review on healthy urban planning - phac new zealand - 2008

8/14/2019 Review on Healthy Urban Planning - PHAC New Zealand - 2008

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Report to Minister o Health on Healthy Urban Planning

Introduction

Urban planning re ers to the institutionalised process o making decisions about the uture use and charactero land and buildings in city regions. Te discipline emerged during the 19 th century largely as a result o concerns about the health and housing o populations in early industrial cities.

Much early urban development produced unsanitary conditions and contributed to the spread o in ectiousdisease. By the middle o the 20th century good urban planning and other public health measures had largely conquered the spread o in ectious disease in cities in developed societies and the involvement o publichealth pro essionals diminished accordingly.

In recent times the main public health involvement in urban health issues has been concerned with ensuringpeople are protected rom environmental hazards associated with certain industrial practices. In the mainthis has been accomplished success ully with the result that today ar ewer people in developed societies areexposed to hazardous industrial pollutants than was the case in previous decades.

However new concerns have emerged about the potential impact o the contemporary urban environmenton population health; in particular the impact o transport, housing development and land use planning onpeoples li estyles and opportunities to maintain their health and wellbeing throughout the li ecourse. Tishas coincided with unease about the environment, our use o scarce resources and the impact that humansmay be having on the global climate.

Te World Health Organization (WHO) identifed the urban environment as a key area or uture policy development and intersectoral collaboration when it established the Healthy Cities project in the 1980s. Tisproject is now in its ourth phase and healthy urban planning is identifed as one o the key activities or

participant cities. Tis review will provide a brie introduction to the modern development o the HealthyCities approach and healthy urban planning and identi y the key eatures and methods that need to bedeveloped to make it success ul.

Background

During the 1970s people worldwide became dissatisfed with the inability o existing health services torespond to newly emerging health requirements and expectations. Te resulting strategy, Health for All by theYear 2000, was launched at the World Health Assembly in 1979 1. It highlighted the idea that the main areaswhere action was required to improve health and wellbeing lay outside the ormal health sector. In 1986, the

First International Con erence on Health Promotion in Ottawa declared that the undamental conditionsand resources or health are peace, shelter, education, ood, income, a stable ecosystem, sustainable resources,social justice and equity. Improvement in health requires a secure oundation in these basic prerequisites 2.

Te international Healthy Cities movement began in 1986 as a WHO project with the aim o taking therhetoric o Health for All and the Ottawa Charter o the shelves and into the streets o European cities. Ahealthy city has been defned as one that is continually creating and improving those physical and socialenvironments and expanding those community resources which enable people to mutually support eachother in per orming all the unctions o li e and in developing to their maximum potential 3. Initially theHealthy Cities approach sought to put health high on the political and social agenda and to build a strongmovement or public health at the local level. It puts a major emphasis on intersectoral collaboration,community development and the development o city health profles. Te WHO has identifed the ollowing

1 Global Strategy orHealth for All by the Year 2000. Geneva: World Health Organisation.2 Ottawa charter or health promotion. 1986. Health Promotion, 4: iiiv.3 Hancock , Duhl. 1988. Promoting health in the urban context. Copenhagen (WHO Healthy Cities Papers, No.1).


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11 principles o a healthy city 4:

1. Te meeting o basic needs ( or ood, water, shelter, income, sa ety and work) or all the cityspeople

2. A clean, sa e physical environment o high quality, including housing quality 3. An ecosystem that is stable now and sustainable in the long-term4. A diverse, vital and innovative economy 5. A strong mutually supportive and non-exploitative community 6. A high degree o participation and control by the public over the decisions a ecting their lives,

health and wellbeing7. Te encouragement o connectedness with the past, with the cultural and biological heritage o

city-dwellers and with other groups and individuals8. Access to a wide variety o experiences and resources with the chance or a wide variety o

contact, interaction and communications9. A orm that is compatible with and enhances the preceding characteristics10. An optimum level o appropriate public health and sick care services accessible to all11. High health status (high levels o positive health and low levels o disease).

Agenda 21 emerged in the early 1990s as a parallel development to the Health for All and Healthy Citiesapproaches but it was quickly recognised that it has much in common with these approaches. Adopted by UN member states at the 1992 Rio summit, it sets out a comprehensive programme o action or sustainabledevelopment into the twenty-frst century. Central tenets o sustainable development include quality o li e, equity within and between generations and social justice. One chapter is specifcally devoted to theprotection and promotion o human health, and the whole document is concerned with issues o wellbeing,with more than 200 re erences to health. Te centrality o health to sustainable development is illustratedby the accompanying Rio Declaration, which states as its frst principle that Human beings are at the centreo concerns or sustainable development. Tey are entitled to a healthy and productive li e in harmony withnature.

In 1998 the WHO adopted an updated strategy or Health for All in the 21 st century (Health 21) andsupported this with a World Health Declaration 5. Tis strategy frmly recognised the role o agencies outsidethe ormal health sector to tackle the wider determinants o health and the interaction between healthand sustainable development. Within Europe our strategies or action were chosen to ensure scientifc,economic, social and political sustainability drive the implementation o Health 21:

Multisectoral strategies to tackle the determinants o health, taking into account physical, economic,social, cultural and gender perspectives and ensuring the use o health impact assessments

Health outcome driven programmes and investments or health development and clinical care

Integrated amily and community-oriented primary health care, supported by a exible and responsive hospital system A participatory health development process that involves relevant partners or health at all levels (eg,

local community, workplace, school) and that promotes joint decision-making, implementation andaccountability.

Healthy Cities today

Te Healthy Cities project is now into its ourth fve-year phase in Europe and has three main themes whichparticipating cities are expected to work on: healthy ageing, healthy urban planning and health impact

assessment. In addition, all participating cities ocus on the topic o physical activity and active living. Morethan 1000 towns and cities rom more than 30 countries o the WHO European Region have signed up to theprinciples o Healthy Cities. Te Healthy Cities approach was adopted by the WHO Western Pacifc Region

4 Goldstein G. 2000. Healthy Cities: Overview o a WHO international program. Rev. Environ Health; 15(1-2): 207-14.5 Health21- the Health for All policy ramework or the WHO European Region. Copenhagen, WHO Regional O ce or Europe.


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in the early 1990s with around 100 cities now participating rom this region. By becoming a healthy city,local government organisations commit themselves to a new way o working which has our key operationalelements that together provide the basis or the transition to a healthy city, as illustrated below:

Te Healthy Cities approach our ways o working

AExplicit political commitment at the highestlevel to the principles and strategies o theHealthy Cities project

BEstablishment o new organisationalstructures to manage change

CCommitment to developing a shared vision

or the city, with a health plan and work onspecifc themes

DInvestment in ormal and in ormalnetworking and cooperation

A- Political commitment: Reorienting urban decision-making processes towards health and sustainabledevelopment requires changing how decisions are made and how di erent sectors implement thesedecisions. Tis requires political support at the highest level, because change needs to disseminatethroughout the entire city and not just in one department or area o work. It requires politicalendorsement o the principles and strategies o Health for All Health 21, Agenda 21 and the Healthy Citiesapproach.

B- Organisational structures: Te principle o intersectoral collaboration is critical to the development o healthy and sustainable cities. Cities which participate in the WHO initiative are expected to establishan intersectoral steering group that oversees initiatives and the work o the project. Tere is also a need

or city-wide partnerships or health to be established which should be extended beyond health and localgovernment to include representatives rom business, community groups and NGOs.

C- Realising a shared vision: Te shared vision or the healthy city is usually expressed through a city healthdevelopment plan (see below) which addresses how the di erent sectors within the city will work towardsimproving health and wellbeing. Tis is likely to include aspects o urban environment planning whichsupport good health such as housing management, transport and parks. A wide range o people shouldbe involved in the development o a city health plan such as local politicians, planners, representatives

rom public sector organisations, voluntary sector organisations/interest groups, healthcare pro essionalsand community representatives.

D- Networking: Regional, national and international networking is an important component o HealthyCities work. In addition thematic networks have been a success ul approach to support work in specifc

topic areas.

City Health Development Plans

Te development o a City Health Development Plan requires a comprehensive understanding o thehealth and social needs o the population and is there ore likely to be preceded by the development o ahealth profle which is a public health report that uses in ormation to identi y the health status o the localpopulation and identifes the areas where change and action is most needed. Te City Health DevelopmentPlan should identi y the role o di erent partner organisations in improving health and set out some o the actions that will be undertaken. Te creation o supportive environments or health is an importantcomponent o city health development plans so urban planners should have a signifcant role to play.

Intersectoral Collaboration/Action or Health

From the outset o Healthy Cities there was a strong emphasis on intersectoral collaboration, i.e., the


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need or health agencies to develop links and working relationships with other key agencies, especially local government. oday the emphasis is on intersectoral action or health to ensure that collaborationbrings about changes in policies and programmes. 6 Tis is driven by the recognition that, with increasingcomplexity in society and in governance, there is a need to build strong coalitions in order to drive change 7.

Intersectoral action or health has been defned by the WHO as a recognised relationship between part orparts o the health sector with part or parts o another sector which has been ormed to take action on anissue to achieve health outcomes (or intermediate health outcomes) in a way that is more e ective, e cient orsustainable than could be achieved by the health sector acting alone 8.

In 2001 a New Zealand Ministry o Health report carried out a literature review o intersectoral initiativesor improving the health o local communities 9. Recently the Canadian Public Health Agency has produced

a report identi ying experiences, methods and achievements in intersectoral action, public policy and healthwhich is an important contribution to this literature and provides guidelines or e ective intersectoralaction 10.

Community Participation

Engagement and empowerment o the community has been a key eature o the Healthy Cities approachsince the outset. Active community involvement is a necessary condition not only to identi y the real healthneeds o the population and to establish the priority interventions but also to strengthen the social cohesionand individual sel -determination, both very important especially or mental health. More recently an evengreater importance has been attached to community participation and there is now an expectation that citiesshould demonstrate increased public participation in the decision-making processes that a ect health in thecity, thereby contributing to the empowerment o local people 11 12.

From Healthy Cities to Healthy Urban Planning

Te major causes o death and injury in the urban environment today include alcohol, tobacco, drugs,environmental toxins, motor vehicles and weapons such as guns and knives 13. Tese are all areas where the

ormal health sector has relatively little impact. In addition, public health research suggests disease occursmore requently among those who have ewer meaning ul social relationships, are in lower hierarchicalpositions and are disconnected rom their biological and cultural heritages 14. Both the literature andstatistical trends reveal the complex and interconnected nature o modern ills and demand a broaderperspective in urban health policy than the conventional approach one that moves away rom thetraditional health concerns o urban planning and into a comprehensive realm which links the unctionso urban planning and the creation o strong, healthy and vibrant neighbourhoods, towns and cities. Tepublication o Social determinants of health: the solid facts by the WHO in Europe helped to move orward

6 Public Health Advisory Committee. 2006. Health Is Everyones Business: Working ogether or Health and Wellbeing. PublicHealth Advisory Committee, Wellington.

7 Duhl L. 1995. Te social entrepreneurship o change. New York, Pace University.8 WHO. 1997. Intersectoral Action or Health: A Cornerstone or Health- or-All in the wenty-First Century, Report to the

International Con erence 20-23 April 1997 Hali ax, Nova Scotia, Canada, World Health Organisation, Geneva.9 New Zealand Ministry o Health. 2001. Intersectoral Initiatives or Improving the Health o Local Communities: A Literature

Review. http://www.moh.govt.nz/moh.ns /pagesmh/369?Open , accessed 14/08/07.10 Publc Health Agency o Canada. 2007. Crossing Sectors- Experiences in Intersectoral Action, Public Policy and Health.

http://www.phac-aspc.gc.ca/publicat/2007/cro-sec/pd /cro-sec_e.pd , accessed 14/08/07.11 WHO Regional O ce or Europe. 1999. Community participation in local health and sustainable development: a working

document on approaches and techniques. Copenhagen, European Sustainable Development and Health Series, no 4.

http://www.euro.who.int/document/e78652.pd , accessed 20/08/0712 Public Health Advisory Committee. 2006. Health Is Everyones Business: Working ogether or Health and Wellbeing. Public

Health Advisory Committee, Wellington.13 Mcginnis JM, Foege JM. 1993. Actual causes o death in the United States. Journal o the American Medical Association; 270:

22072212.14 Lindheim R. Syme L. 1983. Environments, people and health. Annual Review o Public Health; 4: 335359.
http://www.moh.govt.nz/moh.nsf/pagesmh/369?Openhttp://www.phac-aspc.gc.ca/publicat/2007/cro-sec/pdf/cro-sec_e.pdfhttp://www.euro.who.int/document/e78652.pdfhttp://www.euro.who.int/document/e78652.pdfhttp://www.phac-aspc.gc.ca/publicat/2007/cro-sec/pdf/cro-sec_e.pdfhttp://www.moh.govt.nz/moh.nsf/pagesmh/369?Open


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thinking in this area 15.

Te booklet highlighted ten interrelated areas that are critical to good health in the modern environmentincluding the importance o addressing poverty and deprivation, unemployment, the environment thatchildren grow up in, social exclusion, the role o riendship and social connections, the impact o alcohol anddrugs, the need to ensure access to healthy ood and the importance o a healthy transport system. In thesame year the National Health Committee o New Zealand produced a similar report on the social, culturaland economic determinants o health in New Zealand which reached broadly similar conclusions 16 17.

Although the Healthy Cities approach success ully changed the way the health sector engages with localgovernment and other agencies, the actual impact on the environment that people live in has o en beenlimited. Planning policies have been resistant to change and many cities have continued to emphasise theneeds o the individual over those o the community. Suburban sprawl and road building has continued,

acilities or pedestrians and cyclists receive minimal investment and only a minority o cities have investedin substantial improvements in public transport. Hence car dependency has increased over the past 20 years.

Tis has created the demand or a new orm o urban planning which once again makes improved publichealth a primary objective o planning considerations. Tese demands have emerged both rom within theplanning sector and rom the public health community. Within planning, a new movement or change hasemerged rom the USA called New Urbanism or neo-traditional planning.

It developed in response to growing concern that post war planning had done great damage to the Americanurban environment creating towns and cities dominated by cars and lacking in aesthetic qualities. Te NewUrbanists argue that the dominance o the suburb and the associated decline o inner urban areas reducedwellbeing in American society due to less time or personal enjoyment, fnancial constraints and a growingsense o disconnection rom the wider community 18.

Coinciding with the emergence o New Urbanism, public health practitioners in uenced by Health for All

and Healthy Cities principles are taking a greater interest in how the social and economic environment thatwe live in a ects our health and wellbeing and the likelihood o maintaining good health into old age. Teimpact o the post war urban environment on opportunities or physical activity and social interaction and itsimpact on mental health and wellbeing have become a common concern or New Urbanist and new publichealth advocates and both have called or reintegration o public health and urban planning.

Healthy Cities programmes throughout Europe have sought to involve urban planners in their work sincethe late 1980s, but since the third phase o the WHO Healthy Cities network (1998-2002), a more concertedemphasis has been placed on the need to integrate health objectives into urban planning. Te baseline orthis new area o work was established in 1998, through a questionnaire survey targeted at the heads o urban

planning departments in 38 cities participating in the second phase o the Healthy Cities project.Te survey ound that planning departments and health agencies operate largely in isolation rom oneanother and regular co-operation between health and planning occurred in only a quarter o cases. Nearly athird o planning chie s considered that, in certain ways, planning policies were actually incompatible withhealth, in particular rigid standards o zoning and design 19.

In 1998, WHO began to work with urban planning practitioners and academics rom across Europe andbeyond in a more concerted way. As a frst step, in 2000, Barton and sourou published the book Healthy15 Wilkinson R. Marmot M., ed. 1998. Social determinants o health: the solid acts. Copenhagen, WHO Regional O ce or

Europe.

16 National Health Committee. 1998. Te social, cultural and economic determinants o health in New Zealand: Action toimprove health. National Health Committee, Wellington.

17 Public Health Advisory Committee. 2004. Te Health o People and Communities A Way Forward: Public Policy and theEconomic Determinants o Health. Public Health Advisory Committee, Wellington.

18 Langdon P. 1994. A better place to live: reshaping the American suburb. Amherst, University o Massachusetts Press.19 Barton H, sourou C. 2000. Healthy Urban Planning. London: Spon and Copenhagen: WHO.


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Urban Planning with WHO support. It makes the case or health as a central goal o urban planningpolicy and practice, highlighting the role o planners in tackling the social, economic and environmentaldeterminants o health. Te next section summarises the approach suggested in this publication ordeveloping healthy urban planning in municipal government.

Healthy Urban Planning in Practice

A comprehensive approach to healthy urban planning should address all the health determinants relating tothe physical environment and should re ect the core principles o the WHO Health for All strategy such ascommunity participation, intersectoral collaboration and equity 20.

Active community involvement throughout the planning process is a necessary condition to identi y the realneeds o town users and to establish priority interventions 21 22 23. It can also strengthen social cohesion andindividual sel -determination, both important or mental health.

Te operational and assessment tools developed during the Healthy Cities experience (indicators, healthprofle, and city health development plan) can provide urban environment planners and policy-makers

with good in ormation to identi y priorities, understand local needs and assess the e ects o implementedplanning decisions. Since di erent public sector policies as well as activities o the private and voluntary sectors produce an impact on health, intersectoral collaboration represents a way to achieve a shared vision,legitimacy or action, knowledge exchange and co-ordinated actions among specialists, administrators andusers24 25.

Te e ective integration o the equity principle in urban planning should result in reduction o urban abricimbalances, car use, air and noise pollution, while quality o public spaces, social cohesion, healthy li estylesand employment opportunities are increased 26 27.

An integrated and holistic approach to pursuing the objectives highlighted in able 1 is needed whichrequires cooperation and partnership to replace competition. Te most important areas o cooperation are as

ollows:

Land use and transport planning, linking the location o housing, employment and acilities with astrategy or transport

Strategies or social services, embracing the orward planning or social housing, health, education,open spaces with integrated land use and transport planning

Economic regeneration strategies, so that economic development and urban regenerationprogrammes are mechanisms or implementing a healthy planning strategy

Integrated transport strategy, incorporating roading policies, car parking, public transport planning

and operations, cycling and walking Integrated resource planning or energy, water, ood, waste etc.

20 WHO Regional O ce or Europe. 1999. Health 21 - theHealth for All policy ramework or the WHO European Region.Copenhagen, European Health for All Series, No 6.

21 WHO Regional O ce or Europe. 1999. Community participation in local health and sustainable development: a workingdocument on approaches and techniques. Copenhagen, European Sustainable Development and Health Series, no 4. http://www.euro.who.int/document/e78652.pd , accessed 20/08/07.

22 WHO Regional O ce or Europe. 1997. own planning and health, Copenhagen, Local authorities, health and environmentbriefng pamphlet series, No 16.

23 Public Health Advisory Committee. 2004. A Guide to Health Impact Assessment (second edition). Public Health Advisory Committee, Wellington.

24 Woodward, S. 1998. A conceptual ramework or the analysis o intersectoral working groups. Paper presented at the HealthyCities International Con erence, Athens, 20-24 June.

25 OECD. 2001. owards a new role or spatial planning. erritorial Development, OECD Proceedings.26 United Nations. 2000. Agenda 21. http://www.un.org/esa/sustdev/documents/agenda21/index.htm , accessed 08/08/07.27 WHO Regional O ce or Europe. 1997. City planning or health and sustainable development. Copenhagen: European

Sustainable Development and Health Series, No.1.
http://www.un.org/esa/sustdev/documents/agenda21/index.htmhttp://www.un.org/esa/sustdev/documents/agenda21/index.htm


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In many urban localities, the municipal units responsible or transport, energy, water, housing, ood andhealth do not coincide, and it makes it di cult to pursue healthy planning objectives. Systems o urbanplanning and management in western societies tend to rely on specialist agencies pursuing their particularremits largely in isolation.

For example, there are o en separate agencies or transport, pollution control, energy, water, health andland development. According to Barton & sourou 28 these systems have been ailing as they are based on anoverly simplistic linear view o cause and e ect and a competitive ideology.

One key to consistency is a shared planning approach whereby settlements and their hinterlands are seen asecosystems di erent groups and activities are seen as interdependent and the relationship with the resourcebase o land, air, water, energy, ood and materials is made explicit.

Te shared objective, which overrides specifc agency responsibilities, is to create a healthy human habitatunctioning to create opportunities and a high quality o environment or people irrespective o socio

economic position in a manner that is ecologically sustainable.

Joint working across all o these di erent areas is challenging and o en cuts across existing corporateobjectives. Where this is the case the frst stage must be to ensure that health and environmental concernsare made high priorities or organisations. Tis will requently require central government to change theremits o organisations either through legislation or regulation.

In addition Government may require the application o rigorous process which ensures that health andsustainable development objectives are high priorities when dealing with major planning issues that involveagencies in all the above areas.

Governments in many countries now require the application o Strategic Environmental Assessment (SEA)o major planning policies and schemes to ensure they support central objectives or health and sustainable

development. SEAs include a detailed report on the state o the environment and the likely impacts o theproposed plans on the environment. Health implications should be a signifcant component o the SEAprocess and can be integrated within the SEA or considered within a Health impact assessment (HIA)running alongside 29. Either way the process should be collaborative and the development o a health proflewhich all responsible agencies can utilise is good practice.

Much o the process or implementing healthy urban planning there ore builds on the methodsrecommended or developing Healthy Cities. Barton proposes the ollowing fve-stage process or agenciesseeking to collaborate on healthy urban planning:

1. Negotiate clear goals and purpose o the plan agencies should consult widely with partners, publicand politicians about the scope o their plans. Putting the health o the public as a central objective issomething that many agencies and public will agree on and other potential objectives around housing,transport, resources and environment can ow rom this. Te public can be consulted through arange o methods such as social attitude surveys.

2. Establish the baseline by creating a city health profle which incorporates baseline social, health,economic and environmental conditions. Tis will provide an opportunity to recognise problemsexperienced by communities. Obtaining agreement that particular problems need to be addressed isan important step towards establishing the alliances to address the problems.

3. Scope and explore options scoping and policy development is an ongoing process that should occuralongside identifcation and analysis o problems. A range o alternative options to the avouredoption should be considered and evaluated to overcome policy inertia and ensure that the processstands up to assessment that might be applied through SEA.

28 Barton H, sourou C. 2000. Healthy Urban Planning. London: Spon and Copenhagen: WHO29 Public Health Advisory Committee. 2004. A Guide to Health Impact Assessment (second edition). Public Health Advisory

Committee, Wellington.


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4. Evaluate and refne policies the process o evaluating and choosing policy should be open,explicit and transparent i the resulting decisions are to carry weight. Quantitative and qualitativeassessments need to be balanced and the interests o di erent groups recognised.

5. Coordinate implementation many planning agencies have restricted powers which can be limitedto yes or no responses to specifc planning proposals. However there is little to be gained romallocating land or housing i water, transport, schools, jobs or health services are unavailable. Te job o the healthy urban planner should be to negotiate and establish coordinated programmes o implementation in which the di erent agencies agree on social objectives and invest accordingly.

Another approach or healthy urban planning which is increasingly promoted is to ocus on the needs o the most vulnerable populations 30. Tis approach is requently adopted in health protection considerationswhere, or example, the standard or the maximum permitted levels o lead exposure is set or the mostsusceptible population, i.e., children. Yet research suggests that urban planning is seldom ocused onthe needs o the most vulnerable groups 31. Instead urban areas are mainly designed around the needs o economy and commerce.

30 Crowhurst-Lennard SH, Lennard HL. 1987. Livable cities. Southampton, NY, Gondolier Press.31 Duhl LJ, Sanchez AK. 1999.Healthy Cities and the planning process. WHO Europe.

http://www.euro.who.int/document/e67843.pd , accessed 21/08/07.
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able 1: welve Key Health Objectives or Planners

Key Objective Unhealthy Urban Planning Healthy Urban Planning

Healthy Li estyle:Do planning policies andproposals encourage and

promote healthy exercise?

Low density housing and acilitiesthat lead to longer trip patternsor encourage use o cars do not

encourage healthy li estyles.

Planning can create attractive, sa eand convenient environments thatencourage walking or cycling to work,

school etc. Planning can ensurerecreational opportunities in accessiblelocations.

Social Cohesion:Do planning policies andproposals encourage socialcohesion?

Social cohesion can be underminedby insensitive housing developmentand dispersal o communities. It isalso undermined by roads severingcommunity links, constructingbarriers to pedestrian connectivity andby large commercial schemes.

Urban planning cannot create localcommunity or cohesive social networks.It can though be acilitated by creatingsa e, permeable environmentswith places where people can meetin ormally. Mixed use development intown centres, commercial environmentsand neighbourhoods can broaden socialoptions.

Housing Quality:Do planning policies andproposals encourage andpromote housing quality?

Insu cient overcrowded housing,poorly insulated, built with toxicmaterials and unsa e structures aredetrimental to physical health, mentalhealth and increased risk o accidents.Poor locations, design and orientationo housing can exacerbate crime and vandalism.

Housing quality can be improved by ensuring detailed design, orientationand energy saving materials. Providinga range o housing tenure or di erentincomes and close to public amenitieswill beneft health.

Access to Work:Do planning policies andproposals encourage andpromote access to employmentopportunities?

Employment opportunities createdin inaccessible locations or a lack o a variety o jobs in a community cannegatively a ect health directly andindirectly.

Urban planning linked to strategiesor economic regeneration can assist

by acilitating opportunities orbusiness and can encourage diversity inemployment and ensure that local jobopportunities are retained. Provision o transport in rastructure is important.

Accessibility:Do planning policies andproposals encourage andpromote accessibility?

Service rationalisation in recent timeshas o en resulted in closure o localpublic acilities. Tis can result inrestricted access especially amongstthe old, women, children, people withdisabilities and ethnic minorities.Out o town retail centres haveproli erated, o en to the detriment o

local acilities.

Planning can ensure a choice o transport modes, especially ensuringthat acilities are accessible to peoplewalking, cycling and using publictransport. Sa e walking and cyclingroutes can be promoted and tra cmanaged to slow, calm and reduce vehicle speeds.

Local Food Production:Do planning policies andproposals encourage andpromote local ood production?

Planning can overlook the importanceo accessible open spaces andproviding allotment gardens.Centralisation o shopping acilitiescan reduce variety o ood availablelocally and disadvantages thosewithout private transport.

Local ood sources such as marketgardens, allotments and city armscan enable people on low incomes togrow their own ood. Urban planningcan encourage a diversity o shopping

acilities, helping to prevent dependenceon large out o town shopping.


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Sa ety:Do planning policies andproposals encourage andpromote sa ety and theperception o sa ety in thecommunity?

Urban planning can create alienatingenvironments where people areuncom ortable being out on the street.Tis can be due to inadequate lighting,heavy tra c or poor urban design.Where the pedestrian environment isintimidating people use cars more andstreets become deserted increasing theperception o danger.

ra c calming techniques which givepriority to pedestrians and cyclists are vital or a sa er environment. Goodurban design or residential andcommercial areas can ensure a naturalprocess o surveillance over public spacethat reduces crime and the ear o crime.

Equity:Do planning policies andproposals encourage andpromote equity and thedevelopment o social capital?

Planning does not directly a ectincome but does have indirect e ects.Te planning system can be used,

or example, to hinder or to helpthe process or providing a range o

acilities and providing opportunitiesor improving levels o equity.

Te planning system can help withprovision o social or low-cost housing,

acilitate creation o job opportunitiesand can in uence movement patternsby ensuring a range o easily accessible

acilities.

Air Quality & Aesthetics:Do planning policies andproposals encourage and

promote good air quality,protection rom excessive noiseand an attractive environment

or living and working?

Poor air quality results in part romine ective land use and transportstrategies leading to high levels o

road tra c and actories pollutingresidential areas. Te absence o good neighbour policies can meanthat residents and workers are subjectto excessive noise, unpleasant umesand visually arid environments thatundermine wellbeing and contributeto ill health.

Planning can assist by putting localenvironmental quality high on theagenda in commercial, industrial

and residential areas; by segregatingpolluting and noisy industrial uses o land; by promoting less polluting ormso public transport, deterring car useand restricting lorries to specifc routes;and by supporting the developmento energy-e cient buildings andneighbourhoods.

Water and Sanitation Quality:Do planning policies andproposals encourage andpromote improved water andsanitation quality

Health can be adversely a ectedi the use o local sourcing andlocal treatment o supplies is notencouraged.

Urban planning can impose standardsand criteria that new developments mustmeet. It can promote sa e on-site watercollection, purifcation and infltrationback into the ground or replenishingstreams. It can ensure that developmentsdo not take place where there is athreat o ooding and that aqui ers arenot contaminated when agricultural,transport and industrial processes areplanned.

Quality o Land or MineralResources:Do planning policies andproposals encourage andpromote the conservation andquality o land and mineralresources?

Planning can enable developmentsthat cause land degradation such asdevelopments on greenfeld land,intensive agriculture or de orestationas well as excessive use o mineralresources in in rastructure projects.

Planning can ensure that recycled andrenewable materials are used wheneverpossible in the building constructionprocess. Green space, urban openspaces, allotments, market gardens andparks can be sa eguarded in planning.Brownfeld developments can beencouraged instead.

Climate Stability:Do planning policies andproposals encourage andpromote climate stability?

Planning can contribute to climateproblems by ailing to considerpolicies that encourage reductionsin ossil uel use, including energy conservation in the construction anduse o buildings.

Urban planning can a ect the rate o human emissions o greenhouse gases by in uencing energy use in buildings andtransport and by developing renewableenergy sources.

Adapted rom Barton & sourou 2000 Pg. 13-22.


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Healthy Urban Planning: Brie Introduction to Strategies, Policies, and theRole o Health Impact Assessment

Strategies

Urban areas vary enormously both in size and in social, economic, environmental and political dynamics.Tis means that any approach to healthy urban planning must be adapted to the individual circumstances o a particular urban area. Barton and sourou 32 describe our healthy urban planning strategies which may beapplicable within the New Zealand urban context.

Tese are urban regeneration; compact growth; ocused decentralisation; and linear concentration. Tey are long-term development strategies and are deliberately organised sequentially, so that those which arehealthiest are considered frst, e.g., urban regeneration is the best o all options. However it is not appropriatein all cases so it becomes necessary to move onto compact growth etc. I well planned, all these strategies canhelp to prevent uncontrolled sprawl and leap rog developments which lead to increased vehicle dependency.

Urban Regeneration Strategy

A strategy or urban regeneration is based upon accommodating the vast majority o new developmentwithin existing urban boundaries. Tis approach needs e ective planning policies to ensure that valuedpublic open space is not lost and connectivity is built in to new developments. Tis approach appliesespecially in regions where growth and economic restructuring is occurring and where existing urban density is low.

Strategy for Compact GrowthA strategy or compact growth may be considered when the existing urban area has insu cient capacity toaccommodate predicted growth. Te strategy then is to release land close to the town/city with good accessby walking, cycling and public transport. Te compact growth strategy is likely to apply to smaller citieswhich are growing rapidly and is rarely appropriate in large conurbations. Tere is evidence to support a1.5km distance that people are prepared to walk to access town centres which needs to be considered ordevelopments in this approach.

Focused DecentralisationTis is an adaptation o the compact-growth strategy which is more appropriate to larger urban settlementswith signifcant smaller towns in the local area. Te ocused decentralisation strategy de ects some o theurban growth into suburban towns or ree standing commuter towns with the aim o making these more sel -su cient in jobs and services. Tis strategy is most appropriate in highly urbanised regions with clusters o closely linked towns and cities.

Linear ConcentrationTe ocused decentralisation strategy works well in theory but in practice is very di cult to implement,especially in countries where the cost o uel is low and people think little o travelling considerable distancesto access work or shopping. So the ourth option is to return to the idea o concentration, not on a peripheralpattern but instead on a linear pattern. Linear concentration means growth along broad transport corridors,ideally public transport corridors linking the central city with smaller centres and suburbs. It is importantto avoid these corridors becoming too long or trip lengths can become too lengthy. Te strength o thisapproach is that it recognises the central city as the driving orce o the regional economy whilst encouragingdevelopment o local acilities.

32 Barton H, sourou C. 2000. Healthy Urban Planning. London: Spon and Copenhagen: WHO.


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Policies

Tis section will highlight three policy areas where urban planning can have a signifcant impact on health:transport, neighbourhoods and public spaces.

Transport ransport is a key component o healthy urban planning. Tis has been recognised in Europe where a

Charter on ransport, Environment and Health was adopted in a Ministerial con erence in 1999. TeCharter essentially recognises that we need to seek ways to reverse car dependency and promote alternativeand active transport modes. It includes the ollowing health priorities:

Improve air quality especially in inner urban areas which usually have the highest levels o air pollution

Encourage regular exercise in the orm o walking and cycling which can reduce incidence o obesity,diabetes and heart disease and increase wellbeing

Reduce the level o road tra c accidents, which result in high levels o death and injury and signifcant healthcare costs

Improve levels o accessibility to jobs and services or those lacking access to a private car Enhance opportunities or social interaction and a sense o community - road tra c can cause

alienation and isolation in cities with roads dividing communities and causing severance Reduce consumption o scarce energy and road building resources Reduce transport-related carbon dioxide emissions.

Con ronting the transport issue in urban areas is one o the most important and challenging healthy urbanplanning issues and is probably the least well addressed. Constraining car use is o en presented as restricting

reedom and provokes opposition rom politicians, especially those with a market-oriented approach, androm newspapers.

It is important that those seeking to initiate change con ront the basis o the reedom arguments.Conventional policies which acilitate increased dependence on cars in many instances reduce reedom.Tey exclude people who do not have access to a car including children, many older people and many disabled people. And over time they have even reduced the reedom o those who do have access to cars by leading to decline o public transport networks and reduced opportunities or walking and cycling.

So a healthy urban transport strategy should seek to inject more choice into the system to ensure that allpopulation groups can easily make the trips they need to make whether they have access to a car or not.Some progress is however being made. A recent WHO report highlights 48 case studies o intersectoralcollaboration between health and transport bodies which have promoted physical activity in local

populations33

. able 2 below includes some o the success ul policies which have been adopted in these townsand cities.

33 WHO Europe. 2006. Collaboration between the health and transport sectors in promoting physical activity: Examplesrom European countries. http://www.euro.who.int/document/e90144.pd , http://www.euro.who.int/document/hepan/

casestudies &H/E90144_annexes_1-48.pd , accessed 27/08/07.
http://www.euro.who.int/document/e90144.pdfhttp://www.euro.who.int/document/hepan/http://www.euro.who.int/document/hepan/http://www.euro.who.int/document/e90144.pdf


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Creating healthy neighbourhoods there ore inevitably involves challenging these principles. able 3 givesan overview o the policies that are needed. Te table identifes policy objectives or each o the key healthissues in relation to the our policy areas o housing, local acilities, movement and open space. A clearneighbourhood planning strategy can be identifed ocused around the ollowing broad headings:

Increased population stability Housing diversity and quality Local jobs Access to acilities Pedestrian and cyclist networks Car restraint and public transport support A network o open spaces Energy strategy Water strategy Integrated spatial planning Community development


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able 3: Policies or Healthy Neighbourhoods

Key Issues Housing Local acilities Movement Open space

Air quality Energy e cientNon-toxic materials

Local acilitiesor pedestrian

convenience

Reduce car relianceReduce through tra c

Good microclimatedesignIncrease tree cover

Exercise Attractive, sa eresidential

environment

Accessible localacilities

Convenient & sa epedestrian and cyclist

routes

Recreationalgreenways, parks &

playgroundsSa ety Good surveillance and

clarity o ownershipo public and privatespaces

Accessible localacilities to encourage

street use

Calmed tra cNatural surveillancealong ootpaths &pavements

Good visibility acrossopen land

Accessibility Develop close topublic transport andlocal servicesGrade densitiesNo new housing ininaccessible locations

Localise serviceswithin housing areasLocate orconvenience o pedestriansDesign or disability

Permeable pedestrianand cyclistenvironmentPlan to ensure publictransport is viable

Provide accessibleopen space or allkinds o activities

Shelter Good range o housing tenure, sizeand price in every neighbourhoodEnergy e cienthousing; siting toreduce heat loss

Adaptable buildingsor local, social and

commercial usesInexpensive to operateand energy e cient;Siting to reduce heatloss

Bus shelters Shelter belts

Work Support dwelling-based working optionsLocate housingaccessible by publictransport to mainwork centres

Support local, smallscale jobs

Good public transportservices to maincentresStrategic cyclingnetwork servinglocality

Encourage productiveuse o land

Community Support community actionDesign residentialplacesSupport co-housingand sel -build schemes

Foster local servicesand employment

Permeable andattractive pedestrian/cyclist environmentSa ety on the streetsDesign or casualgatherings

Parks, play areas,playing felds andallotments as meetingplaces

Water andbiodiversity

Increase waterautonomy Local wastewaterand groundwater

replenishmentPreserve and enhancehabitats

Increase selsu ciency in waterLocal wastewaterand groundwater

replenishmentPreserve and enhancehabitats

Ensure local, cleanroad drainage,replenishing groundwater

Reduce vehicle tra c

Structure open spacearound watercoursesto create habitats andconserve water

Create a range o wildli e habitats

Naturalresources,soil andminerals

Build using recycledor renewable materialsSa eguard topsoilEncourage residentialcomposting

Build using recycledor renewable materials

Construct ewer roads Facilitate localallotment use andorganic recyclingGrow crops that canbe used or cra andbuilding materials

Globalecosystem

Low energy inconstruction and use

Low energy inconstruction and use

Reduce dependenceon ossil uel

Grow energy cropsReduce wind speed by

planningIncrease carbon fxing


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Public Spaces and Urban Spaces/Green spaceMany international reports published in recent years have highlighted the evidence base supporting theneed or open space, especially green space in urban areas, or good health and wellbeing 34 35 36. It has beenassociated with reducing eelings o stress37 38, increased levels o physical activity 39 40, more opportunities orsocial interaction 41 and assisting in child development 42.

Wild spaces, woodland, parks, city squares, waterways, urban arms, allotments and other community spacesare all important in urban areas, especially in areas o density. Individuals should be able to relax in contactwith elements o nature in green spaces or recreation, social, cultural and physical activities.

Post-war urban planning has produced many sprawling urban environments which impede regularengagement with the natural environment and are not conducive to good health and wellbeing. Examplesare shopping centres that devote large tracts o land to parking, wide roads which deter people rom walkingor cycling, the loss o open spaces in city centres to make way or new o ce or residential developments. Wehave made contact with the natural environment too di cult or people who live and work in our towns andcities.

Te urban poor in particular have limited opportunity or regular contact with the natural environment dueto planning and land use policies and the neglect o city parks in some societies. Tis is increasing healthinequalities. Public policy must identi y how to increase peoples access to green space through a broad rangeo new policies43.

A report or the Dutch government on the relationship between nature and health concluded that themain public policy implications o current knowledge on the natural environment and health were inspatial planning 44. In particular the report proposed an improvement in the accessibility o natural areasand public green spaces and the creation o additional natural areas in and around the large cities. It isparticularly important given the strength o the evidence available that people in urban areas are providedwith opportunities or recovery rom stress and mental atigue and to encourage them to take more exercise.

Tere is certainly growing demand or such places.

For instance the UK has experienced a massive increase in demand or urban allotments leading to longwaiting lists. oday there are 300,000 occupied allotments on 12,000 hectares o land. However this is down

rom 120,000 hectares in the 1940s. In the intervening years most o these spaces have been lost to make way or developments.

34 Morris N. 2003. Well-being and Open Space. 2003. Edinburgh College o Art and Herriot-Watt University.35 Cabe Space. 2004. Te Value o Public Space. http://www.cabespace.org.uk/publications/index.html , accessed 21/08/07.36 Royal Society or the Protection o Birds. 2007. Natural Tinking.

http://www.rspb.org.uk/Images/naturalthinking_tcm9-161856.pd , accessed 21/08/07.37 Kaplan R, Kaplan S. 1989. Te experience o nature. A psychological perspective. Cambridge: Cambridge University Press.38 Kaplan S. 1995. Te restorative benefts o nature toward an integral ramework. Journal o Environmental Psychology; 15:

169-182.39 Giles-Corti B, Broomhall MH, Kniuman M, et al. 2005. Increasing walking: how important is distance to, attractiveness and

size o public open space. American Journal o Preventative Medicine. 28: 169-176.40 Giles-Corti B, Donovan RJ. 2002. Te relative in uence o individual, social and physical environment determinants o

physical activity. Social Science and Medicine, 54(12): 1793-1812.41 Coley RL, Kuo FE, Sullivan WC. 1997. Where does community grow? Te social context created by nature in Urban Public

Housing. 1997. Environment and Behavior; 29(4): 468-494.

42 Kaplan R, Kaplan S. 1989. Te experience o nature. A psychological perspective. Cambridge: Cambridge University Press.43 CJC Consulting. 2005. Economic Benefts o Accessible Green Spaces or Physical and Mental Health, Scoping Study: Final

Report or the Forestry Commission.44 Health Council o the Netherlands and Dutch Advisory Council on Spatial Planning, Nature and the Environment. 2004.

Nature and Health: Te in uence o nature on social, psychological and physical well-being. Te Hague: Health Council o theNetherlands and RMNO.
http://www.cabespace.org.uk/publications/index.htmlhttp://www.rspb.org.uk/Images/naturalthinking_tcm9-161856.pdfhttp://www.rspb.org.uk/Images/naturalthinking_tcm9-161856.pdfhttp://www.cabespace.org.uk/publications/index.html


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An open space/green space strategy needs there ore to work towards an urban green network accessibleto all residents and structured as much as possible around water and trees. Tis should be complementedby a network o squares and other outdoor acilities providing opportunities or interaction in a car- reeenvironment.

Whilst access to green space in most New Zealand urban areas is clearly easier than in many European cities,there are elements o contemporary urban development in some New Zealand cities which impede access toopen space/ green space which should be addressed in uture planning.

Te Role o Health Impact Assessment

Health impact assessment has emerged as a practical support to the development o healthy urban planning.It supports multi-sectoral, community oriented and participatory approaches and can be initiated by a widerange o di erent organisations both within and outside the health sector. It has been ound that or peopleoutside health, involvement in HIA increases awareness about health-related issues which is likely to producehealthier policy in the long term. HIA is now taught within some graduate urban and town planningcourses, e.g., at Bel asts Queens University.

New Zealand has become an international leader in the application o HIA within urban policy andplanning 45 46. o date it has been applied in a wide range o urban policy settings such as urban design plans,urban transport options, uture energy scenarios and a regional land transport strategy 47 48 49.

It has high level support within government which has led to the establishment o a HIA support unit withinthe Ministry o Health. Te central challenge or the support unit and HIA advocates in New Zealandis to ensure that health impact assessment becomes part o the normal process or urban environmentpolicy development, rather than something which is undertaken as a result o lobbying by individuals ororganisations.

Healthy Urban Planning: Progress to DateTe fnal section o this paper will describe progress that has been made internationally in applying theprinciples o healthy urban planning and draw on the experiences o cities which are regarded as leaders inthis regard. Barton et al 50 reports on the progress o some o the European cities who participated in the thirdstage o theHealthy Cities project which put a special emphasis on developing healthy urban planning 51 52.

Te concept was entirely new to many o the participating cities and most reported that health had been apower ul motivator or addressing issues that had not previously been aced, drawing in new constituencieso political support. Other participating cities, especially those rom northern Europe, have had health

embedded in planning and transport policy-making or some years.

45 Public Health Advisory Committee. 2004. A guide to health impact assessment: A policy tool or New Zealand, NationalHealth Committee, Wellington.

46 Public Health Advisory Committee. 2007. An idea whose time has come: New opportunities or Health Impact Assessment inNew Zealand public policy and planning. National Health Committee, Wellington.

47 Quigley R, Burt S. 2006. Assessing the health and wellbeing impacts o urban planning in Avondale: A New Zealand case study.Social Policy Journal o New Zealand; 29:165175.

48 Signal L, Lang ord B, Quigley R, Ward M. 2006. Strengthening health, wellbeing and equity: Embedding policy-level HIA inNew Zealand. Social Policy Journal o New Zealand; 29:1731.

49 Stevenson, A, Banwell K, Pink R. 2006. Assessing the impacts on health o an urban development strategy: A case study o the

Greater Christchurch Urban Development Strategy. Social Policy Journal o New Zealand; 29:146164.50 Barton H, Mitcham C, sourosu C. 2003. Healthy urban planning and transport. WHO Regional O ce or Europe. ransport,

Health and Environment Programme or Europe.51 Barton H, Mitcham C, sourou C. 2003. Healthy urban planning in practice: experience o European cities.52 Barton H, Mitcham C, sourou C. 2003. Healthy urban planning and transport. WHO Regional O ce or Europe. ransport,

Health and Environment Programme or Europe.


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Tere was widespread agreement rom participating cities that health-integrated planning was a positivedevelopment. Health is seen by the planners as providing re-en orcement or and validation o otherplanning goals. Planning policies have become better and more responsive to community needs. Five key elements to creating the ideal conditions or healthy urban planning were identifed:

1. An acceptance o inter-departmental and inter-agency collaboration so that health implications canbe properly explored and integrated solutions pursued across institutional remits. Tis is criticalwhere transport is concerned

2. Strong political backing, which helps to ensure consistency o approach and the resources needed3. Full integration o health with environmental, social and economic concerns in the context o the

main land use planning, transport, housing and economic development policy statements: placinghealth at the heart o the plan-making

4. Te active involvement o citizens and private/ public/ voluntary sector stakeholders in the policy process, so that health and other priorities are understood not just by town planners but by otherinterests whose actions might in uence the situation

5. A toolbox o planning techniques which ully re ect health-promoting goals, e.g., quality-o -li emonitoring, impact assessments, strategic environment assessments, urban capacity studies.

Many towns and cities both within and outside the international Healthy Cities network have been working toapply the principles o healthy urban planning. Summaries o progress rom nine towns, cities and regions isincluded below. A broad range o examples are presented including European initiatives that predate HealthyCities, other European initiatives largely driven by Healthy Cities and initiatives rom the USA, Australia andNew Zealand which are success ully recreating healthy and sustainable cities rom sprawling environments,largely developed in the post war period.


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Case Studies

Driving Change: Political Leadership

Case Study 1: Portland, OregonPolitical leadership is requently an important component o healthy urban planning and this is exemplifedin the case o Portland, Oregon, USA. By the 1970s this city had declined economically and culturally and

the population had abandoned the inner city.

Te state Governor, om McCall, called or a rejuvenation o the old city. Tis began with the introductiono an urban growth boundary to try and prevent continued urban sprawl. Tis boundary ensured thatpopulation growth o over 50 percent since 1980 has largely been concentrated within the existing urbanboundaries and has provided the opportunity to develop new public transport routes including a 71km lightrail network.

Planning policies have ocused on reviving the city centre and ensuring that development away rom thecity centre is ocused on public transport corridors. Facilities or walking and cycling have also been much

improved. Walking magazine has rated it as one o the nations top cities or walking and 2001 Bicyclingmagazine named it the best city in North America to ride a bike.

Portland adopted a greenhouse gas reduction plan in 1993, the frst local plan in the USA. Te plan wasupdated in 2001 with a goal o reducing greenhouse gas emissions to 10% below 1990 levels by 2010. Itincludes a target o supplying 100% o the municipal governments electricity needs rom renewable energy by 2010. From 1990 to 2003, Portlands per-capita greenhouse gas emissions decreased by 13%, petrolconsumption ell by 8% and electricity use or households ell by 10%.

oday, Portland is widely acknowledged as one o the most liveable cities in the USA and amongst the mostsustainable cities in the world.

Case Study 2: Waitakere, New Zealand Within New Zealand some o the greatest modern advances in healthy urban planning have emerged romthe Waitakere city in Greater Auckland. Tis district orms part o one o the most sprawling low density, cardependent urban environments on the planet.

Under the leadership o its Mayor, Bob Harvey, the city sought to redefne itsel as an eco-city and placedan emphasis on improving its environment and on sustainable development. Amongst its achievementsin recent years are that it has halved child pedestrian and cyclist injuries since 1998, enhanced the naturalenvironment, built strong partnerships with Maori iwi and ensured that new housing is overwhelmingly developed within the existing urban area. Tis has provided opportunities to improve walking and cycling

acilities and support substantial improvements in public transport 53.

Driving Change: Communities

Case Study 3: Salzburg, AustriaTe city o Salzburg grew substantially in the post war period. Much o this growth was not in keeping withthe citys historic traditions and by the end o the 1970s many citizens were disenchanted with what hadhappened to the city 54. When plans emerged or a new urban motorway which would urther denigrate the

citys heritage, citizens ormed groups to advocate or the old city.

53 Documents located at http://www.waitakere.govt.nz/AbtCit/ec/index.asp , accessed 18/07/07.54 Crowhurst-Lennard SH, Lennard HL. 1987. Livable cities. Southampton, NY, Gondolier Press.
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Individuals rom the citizens group were eventually elected to positions on the City Council and trans ormedthe citizen participation process in Salzburg. Tis led to an agreed plan or a greenbelt around the city andthe dropping o past policies that set aside 70% o the citys land reserves or new construction. Secondly,the citizens groups initiated a project to renovate the historic city centre. Tirdly, Salzburg initiated work on architectural re orm. Finally, a completely new tra c policy or the entire city was conceived, giving frstpriority in all planning decisions to pedestrians, second to cyclists, third to public transport and last to thecar.

Case Study 4: Horsens, DenmarkHorsens is a historic market town with 60,000 population. Te citys economy has been vulnerable duringtimes o economic downturn leading to complex social issues more associated with larger urban areas.Horsens enthusiastically embraced both the Healthy Cities and Agenda 21 approach and has establishedhealth as the central goal o the planning system. o achieve this it has built up citizen involvement by supporting new councils and orums or youth, older people and the wider population and by ensuring thesecitizens groups have good access to the planning system.

Neighbourhood regeneration initiatives and community empowerment activities have provided animportant vehicle or implementing the health-oriented goals o the municipal plan. Tis has resulted in joint ownership o city plans, extensive use o health impact assessment within the planning system and acomprehensive transport plan ocused around the objectives o road sa ety, environmental improvement,noise reduction and reduction o carbon dioxide emissions.

Case Study 5: Sandnes, Norway Sandnes has a population o 55,000 and has been trans ormed rom a largely industrial town 20 years agoto a service-based economy today benefting rom prosperity associated with the oil industry. It becamea Healthy City in 1991 and immediately joined a Ministry o the Environment-led initiative to reduce cartransport and increase walking, cycling and public transport.

Sandnes began to promote itsel as a Bike City ocused on the health and wellbeing o children,constructing 70km o cycle lanes, with 400 bicycle parking places and ree bicycle hire. Te main strategy has been to promote sustainable development through a planning process in which land use, transportand environmental protection are integrated in long-term policies. It established a Childrens City Councilwhich provides direct access or children into the local electoral system and carried out research to identi y childrens in ormal play and moving areas so that they could be protected by the planning system. TeChildrens rail programme has enabled children to identi y and register 1265 play areas, 550 short cuts, 130re erence areas or schools and 185 re erence areas or nurseries. Tese registered areas have been entered ondigital maps and air photo maps and are required to be used in all planning activities to sa eguard importantplay areas.

Driving Change: Government

Case Study 6: Belfast, UK Bel ast has a population o 280,000 people. Te economy o the city used to be port-based and industrial buteconomic downturn and the impact o a 30-year sectarian con ict le the city with some o the most severesocial and economic problems in western Europe with excessive rates o unemployment, low educationalattainment and run down housing. Bel ast became a Healthy City in 1988 and enthusiastically embraced thehealthy urban planning concept in the late 90s.

Te Department o the Environment (Northern Ireland) and Bel ast Healthy Cities have taken a jointapproach to promote and integrate health into a wide range o local and regional plans and policies. oolssuch as Strategic Environmental Assessment, HIA and a quality o li e matrix have been used extensively toassist this process. Urban planners in the city contribute to health by ormerly incorporating health issues


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into regional and area plans and by active participation in the Healthy Cities strategic planning groups. TeCity Health Development Plan assisted in the development o a more integrated planning approach andincreased the understanding o healthy urban planning.

With the assistance o the Healthy Cities project Queens University, Bel ast has recently established the frstHealthy Urban Planning module in the UK into their own Planning degree courses. In recent years Bel astcity centre has been trans ormed and the economy has been revitalised. With the ormal end o the con ictit is anticipated that the success o healthy urban planning within the central city can be rolled out intodeprived housing estates throughout the city.

Case Study 7: Victoria State, AustraliaAlthough not a city, the State o Victoria includes Melbourne, which has over three million population andis one o the largest cities in Australia. Te State took an early lead in healthy urban planning by introducingMunicipal Public Health Plans (MPHPs) in 1988 in order to integrate Healthy Cities principles across the 210Local Government areas that operated within the state at that time (today that has been reduced to 79).

MPHPs are local authority-led documents which identi y signifcant local health issues and set out organised,multisectoral programmes or tackling them. In 2000 a survey was carried out to assess the e ectivenesso the plans. Positive eatures reported included that they provide a strategic planning ocus by promotingpartnerships and networks throughout the municipality, they highlight local health issues and provide a vehicle to address them, they promote community involvement and ownership and they enable councils tointegrate a social model o health into public health planning.

A wide range o suggestions were made or improving the plans including ideas or how they might addressissues within the built environment more e ectively. Tis led to the introduction o Victorias Environments

or Health Municipal Public Heath Planning Framework in 2001 55. Te ramework is based on a social viewo health and highlights the impact o the our environmental domains - social, built, economic and natural-on community health and wellbeing and is designed to provide an integrated planning approach or MPHPs.

It provides a practical guide or implementing the new public health approach within local government, aimsto make public health a central ocus or local government and to increase its capacity to prevent ill healthand increase wellbeing.

An external evaluation recently concluded that the ramework has had a major impact on local governmenthealth planning since its launch in 2001 56. In particular it has led to better public policy, ocused onimproved health and wellbeing, and helped to create supportive environments in local government.

Case Study 8: Seixal, Portugal

Seixal is a city o 150,000 population on the banks o the River agus within the wider city region o Lisbon, Portugal. Following the building o a new highway and a bridge over the river in the 1960s the city grew substantially, attracting immigrants and becoming a commuter community or Lisbon. Te urbandevelopment o Seixal was marked by extensive and scattered low-density settlement along the major roads.

Seixal only joined the Healthy Cities network in 1998 but immediately sought to apply the principles o healthy urban planning within its uture development plans. Its central aim was to reverse the sprawl o thelast quarter o the 20th century by enhancing the quality o the urban environment, reducing excessive caruse and improving and promoting public transport.

55 Victoria State Government Department o Human Services. 2001. Environments or Health: Promoting health and wellbeingthrough built, social, economic and natural environments. http://www.health.vic.gov.au/localgov/mphp r/index.htm , accessed20/08/07.

56 Deakin University Program Evaluation Unit, School o Population Health- Te University o Melbourne. 2006. Evaluation o the Environments or Health Framework. http://www.health.vic.gov.au/localgov/mphp r/eval.htm , accessed 20/08/07.
http://www.health.vic.gov.au/localgov/mphpfr/index.htmhttp://www.health.vic.gov.au/localgov/mphpfr/eval.htmhttp://www.health.vic.gov.au/localgov/mphpfr/eval.htmhttp://www.health.vic.gov.au/localgov/mphpfr/index.htm


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ransport was at the root o many o Seixals problems. Seixal had been designed around the needs o thosewanting to travel out o the city towards central Lisbon and there were inadequate connections betweenneighbourhoods within the city. In addition, the scattered low density settlement encouraged people to drivealmost everywhere school, work, shopping and leisure activities.

A study in 2001 suggested that 23% o the population lacked vehicle access and had major di culties gettingabout the city. Regulations have since been introduced to ensure that mobility and transport needs areconsidered in planning applications. Te aim is to increase the proportion o people living close to railway stations by ensuring development is targeted in these areas and by introducing a new light rail system. Otherrecent initiatives launched by the municipal working group or healthy urban planning include establishinga method or renewing the historic urban centres, identi ying green spaces that should be protected andincluded in the municipal ecological network and revitalizing urban allotment gardens.

Driving Change: Health Sector

Case Study 9: London Healthy Urban Development Unit

Te London Healthy Urban Development Unit was established in 2004 as an alliance between the NationalHealth Service, the London Development Agency and the Regional Public Health Group in response to

orecasts o unprecedented growth in the population o London and on demands on health services.

It has a broad remit which includes in uencing the London planning agenda to ensure that health objectivesare a primary concern in urban planning decisions, or instance it has recently hosted a major nationalcon erence highlighting the importance o maintaining green spaces in urban areas.

It provides training and support in health impact assessment methods and has lobbied or its widespreaduse in planning. Finally, it in uences urban development to ensure that high quality healthcare acilities aredeveloped or new communities and that new NHS acilities support sustainable development principles.

Geo BarnesSeptember 2007


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Glossary

Agenda 21: Sets out a comprehensive plan or sustainable development or cities and was adopted by UNmember states at the 1992 Rio summit.

Charter on ransport, Environment and Health: Adopted in Europe in 1999 in recognition that transport isa key component o healthy urban planning.

Health for All by the Year 2000 : Strategy launched at the World Health Assembly in 1979 to address concernsat health services inability to respond to health needs.

Health for All in the 21 st century (Health 21 ): An update o the 1979 strategy and adopted by WHO in 1998.Tis strategy recognised the role o agencies outside the health sector to tackle the wider determinants o health.

Healthy Cities : Project established by the World Health Organization in the 1980s to raise health high on thepolitical and social agenda, particularly in relation to planning.

Health Impact Assessment (HIA): Assessment o the impacts policy or planning will have on the health o acommunity.

Healthy Urban Planning: An approach where health is the central goal o urban planning policy and practice.Te book Healthy Urban Planning was frst published in 2000 with WHO support.

New Urbanism: A movement or change in planning developed since the 1980s in the USA which believes adecline o inner urban areas, in avour o suburban development, has reduced the wellbeing o Americans.

Municipal Public Health Plans (MPHPs): Developed in Victoria, Australia in 1988 to integrate Healthy Cities

principles across the 210 Local Government areas (79 areas in 2007).

Strategic Environmental Assessment (SEA): Required in many countries or major planning policies andschemes to ensure they support central objectives or health and sustainable development. SEAs include a detailedreport on the state o the environment and the likely impacts o the proposed plans on the environment.

Tematic networks: Cities networking together where they have common areas o interest in the Healthy Cities programme.