looking upstream: the main barriers and opportunities
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UPSTREAM
Looking upstream: the main barriers and opportunities
to healthier urban development according to the UK's main delivery agencies
Gabriel Scally
Public HealthDaniel Black + Associates | db+a
Presentation at Building Health in to the Urban Environment: Evidence and Opportunities
Royal Society of Medicine, Thursday 13th December 2018
Daniel Black
Director | db+a
Project Director | UPSTREAM
Black, D., Scally, G., Orme, J., Hunt, A., Pilkington, P., Lawrence, R., and Ebi, K. (2018) Moving Health Upstream in Urban Development: Reflections
on the Operationalisation of a Trans-disciplinary Case Study, Global Challenges, Wiley.
No “knowledge broker certificate”
(Robeson et al, 2008)
“often endorsed uncritically”
(Kislov et al, 2017)
Human
and
planetary
health
outcomes
Planning,
architecture,
engineering,
urban design
Controls
Land
Finance
Delivery
Public Health &
Sustainability
Specialists
National policy-making
Planning
Permission
Governance
City
Private
?
Black, D., Scally, G., Hunt, A., and Orme, J (2018) We must look further upstream to enable planetary health-literate
urban development. The Lancet Planetary Health. Vol 2, No.4, e145-e146, April2018. Elsevier.
(Observer Partner)
• City Council
• District Council
• Volume House-Builder
• Development Corporation
• Real Estate Developer & Asset
Manager
• New Investment Social Enterprise
• Regeneration Joint Venture
(contractor-social housing
provider)
• Combined Authority
ORGANISATION TYPES
CASE STUDY PARTNERS
Interviewees, Organisations and Positions
Sector OrganisationNumber of
intervieweesPosition within company
Private
• Volume House-Builder
• Developer/Asset manager
• Regeneration JV
• Investor Social Enterprise
6 Senior Executives
2 Sustainability / Health Specialist
Public
• City Council
• District Council
• Development Corporation
5 Senior Executives
2 Sustainability / Health Specialist
METHODOLOGY
‘Elite’ Interviews + Academic-Practitioner Partnership
‘Elite’ interviewing with thematic ‘probes’
Transcriptions
479 pages
codified
ACADEMIC
SPHERE
Final Analysis
Field Notes
69 pages, cross-checked
against transcriptions
PRACTITIONER
SPHERE
Reflexivity
Synthesis and
thematic analysis
2nd Round: 5 areas of deeper enquiry / testing valuation
1st Round: 13 thematic areas / wide ranging
1. Understanding of health
2. Valuation
3. Barriers and opportunities:
i. Land
ii. Partnership
iii. Finance
iv. Governance
v. Public Realm
vi. Politics
vii. Capacity
viii. Risk
ix. Knotty Problems
Key thematic areas identified
We must “balance between complexity and
the reduction of that complexity”
(El-Sayed, 2017)
UNDERSTANDING OF URBAN-HEALTH
‣ Interviewees aware of most of the evidence (e.g. air pollution, green space, physical inactivity)
‣ Some areas of surprise e.g.: ‣ Noise from road traffic > child conduct disorder
‣ Air pollution > dementia
“Almost surprised it’s not more.
Bears out my assumptions.”
“All expected”
“Broadly not surprising”
“Most are obvious, but
dementia surprising”
VALUATION
‣ Health not adequately accounted for
‣ Supportive of use of economic valuation, depending
on assumptions/detail
‣ Exact monetary value less important than ability to
compare, prioritise, get a sense of scale
‣ “Who bears additional costs?” (e.g. Consumers?
State? Landowners? Tech giants?)
‣ Multiple uses suggested (e.g. Treasury, RICS,
planning evidence, etc.)
‣ “Difficult to do”…yet private sector leading the way?
‣ Agreed mechanisms needed?
“…this looks like a really useful checklist…
…actual costs are less important…”
LAND
• Control of land (public sector?)
• Land disposal (e.g. NHS Property?)
• Land value capture widely supported…but “dangerous”
PARTNERSHIP
• Critical to balance the various strengths of stakeholders
• Concern on both sides about value that is taken out;
planning requirements “never enough”
“I think it’s very dangerous when
you try and intervene in things like
(land value capture)”
“I think land value capture
is really key…
there’s a cost and where’s
that money coming from?”
“You’ve got to understand
what you’re putting in to
the pot, and be able to
value that.
If it’s only 10% of the
partnership, then you only
get 10% of the control.”
GOVERNANCE
• Clear demand for greater devolution
• Policy alignment with delivery critical (e.g. PPG3)
• Law (e.g. Social Value Act, EIA) - “limp”?
FINANCE
• Financial short termism likely significant, but…
• … length of financial interest not a panacea
• Pension funds or niche ‘enlightened’ investors?
• ‘Localisation’ of investment?
“not to long ago there was more
about maximising stakeholder
value…
…but it’s definitely shareholder
value today…”
“…making a profit, but not profiteering…”
“Planning Policy Guidance 3
(PPG3) set minimum densities…
…now if you visit those
developments, they’re a complete
nightmare…”
PUBLIC REALM
• Maintenance
“…we don’t retain an ownership in a development…
…our business is about developing and selling houses and moving on…”
POLITICS
• Short-termism
• Prioritisation
“…elections every 5 years drives a lot of
extremely short-term decision-making...”
“If health, air quality and noise are high up
your agenda, then you’ll deliver it.”
REFERENCES
• R.J. Lawrence (2015) Mind the Gap: Bridging the divide between knowledge, policy and practice. In H. Barton, S. Thompson, S. Burgess
& M. Grant (eds.) The Routledge Handbook of Planning for Health and Well-Being, pp. 74-84, New York, London: Routledge.
• H. Frumkin (2017) ‘Welcome & Meeting Overview: What is Planetary Health and Why Now?’ [PowerPoint Presentation - Planetary
Health Alliance Inaugural Meeting. Saturday, April 29th.]
• Williams, K. (2014) Urban Form and infrastructure: a morphological review, Future of cities: working paper. Foresight, Government
Office for Science. [WWW]
• Rao, M., Barten, F., Blackshaw, N., Lapitan, J., Galea, G., Jacoby, E., Samarth, A. and Bucley, E., 2011. Urban planning, development
and non-communicable diseases. Planning Practice and Research 26 (4), 373-391.
• Bai X, Nath I, Capon A, Hasan N, Jaron D (2012) Health and wellbeing in the changing urban environment: complex challenges,
scientific responses, and the way forward. Current Opinion in Environmental Sustainability. Vol.4, Issue 4, pp.465-472. Elsevier.
• Stern, N. (2007) The Stern Review: The Economics of Climate Change. Cabinet Office - HM Treasury. ISBN: 9780521700801.
• Hoyler, M., Lizieri, C. M., Pain, K., Taylor, P., Vinciguerra, S., Derudder, B. and Pelckmans, D.(2014) European cities in advanced
producer services and real estate capital flows: a dynamic perspective. In: Pain, K. and Van Hamme, G. (eds.) Changing Urban and
Regional Relations in a Globalizing World: Europe as a Global Macro-Region. Edward Elgar, Cheltenham, pp. 115-137. ISBN
9781782544647
• Kemm J. (2012) Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress. Oxford University Press.
ISBN 0191629502, 9780191629501
• Carney, M (2015) Speech at Lloyd’s of London. Breaking the tragedy of the horizon – climate change and financial stability. Bank of
England.
• Greenhalgh T. et al (2016) Research impact: a narrative review. BMC Medicine.
• Black, D., Scally, G., Orme, J., Hunt, A., Pilkington, P., Lawrence, R., and Ebi, K. (2018) Moving Health Upstream in Urban
Development: Reflections on the Operationalisation of a Trans-disciplinary Case Study, Global Challenges, Wiley.
• Black, D., Scally, G., Hunt, A., and Orme, J (2018) We must look further upstream to enable planetary health-literate urban development.
The Lancet Planetary Health. Vol 2, No.4, e145-e146, April2018. Elsevier.
• El-Sayed, Abdulrahman M & Galea, S. Systems Science and Population Health. (Oxford University Press, 2017)
• Kislov R, Wilson P, Boaden R (2016) The ‘dark side’ of knowledge brokering. Journal of Health Service Research and Policy. Sage.
• Robeson P, Dobbins M, DeCorby K. (2008) Life as a knowledge broker in public health. Journal of the Canadian Health Libraries
Association. 2008;29:79–82.
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