A healthy approach: how to turn what we know about liveable cities into public policy

16 December 2015

Rising rates of many non-communicable physical and psychological conditions in urban populations - particularly cancer, heart disease, diabetes, asthma and depression - are causing global concern. At the same time, there has been increased focus on how a city's structure impacts collective well-being.

We now appreciate that place, scale and context influence health. Planning directly influences exposure to air pollutants and noise, and affects the reliance on private cars for transport. It also results in access for some – but not others – to opportunities inherent in city living.

This means urban planners are essential to creating environments that support healthy behaviour.

The reinvigorated relationship between health and planning reflects a broader trend. Urban planning is being positioned as a point for better policy integration. Other sectors, which increasingly recognise the influence of city structure and function, are looking to planning as a policy mechanism to deal with the spatial expressions of their various challenges.

The need to integrate the concerns of other sectors is an accepted prerequisite to best-practice planning policy. Yet how this might occur in practice remains under-explored.

Health gains status of a planning objective

Recently, health enjoyed relative success in permeating planning policy during a review of the New South Wales planning system. This resulted in the drafting of planning legislation with human health listed as a primary objective. Internationally unprecedented, it implied that health should be considered in any planning decision-making.

The NSW Planning Bill includes controversial elements and remains subject to considerable debate. Nevertheless, it provides an opportunity to examine how health priorities might gain traction in planning policy.

The policy process can be thought of as a series of sequential phases. It begins with positioning an idea or problem on the policy agenda, in full view of those responsible for potential government action. Getting an idea on the agenda of another sector is, partially, a task of building consensus on the nature of a problem and its potential solutions.

Providing public open space for activities that reduce risks of heart disease is an obvious example of the link between planning and health.

For health to be considered a priority for urban planners, the health sector needed to frame its problems as urban planning problems. For example, the rapid increase in heart disease could be related to a lack of well-maintained open spaces for physical recreation.

During the two-year review process, submissions were invited from any organisation or individual at four junctures. These totalled more than 7000 publicly available documents. We analysed a sample of these submissions to explore how health was framed as a problem that better urban planning can help resolve.

We first scrutinised a sample of submissions from organisations we knew had health priorities. We then compared these submissions to a random sample of other stakeholders, and then again to submissions by stakeholders recognised as key influencers of the review process.

Our initial analysis revealed that only submissions from organisations with an expressed interest in healthy planning positioned health as a problem for the planning system. This suggests that, without these submissions, health may not have gained as much traction in the proposed policy as it did.

We also found that these health-focused organisations consistently proposed that health be included as an objective of planning legislation. This singular focus provided both sectors with an end-point, where the health objective was seen as an acceptable governing legislative issue for the planning system. This objective was carefully defined as relevant and resolvable through an urban planning focus.

Health-related organisations used several simple and powerful causal stories to define their message. The most obvious relates to the link between ill health, the role of built environments in its mitigation and the use of legislative objectives as a mechanism for resolving the problem.

Finally, our analysis found that submissions from health-related organisations were consistent and rigorous. These submissions were, on average, much longer than submissions from other stakeholders. They also displayed a relatively high degree of attention to detail.

What are the keys to shaping policy?

Written submissions alone cannot answer the question of why health was included in the NSW planning review. However, our analysis does indicate how planning policy might be influenced to integrate ideas of health.

• First, the review presented a unique opportunity. It opened a window to incorporating health as a problem associated with urban planning.

• Second, our review emphasises the importance of sectors and their influence. Sectors must attempt to influence land-use planning in providing a consistent, focused and evidence-based argument.

• Third, we reveal the value of giving the planning sector a simple and tangible symbol, such as a legislative objective, with which to resolve a mutual problem. It cuts through the complexities, and sometimes contested ideas, within planning reforms.

Cities can both create and resolve many of the grave problems confronting modern society. Resolution requires seemingly disparate disciplines and agendas to strategically merge when policy opportunities arise.

The experience of the NSW planning reforms demonstrates that rigorous and consistent advice about health as a relevant issue for urban planning did have an influence.