A HIA Approach’ (PHW, 2019) and the ‘Health Impact Assessment of the Staying at Home and Social Distancing Policy in response to COVID-19 in Wales’ (PHW, 2021). More recently, Liz was awarded the title of 'Woman of Influence 2022' by the Royal Town Planning Institutes, UK.